2026
Euvrard, Jonathan; Keene, Claire Marriott; von der Heyden, Erin; Osler, Meg; Pienaar, David; Mahomed, Hassan; Meintjes, Graeme; Davies, Mary-Ann; Boulle, Andrew
Contemporary Disengagement From Antiretroviral Therapy in the Western Cape, South Africa: A Cross-Sectional Study Journal Article
In: J Int AIDS Soc, vol. 29, no. 5, pp. e70124, 2026, ISSN: 1758-2652.
@article{pmid42145055,
title = {Contemporary Disengagement From Antiretroviral Therapy in the Western Cape, South Africa: A Cross-Sectional Study},
author = {Jonathan Euvrard and Claire Marriott Keene and Erin von der Heyden and Meg Osler and David Pienaar and Hassan Mahomed and Graeme Meintjes and Mary-Ann Davies and Andrew Boulle},
doi = {10.1002/jia2.70124},
issn = {1758-2652},
year = {2026},
date = {2026-05-01},
journal = {J Int AIDS Soc},
volume = {29},
number = {5},
pages = {e70124},
abstract = {INTRODUCTION: South Africa has the largest antiretroviral therapy (ART) programme in the world, with universal access available through the public health system. Yet, gaps in coverage persist. In the Western Cape (WC), an estimated 200,000 people living with HIV are not currently on ART-many of whom are known to the health services. Exploring how people who are not on ART differ from those who are on ART may help guide more effective strategies for re-engagement and retention in care.nnMETHODS: We conducted a cross-sectional analysis of routine person-level data from the WC Provincial Health Data Centre, including adults (≥15 years) known to be living with HIV who accessed public services between October 2022 and September 2024. ART status was inferred from visit and dispensing records. Relative risks (RRs) of current disengagement were estimated using multivariable log-binomial regression on 25 imputed data sets, adjusting for sex, age, years since diagnosis, diagnosis setting and baseline CD4 count.nnRESULTS: Of 494,071 adults included, 131,368 (27%) were currently disengaged from ART. Those at elevated risk included men (aRR 1.20, 95% CI 1.19-1.21), younger people aged 15-24 years (aRR 1.54, 95% CI 1.51-1.57), those with CD4 >500 cells/mm at diagnosis (aRR 1.26, 95% CI 1.24-1.28) and individuals diagnosed in hospital (aRR 1.41, 95% CI 1.39-1.43) or during pregnancy (aRR 1.20, 95% CI 1.18-1.22). However, the majority of those disengaged were not from these groups, proportionally representing the underlying population living with HIV. Model discrimination was poor (AUC 0.614), indicating that these characteristics do not reliably identify those disengaged.nnCONCLUSIONS: Most disengaged individuals are from larger, lower-risk demographic groups and would be missed by interventions targeting higher-risk demographics. Whole-population strategies that address common barriers to retention through more inclusive, person-centred care offer the greatest potential to improve ART coverage.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
INTRODUCTION: South Africa has the largest antiretroviral therapy (ART) programme in the world, with universal access available through the public health system. Yet, gaps in coverage persist. In the Western Cape (WC), an estimated 200,000 people living with HIV are not currently on ART-many of whom are known to the health services. Exploring how people who are not on ART differ from those who are on ART may help guide more effective strategies for re-engagement and retention in care.nnMETHODS: We conducted a cross-sectional analysis of routine person-level data from the WC Provincial Health Data Centre, including adults (≥15 years) known to be living with HIV who accessed public services between October 2022 and September 2024. ART status was inferred from visit and dispensing records. Relative risks (RRs) of current disengagement were estimated using multivariable log-binomial regression on 25 imputed data sets, adjusting for sex, age, years since diagnosis, diagnosis setting and baseline CD4 count.nnRESULTS: Of 494,071 adults included, 131,368 (27%) were currently disengaged from ART. Those at elevated risk included men (aRR 1.20, 95% CI 1.19-1.21), younger people aged 15-24 years (aRR 1.54, 95% CI 1.51-1.57), those with CD4 >500 cells/mm at diagnosis (aRR 1.26, 95% CI 1.24-1.28) and individuals diagnosed in hospital (aRR 1.41, 95% CI 1.39-1.43) or during pregnancy (aRR 1.20, 95% CI 1.18-1.22). However, the majority of those disengaged were not from these groups, proportionally representing the underlying population living with HIV. Model discrimination was poor (AUC 0.614), indicating that these characteristics do not reliably identify those disengaged.nnCONCLUSIONS: Most disengaged individuals are from larger, lower-risk demographic groups and would be missed by interventions targeting higher-risk demographics. Whole-population strategies that address common barriers to retention through more inclusive, person-centred care offer the greatest potential to improve ART coverage.
Jarvis, Joseph N; Ehrenkranz, Peter; Lawrence, David S; Keene, Claire M; Reid, Michael J; Katz, Ingrid T; Shodell, Daniel; Pérez-Casas, Carmen; Mupeli, Kennedy; Sivile, Suilanji; Couto, Aleny M; Doherty, Meg; Rangaraj, Ajay; Ford, Nathan
Reducing HIV incidence and mortality: two sides of the same coin in the approach to ending AIDS Journal Article
In: Lancet HIV, vol. 13, no. 3, pp. e207–e212, 2026, ISSN: 2352-3018.
@article{pmid41135558,
title = {Reducing HIV incidence and mortality: two sides of the same coin in the approach to ending AIDS},
author = {Joseph N Jarvis and Peter Ehrenkranz and David S Lawrence and Claire M Keene and Michael J Reid and Ingrid T Katz and Daniel Shodell and Carmen Pérez-Casas and Kennedy Mupeli and Suilanji Sivile and Aleny M Couto and Meg Doherty and Ajay Rangaraj and Nathan Ford},
doi = {10.1016/S2352-3018(25)00265-6},
issn = {2352-3018},
year = {2026},
date = {2026-03-01},
journal = {Lancet HIV},
volume = {13},
number = {3},
pages = {e207--e212},
abstract = {HIV programmes globally continue to face two persistent challenges: advanced HIV disease and high HIV incidence. These issues are often viewed separately, with advanced HIV disease viewed as a late-stage clinical failure and high HIV incidence as a failure of early prevention. However, these issues are closely linked at the individual and population level; both reflect the inability of current care models to engage and sustain viral suppression among a sizeable subgroup of people living with HIV who initiate antiretroviral therapy late or cycle in and out of care. In sub-Saharan Africa, where the HIV burden is highest, most individuals with advanced HIV disease are people who have previously initiated antiretroviral therapy and subsequently disengaged, often multiple times. This type of interruption in care has substantial implications for immune decline, viral rebound, and mortality. As donor funding decreases, there is a risk that global HIV responses will revert focus to maintaining aggregate antiretroviral therapy coverage, overlooking harder-to-reach populations with persistent viraemia.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
HIV programmes globally continue to face two persistent challenges: advanced HIV disease and high HIV incidence. These issues are often viewed separately, with advanced HIV disease viewed as a late-stage clinical failure and high HIV incidence as a failure of early prevention. However, these issues are closely linked at the individual and population level; both reflect the inability of current care models to engage and sustain viral suppression among a sizeable subgroup of people living with HIV who initiate antiretroviral therapy late or cycle in and out of care. In sub-Saharan Africa, where the HIV burden is highest, most individuals with advanced HIV disease are people who have previously initiated antiretroviral therapy and subsequently disengaged, often multiple times. This type of interruption in care has substantial implications for immune decline, viral rebound, and mortality. As donor funding decreases, there is a risk that global HIV responses will revert focus to maintaining aggregate antiretroviral therapy coverage, overlooking harder-to-reach populations with persistent viraemia.
Otambo, Wilfred Ouma; Harling, Guy; Inghels, Maxime; Otto, Margot; Blose, Ntombifuthi; Tram, Khai Hoan; Tanser, Frank; Mee, Paul
Peer network approaches for improving HIV testing, prevention and care utilisation among men in sub-Saharan Africa: a scoping review Journal Article
In: BMJ Open, vol. 16, no. 3, pp. e106124, 2026, ISSN: 2044-6055.
@article{pmid41819590,
title = {Peer network approaches for improving HIV testing, prevention and care utilisation among men in sub-Saharan Africa: a scoping review},
author = {Wilfred Ouma Otambo and Guy Harling and Maxime Inghels and Margot Otto and Ntombifuthi Blose and Khai Hoan Tram and Frank Tanser and Paul Mee},
doi = {10.1136/bmjopen-2025-106124},
issn = {2044-6055},
year = {2026},
date = {2026-03-01},
journal = {BMJ Open},
volume = {16},
number = {3},
pages = {e106124},
abstract = {INTRODUCTION: Limited male engagement in HIV prevention and care is a global challenge more pronounced in sub-Saharan Africa (SSA) contributing to ongoing transmission. However, peer network interventions show promise in improving engagement.nnOBJECTIVE: To map and synthesise evidence on peer network interventions for HIV prevention and care among men in SSA, with a focus on the types of strategies used, populations reached and how these interventions address cultural, social and structural barriers across the HIV care cascade.nnDESIGN: Scoping review of peer-reviewed literature, conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.nnSETTING: Community and facility-based HIV prevention and care settings across multiple countries in SSA.nnPARTICIPANTS: Populations included men having sex with men, men in key occupational groups (fishermen, truck drivers), adolescents and young people, and men living with HIV. Studies not conducted in SSA, not peer-reviewed or not focused on male peer networks were excluded.nnINTERVENTIONS: Peer network interventions included peer education, peer navigation, HIV self-testing (HIVST) distribution, adherence support groups, disclosure and stigma-reduction counselling, technology-enabled peer support (SMS and social media) and community-based antiretroviral therapy (ART) delivery. Intervention duration and intensity varied across studies.nnOUTCOME MEASURES: Primary outcomes included HIV testing uptake, linkage to care, ART initiation, adherence, retention in care and viral suppression. Secondary outcomes included stigma reduction, disclosure and engagement among hard-to-reach male populations.nnMETHODS: We conducted a review of literature published between November 2013 and November 2024, searching PubMed, Web of Science, Scopus and Cochrane databases. Studies were included if they examined peer network approaches in HIV prevention and care among men in SSA.nnRESULTS: A total of 905 records were identified, of which 75 studies met the inclusion criteria. Peer network interventions were implemented across diverse SSA contexts and male populations. Strategies such as peer-led education, social diffusion models, HIVST distribution and technology-enabled peer support consistently improved HIV testing uptake, linkage to care, ART initiation and adherence. Contextually tailored interventions such as community-based outreach addressing occupational risk environments and economic vulnerabilities were particularly effective in engaging men traditionally underserved by facility-based services. However, challenges persisted, including variable linkage to care following HIVST and sensitivity to user costs.nnCONCLUSIONS: Peer-led interventions in HIV care for men in SSA effectively address cultural, social and structural barriers, improving testing, ART adherence and viral suppression. Tailored, technology-enhanced and community-based approaches ensure equitable HIV prevention and treatment outcomes, despite challenges like linkage to care.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
INTRODUCTION: Limited male engagement in HIV prevention and care is a global challenge more pronounced in sub-Saharan Africa (SSA) contributing to ongoing transmission. However, peer network interventions show promise in improving engagement.nnOBJECTIVE: To map and synthesise evidence on peer network interventions for HIV prevention and care among men in SSA, with a focus on the types of strategies used, populations reached and how these interventions address cultural, social and structural barriers across the HIV care cascade.nnDESIGN: Scoping review of peer-reviewed literature, conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.nnSETTING: Community and facility-based HIV prevention and care settings across multiple countries in SSA.nnPARTICIPANTS: Populations included men having sex with men, men in key occupational groups (fishermen, truck drivers), adolescents and young people, and men living with HIV. Studies not conducted in SSA, not peer-reviewed or not focused on male peer networks were excluded.nnINTERVENTIONS: Peer network interventions included peer education, peer navigation, HIV self-testing (HIVST) distribution, adherence support groups, disclosure and stigma-reduction counselling, technology-enabled peer support (SMS and social media) and community-based antiretroviral therapy (ART) delivery. Intervention duration and intensity varied across studies.nnOUTCOME MEASURES: Primary outcomes included HIV testing uptake, linkage to care, ART initiation, adherence, retention in care and viral suppression. Secondary outcomes included stigma reduction, disclosure and engagement among hard-to-reach male populations.nnMETHODS: We conducted a review of literature published between November 2013 and November 2024, searching PubMed, Web of Science, Scopus and Cochrane databases. Studies were included if they examined peer network approaches in HIV prevention and care among men in SSA.nnRESULTS: A total of 905 records were identified, of which 75 studies met the inclusion criteria. Peer network interventions were implemented across diverse SSA contexts and male populations. Strategies such as peer-led education, social diffusion models, HIVST distribution and technology-enabled peer support consistently improved HIV testing uptake, linkage to care, ART initiation and adherence. Contextually tailored interventions such as community-based outreach addressing occupational risk environments and economic vulnerabilities were particularly effective in engaging men traditionally underserved by facility-based services. However, challenges persisted, including variable linkage to care following HIVST and sensitivity to user costs.nnCONCLUSIONS: Peer-led interventions in HIV care for men in SSA effectively address cultural, social and structural barriers, improving testing, ART adherence and viral suppression. Tailored, technology-enhanced and community-based approaches ensure equitable HIV prevention and treatment outcomes, despite challenges like linkage to care.
Keene, Claire M; Jennings, Lauren; Källström-Ståhlgren, Carl-Oscar; Katz, Ingrid T; Sabin, Lora L; Schreuder, Chantel; Singh, Yashna; Orrell, Catherine; Amico, Rivet
In: AIDS Behav, vol. 30, no. 1, pp. 291–306, 2026, ISSN: 1573-3254.
@article{pmid41051588,
title = {Antiretroviral Therapy Adherence Interventions in the Era of Universal Test and Treat: A Hybrid Systematic-Narrative Literature Review of Global Evidence},
author = {Claire M Keene and Lauren Jennings and Carl-Oscar Källström-Ståhlgren and Ingrid T Katz and Lora L Sabin and Chantel Schreuder and Yashna Singh and Catherine Orrell and Rivet Amico},
doi = {10.1007/s10461-025-04867-9},
issn = {1573-3254},
year = {2026},
date = {2026-01-01},
journal = {AIDS Behav},
volume = {30},
number = {1},
pages = {291--306},
abstract = {An undetectable viral load (VL) in people living with HIV (PWH) is key to both individual and public health success. But for the millions of PWH on oral antiretroviral therapy (ART) worldwide, this requires consistent, sustained adherence. Review of interventions to support adherence published in recent literature can provide insights into promising and effective strategies. We conducted a hybrid systematic-narrative literature review to explore optimal adherence strategies in the era of universal test-and-treat. We searched PubMed, Scopus, and Web of Science according to PRISMA guidelines for peer-reviewed studies, available in English, including people ≥ 12 years old taking ART, published between 01 January 2015 and 18 January 2024. We extracted data on the included studies and the adherence interventions (strategies used -allocated to one of 14 a priori categories or 'other', measures of adherence, and intervention outcomes). Descriptive statistics were used for study information and those interventions with a positive effect were described narratively. We extracted data from 230 studies evaluating a total of 262 interventions among 97,037 PWH. Most studies enrolled participants in Africa (106, 46%) or North America (80, 35%). The majority randomized participants (215, 94%), including 30 cluster-randomized trials. Most included general HIV clinic populations, with 51 (22%) focused on youth and 23 (10%) on pregnant and post-partum women. Many (146, 64%) used VL as an outcome. Self-reported adherence was also a commonly used outcome (129, 56%), but a minority used self-reported measures alone (36, 16%). The most common intervention strategies included across the 262 interventions were eHealth/ mHealth technologies (90, 34%) and adherence-focused counseling (81, 31%). The majority of interventions had 'other' intervention features (133, 51%), typically combined with one or more of the a priori-defined strategies (107, 80%). Most studies evaluated an approach with multiple strategies packaged into a single intervention (k = 182/262, 70%).The majority of interventions had some evidence of effect on an adherence outcome (k = 159, 61%). In studies reporting VL outcomes, 52% (k = 87/166) found some evidence of effect, while 28% (k = 47/166) found significant effects. Intervention strategies demonstrating significant impact on VL included task-shifting and changing dispensing schedules (3/5, 60% in both), while nearly half the evaluations of economic strategies demonstrated significant impact on VL (10/21). A number of different adherence intervention strategies have the potential to impact viral suppression in different populations. Variability in intervention strategies and the resulting outcomes, supports calls to target interventions to PWH who are most likely to benefit, while at the same time addressing social determinants of health and reducing barriers to accessing care to make services more person-centered. Greater attention to evaluating flexible, tailored, complex interventions may offer valuable insights for moving towards the next generation of highly generalizable, sustainable adherence support.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
An undetectable viral load (VL) in people living with HIV (PWH) is key to both individual and public health success. But for the millions of PWH on oral antiretroviral therapy (ART) worldwide, this requires consistent, sustained adherence. Review of interventions to support adherence published in recent literature can provide insights into promising and effective strategies. We conducted a hybrid systematic-narrative literature review to explore optimal adherence strategies in the era of universal test-and-treat. We searched PubMed, Scopus, and Web of Science according to PRISMA guidelines for peer-reviewed studies, available in English, including people ≥ 12 years old taking ART, published between 01 January 2015 and 18 January 2024. We extracted data on the included studies and the adherence interventions (strategies used -allocated to one of 14 a priori categories or ‘other’, measures of adherence, and intervention outcomes). Descriptive statistics were used for study information and those interventions with a positive effect were described narratively. We extracted data from 230 studies evaluating a total of 262 interventions among 97,037 PWH. Most studies enrolled participants in Africa (106, 46%) or North America (80, 35%). The majority randomized participants (215, 94%), including 30 cluster-randomized trials. Most included general HIV clinic populations, with 51 (22%) focused on youth and 23 (10%) on pregnant and post-partum women. Many (146, 64%) used VL as an outcome. Self-reported adherence was also a commonly used outcome (129, 56%), but a minority used self-reported measures alone (36, 16%). The most common intervention strategies included across the 262 interventions were eHealth/ mHealth technologies (90, 34%) and adherence-focused counseling (81, 31%). The majority of interventions had ‘other’ intervention features (133, 51%), typically combined with one or more of the a priori-defined strategies (107, 80%). Most studies evaluated an approach with multiple strategies packaged into a single intervention (k = 182/262, 70%).The majority of interventions had some evidence of effect on an adherence outcome (k = 159, 61%). In studies reporting VL outcomes, 52% (k = 87/166) found some evidence of effect, while 28% (k = 47/166) found significant effects. Intervention strategies demonstrating significant impact on VL included task-shifting and changing dispensing schedules (3/5, 60% in both), while nearly half the evaluations of economic strategies demonstrated significant impact on VL (10/21). A number of different adherence intervention strategies have the potential to impact viral suppression in different populations. Variability in intervention strategies and the resulting outcomes, supports calls to target interventions to PWH who are most likely to benefit, while at the same time addressing social determinants of health and reducing barriers to accessing care to make services more person-centered. Greater attention to evaluating flexible, tailored, complex interventions may offer valuable insights for moving towards the next generation of highly generalizable, sustainable adherence support.
2025
Keene, Claire M; Euvrard, Jonathan; Cassidy, Tali; English, Mike; McKnight, Jacob; Katz, Ingrid T; Orrell, Catherine
In: The Lancet Primary Care, vol. 1, no. 6, 2025, ISSN: 3050-5143.
@article{Keene2025,
title = {Longitudinal patterns of antiretroviral treatment interruptions in a high burden, low-resource setting in South Africa: a retrospective cohort study},
author = {Claire M Keene and Jonathan Euvrard and Tali Cassidy and Mike English and Jacob McKnight and Ingrid T Katz and Catherine Orrell},
doi = {10.1016/j.lanprc.2025.100077},
issn = {3050-5143},
year = {2025},
date = {2025-12-00},
journal = {The Lancet Primary Care},
volume = {1},
number = {6},
publisher = {Elsevier BV},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Ratevosian, Jirair; Ngangula, Paul; Tram, Khai Hoan
Modeling the fallout: projecting the global impact of donor funding cuts on HIV prevention, treatment, and care Journal Article
In: Curr Opin HIV AIDS, vol. 20, no. 6, pp. 621–631, 2025, ISSN: 1746-6318.
@article{pmid40891590,
title = {Modeling the fallout: projecting the global impact of donor funding cuts on HIV prevention, treatment, and care},
author = {Jirair Ratevosian and Paul Ngangula and Khai Hoan Tram},
doi = {10.1097/COH.0000000000000977},
issn = {1746-6318},
year = {2025},
date = {2025-11-01},
journal = {Curr Opin HIV AIDS},
volume = {20},
number = {6},
pages = {621--631},
abstract = {PURPOSE OF REVIEW: Recent U.S. funding cuts and subsequent terminations to global HIV programs threaten decades-long progress towards ending the HIV epidemic. In response to financial and programmatic uncertainty, mathematical models have projected dire consequences of current and future reductions in aid. This review examines modeling studies published from 20 January through 30 May 2025 and presents a comparative analysis of model estimates and synthesizes key findings.nnRECENT FINDINGS: Nine modeling studies examined U.S. and international donor funding reduction scenarios, ranging from a temporary pause to indefinite termination, with most analyses focused on sub-Saharan Africa and PEPFAR-supported programs. Time horizons varied from short-term projections (2025-2026) to long-term estimates spanning the next 20 years. Geographic coverage differed across studies, with some models focused on individual countries (e.g., South Africa) and others projecting outcomes across all low- and middle-income countries (LMICs). Based on consensus projections, global donor funding cuts - including those proposed by the Trump administration - could result in 10 million additional HIV infections, including 1 million among children, and 3 million additional deaths over the next 5 years.nnSUMMARY: Early modeling studies converge on a clear message, that even partial reductions in external HIV funding pose the risk of reversing decades of progress, with disproportionate effects in high-burden countries reliant on PEPFAR funding. However, estimates vary widely due to heterogenous model structures and varying assumptions regarding funding cuts and adaptability of programs. These models should be interpreted as directional tools to guide decision-making, offering policymakers a tool to assess funding scenarios and anticipate potential consequences. For national governments, the models underscore the urgent need for sustained investment in HIV mitigation programs.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE OF REVIEW: Recent U.S. funding cuts and subsequent terminations to global HIV programs threaten decades-long progress towards ending the HIV epidemic. In response to financial and programmatic uncertainty, mathematical models have projected dire consequences of current and future reductions in aid. This review examines modeling studies published from 20 January through 30 May 2025 and presents a comparative analysis of model estimates and synthesizes key findings.nnRECENT FINDINGS: Nine modeling studies examined U.S. and international donor funding reduction scenarios, ranging from a temporary pause to indefinite termination, with most analyses focused on sub-Saharan Africa and PEPFAR-supported programs. Time horizons varied from short-term projections (2025-2026) to long-term estimates spanning the next 20 years. Geographic coverage differed across studies, with some models focused on individual countries (e.g., South Africa) and others projecting outcomes across all low- and middle-income countries (LMICs). Based on consensus projections, global donor funding cuts – including those proposed by the Trump administration – could result in 10 million additional HIV infections, including 1 million among children, and 3 million additional deaths over the next 5 years.nnSUMMARY: Early modeling studies converge on a clear message, that even partial reductions in external HIV funding pose the risk of reversing decades of progress, with disproportionate effects in high-burden countries reliant on PEPFAR funding. However, estimates vary widely due to heterogenous model structures and varying assumptions regarding funding cuts and adaptability of programs. These models should be interpreted as directional tools to guide decision-making, offering policymakers a tool to assess funding scenarios and anticipate potential consequences. For national governments, the models underscore the urgent need for sustained investment in HIV mitigation programs.
Phillips, Tammy; Euvrard, Jonathan; Harley, Beth; Kalaris, Katherine; Mqadi, Luyanduthando; Mohr, Erika; Mukumbang, Ferdinand; von der Heyden, Erin; Keene, Claire M; [Abstract], Khai Hoan Tram
Understanding Mobility and Engagement with ART Care in the Western Cape, South Africa: an ON-THE-MOVE Research Study Proposal Conference
Khayelitsha and Eastern Substructure (KESS) Research Day, 2025.
@conference{nokey,
title = {Understanding Mobility and Engagement with ART Care in the Western Cape, South Africa: an ON-THE-MOVE Research Study Proposal},
author = {Tammy Phillips AND Jonathan Euvrard AND Beth Harley AND Katherine Kalaris AND Luyanduthando Mqadi AND Erika Mohr AND Ferdinand Mukumbang AND Erin von der Heyden AND Claire M Keene AND Khai Hoan Tram [Abstract]},
year = {2025},
date = {2025-10-31},
urldate = {2025-10-31},
booktitle = {Khayelitsha and Eastern Substructure (KESS) Research Day},
keywords = {},
pubstate = {published},
tppubtype = {conference}
}
Keene, Claire M; Euvrard, Jonathan; Phillips, Tamsin K; English, Mike; McKnight, Jacob; Orrell, Catherine
In: J Int AIDS Soc, vol. 28, no. 10, pp. e70046, 2025, ISSN: 1758-2652.
@article{pmid41085485,
title = {Retention in a low-resource, high-burden South African cohort on antiretroviral therapy: Retrospective, longitudinal analysis comparing six measures of retention},
author = {Claire M Keene and Jonathan Euvrard and Tamsin K Phillips and Mike English and Jacob McKnight and Catherine Orrell},
doi = {10.1002/jia2.70046},
issn = {1758-2652},
year = {2025},
date = {2025-10-01},
journal = {J Int AIDS Soc},
volume = {28},
number = {10},
pages = {e70046},
abstract = {INTRODUCTION: Retention on antiretroviral therapy (ART) is a prerequisite for adherence and subsequent treatment success. Measuring retention is also easily implementable at facility and population levels, making it pragmatic to monitor ART programme success. However, despite its ubiquitous global use, there is little consistency in the measurement of retention.nnMETHODS: This study retrospectively applied six measures of retention to one cohort of adults (initiating ART after 01-09-2016, with ≥1 year of observation time to database closure on 30-09-2022), in a low-resource, high HIV-burden setting in South Africa. Using routine healthcare data from the Western Cape's Provincial Health Data Centre, loss to follow-up (LTFU), fixed-point retention, visit constancy, visit gaps, treatment interruptions and medication possession ratio (MPR) were described over 5 years from initiation. Individuals were considered "continuously retained" if they did not experience attrition throughout their observed follow-up. Measures were compared using the proportion misassigned and Cohen's Kappa statistic.nnRESULTS: The median age of the cohort (n = 68,888) was 31 years (interquartile range [IQR] 26-38) at initiation, with 69% (47,631/68,888) female, and a median observed follow-up of 4 years (IQR 3-5). Across different measures, retention was low, and declined over time. There was variable overlap; the proportion continuously retained throughout their observed follow-up ranged from 60% (41,268/68,888 not LTFU) to 32% (22,381/68,888 MPR ≥80%). Retention by all measures was strongly associated with viral suppression.nnCONCLUSIONS: By all measures, large proportions of people in this setting were considered out of ART care during 5 years of observed follow-up time from initiation. This makes retention a critical target for intervention to improve population-level viral suppression and achieve epidemic control. Measuring longitudinal retention revealed that most people disengaged from ART care at some point after initiation. Certain measures of retention (e.g. treatment interruptions) identified people in and out of care with more granularity, whereas blunter measures (e.g. LTFU) misassigned individuals' retention status and missed patterns of retention over time as people cycled in and out of care between points of measurement. Ultimately, the choice of measure depends on the purpose of the evaluation and on the data available, but, where possible, more granular measures are recommended.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
INTRODUCTION: Retention on antiretroviral therapy (ART) is a prerequisite for adherence and subsequent treatment success. Measuring retention is also easily implementable at facility and population levels, making it pragmatic to monitor ART programme success. However, despite its ubiquitous global use, there is little consistency in the measurement of retention.nnMETHODS: This study retrospectively applied six measures of retention to one cohort of adults (initiating ART after 01-09-2016, with ≥1 year of observation time to database closure on 30-09-2022), in a low-resource, high HIV-burden setting in South Africa. Using routine healthcare data from the Western Cape’s Provincial Health Data Centre, loss to follow-up (LTFU), fixed-point retention, visit constancy, visit gaps, treatment interruptions and medication possession ratio (MPR) were described over 5 years from initiation. Individuals were considered “continuously retained” if they did not experience attrition throughout their observed follow-up. Measures were compared using the proportion misassigned and Cohen’s Kappa statistic.nnRESULTS: The median age of the cohort (n = 68,888) was 31 years (interquartile range [IQR] 26-38) at initiation, with 69% (47,631/68,888) female, and a median observed follow-up of 4 years (IQR 3-5). Across different measures, retention was low, and declined over time. There was variable overlap; the proportion continuously retained throughout their observed follow-up ranged from 60% (41,268/68,888 not LTFU) to 32% (22,381/68,888 MPR ≥80%). Retention by all measures was strongly associated with viral suppression.nnCONCLUSIONS: By all measures, large proportions of people in this setting were considered out of ART care during 5 years of observed follow-up time from initiation. This makes retention a critical target for intervention to improve population-level viral suppression and achieve epidemic control. Measuring longitudinal retention revealed that most people disengaged from ART care at some point after initiation. Certain measures of retention (e.g. treatment interruptions) identified people in and out of care with more granularity, whereas blunter measures (e.g. LTFU) misassigned individuals’ retention status and missed patterns of retention over time as people cycled in and out of care between points of measurement. Ultimately, the choice of measure depends on the purpose of the evaluation and on the data available, but, where possible, more granular measures are recommended.
Phillips, Tamsin K; Gomba, Yolanda; Mogoba, Pheposadi; Phelanyane, Florence; Anderson, Kim; Chi, Benjamin H; Clouse, Kate; Davies, Mary-Ann; Euvrard, Jonathan; Knight, Lucia; Myer, Landon; Abrams, Elaine J
In: AIDS Behav, vol. 29, no. 9, pp. 2689–2700, 2025, ISSN: 1573-3254.
@article{pmid40240722,
title = {Routine Electronic Mother-Infant Data (REMInD): A proof-of-Concept Data to Care Study to Support Retention in Maternal HIV Treatment and Infant HIV Testing in Cape Town, South Africa},
author = {Tamsin K Phillips and Yolanda Gomba and Pheposadi Mogoba and Florence Phelanyane and Kim Anderson and Benjamin H Chi and Kate Clouse and Mary-Ann Davies and Jonathan Euvrard and Lucia Knight and Landon Myer and Elaine J Abrams},
doi = {10.1007/s10461-025-04726-7},
issn = {1573-3254},
year = {2025},
date = {2025-09-01},
journal = {AIDS Behav},
volume = {29},
number = {9},
pages = {2689--2700},
abstract = {Data to Care (D2C) strategies- using routine data to identify and re-engage people living with HIV who are not in care- have shown promise in high-income settings but remain underexplored in lower-resource and vertical HIV transmission prevention (VTP) contexts. In this prospective, single-arm, proof-of-concept study, we used facility-linked public sector electronic medical records (Provincial Health Data Centre [PHDC] data) to identify, validate and trace postpartum VTP gaps among 336 mothers living with HIV and their infants in Cape Town, South Africa (March 2021-April 2022). Of 302 observed gaps, 123 (41%) were false, while 179 (59%) were probable gaps affecting 133 mother-infant pairs. Overall, 16% of mothers did not link to HIV care within 12 weeks postpartum and 13% had ART dispensing gaps, while 10% and 17% of infants had no HIV test around 10 weeks and six months, respectively. Only 100 (56%) probable gaps were confirmed through telephonic tracing, with 47 mothers subsequently re-linked to care. Mobility, stigma, and employment challenges contributed to disengagement. While our D2C approach streamlined tracing efforts, re-engagement remained difficult. Strategies integrating D2C approaches with interventions addressing social determinants are needed.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Data to Care (D2C) strategies- using routine data to identify and re-engage people living with HIV who are not in care- have shown promise in high-income settings but remain underexplored in lower-resource and vertical HIV transmission prevention (VTP) contexts. In this prospective, single-arm, proof-of-concept study, we used facility-linked public sector electronic medical records (Provincial Health Data Centre [PHDC] data) to identify, validate and trace postpartum VTP gaps among 336 mothers living with HIV and their infants in Cape Town, South Africa (March 2021-April 2022). Of 302 observed gaps, 123 (41%) were false, while 179 (59%) were probable gaps affecting 133 mother-infant pairs. Overall, 16% of mothers did not link to HIV care within 12 weeks postpartum and 13% had ART dispensing gaps, while 10% and 17% of infants had no HIV test around 10 weeks and six months, respectively. Only 100 (56%) probable gaps were confirmed through telephonic tracing, with 47 mothers subsequently re-linked to care. Mobility, stigma, and employment challenges contributed to disengagement. While our D2C approach streamlined tracing efforts, re-engagement remained difficult. Strategies integrating D2C approaches with interventions addressing social determinants are needed.
Turnnidge, Jennifer; Kuforiji, Oluwatoyosi; Sayyad, Sina; Greco, Sarah; Kirupaharan, Sawmmiya; Roy, Angélique; Dalgarno, Nancy; Zhou, Angel; Mamun, Mir Sanim Al; Mamiya, Hiroshi; Tram, Khai Hoan; Saeed, Sahar
How has Aggregated Mobility Data-informed public health research? Journal Article
In: Health Policy and Technology, vol. 14, no. 5, 2025, ISSN: 2211-8837.
@article{Turnnidge2025,
title = {How has Aggregated Mobility Data-informed public health research?},
author = {Jennifer Turnnidge and Oluwatoyosi Kuforiji and Sina Sayyad and Sarah Greco and Sawmmiya Kirupaharan and Angélique Roy and Nancy Dalgarno and Angel Zhou and Mir Sanim Al Mamun and Hiroshi Mamiya and Khai Hoan Tram and Sahar Saeed},
doi = {10.1016/j.hlpt.2025.101055},
issn = {2211-8837},
year = {2025},
date = {2025-09-00},
journal = {Health Policy and Technology},
volume = {14},
number = {5},
publisher = {Elsevier BV},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Mathenjwa, Thulile; Okango, Elphas Luchemo; Tram, Khai Hoan; Inghels, Maxime; Cuadros, Diego; Kim, Hae-Young; Walsh, Fiona; Barnighausen, Till; Dobra, Adrian; Tanser, Frank
Leveraging Smartphone Mobility Data to Understand HIV Risk Among Rural South African Young Adults: Feasibility Study Journal Article
In: JMIR Mhealth Uhealth, vol. 13, pp. e67519, 2025, ISSN: 2291-5222.
@article{pmid40854097,
title = {Leveraging Smartphone Mobility Data to Understand HIV Risk Among Rural South African Young Adults: Feasibility Study},
author = {Thulile Mathenjwa and Elphas Luchemo Okango and Khai Hoan Tram and Maxime Inghels and Diego Cuadros and Hae-Young Kim and Fiona Walsh and Till Barnighausen and Adrian Dobra and Frank Tanser},
doi = {10.2196/67519},
issn = {2291-5222},
year = {2025},
date = {2025-08-01},
journal = {JMIR Mhealth Uhealth},
volume = {13},
pages = {e67519},
abstract = {BACKGROUND: Smartphones provide a precise method to study human mobility at an unprecedented scale, allowing researchers to explore the links between mobility, HIV risk, and treatment outcomes. However, leveraging smartphone technology to study HIV risk in rural settings presents unique challenges and opportunities.nnOBJECTIVE: This study assessed the feasibility of using smartphone GPS technology to collect mobility data from young adults in rural KwaZulu Natal, South Africa. We also present key lessons learned during the study.nnMETHODS: The study was conducted in 2 phases (June 2021-May 2023) with males and females aged 20-30 years old. In phase I, participants received smartphones with a customized study app (Avicenna research software). In phase II, they used their personal smartphones and installed the study app. The app used Android location services to record the smartphone location every 30 minutes and send it to a secure study server hourly. Participants were followed up for 6 months (26 wk). If location data were missing for 48-72 hours, participants were contacted for troubleshooting. Engagement strategies, including reverse billing and gamification (Wheel of Fortune), were implemented to address internet connection barriers and aid data collection.nnRESULTS: A total of 207 participants were enrolled (phase I: 163; phase II: 44) with 204 providing mobility data. Participants recorded 27.6 million location points with a median number of 74,865 (IQR 28,471-186,578) per participant. The mean weekly location points recorded was 95.3 out of 336 possible half-hour intervals (28.4%). Phase II saw more stable data collection in the latter half of the study, due to increased user engagement with the app. Challenges included phone-related issues (screen malfunctions, lost and broken phone), app terminations, and limited internet connectivity. Reverse billing and gamification strategies improved location data collection through increased user engagement.nnCONCLUSIONS: This study demonstrates that the use of smartphone-based GPS technology is feasible among young adults in a rural South African setting. Although only 28.4% (95.3/336) of expected weekly location data were collected, the study offers insights into engagement strategies that can be used to enhance location data collection in similar contexts. Continuous troubleshooting identified challenges and informed solutions to data collection gaps. Reverse billing system and gamification resulted in significant increases in location data received. These findings underscore the potential of integrating mobile health tools into health systems to better support high-risk mobile populations.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Smartphones provide a precise method to study human mobility at an unprecedented scale, allowing researchers to explore the links between mobility, HIV risk, and treatment outcomes. However, leveraging smartphone technology to study HIV risk in rural settings presents unique challenges and opportunities.nnOBJECTIVE: This study assessed the feasibility of using smartphone GPS technology to collect mobility data from young adults in rural KwaZulu Natal, South Africa. We also present key lessons learned during the study.nnMETHODS: The study was conducted in 2 phases (June 2021-May 2023) with males and females aged 20-30 years old. In phase I, participants received smartphones with a customized study app (Avicenna research software). In phase II, they used their personal smartphones and installed the study app. The app used Android location services to record the smartphone location every 30 minutes and send it to a secure study server hourly. Participants were followed up for 6 months (26 wk). If location data were missing for 48-72 hours, participants were contacted for troubleshooting. Engagement strategies, including reverse billing and gamification (Wheel of Fortune), were implemented to address internet connection barriers and aid data collection.nnRESULTS: A total of 207 participants were enrolled (phase I: 163; phase II: 44) with 204 providing mobility data. Participants recorded 27.6 million location points with a median number of 74,865 (IQR 28,471-186,578) per participant. The mean weekly location points recorded was 95.3 out of 336 possible half-hour intervals (28.4%). Phase II saw more stable data collection in the latter half of the study, due to increased user engagement with the app. Challenges included phone-related issues (screen malfunctions, lost and broken phone), app terminations, and limited internet connectivity. Reverse billing and gamification strategies improved location data collection through increased user engagement.nnCONCLUSIONS: This study demonstrates that the use of smartphone-based GPS technology is feasible among young adults in a rural South African setting. Although only 28.4% (95.3/336) of expected weekly location data were collected, the study offers insights into engagement strategies that can be used to enhance location data collection in similar contexts. Continuous troubleshooting identified challenges and informed solutions to data collection gaps. Reverse billing system and gamification resulted in significant increases in location data received. These findings underscore the potential of integrating mobile health tools into health systems to better support high-risk mobile populations.
Keene, Claire M; Sabin, Lora L; Jennings, Lauren; Schreuder, Chantel; Källström-Ståhlgren, Carl-Oscar; Katz, Ingrid T; Singh, Yashna; Orrell, Catherine; Amico, K Rivet
Oral antiretroviral adherence interventions in the era of U=U Journal Article
In: Lancet HIV, vol. 12, no. 8, pp. e587–e595, 2025, ISSN: 2352-3018.
@article{pmid40582365,
title = {Oral antiretroviral adherence interventions in the era of U=U},
author = {Claire M Keene and Lora L Sabin and Lauren Jennings and Chantel Schreuder and Carl-Oscar Källström-Ståhlgren and Ingrid T Katz and Yashna Singh and Catherine Orrell and K Rivet Amico},
doi = {10.1016/S2352-3018(25)00096-7},
issn = {2352-3018},
year = {2025},
date = {2025-08-01},
journal = {Lancet HIV},
volume = {12},
number = {8},
pages = {e587--e595},
abstract = {Antiretroviral therapy (ART) is a keystone of the public health response to HIV, making the support of adherence a point of focus in research and service delivery. Over the past decade, measurements of viral suppression have increasingly been used to evaluate interventions, with more robust study designs gaining traction. Effective approaches include adherence counselling beyond ART education (including mental health and wellbeing approaches), reducing burden of care, tackling structural and societal determinants of health, and using mHealth platforms to deliver interventions. Increasingly, single-strategy interventions are giving way to multicomponent approaches to respond to nuances in adherence behaviour. However, determining which effective strategy to offer and to whom, when, and how remain pressing questions if professionals in the field (eg, researchers, clinicians, and community health workers) are to reach the UNAIDS 95-95-95 goals in the recent context of decreased funding. As new long-acting treatments enter global formularies, interventions showing success with oral ART will probably remain relevant to inform service delivery in most contexts.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Antiretroviral therapy (ART) is a keystone of the public health response to HIV, making the support of adherence a point of focus in research and service delivery. Over the past decade, measurements of viral suppression have increasingly been used to evaluate interventions, with more robust study designs gaining traction. Effective approaches include adherence counselling beyond ART education (including mental health and wellbeing approaches), reducing burden of care, tackling structural and societal determinants of health, and using mHealth platforms to deliver interventions. Increasingly, single-strategy interventions are giving way to multicomponent approaches to respond to nuances in adherence behaviour. However, determining which effective strategy to offer and to whom, when, and how remain pressing questions if professionals in the field (eg, researchers, clinicians, and community health workers) are to reach the UNAIDS 95-95-95 goals in the recent context of decreased funding. As new long-acting treatments enter global formularies, interventions showing success with oral ART will probably remain relevant to inform service delivery in most contexts.
Tram, Khai Hoan; Okango, Elphas; Mathenjwa, Thulile; Nitschke, Anna; Egersdörfer, Fabian; Bärnighausen, Till; Dobra, Adrian; Tanser, Frank
13th IAS Conference on HIV Science 2025.
@conference{nokey,
title = {Towards precision public health in HIV prevention: Leveraging smartphone GPS data to understand activity spaces for young adults in rural KwaZulu-Natal, South Africa [Abstract]},
author = {Khai Hoan Tram AND Elphas Okango AND Thulile Mathenjwa AND Anna Nitschke AND Fabian Egersdörfer AND Till Bärnighausen AND Adrian Dobra AND Frank Tanser},
url = {https://www.iasociety.org/sites/default/files/IAS2025/abstract-book/IAS-2025_Abstracts_Medium.pdf},
year = {2025},
date = {2025-07-17},
organization = {13th IAS Conference on HIV Science},
keywords = {},
pubstate = {published},
tppubtype = {conference}
}
Otto, Margot; Okango, Elphas; Mee, Paul; Dobra, Adrian; Tram, Khai Hoan; Gareta, Dickman; Otambo, Wilfred; Moyo, Reuben; Sereo, Tumelo; Blose, Ntombifuthi; Letoao, Nthoesele Shoeshoe; Mupanguri, Letitsia; Mwambi, Henry; Herbst, Kobus; Tanser, Frank
Trends in population HIV viral suppression: a longitudinal analysis Journal Article
In: AIDS, vol. 39, no. 8, pp. 1088–1092, 2025, ISSN: 1473-5571.
@article{pmid40440236,
title = {Trends in population HIV viral suppression: a longitudinal analysis},
author = {Margot Otto and Elphas Okango and Paul Mee and Adrian Dobra and Khai Hoan Tram and Dickman Gareta and Wilfred Otambo and Reuben Moyo and Tumelo Sereo and Ntombifuthi Blose and Nthoesele Shoeshoe Letoao and Letitsia Mupanguri and Henry Mwambi and Kobus Herbst and Frank Tanser},
doi = {10.1097/QAD.0000000000004183},
issn = {1473-5571},
year = {2025},
date = {2025-07-01},
journal = {AIDS},
volume = {39},
number = {8},
pages = {1088--1092},
abstract = {This study examines trends in HIV viral suppression and the impact of age and sex on suppression rates in a rural KwaZulu-Natal (KZN) population-based cohort from 2011 to 2023. Population viral suppression improved over time, peaking at 71% for men and 79% for women in 2022, but declined in 2023 possibly due to COVID-19 disruptions. Viral suppression rates were substantially lower than reported regional estimates for KZN. Disparities among younger males highlight the need for interventions to achieve UNAIDS 95-95-95 targets.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
This study examines trends in HIV viral suppression and the impact of age and sex on suppression rates in a rural KwaZulu-Natal (KZN) population-based cohort from 2011 to 2023. Population viral suppression improved over time, peaking at 71% for men and 79% for women in 2022, but declined in 2023 possibly due to COVID-19 disruptions. Viral suppression rates were substantially lower than reported regional estimates for KZN. Disparities among younger males highlight the need for interventions to achieve UNAIDS 95-95-95 targets.
Odayar, Jasantha; Phillips, Tamsin K; Hennessey, Claudine; Myer, Landon
Guidelines for the transfer of people living with HIV attending primary healthcare facilities in South Africa: a scoping review Journal Article
In: Int Health, vol. 17, no. 3, pp. 237–244, 2025, ISSN: 1876-3405.
@article{pmid39446492,
title = {Guidelines for the transfer of people living with HIV attending primary healthcare facilities in South Africa: a scoping review},
author = {Jasantha Odayar and Tamsin K Phillips and Claudine Hennessey and Landon Myer},
doi = {10.1093/inthealth/ihae057},
issn = {1876-3405},
year = {2025},
date = {2025-05-01},
journal = {Int Health},
volume = {17},
number = {3},
pages = {237--244},
abstract = {People living with HIV may move between health facilities: this is called 'transfer', and includes up- and down-referral based on clinical condition and lateral transfer (e.g. between primary healthcare [PHC] facilities for reasons such as geographic mobility or stigma). Transfers involving PHC facilities occur frequently and are associated with viraemia and disengagement. We reviewed the South African National Department of Health (NDOH) and Southern African HIV Clinicians Society websites and contacted NDOH officials to identify national guidelines applicable to HIV care in South Africa for recommendations on transfers involving PHC facilities. In total, 21/24 (88%) documents mentioned transfer, using the terms 'referral', 'linkage', 'transfer', 'transition' and 'handover'. Guidelines defined 'linkage to care' as connecting individuals to care after HIV testing, but other terms were not well defined. Documents emphasised transfers between different levels of the health system, and transfers between PHC facilities received limited attention. The transfer process was delineated for linkage to care, up- and down-referrals, but not for transfers between PHC facilities. Clinical management of patients transferring between PHC facilities and tracing of patients who requested transfers and missed their visits were not specified. Overall, transfers between PHC facilities were not well addressed and require attention to improve HIV treatment outcomes.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
People living with HIV may move between health facilities: this is called ‘transfer’, and includes up- and down-referral based on clinical condition and lateral transfer (e.g. between primary healthcare [PHC] facilities for reasons such as geographic mobility or stigma). Transfers involving PHC facilities occur frequently and are associated with viraemia and disengagement. We reviewed the South African National Department of Health (NDOH) and Southern African HIV Clinicians Society websites and contacted NDOH officials to identify national guidelines applicable to HIV care in South Africa for recommendations on transfers involving PHC facilities. In total, 21/24 (88%) documents mentioned transfer, using the terms ‘referral’, ‘linkage’, ‘transfer’, ‘transition’ and ‘handover’. Guidelines defined ‘linkage to care’ as connecting individuals to care after HIV testing, but other terms were not well defined. Documents emphasised transfers between different levels of the health system, and transfers between PHC facilities received limited attention. The transfer process was delineated for linkage to care, up- and down-referrals, but not for transfers between PHC facilities. Clinical management of patients transferring between PHC facilities and tracing of patients who requested transfers and missed their visits were not specified. Overall, transfers between PHC facilities were not well addressed and require attention to improve HIV treatment outcomes.
Tram, Khai Hoan; Ratevosian, Jirair; Beyrer, Chris
By executive order: The likely deadly consequences associated with a 90-day pause in PEPFAR funding Journal Article
In: J Int AIDS Soc, vol. 28, no. 3, pp. e26431, 2025, ISSN: 1758-2652.
@article{pmid39996580,
title = {By executive order: The likely deadly consequences associated with a 90-day pause in PEPFAR funding},
author = {Khai Hoan Tram and Jirair Ratevosian and Chris Beyrer},
doi = {10.1002/jia2.26431},
issn = {1758-2652},
year = {2025},
date = {2025-03-01},
journal = {J Int AIDS Soc},
volume = {28},
number = {3},
pages = {e26431},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Tram, K H; Ong’ang’o, J; Kiplimo, R; Hawn, T R; Nduba, V; Horne, D J; Ross, J M
Mobility patterns, activity locations, and TB in Nairobi, Kenya Journal Article
In: Int J Tuberc Lung Dis, vol. 29, no. 3, pp. 103–112, 2025, ISSN: 1815-7920.
@article{pmid40052657,
title = {Mobility patterns, activity locations, and TB in Nairobi, Kenya},
author = {K H Tram and J Ong'ang'o and R Kiplimo and T R Hawn and V Nduba and D J Horne and J M Ross},
doi = {10.5588/ijtld.24.0372},
issn = {1815-7920},
year = {2025},
date = {2025-03-01},
journal = {Int J Tuberc Lung Dis},
volume = {29},
number = {3},
pages = {103--112},
abstract = {BACKGROUND Annually, over 3 million people develop TB but are not diagnosed and treated. We aimed to characterize the mobility patterns and activity locations of people with TB in an urban, high-burden setting to inform future active case-finding (ACF) efforts.METHODS We conducted a population-based TB prevalence survey in Nairobi, Kenya, in 2022. Participants aged ≥15 years with TB symptoms or a suggestive chest X-ray submitted sputum for Xpert Ultra and culture. We collected data on individual activity locations and mobility and evaluated their association with the risk of pulmonary TB.RESULTS The prevalence survey enrolled 6,369 participants across nine clusters. There were significant differences in mobility patterns and activity locations between sexes and age groups. Mobility factors were not significantly associated with TB. In the adjusted analysis, age group 45-54 (OR 2.45), male sex (OR 2.95), and use of a social activity location (OR 1.96) were significantly associated with a higher risk of TB.CONCLUSIONS We did not find a significant association between mobility patterns and TB, but there was a positive association between reported 'social' activity locations and TB. Identification of 'social' activity locations, particularly bars, provides important insight into possible venues for spatially-targeted ACF activities.
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Kingston, Hanley; Chohan, Bhavna H; Mbogo, Loice; Bukusi, David; Monroe-Wise, Aliza; Sambai, Betsy; Omballa, Victor; Tram, Khai Hoan; Guthrie, Brandon; Giandhari, Jennifer; Masyuko, Sarah; Bosire, Rose; Sinkele, William; de Oliveira, Tulio; Scott, John; Farquhar, Carey; Herbeck, Joshua T
Using HIV and Hepatitis C Molecular Epidemiology to Investigate Assisted Partner Services Recruitment Among People Who Inject Drugs in Kenya Journal Article
In: AIDS Res Hum Retroviruses, vol. 41, no. 2, pp. 76–86, 2025, ISSN: 1931-8405.
@article{pmid39686724,
title = {Using HIV and Hepatitis C Molecular Epidemiology to Investigate Assisted Partner Services Recruitment Among People Who Inject Drugs in Kenya},
author = {Hanley Kingston and Bhavna H Chohan and Loice Mbogo and David Bukusi and Aliza Monroe-Wise and Betsy Sambai and Victor Omballa and Khai Hoan Tram and Brandon Guthrie and Jennifer Giandhari and Sarah Masyuko and Rose Bosire and William Sinkele and Tulio de Oliveira and John Scott and Carey Farquhar and Joshua T Herbeck},
doi = {10.1089/aid.2024.0036},
issn = {1931-8405},
year = {2025},
date = {2025-02-01},
journal = {AIDS Res Hum Retroviruses},
volume = {41},
number = {2},
pages = {76--86},
abstract = {Sexual and/or injecting partners of people who inject drugs (PWID) may have an elevated risk of HIV infection either from sharing a transmission network or an epidemiological environment. We estimated the degree of similarity between HIV and hepatitis C (HCV) sequences from PWID and their partners to assess whether partner-based recruitment identifies sexual or injecting partners within transmission networks. We used assisted partner services (APS) to recruit sexual and injecting partners of PWID living with HIV in Kenya and evaluated trends in the TN93 distances (an adjusted measure of sequence similarity) of the HIV-1 and HCV sequences from partner pairs. Of 135 unique pairs identified, 2 sexual, 2 injecting, and 3 unique sexual and injecting partner pairs had HIV sequences within a TN93 distance of 0.045, and 4 unique partner pairs had HCV sequences with distances <0.015. Sexual but not injecting partner pairs had HIV sequences with significantly smaller distances than non-partners, on average, but injecting partner pairs did have significantly smaller HCV-4a patristic distances than non-partners. APS recruitment partly reflects the HIV transmission network among sexual, but not injecting, partners of PWID. The relationship between the injecting partner recruitment and molecular networks is stronger for HCV than HIV and may reflect some recent parenteral HCV transmission. Our results show the importance of continued focus on reducing sexual HIV transmission among PWID and on education and services to address HCV transmission through needle- and/or equipment-sharing.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Sexual and/or injecting partners of people who inject drugs (PWID) may have an elevated risk of HIV infection either from sharing a transmission network or an epidemiological environment. We estimated the degree of similarity between HIV and hepatitis C (HCV) sequences from PWID and their partners to assess whether partner-based recruitment identifies sexual or injecting partners within transmission networks. We used assisted partner services (APS) to recruit sexual and injecting partners of PWID living with HIV in Kenya and evaluated trends in the TN93 distances (an adjusted measure of sequence similarity) of the HIV-1 and HCV sequences from partner pairs. Of 135 unique pairs identified, 2 sexual, 2 injecting, and 3 unique sexual and injecting partner pairs had HIV sequences within a TN93 distance of 0.045, and 4 unique partner pairs had HCV sequences with distances <0.015. Sexual but not injecting partner pairs had HIV sequences with significantly smaller distances than non-partners, on average, but injecting partner pairs did have significantly smaller HCV-4a patristic distances than non-partners. APS recruitment partly reflects the HIV transmission network among sexual, but not injecting, partners of PWID. The relationship between the injecting partner recruitment and molecular networks is stronger for HCV than HIV and may reflect some recent parenteral HCV transmission. Our results show the importance of continued focus on reducing sexual HIV transmission among PWID and on education and services to address HCV transmission through needle- and/or equipment-sharing.
Mathenjwa, Thulile; Malila, Bessie; Knight, Lucia; Tanser, Frank; Makwambeni, Patricia; Phillips, Tamsin K
In: Syst Rev, vol. 14, no. 1, pp. 28, 2025, ISSN: 2046-4053.
@article{pmid39875963,
title = {To what extent are digital health interventions targeting HIV care cascade among mobile populations feasible, acceptable, and effective? A mixed methods systematic review protocol},
author = {Thulile Mathenjwa and Bessie Malila and Lucia Knight and Frank Tanser and Patricia Makwambeni and Tamsin K Phillips},
doi = {10.1186/s13643-024-02747-2},
issn = {2046-4053},
year = {2025},
date = {2025-01-01},
journal = {Syst Rev},
volume = {14},
number = {1},
pages = {28},
abstract = {INTRODUCTION: Human mobility is associated with an increased risk of HIV acquisition and disengagement from HIV care, leading to poorer health outcomes among highly mobile individuals compared to less mobile individuals. Mobile individuals, broadly defined as those who temporally, seasonally, or permanently move from one place to another for voluntary or involuntary reasons, face many challenges in accessing HIV care services. These challenges include logistical difficulties, interruptions in HIV care continuity, and limited access to services across different locations, which together hinder timely testing, treatment initiation, and viral suppression. Digital health interventions offer flexible approaches that can adjust to the mobile individual's location to improve HIV care engagement and health outcomes for this underserved and hard-to-reach population. However, evidence on the feasibility, acceptability, and efficacy of digital health interventions across the HIV care cascade among mobile populations has not yet been appraised.nnOBJECTIVES: We seek to synthesize empirical evidence on the feasibility, acceptability, and efficacy of digital health interventions targeting the HIV care cascade among mobile populations.nnMETHODS: We will conduct a mixed methods systematic review of peer reviewed studies published between 1 January 2010 and 31 July 2024 that evaluated digital health interventions targeting the HIV care cascade among mobile populations. We will search PubMed, Web of Science, and EBSCOhost (Academic Search Premier, Africa-Wide information, CINAHL, Health Source: Nursing/Academic Edition, APA PsycInfo, APA PsycArticles) electronic databases. Bibliographies of retrieved studies will also be reviewed for relevant citations. Only studies published in English language and involved a digital health intervention, report an outcome related to the HIV care cascade, and involve mobile populations either partially or completely will be included. Two reviewers will independently screen titles and abstracts against the inclusion criteria, followed by full text screening for eligible articles. In case of disagreements, consensus will be sought from a third reviewer. Data synthesis will follow the Joanne Briggs Institute's convergent segregated approach. If sufficient quantitative studies with comparable outcome measures are available, a meta-analysis will be performed.nnDISCUSSION: This review will address a critical evidence gap by consolidating data on digital health interventions' feasibility, acceptability, and efficacy across the HIV care cascade among mobile populations. The results will inform the development of tailored digital health interventions to enhance HIV care delivery and health outcomes for this hard-to-reach population, supporting global HIV prevention and treatment goals.nnSYSTEMATIC REVIEW REGISTRATION: This protocol is registered on PROSPERO (CRD42024528122).},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
INTRODUCTION: Human mobility is associated with an increased risk of HIV acquisition and disengagement from HIV care, leading to poorer health outcomes among highly mobile individuals compared to less mobile individuals. Mobile individuals, broadly defined as those who temporally, seasonally, or permanently move from one place to another for voluntary or involuntary reasons, face many challenges in accessing HIV care services. These challenges include logistical difficulties, interruptions in HIV care continuity, and limited access to services across different locations, which together hinder timely testing, treatment initiation, and viral suppression. Digital health interventions offer flexible approaches that can adjust to the mobile individual’s location to improve HIV care engagement and health outcomes for this underserved and hard-to-reach population. However, evidence on the feasibility, acceptability, and efficacy of digital health interventions across the HIV care cascade among mobile populations has not yet been appraised.nnOBJECTIVES: We seek to synthesize empirical evidence on the feasibility, acceptability, and efficacy of digital health interventions targeting the HIV care cascade among mobile populations.nnMETHODS: We will conduct a mixed methods systematic review of peer reviewed studies published between 1 January 2010 and 31 July 2024 that evaluated digital health interventions targeting the HIV care cascade among mobile populations. We will search PubMed, Web of Science, and EBSCOhost (Academic Search Premier, Africa-Wide information, CINAHL, Health Source: Nursing/Academic Edition, APA PsycInfo, APA PsycArticles) electronic databases. Bibliographies of retrieved studies will also be reviewed for relevant citations. Only studies published in English language and involved a digital health intervention, report an outcome related to the HIV care cascade, and involve mobile populations either partially or completely will be included. Two reviewers will independently screen titles and abstracts against the inclusion criteria, followed by full text screening for eligible articles. In case of disagreements, consensus will be sought from a third reviewer. Data synthesis will follow the Joanne Briggs Institute’s convergent segregated approach. If sufficient quantitative studies with comparable outcome measures are available, a meta-analysis will be performed.nnDISCUSSION: This review will address a critical evidence gap by consolidating data on digital health interventions’ feasibility, acceptability, and efficacy across the HIV care cascade among mobile populations. The results will inform the development of tailored digital health interventions to enhance HIV care delivery and health outcomes for this hard-to-reach population, supporting global HIV prevention and treatment goals.nnSYSTEMATIC REVIEW REGISTRATION: This protocol is registered on PROSPERO (CRD42024528122).
2024
Mathenjwa, Thulile; Okango, Elphas; Tram, Khai Hoan; Dobra, Adrian; Tanser, Frank
25th International AIDS Conference, Munich 2024.
@conference{nokey,
title = {Opportunities and challenges of using smartphone GPS technology to understand linkages between mobility patterns and HIV risk among young adults in rural South Africa [Abstract]},
author = {Thulile Mathenjwa AND Elphas Okango AND Khai Hoan Tram AND Adrian Dobra AND Frank Tanser},
url = {https://www.iasociety.org/sites/default/files/AIDS2024/abstract-book/AIDS-2024_Abstracts.pdf},
year = {2024},
date = {2024-07-22},
organization = {25th International AIDS Conference, Munich},
keywords = {},
pubstate = {published},
tppubtype = {conference}
}
Clouse, Kate; Noholoza, Sandisiwe; Madwayi, Sindiswa; Mrubata, Megan; Robbins, Natalie N; Camlin, Carol S; Myer, Landon; Phillips, Tamsin K
Peripartum mobility and maternal/child separation among women living with HIV in South Africa Journal Article
In: AIDS Care, vol. 36, no. 7, pp. 946–953, 2024, ISSN: 1360-0451.
@article{pmid38176056,
title = {Peripartum mobility and maternal/child separation among women living with HIV in South Africa},
author = {Kate Clouse and Sandisiwe Noholoza and Sindiswa Madwayi and Megan Mrubata and Natalie N Robbins and Carol S Camlin and Landon Myer and Tamsin K Phillips},
doi = {10.1080/09540121.2023.2299745},
issn = {1360-0451},
year = {2024},
date = {2024-07-01},
journal = {AIDS Care},
volume = {36},
number = {7},
pages = {946--953},
abstract = {This prospective cohort study investigated the mobility patterns of 200 pregnant and postpartum women living with HIV in South Africa. Participants were enrolled during their third trimester from routine antenatal care near Cape Town, South Africa, and followed for six months postpartum. Quantitative data were collected at enrollment and follow-up. Mobility (self-reported) was common among the participants, despite the brief study period and the concurrent COVID-19 pandemic. While most reported stability in their current residence, 71% had a second main residence, primarily in the Eastern Cape (EC). Participants had a median of two lifetime moves, motivated by work, education, and family life. During the study period, 20% of participants met the study definition of travel (>7 days and >50 km), with trips predominantly to the EC, lasting a median duration of 30 days. Over one-third of participants with other living children reported that these children lived apart from them, with the mother's family being primary caregivers. These findings emphasize the need for targeted interventions to support continuity of care for mobile populations, particularly peripartum women living with HIV. The study contributes valuable insights into mobility dynamics and highlights unique barriers faced by this population, contributing to improved HIV care in resource-limited settings.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
This prospective cohort study investigated the mobility patterns of 200 pregnant and postpartum women living with HIV in South Africa. Participants were enrolled during their third trimester from routine antenatal care near Cape Town, South Africa, and followed for six months postpartum. Quantitative data were collected at enrollment and follow-up. Mobility (self-reported) was common among the participants, despite the brief study period and the concurrent COVID-19 pandemic. While most reported stability in their current residence, 71% had a second main residence, primarily in the Eastern Cape (EC). Participants had a median of two lifetime moves, motivated by work, education, and family life. During the study period, 20% of participants met the study definition of travel (>7 days and >50 km), with trips predominantly to the EC, lasting a median duration of 30 days. Over one-third of participants with other living children reported that these children lived apart from them, with the mother’s family being primary caregivers. These findings emphasize the need for targeted interventions to support continuity of care for mobile populations, particularly peripartum women living with HIV. The study contributes valuable insights into mobility dynamics and highlights unique barriers faced by this population, contributing to improved HIV care in resource-limited settings.
Euvrard, Jonathan; Timmerman, Venessa; Keene, Claire Marriott; Phelanyane, Florence; Heekes, Alexa; Rice, Brian D; Grimsrud, Anna; Ehrenkranz, Peter; Boulle, Andrew
The cyclical cascade of HIV care: Temporal care engagement trends within a population-wide cohort Journal Article
In: PLoS Med, vol. 21, no. 5, pp. e1004407, 2024, ISSN: 1549-1676.
@article{pmid38728361,
title = {The cyclical cascade of HIV care: Temporal care engagement trends within a population-wide cohort},
author = {Jonathan Euvrard and Venessa Timmerman and Claire Marriott Keene and Florence Phelanyane and Alexa Heekes and Brian D Rice and Anna Grimsrud and Peter Ehrenkranz and Andrew Boulle},
doi = {10.1371/journal.pmed.1004407},
issn = {1549-1676},
year = {2024},
date = {2024-05-01},
journal = {PLoS Med},
volume = {21},
number = {5},
pages = {e1004407},
abstract = {BACKGROUND: The traditional HIV treatment cascade aims to visualise the journey of each person living with HIV from diagnosis, through initiation on antiretroviral therapy (ART) to treatment success, represented by virological suppression. This representation has been a pivotal tool in highlighting and quantifying sequential gaps along the care continuum. There is longstanding recognition, however, that this may oversimplify the complexity of real-world engagement with HIV services in settings with mature high-burden HIV epidemics. A complementary "cyclical" cascade has been proposed to represent the processes of disengagement at different points on the care continuum, with multiple pathways to re-engagement, although the feasibility of implementing this at scale has been uncertain. This study aimed to populate, refine, and explore the utility of a cyclical representation of the HIV cascade, using routine data from a high-burden HIV setting.nnMETHODS AND FINDINGS: This observational cohort study leveraged person-level data on all people living with HIV in the Western Cape (WC), South Africa, who accessed public health services in the 2 years prior to 31 December 2023. Programme data from disease registers were complemented by data from pharmacy and laboratory systems. At study closure, 494 370 people were included, constituting 93% of those of those estimated to be living with HIV in the province, of whom 355 104 were on ART. Substantial disengagement from HIV care was evident at every point on the cascade. Early treatment emerged as a period of higher risk of disengagement, but it did not account for the majority of disengagement. Almost all those currently disengaged had prior experience of treatment. While re-engagement was also common, overall treatment coverage had increased slowly over 5 years. The transition to dolutegravir-based regimens was dramatic with good virological outcomes for those in care, notwithstanding a clearly discernible impact of the Coronavirus Disease 2019 (COVID-19) pandemic on viral load (VL) testing. People currently engaged and disengaged in care are similar with respect to age and gender. Those who died or disengaged recently were previously distributed across a range of cascade statuses, and a substantial proportion of those newly initiating and re-initiating treatment were no longer on treatment 6 months later. The main limitation of this study was incomplete evidence of HIV testing, linkage to HIV-specific services, and out-of-facility mortality.nnCONCLUSIONS: Using routine data, it was possible to populate and automate a cyclical cascade of HIV care that continuously captured the nonlinear care journeys of individuals living with HIV. In this generalised mature HIV epidemic, most people are treatment experienced. Disengagement is common and occurs at various points along the cascade, making it challenging to identify high-impact intervention opportunities. While historical HIV cascades remain valuable for target setting and service monitoring, they can be complemented with insights from more detailed cyclical cascades.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: The traditional HIV treatment cascade aims to visualise the journey of each person living with HIV from diagnosis, through initiation on antiretroviral therapy (ART) to treatment success, represented by virological suppression. This representation has been a pivotal tool in highlighting and quantifying sequential gaps along the care continuum. There is longstanding recognition, however, that this may oversimplify the complexity of real-world engagement with HIV services in settings with mature high-burden HIV epidemics. A complementary “cyclical” cascade has been proposed to represent the processes of disengagement at different points on the care continuum, with multiple pathways to re-engagement, although the feasibility of implementing this at scale has been uncertain. This study aimed to populate, refine, and explore the utility of a cyclical representation of the HIV cascade, using routine data from a high-burden HIV setting.nnMETHODS AND FINDINGS: This observational cohort study leveraged person-level data on all people living with HIV in the Western Cape (WC), South Africa, who accessed public health services in the 2 years prior to 31 December 2023. Programme data from disease registers were complemented by data from pharmacy and laboratory systems. At study closure, 494 370 people were included, constituting 93% of those of those estimated to be living with HIV in the province, of whom 355 104 were on ART. Substantial disengagement from HIV care was evident at every point on the cascade. Early treatment emerged as a period of higher risk of disengagement, but it did not account for the majority of disengagement. Almost all those currently disengaged had prior experience of treatment. While re-engagement was also common, overall treatment coverage had increased slowly over 5 years. The transition to dolutegravir-based regimens was dramatic with good virological outcomes for those in care, notwithstanding a clearly discernible impact of the Coronavirus Disease 2019 (COVID-19) pandemic on viral load (VL) testing. People currently engaged and disengaged in care are similar with respect to age and gender. Those who died or disengaged recently were previously distributed across a range of cascade statuses, and a substantial proportion of those newly initiating and re-initiating treatment were no longer on treatment 6 months later. The main limitation of this study was incomplete evidence of HIV testing, linkage to HIV-specific services, and out-of-facility mortality.nnCONCLUSIONS: Using routine data, it was possible to populate and automate a cyclical cascade of HIV care that continuously captured the nonlinear care journeys of individuals living with HIV. In this generalised mature HIV epidemic, most people are treatment experienced. Disengagement is common and occurs at various points along the cascade, making it challenging to identify high-impact intervention opportunities. While historical HIV cascades remain valuable for target setting and service monitoring, they can be complemented with insights from more detailed cyclical cascades.
Phillips, Tamsin Kate; Kassanjee, Reshma; Maxwell, Nicola; Anderson, Kim; Johnson, Leigh; Moolla, Haroon; Myer, Landon; Chi, Benjamin H; Euvrard, Jonathan; Boulle, Andrew; Davies, Mary-Ann; Cornell, Morna; de Waal, Renee
In: J Int AIDS Soc, vol. 27, no. 4, pp. e26236, 2024, ISSN: 1758-2652.
@article{pmid38566482,
title = {ART history prior to conception: trends and association with postpartum disengagement from HIV care in Khayelitsha, South Africa (2013-2019): a retrospective cohort study},
author = {Tamsin Kate Phillips and Reshma Kassanjee and Nicola Maxwell and Kim Anderson and Leigh Johnson and Haroon Moolla and Landon Myer and Benjamin H Chi and Jonathan Euvrard and Andrew Boulle and Mary-Ann Davies and Morna Cornell and Renee de Waal},
doi = {10.1002/jia2.26236},
issn = {1758-2652},
year = {2024},
date = {2024-04-01},
journal = {J Int AIDS Soc},
volume = {27},
number = {4},
pages = {e26236},
abstract = {INTRODUCTION: In recent years, the expansion of HIV treatment eligibility has resulted in an increase in people with antiretroviral therapy (ART) experience prior to pregnancy but little is known about postpartum engagement in care in this population. We examined differences in disengagement from HIV care after delivery by maternal ART history before conception.nnMETHODS: We analysed data from people living with HIV (aged 15-49) in Khayelitsha, South Africa, with ≥1 live birth between April 2013 and March 2019. We described trends over time in ART history prior to estimated conception, classifying ART history groups as: (A) on ART with no disengagement (>270 days with no evidence of HIV care); (B) returned before pregnancy following disengagement; (C) restarted ART in pregnancy after disengagement; and (D) ART new start in pregnancy. We used Kaplan-Meier curves and proportional-hazards models (adjusted for maternal age, number of pregnancy records and year of delivery) to examine the time to disengagement from delivery to 2 years postpartum.nnRESULTS: Among 7309 pregnancies (in 6680 individuals), the proportion on ART (A) increased from 19% in 2013 to 41% in 2019. The proportions of those who returned (B) and restarted (C) increased from 2% to 13% and from 2% to 10%, respectively. There was a corresponding decline in the proportion of new starts (D) from 77% in 2013 to 36% in 2019. In the first recorded pregnancy per person in the study period, 26% (95% CI 25-27%) had disengaged from care by 1 year and 34% (95% CI 33-36%) by 2 years postpartum. Individuals who returned (B: aHR 2.10, 95% CI 1.70-2.60), restarted (C: aHR 3.32, 95% CI 2.70-4.09) and newly started ART (D: aHR 2.41, 95% CI 2.12-2.74) had increased hazards of postpartum disengagement compared to those on ART (A).nnCONCLUSIONS: There is a growing population of people with ART experience prior to conception and postpartum disengagement varies substantially by ART history. Antenatal care presents an important opportunity to understand prior ART experiences and an entry into interventions for strengthened engagement in HIV care.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
INTRODUCTION: In recent years, the expansion of HIV treatment eligibility has resulted in an increase in people with antiretroviral therapy (ART) experience prior to pregnancy but little is known about postpartum engagement in care in this population. We examined differences in disengagement from HIV care after delivery by maternal ART history before conception.nnMETHODS: We analysed data from people living with HIV (aged 15-49) in Khayelitsha, South Africa, with ≥1 live birth between April 2013 and March 2019. We described trends over time in ART history prior to estimated conception, classifying ART history groups as: (A) on ART with no disengagement (>270 days with no evidence of HIV care); (B) returned before pregnancy following disengagement; (C) restarted ART in pregnancy after disengagement; and (D) ART new start in pregnancy. We used Kaplan-Meier curves and proportional-hazards models (adjusted for maternal age, number of pregnancy records and year of delivery) to examine the time to disengagement from delivery to 2 years postpartum.nnRESULTS: Among 7309 pregnancies (in 6680 individuals), the proportion on ART (A) increased from 19% in 2013 to 41% in 2019. The proportions of those who returned (B) and restarted (C) increased from 2% to 13% and from 2% to 10%, respectively. There was a corresponding decline in the proportion of new starts (D) from 77% in 2013 to 36% in 2019. In the first recorded pregnancy per person in the study period, 26% (95% CI 25-27%) had disengaged from care by 1 year and 34% (95% CI 33-36%) by 2 years postpartum. Individuals who returned (B: aHR 2.10, 95% CI 1.70-2.60), restarted (C: aHR 3.32, 95% CI 2.70-4.09) and newly started ART (D: aHR 2.41, 95% CI 2.12-2.74) had increased hazards of postpartum disengagement compared to those on ART (A).nnCONCLUSIONS: There is a growing population of people with ART experience prior to conception and postpartum disengagement varies substantially by ART history. Antenatal care presents an important opportunity to understand prior ART experiences and an entry into interventions for strengthened engagement in HIV care.
Tram, Khai Hoan; Okango, Elphas; Mathenjwa, Thulile; Mee, Paul; Kim, Hae-Young; Bärnighausen, Till; Dobra, Adrian; Tanser, Frank
Conference on Retrovirus and Opportunistic Infections 2024.
@conference{nokey,
title = {Ultra-high-resolution GPS to measure human mobility in high HIV prevalence areas in Rural South Africa [Abstract]},
author = {Khai Hoan Tram AND Elphas Okango AND Thulile Mathenjwa AND Paul Mee AND Hae-Young Kim AND Till Bärnighausen AND Adrian Dobra AND Frank Tanser},
url = {https://www.croiconference.org/wp-content/uploads/sites/2/resources/2024/croi2024-abstract-ebook-v3.pdf},
year = {2024},
date = {2024-03-04},
urldate = {2024-03-04},
organization = {Conference on Retrovirus and Opportunistic Infections},
keywords = {},
pubstate = {published},
tppubtype = {conference}
}
Arendse, Kirsten D; Walker, Caroline; Pfaff, Colin; Lebelo, Keitumetse; Cassidy, Tali; Isaakidis, Petros; von der Heyden, Erin; Abdullah, Fareed; Ellman, Tom; Katz, Ingrid T; Euvrard, Jonathan; Keene, Claire M
In: Sci Rep, vol. 14, no. 1, pp. 7317, 2024, ISSN: 2045-2322.
@article{pmid38538754,
title = {Supporting re-engagement with HIV services after treatment interruption in South Africa: a mixed method program evaluation of MSF's Welcome Service},
author = {Kirsten D Arendse and Caroline Walker and Colin Pfaff and Keitumetse Lebelo and Tali Cassidy and Petros Isaakidis and Erin von der Heyden and Fareed Abdullah and Tom Ellman and Ingrid T Katz and Jonathan Euvrard and Claire M Keene},
doi = {10.1038/s41598-024-57774-9},
issn = {2045-2322},
year = {2024},
date = {2024-03-01},
journal = {Sci Rep},
volume = {14},
number = {1},
pages = {7317},
abstract = {Psychosocial challenges impact patients' ability to remain on antiretroviral therapy lifelong, magnified by disorganized health-systems and healthcare worker (HCW) attitudes. To address this, Médecins Sans Frontières and the Department of Health developed the Welcome Service intervention, to provide person-centered care at re-engagement after HIV treatment interruption. Implemented in Khayelitsha, South Africa, between August 2020 and February 2021, the intervention aimed to reorganize triage, optimize clinical and counselling services and address HCW attitudes. The study used a mixed-methods design, incorporating in-depth interviews, and analyses of programmatic and routine health data. Interviews demonstrated positive patient care experiences. HCWs understood the potential impact of attitudes on patient engagement, however, some continued to demonstrate judgmental attitude. Clinical objectives were variably met at re-engagement: 98% were re-initiated the same day, 50% had a CD4 done, and 45% received tuberculosis prevention. Nevertheless, 4-month retention was 66%, and 88% had a VL < 1000 c/mL. Despite HCWs' understanding of person-centered care not translating into supportive behaviors, patients had positive care experiences and the intervention ended with a high rate of VL suppression. More efforts are needed to design interventions building on Welcome Service principles to provide person-centered care and sustain retention after re-engagement.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Psychosocial challenges impact patients’ ability to remain on antiretroviral therapy lifelong, magnified by disorganized health-systems and healthcare worker (HCW) attitudes. To address this, Médecins Sans Frontières and the Department of Health developed the Welcome Service intervention, to provide person-centered care at re-engagement after HIV treatment interruption. Implemented in Khayelitsha, South Africa, between August 2020 and February 2021, the intervention aimed to reorganize triage, optimize clinical and counselling services and address HCW attitudes. The study used a mixed-methods design, incorporating in-depth interviews, and analyses of programmatic and routine health data. Interviews demonstrated positive patient care experiences. HCWs understood the potential impact of attitudes on patient engagement, however, some continued to demonstrate judgmental attitude. Clinical objectives were variably met at re-engagement: 98% were re-initiated the same day, 50% had a CD4 done, and 45% received tuberculosis prevention. Nevertheless, 4-month retention was 66%, and 88% had a VL < 1000 c/mL. Despite HCWs' understanding of person-centered care not translating into supportive behaviors, patients had positive care experiences and the intervention ended with a high rate of VL suppression. More efforts are needed to design interventions building on Welcome Service principles to provide person-centered care and sustain retention after re-engagement.