Zambart-Publication

Differences in health-related quality of life between HIV-positive and HIV-negative people in Zambia and South Africa…

Ranjeeta Thomas, Ronelle Burger, Abigail Harper, Sarah Kanema, Lawrence Mwenge, Nosivuyile Vanqa, Nomtha Bell-Mandla, Peter C Smith,
Sian Floyd, Peter Bock, Helen Ayles, Nulda Beyers, Deborah Donnell, Sarah Fidler, Richard Hayes, Katharina Hauck, on behalf of the HPTN 071 (PopART) Study Team*
Summary
Background The life expectancy of HIV-positive individuals receiving antiretroviral therapy (ART) is approaching that of HIV-negative people. However, little is known about how these populations compare in terms of health-related quality of life (HRQoL). We aimed to compare HRQoL between HIV-positive and HIV-negative people in Zambia and South Africa. Read full article.

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Community Engagement Award

The HIV Prevention Trials Network (HPTN) 2017 annual meeting brought together researchers from its clinical trials involved in HIV prevention in countries across the world. Zambart, is part of a consortium of international researchers currently conducting the world’s largest HIV prevention trial in 21 communities in Zambia and South Africa.

The Zambart Community Engagement (CE) team on the HPTN 071(PopART) Trial won the Best Community Engagement Award for outstanding performance in mobilising the biggest community randomised HIV prevention study in the world. During the course of the four year study, Zambart’s CE team has developed novel strategies to engage, sustain, and work together with other study groups to increase participants for the trial, including ancillary studies nested with the main trial.

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Zambart Commemorates National HIV testing, Counselling, and Treatment Day Activities

On August 15, 2017 Zambart joined other health stakeholders and participated in the annual HIV Testing, Counselling and Treatment (HTCT) Day event spearheaded by the Ministry of Health (MoH). National HTCT Day (previously National VCT Day) is held to raise public awareness on HIV prevention and treatment.  During this year’s event, the President of Zambia Edgar Lungu announced the government shift to routine HIV testing and treatment in all health facilities in the country.

Zambart’s objective of participating in this event was to support HIV prevention and treatment, and showcase some of the organisation’s innovative activities aimed at enhancing uptake of HIV testing and treatment.

Across all its research sites on the Copperbelt, Central, Lusaka, and Southern provinces, Zambart field teams mobilised and conducted various community engagement and sensitisation activities in different zones, and participated in the district-level commemorations held under the theme: “HIV Test and Treat: Towards Ending AIDS”. The activities were also aimed to increase awareness about HTCT Day.

Zambart conducted satellite outreach activities in the communities prior to HTCT Day. The activities included offering free HIV Counselling and Testing, linkage to care, screening for Tuberculosis  and Sexually Transmitted Infections, distribution of lubricants, condoms and  information and education materials, and providing HIV health talks and counselling to adolescents in Youth Friendly Corners in Zambart supported clinics.

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PopART Study Staff Reflections, Challenges, and Experiences

Reflections on 2017 PopART Study all-staff training & retreat

During the last PopART study all-staff training the various teams had an opportunity to share their personal experiences and reflects about the trial. The field teams, on whom the successful implementation of the study relies heavily, had some great feedback about PopART. Equally the supervisors and technical leaders who support the field teams and enable them to boldly carry out their work had a few things to say.

Here are just a few examples of some of the PopART staff reflections from the field and head office alike:

“When you change a life, you change a life forever,” – Steve Belemu, Zambart Community Engagement Team

“The HPTN 071 is an extraordinary study, and we did it, each and every one of you.” – Dr Helen Ayles, PopART Site Principal Investigator: Z Director of Research- Zambart

“PopART has been an amazing study. It has successfully managed to mobilise efforts of different people, organisations and communities towards the dream of achieving an HIV free Zambia. Yes, it is possible to get rid of HIV if we replicate PopART at country level.” – Dr Musonda Simwinga, Zambart Community Engagement Lead & Social Scientist

“I first became involved in HIV research in 1985. The lab I was in was among those conducting the initial trials of AZT, which became the first drug approved for treatment of individuals infected with HIV. Three decades later, PopART is demonstrating the efficacy of treatment as prevention at the population level. It’s gratifying to be a part of the PopART team and the remarkable advances that have been made in HIV treatment.” – Barry Kosloff, Head of Zambart Laboratories

“One day we went in the field and enrolled a female participant whose husband had died some years before. She wanted to know her HIV status. The research assistant consenting the woman and I was called to collect the sample. After the test was done, she was found to be reactive and we linked her to care. She then asked if I could also test her daughter who was not looking too healthy and she also tested reactive. We linked her to care too. From that time to date, this family is like my family to me. I feel happy when I pass by their home and see how happy they are and getting on with their life.” (PopART CHiP)

“I tested a man in a household that I had been visiting in my zone, he tested HIV positive but it was very difficult to link him to care. When he fell very ill, that is when he started the treatment and he is now doing fine. And after that, his mother disclosed that she was also taking care of a child who lost its mother at a very young age. I probed more and asked if I could test the child. The test was positive and I managed to link the child to care. The child looks good and feels good now. She doesn’t get sick like before. This makes me happy and am proud of myself at least I have saved a life.” (CHiP)

In other bizarre experiences shared by the PopART intervention team staff: A female CHiP reflected how a client insisted to the PopART team visiting his household that he was born naturally circumcised and attempted to show them. And in another instance, a client attempted to remove all his clothes off to show the CHiP team during a household visit a skin rash that had spread all over his body.  Some of the CHiPs narrated how at the beginning of the study they would sometimes be mistaken for political cadres. Another CHiP recalled a field encounter when instead of conducting HCT they found themselves as first responders to an expectant woman’s call for help and helped to conduct a home delivery, after which they assisted the woman to the health facility for onward care.

“In year one we tested the wife in absence of the husband and the results were negative. Shortly afterward, the husband came and the wife asked the husband to also test but with a warning that if her results came out positive that would be the end of their marriage. Later, the wife left the house to go to the market and the husband asked to be tested in the absence of the wife and he tested HIV positive.

In year two, we went back to the household and tested the wife again. She tested positive. But she could not understand how she could be positive when her husband was negative (the husband had told her that he tested negative when in actual fact he was positive). The wife refused to start treatment fearing the husband who thought she was negative. The husband-had refused to start treatment for fear of being divorced by the wife who he believes was negative.”-  (CHiP)

“In annual round two, I went to a household where I tested a seven (7) year old girl and she was reactive. Unfortunately, she was not linked to care because her father’s family said that she was too young to be HIV positive, and the girl’s mother’s relatives insisted her mother died of witchcraft and not HIV. In annual round three, I learned that they had not yet linked her to care because of the misunderstanding and beliefs from the two families. This matter was reported to the supervisor and the youth counsellor but to no avail. Eventually the girl got very ill and that is when they cousin decided to take her to the clinic. The file was opened for the girl. As I.mm writing, the girl’s condition has improved.”(CHiP)

“A 13 year old client told me that he was denied condoms, so he only picks the used condoms, washes them and then use them. The CHiP advised him not to pick used condoms because they are contaminated. He was counselled on abstinence ad tested for HIV and condoms were given to him.”- (CHiP)

In delivering the house-to-house PopART HIV prevention package in the various study communities, the field teams comprised of Community HIV Care Providers (CHiPs); Research  Assistants; Research Nurses; Community Mobilisers; worked in collaboration with community leaders and health facilities. Over the course of the four years of study implementation, PopART staff forged great friendships and further strengthened the nearly 3 decade old partnership Zambart has had with the communities.

Thanks to everyone for their support, dedication, and teamwork that continues to make Zambart a solid community-focused local research organization working to improve health for all Zambians.

 

Helen Ayles presenting at IAS 2017. Photo by Roger Pebody, aidsmap.com

Dr Ayles on the HIV Self Testing at the IAS Paris Conference

courtesy of aidsmap.

Adding HIV self-testing as an additional option to a door-to-door programme offering HIV testing in Zambia boosted the uptake of HIV testing among men, younger adults and those who had previously refused HIV testing, Helen Ayles of the London School of Hygiene and Tropical Medicine told the 9th International AIDS Society Conference on HIV Science (IAS 2017) in Paris today. It appears that HIV self-testing may have a particular impact on testing rates in men and could contribute to meeting the 90-90-90 targets in men.

Ayles emphasised that the effect was seen in communities which had already been exposed to three years of intensive efforts to offer HIV testing to all. People who had not already been tested must be considered the ‘hardest to reach’ and the self-testing intervention was notable for having an impact with these individuals.

The study presented was a substudy of PopART (also known as HPTN 071), a large community-randomised trial being carried out in high-prevalence communities in Zambia and South Africa. PopART is aiming to implement an approach of universal HIV testing and universal access to immediate HIV treatment for those who need it, in order to reduce new HIV infections.

The main approach to HIV testing used in PopART is home based HIV testing, in which lay counsellors (known in the study as Community HIV Care Providers or CHiPs) systematically visit all households in a geographical area and offer HIV testing and counselling. While this approach is feasible and acceptable, it is challenging to achieve very high levels of uptake among men, younger people and mobile individuals (for example, people travelling for work).

By the end of the second year of PopART, the target of having tested 90% of people had been achieved for women, in almost all age groups over 20 years (but not for younger women). But uptake was much lower in men – in most age groups, between 70 and 85% had tested, with uptake only surpassing 90% in those over the age of 55.

Supplementary approaches appear to be necessary.

A substudy of PopART therefore aimed to evaluate whether offering self-testing as an additional option would increase the uptake of HIV testing. This was a cluster-randomised trial in 66 zones in four communities in Zambia. In the 33 intervention zones, household members were offered two options for HIV testing – rapid testing by the lay counsellor or self-testing. In the 33 zones in the control group, only rapid testing by the lay counsellor was offered.

The standard PopART intervention, offered in the control group, involves lay counsellors making door-to-door visits to households and offering rapid HIV testing, using a finger prick blood test. The lay counsellors also test for sexually transmitted infections and tuberculosis, as well as promoting and making referrals to treatment and male circumcision services. They also provide support for retention in care and adherence to treatment.

In the arm of the study in which self-testing was an option, it was chosen by 55% of those who took a test. The vast majority (88%) of those taking a self-test chose to have the lay counsellor present during the test, described as ‘supervised’ self-testing by the researchers. The health worker could help with problems users faced in operating the test or in interpreting the result. Helen Ayles said that she would expect more self-testing to be unsupervised in the future, as people become more familiar with the process.

Another testing modality was ‘secondary distribution’ — when a household member was absent, a self-testing kit could be left with their partner for them to use later.

By the end of a three-month period earlier this year, 60.4% of adult men in the intervention arm knew their HIV status, compared to 55.1% in the control arm. A similar effect was not seen in women.

The effect of providing self-testing was also seen in people of both genders aged 16 to 29 (73.5% in the intervention arm and 70.2% in the control arm knew their status).

There was also strong evidence that providing self-testing improved knowledge of status in individuals who were locally resident during earlier phases of PopART but had previously turned down the offer of testing by the PopART lay counsellors. Among these individuals, 29.7% knew their status in the intervention arm, compared to 20.6% in the control arm.

In the control arm, 2.6% of people testing had reactive results. The figure was similar for people tested by the lay counsellor in the intervention arm (2.5%), people using self-tests with supervision (2.9%) and people using self-tests without supervision (3.5%).

However, it was noticeable that in people tested following secondary distribution (i.e. partners who were absent when the lay counsellor visited), the numbers with reactive results were higher. In 81 people who discussed their results with the lay counsellor, 9.9% had a reactive result and in 242 people whose results were communicated by the partner to the lay counsellor, 5.4% had a reactive result. Secondary distribution may be particularly helpful in reducing undiagnosed infection. In many cases, it led to the couple testing together.

Qualitative findings from in-depth interviews and focus groups suggested that self-testing was acceptable for people who were worried about waiting times and stigma in clinics; self-testing had advantages in terms of confidentiality, control and convenience; and that people felt empowered by knowing how to test themselves. Self-testing was particularly acceptable for busy and mobile people, married men, those living with a partner, people of higher social classes, those in formal employment and members of key populations (such as sex workers).

Helen Ayles said that HIV self testing is a solution for engaging ‘hard-to-reach’ groups such as working men and mobile populations with HIV testing. She said that even if the increase in testing uptake may be modest (a few percentage points), this should be considered in the context of a population that has already been given multiple opportunities to test.

Read the full article on www.aidsmap.com