The potential promise and pitfalls of point-of-care viral load monitoring to expedite HIV treatment decision-making in rural Uganda: a qualitative study DOI Creative Commons
Joseph G. Rosen, William Ddaaki, Neema Nakyanjo

et al.

BMC Health Services Research, Journal Year: 2024, Volume and Issue: 24(1)

Published: Oct. 22, 2024

Abstract Background HIV treatment programs in Africa have implemented centralized testing for routine viral load monitoring (VLM), which may result specimen processing delays inhibiting timely return of results. Decentralized, point-of-care (PoC) VLM is a promising tool expediting clinical decision-making but remains unavailable most African settings. We qualitatively explored the perceived feasibility and appropriateness PoC to address gaps along continuum rural Uganda. Methods Between May September 2022, we conducted 15 in-depth interviews with clinicians (facility in-charges, officers, nurses, counselors) six focus group discussions 47 peer health workers from three south-central Ugandan districts. Topics implementation opportunities/challenges optimizing platforms. perspectives on suitability using iterative thematic analysis. Applying Framework Method, then mapped salient constraints enablers constructs Consolidated Implementation Research. Results Clinicians peers alike emphasized monitoring’s resource-intensiveness susceptibility procedural/infrastructural bottlenecks (e.g., supply stockouts, backlogs, community tracing clients delayed results), decision-making. Participants reacted enthusiastically prospect VLM, anticipating accelerated turnarounds processing, shorter and/or fewer client encounters services, streamlined efficiencies care provision (including expedited VLM-driven decision-making). Anticipated included human resource requirements large quantities specimens (especially when machinery require repair), procurement maintenance costs, training needs existing workforce operating technology, insufficient space lower-tier facilities accommodate installation new laboratory equipment. Conclusions challenges, primarily clustering around requirements, did not diminish enthusiasm among workers, who platforms as potential solutions inefficiencies within ecosystem. Prioritizing rollout available resources optimal adequate physical fiscal infrastructure, capacity manage high volumes) could help overcome anticipated barriers decentralizing monitoring.

Language: Английский

Adolescents and young adults with HIV and unsuppressed viral load: where do we go from here? DOI
Natella Rakhmanina, Caroline Foster, Allison L. Agwu

et al.

Current Opinion in HIV and AIDS, Journal Year: 2024, Volume and Issue: 19(6), P. 368 - 376

Published: July 29, 2024

Purpose of review Adolescents and youth living with HIV (AYLHIV) have worse outcomes at all stages the care cascade when compared adults, yet adolescents unsuppressed viral load are typically excluded from phase 3 studies novel therapeutic agents emerging strategies. Long-acting potential to radically change for young people struggling adherence daily oral medications. Recent findings 1.5 million children aged less than 15 years live more 100 000 acquire perinatally every year. 10–24 comprise ∼40% global incident infections. Rates suppression among AYLHIV vary markedly 44 88%, resulting in morbidity risks transmission partners infants. Virological failure is mostly due poor adherence, express high levels interest acceptability alternatives medications, such as long-acting antiretroviral formulations. Emerging data regarding their use populations encouraging. Summary AYLHIV, including without virologic suppression, must be prioritized programmatic implementation research drugs other strategies prevent mortality ultimately end epidemic.

Language: Английский

Citations

4
Do Adolescents Living With HIV in Kenya Know Their Viral Load Results? Record Audit and Adolescent Exit Surveys in Kiambu and Nakuru Counties: A Cross-Sectional Study DOI

Deepa Oja,

Alvin Onyango, Cyrus Mugo

et al.

Journal of the Association of Nurses in AIDS Care, Journal Year: 2025, Volume and Issue: unknown

Published: March 6, 2025

Timely and accurate return of viral load (VL) results to adolescents living with HIV (ALHIV) is essential for early detection adherence challenges treatment failure. Our cross-sectional study evaluated VL data ALHIV, ages 15-19 years, enrolled in six care facilities Kiambu Nakuru Counties Kenya. We summarized the proportion available both electronic medical record (EMR) national database. Modified Poisson regression models assessed relationship between ALHIV characteristics knowledge results. Of 20% (n = 207) charts that were randomly selected, 86% 179) matched database source; however, 7% 14) missing from clinic-EMR, 8% 17) incongruent EMR. Only half (52%) surveyed 132) reported receiving their last result, older more likely receive than younger (Prevalence ratio: 1.46, p .02). Missing or incorrect records suggest gaps need be addressed addition increasing who optimize management.

Language: Английский

Citations

0
The potential promise and pitfalls of point-of-care viral load monitoring to expedite HIV treatment decision-making in rural Uganda: a qualitative study DOI Creative Commons
Joseph G. Rosen, William Ddaaki, Neema Nakyanjo

et al.

BMC Health Services Research, Journal Year: 2024, Volume and Issue: 24(1)

Published: Oct. 22, 2024

Abstract Background HIV treatment programs in Africa have implemented centralized testing for routine viral load monitoring (VLM), which may result specimen processing delays inhibiting timely return of results. Decentralized, point-of-care (PoC) VLM is a promising tool expediting clinical decision-making but remains unavailable most African settings. We qualitatively explored the perceived feasibility and appropriateness PoC to address gaps along continuum rural Uganda. Methods Between May September 2022, we conducted 15 in-depth interviews with clinicians (facility in-charges, officers, nurses, counselors) six focus group discussions 47 peer health workers from three south-central Ugandan districts. Topics implementation opportunities/challenges optimizing platforms. perspectives on suitability using iterative thematic analysis. Applying Framework Method, then mapped salient constraints enablers constructs Consolidated Implementation Research. Results Clinicians peers alike emphasized monitoring’s resource-intensiveness susceptibility procedural/infrastructural bottlenecks (e.g., supply stockouts, backlogs, community tracing clients delayed results), decision-making. Participants reacted enthusiastically prospect VLM, anticipating accelerated turnarounds processing, shorter and/or fewer client encounters services, streamlined efficiencies care provision (including expedited VLM-driven decision-making). Anticipated included human resource requirements large quantities specimens (especially when machinery require repair), procurement maintenance costs, training needs existing workforce operating technology, insufficient space lower-tier facilities accommodate installation new laboratory equipment. Conclusions challenges, primarily clustering around requirements, did not diminish enthusiasm among workers, who platforms as potential solutions inefficiencies within ecosystem. Prioritizing rollout available resources optimal adequate physical fiscal infrastructure, capacity manage high volumes) could help overcome anticipated barriers decentralizing monitoring.

Language: Английский

Citations

0