Special Issue "HIV Prevention: Approaches Towards Elimination"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (31 August 2019).

Special Issue Editor

Dr. Richard Wamai
Website
Guest Editor
Integrated Initiative for Global Health, Department of Cultures, Societies and Global Studies, Northeastern University, Boston, MA, USA
Interests: HIV/AIDS cost-effectiveness; male circumcision and policy; neglected tropical diseases; visceral leishmaniasis; non-communicable diseases; health systems and policy

Special Issue Information

Dear Colleagues,

It is now going to the fourth decade since identification of the first case of HIV/AIDS. In that time about as many people have died of AIDS as are living today. Progress towards global goals set by the international community for 2020 to dramatically reduce new infections and deaths is slow, causing UNAIDS to ‘sound the alarm’ in the latest report of 2018. The 90–90–90 framework envisions that 90% of those living with HIV know their status, 90% of those diagnosed receive ART, and 90% of those receiving ART achieve viral suppression by 2020; the targets to 2030 are 95–95–95. According to the UNAIDS latest report, in sub-Saharan Africa, which carries two-thirds of the global burden, achievements of these targets in 2017 were, respectively, 81–66–52. Against a target of 200,000 new infections in 2030, 1.8 million people were newly infected in 2017. Infections are also rising in nearly 50 countries. Therefore, much urgent work in addressing barriers to prevent new infections is critically needed over the next decade.

This Special Issue will include research papers on HIV prevention covering behavioral, biomedical, and structural interventions including novel combination prevention approaches. The goal is to produce a collection of scientific research that contributes to solving the challenges for reaching elimination of HIV as a public health problem. Observational, modeling, and cost-effectiveness studies will be considered. High-quality narrative and systematic reviews as well as thoughtful policy evaluations will be also considered.

Assoc. Prof. Richard Wamai
Guest Editor

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2300 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • HIV Prevention
  • Behavior
  • Combination prevention
  • Biomedical
  • Interventions
  • Cost-effectiveness
  • Male circumcision
  • Treatment as prevention
  • Condoms
  • HIV Stigma
  • AIDS
  • Sub-Saharan Africa
  • Key populations
  • Policy
  • Human rights
  • Co-infections

Published Papers (5 papers)

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Research

Open AccessArticle
Predictors of Health Insurance Enrollment among HIV Positive Pregnant Women in Kenya: Potential for Adverse Selection and Implications for HIV Treatment and Prevention
Int. J. Environ. Res. Public Health 2020, 17(8), 2892; https://doi.org/10.3390/ijerph17082892 - 22 Apr 2020
Cited by 1
Abstract
Background: The global push to achieve the 90-90-90 targets designed to end the HIV epidemic has called for the removing of policy barriers to prevention and treatment, and ensuring financial sustainability of HIV programs. Universal health insurance is one tool that can [...] Read more.
Background: The global push to achieve the 90-90-90 targets designed to end the HIV epidemic has called for the removing of policy barriers to prevention and treatment, and ensuring financial sustainability of HIV programs. Universal health insurance is one tool that can be used to this end. In sub-Saharan Africa, where HIV prevalence and incidence remain high, the use of health insurance to provide comprehensive HIV care is limited. This study looked at the factors that best predict social health insurance enrollment among HIV positive pregnant women using data from the Academic Model Providing Access to Healthcare (AMPATH) in western Kenya. Methods: Cross-sectional clinical encounter data were extracted from the electronic medical records (EMR) at AMPATH. We used univariate and multivariate logistic regressions to estimate the predictors of health insurance enrollment among HIV positive pregnant women. The analysis was further stratified by HIV disease severity (based on CD4 cell count <350 and 350>) to test the possibility of differential enrollment given HIV disease state. Results: Approximately 7% of HIV infected women delivering at a healthcare facility had health insurance. HIV positive pregnant women who deliver at a health facility had twice the odds of enrolling in insurance [2.46 Adjusted Odds Ratio (AOR), Confidence Interval (CI) 1.24–4.87]. They were 10 times more likely to have insurance if they were lost to follow-up to HIV care during pregnancy [9.90 AOR; CI 3.42–28.67], and three times more likely to enroll if they sought care at an urban clinic [2.50 AOR; 95% CI 1.53–4.12]. Being on HIV treatment was negatively associated with health insurance enrollment [0.22 AOR; CI 0.10–0.49]. Stratifying the analysis by HIV disease severity while statistically significant did not change these results. Conclusions: The findings indicated that health insurance enrollment among HIV positive pregnant women was low mirroring national levels. Additionally, structural factors, such as access to institutional delivery and location of healthcare facilities, increased the likelihood of health insurance enrollment within this population. However, behavioral aspects, such as being lost to follow-up to HIV care during pregnancy and being on HIV treatment, had an ambiguous effect on insurance enrollment. This may potentially be because of adverse selection and information asymmetries. Further understanding of the relationship between insurance and HIV is needed if health insurance is to be utilized for HIV treatment and prevention in limited resource settings. Full article
(This article belongs to the Special Issue HIV Prevention: Approaches Towards Elimination)
Open AccessArticle
“Our Tradition Our Enemy”: A Qualitative Study of Barriers to Women’s HIV Care in Jimma, Southwest Ethiopia
Int. J. Environ. Res. Public Health 2020, 17(3), 833; https://doi.org/10.3390/ijerph17030833 - 29 Jan 2020
Abstract
Evidence exists that suggests that women are vulnerable to negative HIV treatment outcomes worldwide. This study explored barriers to treatment outcomes of women in Jimma, Southwest Ethiopia. We interviewed 11 HIV patients, 9 health workers, 10 community advocates and 5 HIV program managers [...] Read more.
Evidence exists that suggests that women are vulnerable to negative HIV treatment outcomes worldwide. This study explored barriers to treatment outcomes of women in Jimma, Southwest Ethiopia. We interviewed 11 HIV patients, 9 health workers, 10 community advocates and 5 HIV program managers from 10 institutions using an in-depth interview guide designed to probe barriers to HIV care at individual, community, healthcare provider, and government policy levels. To systematically analyze the data, we applied a thematic framework analysis using NVivo. In total, 35 participants were involved in the study and provided the following interrelated barriers: (i) Availability— most women living in rural areas who accessed HIV cared less often than men; (ii) free antiretroviral therapy (ART) is expensive—most women who have low income and who live in urban areas sold ART drugs illegally to cover ART associated costs; (iii) fear of being seen by others—negative consequences of HIV related stigma was higher in women than men; (iv) the role of tradition—the dominance of patriarchy was found to be the primary barrier to women’s HIV care and treatment outcomes. In conclusion, barriers related to culture or tradition constrain women’s access to HIV care. Therefore, policies and strategies should focus on these contextual constrains. Full article
(This article belongs to the Special Issue HIV Prevention: Approaches Towards Elimination)
Open AccessArticle
Improving the UNAIDS 90-90-90 Treatment Targets: Solutions Suggested from a Qualitative Study of HIV Patients, Community Advocates, Health Workers and Program Managers in Jimma, Southwest Ethiopia
Int. J. Environ. Res. Public Health 2020, 17(1), 378; https://doi.org/10.3390/ijerph17010378 - 06 Jan 2020
Cited by 1
Abstract
Ethiopia’s performance toward the UNAIDS 90-90-90 targets is low. The present study explored interventions to improve delayed HIV care presentation (first 90), poor retention (second 90) and clinical and immunological failure (third 90). We employed a qualitative approach using in-depth interviews with 10 [...] Read more.
Ethiopia’s performance toward the UNAIDS 90-90-90 targets is low. The present study explored interventions to improve delayed HIV care presentation (first 90), poor retention (second 90) and clinical and immunological failure (third 90). We employed a qualitative approach using in-depth interviews with 10 HIV patients, nine health workers, 11 community advocates and five HIV program managers. Ethical approvals were obtained from Australia and Ethiopia. The following were suggested solutions to improve HIV care and treatment to meet the three 90s: (i) strengthening existing programs including collaboration with religious leaders; (ii) implementing new programs such as self-HIV testing, house-to-house HIV testing, community antiretroviral therapy (ART) distribution and teach-test-treat-link strategy; (iii) decentralizing and integrating services such as ART in health post and in private clinics, and integrating HIV care services with mental illness and other non-communicable diseases; and (iv) filling gaps in legislation in issues related with HIV status disclosure and traditional healing practices. In conclusion, the study suggested important solutions for improving delayed HIV care presentation, attrition, and clinical and immunological failure. A program such as the teach-test-treat-link strategy was found to be a cross-cutting intervention to enhance the three 90s. We recommend further nationwide research before implementing the interventions. Full article
(This article belongs to the Special Issue HIV Prevention: Approaches Towards Elimination)
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Open AccessArticle
The Role of Stigma Management in HIV Treatment Adherence
Int. J. Environ. Res. Public Health 2019, 16(24), 5003; https://doi.org/10.3390/ijerph16245003 - 09 Dec 2019
Cited by 4
Abstract
Social stigma is linked to improper HIV treatment adherence, but how stigma impairs adherence outcomes is poorly understood. This study included 93 people living with HIV in the United States who participated in focus groups or one-on-one interviews regarding how stigma might affect [...] Read more.
Social stigma is linked to improper HIV treatment adherence, but how stigma impairs adherence outcomes is poorly understood. This study included 93 people living with HIV in the United States who participated in focus groups or one-on-one interviews regarding how stigma might affect medication management. Latent content analysis and constant comparative techniques of participant responses that were produced three thematic groupings that described how participants (a) orient to HIV stigma, (b) manage HIV stigma in ways that directly impair treatment adherence, and (c) manage HIV stigma in ways that may indirectly impair adherence. These findings illustrate the need to understand how patients orient to HIV stigma when prescribing medications and the complications that are inherent to such assessments. In addition, these findings provide a simple framework for organizing the different ways in which stigma management strategies may disrupt treatment adherence. Conceptually, these findings also offer a paradigm shift to extent theories on disclosure and concealment, in which only disclosure has been cast as an active process. These findings demonstrate how concealment is far from a passive default, often requiring enormous effort. Ultimately, these findings may guide intervention programs that help to entirely eliminate HIV by promoting optimized counseling and subsequent treatment adherence. Full article
(This article belongs to the Special Issue HIV Prevention: Approaches Towards Elimination)
Open AccessArticle
Factors Affecting HIV Testing among Youth in Kenya
Int. J. Environ. Res. Public Health 2019, 16(8), 1450; https://doi.org/10.3390/ijerph16081450 - 24 Apr 2019
Cited by 6
Abstract
With the high prevalence of HIV among youth in sub-Saharan Africa, it is vital to better understand factors affecting HIV testing among this population; this is the first step in the HIV treatment cascade. The purpose of this study was to examine factors [...] Read more.
With the high prevalence of HIV among youth in sub-Saharan Africa, it is vital to better understand factors affecting HIV testing among this population; this is the first step in the HIV treatment cascade. The purpose of this study was to examine factors related to behavioral intentions regarding HIV testing using existing pre-test data from the HIV SEERs (Stigma-reduction via Education, Empowerment, and Research) Project, a community-based participatory research program targeting 13–24-year-olds in Kenya. It was hypothesized that HIV knowledge, social support, subjective well-being, and mental health (depression, anxiety, and stress) would serve as facilitators to HIV testing while projected stigma and substance use would serve as barriers to HIV testing. In partial support of our hypotheses, findings from logistic regression analyses revealed that HIV knowledge, substance use, depression, and social support were significant predictors of HIV testing intentions. However, HIV knowledge and substance use served as facilitators while depression and social support served as barriers. While projected stigma was correlated with HIV testing intentions, it was not a significant predictor in the regression analysis. Subjective well-being, anxiety, and stress were not significant predictors in the regression analysis. These findings have important implications for HIV testing initiatives designed for youth in Kenya as well as future research on HIV testing with this population. Full article
(This article belongs to the Special Issue HIV Prevention: Approaches Towards Elimination)
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