Ruth Morgan Thomas, Andrew Spieldenner, Erika Castellanos, Judy Chang, Jules Kim
Introduction
A Programme Science approach that prioritizes populations who will benefit most and ensuring resources are allocated to programmes that meet the needs of those populations will bring an equity focus to research. Gay men and other men who have sex with men, people who use drugs, sex workers of all genders, and trans and gender-diverse people, defined by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) as key populations, have been disproportionately impacted since the start of the HIV pandemic. Through documenting community experiences from global key population-led networks, the authors explore the potential value and impact of community-led organizations and service delivery as critical components in effective HIV and Sexually Transmitted infections (STI) programmes.
Discussion
Through advocacy and research interventions, global key population networks have identified barriers against scaling up interventions for criminalized and marginalized communities, as well as highlighted solutions. The authors examine some of the current barriers to meaningful involvement of communities and the scaling up of community-led programmes that need to be addressed if Programme Science is to maintain an equity lens and the needs of key populations are to be met and highlight the need to make visible community engagement and participation in embedded research and Programme Science.
Conclusions
The Programme Science approach provides an important opportunity to understand practical issues that will increase effective coverage in the implementation of public health and other interventions, which will require the prioritizing of key populations and their priorities in HIV and STI programmes. It will require extensive time and work to build relationships, increase capacity and share power. Where this has already happened, it has resulted in positive outcomes, including better health outcomes, reduced stigma, increased agency for key populations, and built community-led organizations and responses.
{"title":"Community contexts and knowledge: accountability, leadership and meaningful involvement of communities in Programme Science","authors":"Ruth Morgan Thomas, Andrew Spieldenner, Erika Castellanos, Judy Chang, Jules Kim","doi":"10.1002/jia2.26281","DOIUrl":"10.1002/jia2.26281","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>A Programme Science approach that prioritizes populations who will benefit most and ensuring resources are allocated to programmes that meet the needs of those populations will bring an equity focus to research. Gay men and other men who have sex with men, people who use drugs, sex workers of all genders, and trans and gender-diverse people, defined by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) as key populations, have been disproportionately impacted since the start of the HIV pandemic. Through documenting community experiences from global key population-led networks, the authors explore the potential value and impact of community-led organizations and service delivery as critical components in effective HIV and Sexually Transmitted infections (STI) programmes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Through advocacy and research interventions, global key population networks have identified barriers against scaling up interventions for criminalized and marginalized communities, as well as highlighted solutions. The authors examine some of the current barriers to meaningful involvement of communities and the scaling up of community-led programmes that need to be addressed if Programme Science is to maintain an equity lens and the needs of key populations are to be met and highlight the need to make visible community engagement and participation in embedded research and Programme Science.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The Programme Science approach provides an important opportunity to understand practical issues that will increase effective coverage in the implementation of public health and other interventions, which will require the prioritizing of key populations and their priorities in HIV and STI programmes. It will require extensive time and work to build relationships, increase capacity and share power. Where this has already happened, it has resulted in positive outcomes, including better health outcomes, reduced stigma, increased agency for key populations, and built community-led organizations and responses.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 S2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26281","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141578388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Izukanji Sikazwe, Maurice Musheke, Kanema Chiyenu, Benard Ngosa, Jake M. Pry, Chama Mulubwa, Martin Zimba, Martin Sakala, Mphatso Sakala, Paul Somwe, Goodwin Nyirenda, Theodora Savory, Carolyn Bolton-Moore, Michael E. Herce
<div> <section> <h3> Introduction</h3> <p>Optimizing uptake of pre-exposure prophylaxis (PrEP) for individuals at risk of HIV acquisition has been challenging despite clear scientific evidence and normative guidelines, particularly for key populations (KPs) such as men who have sex with men (MSM), female sex workers (FSWs), transgender (TG) people and persons who inject drugs (PWID). Applying an iterative Programme Science cycle, building on the effective programme coverage framework, we describe the approach used by the Centre for Infectious Disease Research in Zambia (CIDRZ) to scale up PrEP delivery and address inequities in PrEP access for KP in Lusaka, Zambia.</p> </section> <section> <h3> Methods</h3> <p>In 2019, CIDRZ partnered with 10 local KP civil society organizations (CSOs) and the Ministry of Health (MOH) to offer HIV services within KP-designated community safe spaces. KP CSO partners led KP mobilization, managed safe spaces and delivered peer support; MOH organized clinicians and clinical commodities; and CIDRZ provided technical oversight. In December 2021, we introduced a community-based intervention focused on PrEP delivery in venues where KP socialize. We collected routine programme data from September 2019 to June 2023 using programme-specific tools and the national electronic health record. We estimated the before-after effects of our intervention on PrEP uptake, continuation and equity for KP using descriptive statistics and interrupted time series regression, and used mixed-effects regression to estimate marginal probabilities of PrEP continuity.</p> </section> <section> <h3> Results</h3> <p>Most (25,658) of the 38,307 (67.0%) Key Population Investment Fund beneficiaries were reached with HIV prevention services at community-based venues. In total, 23,527 (61.4%) received HIV testing services, with 15,508 (65.9%) testing HIV negative and found PrEP eligible, and 15,241 (98.3%) initiating PrEP. Across all programme quarters and KP types, PrEP uptake was >90%. After introducing venue-based PrEP delivery, PrEP uptake (98.7% after vs. 96.5% before, <i>p</i> < 0.001) and the number of initiations (<i>p</i> = 0.014) increased significantly. The proportion of KP with ≥1 PrEP continuation visit within 6 months of initiation was unchanged post-intervention (46.7%, 95% confidence interval [CI]: 45.7%, 47.6%) versus pre-intervention (47.2%, 95% CI: 45.4%, 49.1%).</p> </section> <section> <h3> Conclusions</h3> <p>Applying Programme Science principles, we demonstrate how decentralizing HIV prevention services to KP venues and safe s
{"title":"Programme science in action: lessons from an observational study of HIV prevention programming for key populations in Lusaka, Zambia","authors":"Izukanji Sikazwe, Maurice Musheke, Kanema Chiyenu, Benard Ngosa, Jake M. Pry, Chama Mulubwa, Martin Zimba, Martin Sakala, Mphatso Sakala, Paul Somwe, Goodwin Nyirenda, Theodora Savory, Carolyn Bolton-Moore, Michael E. Herce","doi":"10.1002/jia2.26237","DOIUrl":"10.1002/jia2.26237","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Optimizing uptake of pre-exposure prophylaxis (PrEP) for individuals at risk of HIV acquisition has been challenging despite clear scientific evidence and normative guidelines, particularly for key populations (KPs) such as men who have sex with men (MSM), female sex workers (FSWs), transgender (TG) people and persons who inject drugs (PWID). Applying an iterative Programme Science cycle, building on the effective programme coverage framework, we describe the approach used by the Centre for Infectious Disease Research in Zambia (CIDRZ) to scale up PrEP delivery and address inequities in PrEP access for KP in Lusaka, Zambia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In 2019, CIDRZ partnered with 10 local KP civil society organizations (CSOs) and the Ministry of Health (MOH) to offer HIV services within KP-designated community safe spaces. KP CSO partners led KP mobilization, managed safe spaces and delivered peer support; MOH organized clinicians and clinical commodities; and CIDRZ provided technical oversight. In December 2021, we introduced a community-based intervention focused on PrEP delivery in venues where KP socialize. We collected routine programme data from September 2019 to June 2023 using programme-specific tools and the national electronic health record. We estimated the before-after effects of our intervention on PrEP uptake, continuation and equity for KP using descriptive statistics and interrupted time series regression, and used mixed-effects regression to estimate marginal probabilities of PrEP continuity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Most (25,658) of the 38,307 (67.0%) Key Population Investment Fund beneficiaries were reached with HIV prevention services at community-based venues. In total, 23,527 (61.4%) received HIV testing services, with 15,508 (65.9%) testing HIV negative and found PrEP eligible, and 15,241 (98.3%) initiating PrEP. Across all programme quarters and KP types, PrEP uptake was >90%. After introducing venue-based PrEP delivery, PrEP uptake (98.7% after vs. 96.5% before, <i>p</i> < 0.001) and the number of initiations (<i>p</i> = 0.014) increased significantly. The proportion of KP with ≥1 PrEP continuation visit within 6 months of initiation was unchanged post-intervention (46.7%, 95% confidence interval [CI]: 45.7%, 47.6%) versus pre-intervention (47.2%, 95% CI: 45.4%, 49.1%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Applying Programme Science principles, we demonstrate how decentralizing HIV prevention services to KP venues and safe s","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 S2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11233926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141562204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Frances M. Cowan, Sithembile Musemburi, Primrose Matambanadzo, Phillip Chida, Richard Steen, Rumbidzo Makandwa, Sungai T. Chabata, Albert Takura, Amber Sheets, Raymond Yekeye, Owen Mugurungi, Bernadette Hensen, Joanna Busza, James R. Hargreaves
<div> <section> <h3> Introduction</h3> <p>We used a Programme Science platform, to generate evidence to support the implementation of programmes for sex workers in Africa. Female sex workers are estimated to make up 1.6% (1.3%–1.8%) of the population of women aged 15−49 years in Zimbabwe. We highlight how programme science can be used to help distinguish between when, where and with whom programmes need to be implemented and discuss two case studies that exemplify implementing better (Case study 1 (1 June 2019−30 June 2021) Optimizing implementation of a risk differentiated microplanning intervention) and implementing differently (Case study 2 (1 October 2016−30 September 2022) Reorientating implementation of DREAMS for young women selling sex).</p> </section> <section> <h3> Methods</h3> <p>Zimbabwe's nationally scaled programme for sex workers was established in 2009 in partnership with sex workers to provide comprehensive services for sex workers and generate evidence for programme design, implementation and scale up. Since inception, comprehensive data have been collected from all sex workers seeking services. As the scope of service provision has expanded so has the scope of data collection and analysis. At enrolment, sex workers are assigned an alphanumeric unique identifier which links consultations within and across programme sites. We conduct descriptive analyses of the Key Population (KP) programme data to guide programme implementation and redesign, embedding programmatic qualitative enquiry as required.</p> </section> <section> <h3> Results</h3> <p>Two case studies describing different approaches to programme optimization are presented. In the first, an optimization exercise was used to strengthen programme implementation ensuring that the KP programme got back on track after SARS-COV-2. In the second, an in-depth review of research and programme data led to a re-orientation of the DREAMS programme to ensure that young women at the highest risk of HIV acquisition were enrolled and had access to DREAMS social support interventions in turn strengthening their uptake of HIV prevention.</p> </section> <section> <h3> Conclusions</h3> <p>Optimizing and sustaining HIV care and treatment programmes requires effective delivery with sufficient scale and intensity for population impact. Our programme science approach guided the scale up of the KP programme in Zimbabwe, providing evidence to support strategy, implementation and ongoing management, and importantly helping us distinguish between when we needed to just implement, implement better or im
{"title":"Using a Programme Science approach to substantially reduce the risk of HIV transmission and acquisition in sex transactions among female sex workers in Zimbabwe","authors":"Frances M. Cowan, Sithembile Musemburi, Primrose Matambanadzo, Phillip Chida, Richard Steen, Rumbidzo Makandwa, Sungai T. Chabata, Albert Takura, Amber Sheets, Raymond Yekeye, Owen Mugurungi, Bernadette Hensen, Joanna Busza, James R. Hargreaves","doi":"10.1002/jia2.26262","DOIUrl":"10.1002/jia2.26262","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>We used a Programme Science platform, to generate evidence to support the implementation of programmes for sex workers in Africa. Female sex workers are estimated to make up 1.6% (1.3%–1.8%) of the population of women aged 15−49 years in Zimbabwe. We highlight how programme science can be used to help distinguish between when, where and with whom programmes need to be implemented and discuss two case studies that exemplify implementing better (Case study 1 (1 June 2019−30 June 2021) Optimizing implementation of a risk differentiated microplanning intervention) and implementing differently (Case study 2 (1 October 2016−30 September 2022) Reorientating implementation of DREAMS for young women selling sex).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Zimbabwe's nationally scaled programme for sex workers was established in 2009 in partnership with sex workers to provide comprehensive services for sex workers and generate evidence for programme design, implementation and scale up. Since inception, comprehensive data have been collected from all sex workers seeking services. As the scope of service provision has expanded so has the scope of data collection and analysis. At enrolment, sex workers are assigned an alphanumeric unique identifier which links consultations within and across programme sites. We conduct descriptive analyses of the Key Population (KP) programme data to guide programme implementation and redesign, embedding programmatic qualitative enquiry as required.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Two case studies describing different approaches to programme optimization are presented. In the first, an optimization exercise was used to strengthen programme implementation ensuring that the KP programme got back on track after SARS-COV-2. In the second, an in-depth review of research and programme data led to a re-orientation of the DREAMS programme to ensure that young women at the highest risk of HIV acquisition were enrolled and had access to DREAMS social support interventions in turn strengthening their uptake of HIV prevention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Optimizing and sustaining HIV care and treatment programmes requires effective delivery with sufficient scale and intensity for population impact. Our programme science approach guided the scale up of the KP programme in Zimbabwe, providing evidence to support strategy, implementation and ongoing management, and importantly helping us distinguish between when we needed to just implement, implement better or im","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 S2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26262","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141578440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ramesh Banadakoppa Manjappa, Parinita Bhattacharjee, Souradet Yuh-Nan Shaw, Joshua Gitonga, Japheth Kioko, Franklin Songok, Faran Emmanuel, Peter Arimi, Helgar Musyoki, Ruth Laibon Masha, James Blanchard
<div> <section> <h3> Introduction</h3> <p>The HIV Prevention 2025 Roadmap, developed by UNAIDS, recommends the adoption of a precision prevention approach focused on priority populations and geographies. With reduction in new HIV acquisitions in many countries, designing a differentiated HIV prevention response, using a Programme Science approach, based on the understanding of the epidemic and transmission dynamics at a sub-national level, is critical.</p> </section> <section> <h3> Methods</h3> <p>To support strategic planning, an epidemic appraisal at the sub-national level across 47 counties, with the 2019 population ranging from 0.14 million in Lamu to 4.40 million in Nairobi City, was conducted in Kenya using several existing data sources. Using 2021 Spectrum/EPP/Naomi model estimates of national and sub-national HIV incidence and prevalence, counties with high HIV incidence and prevalence were identified for geographic prioritization. The size of local key population (KP) networks and HIV prevalence in key and general populations were used to define epidemic typology and prioritize populations for HIV prevention programmes. Analysis of routine programme monitoring data for 2021 was used to assess coverage gaps in HIV prevention programmes, including prevention of vertical transmission, anti-retroviral therapy, KP programmes, adolescent girls and young women programme, and voluntary male medical circumcision programme.</p> </section> <section> <h3> Results</h3> <p>Ten counties with more than 1000 incident acquisitions in 2021 accounted for 57% of new acquisitions. Twenty-four counties were grouped into the concentrated epidemic type—due to their low prevalence in the general population, high prevalence in KPs and relatively higher density of female sex workers and men who have sex with men populations. Four counties reflected a generalized epidemic, where HIV prevalence was more than 10% and 30%, respectively, among the general and key populations. The remaining 19 counties were classified as having mixed epidemics. Gaps in programmes were identified and counties where these gaps need to be addressed were also prioritized.</p> </section> <section> <h3> Conclusions</h3> <p>The HIV burden in Kenya is unevenly distributed and hence the mix of prevention strategies may vary according to the epidemic typology of the county. Prioritization of programmes based not only on disease burden and epidemic typology, but also on the prevailing gaps in coverage for reducing inequities is a key aspect of this appraisal.</p> </section>
{"title":"A sub-national HIV epidemic appraisal in Kenya: a new approach for identifying priority geographies, populations and programmes for optimizing coverage for HIV prevention","authors":"Ramesh Banadakoppa Manjappa, Parinita Bhattacharjee, Souradet Yuh-Nan Shaw, Joshua Gitonga, Japheth Kioko, Franklin Songok, Faran Emmanuel, Peter Arimi, Helgar Musyoki, Ruth Laibon Masha, James Blanchard","doi":"10.1002/jia2.26245","DOIUrl":"10.1002/jia2.26245","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The HIV Prevention 2025 Roadmap, developed by UNAIDS, recommends the adoption of a precision prevention approach focused on priority populations and geographies. With reduction in new HIV acquisitions in many countries, designing a differentiated HIV prevention response, using a Programme Science approach, based on the understanding of the epidemic and transmission dynamics at a sub-national level, is critical.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>To support strategic planning, an epidemic appraisal at the sub-national level across 47 counties, with the 2019 population ranging from 0.14 million in Lamu to 4.40 million in Nairobi City, was conducted in Kenya using several existing data sources. Using 2021 Spectrum/EPP/Naomi model estimates of national and sub-national HIV incidence and prevalence, counties with high HIV incidence and prevalence were identified for geographic prioritization. The size of local key population (KP) networks and HIV prevalence in key and general populations were used to define epidemic typology and prioritize populations for HIV prevention programmes. Analysis of routine programme monitoring data for 2021 was used to assess coverage gaps in HIV prevention programmes, including prevention of vertical transmission, anti-retroviral therapy, KP programmes, adolescent girls and young women programme, and voluntary male medical circumcision programme.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ten counties with more than 1000 incident acquisitions in 2021 accounted for 57% of new acquisitions. Twenty-four counties were grouped into the concentrated epidemic type—due to their low prevalence in the general population, high prevalence in KPs and relatively higher density of female sex workers and men who have sex with men populations. Four counties reflected a generalized epidemic, where HIV prevalence was more than 10% and 30%, respectively, among the general and key populations. The remaining 19 counties were classified as having mixed epidemics. Gaps in programmes were identified and counties where these gaps need to be addressed were also prioritized.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The HIV burden in Kenya is unevenly distributed and hence the mix of prevention strategies may vary according to the epidemic typology of the county. Prioritization of programmes based not only on disease burden and epidemic typology, but also on the prevailing gaps in coverage for reducing inequities is a key aspect of this appraisal.</p>\u0000 </section>\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 S2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11233855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141562202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael J. A. Reid, Rebecca Bunnell, Emily Kainne Dokubo, John Nkengasong
<p>Since its inception, the President's Emergency Plan For AIDS Relief (PEPFAR) has had an unprecedented impact on the global HIV epidemic. In the past 20 years, PEPFAR has saved more than 25 million lives, supporting over 20 million people with life-saving treatment across 55 countries [<span>1</span>]. From the beginning, its programmes have relied on the best scientific insights and biomedical discoveries to advance the strategic HIV agenda. Moving forward, PEPFAR faces numerous important challenges in supporting partner countries to achieve the UNAIDS targets of ensuring that 95% of people with HIV know their status, 95% of those are on treatment and 95% of those are virologically suppressed [<span>2</span>], and achieving its goal of ending the HIV pandemic as a public health threat by 2030. As such, it is important to consider how Programme Science—<i>an approach that emphasizes the need for context-specific evidence and knowledge generated on an ongoing basis, to inform the timely and strategic programmatic decisions</i> [<span>3, 4</span>]—can help ensure that PEPFAR programmes implement the right set of context-specific interventions to achieve and sustain the changes essential for HIV prevention and treatment outcomes. In this paper, we detail (1) the evolving challenges and opportunities PEPFAR faces in achieving 95-95-95, (2) how <i>Programme Science</i> can be strategically applied to overcome these challenges, and (3) the necessary adaptations needed to sustain HIV programmes, informed by the best, contextually relevant science.</p><p>As PEPFAR and its partners intensify efforts to achieve the UNAIDS targets and sustain the progress achieved, they face a range of complex and urgent health challenges. Addressing these challenges requires a Programme Science approach that is responsive to diverse real-world contexts—be they geographical, organizational or sociological [<span>5</span>].</p><p>One of the most urgent challenges PEPFAR programmes face is reaching those populations that are not effectively covered by existing services. This is especially true in many countries with high HIV burden, where there is a pressing and urgent need to devise innovative approaches to engage adolescents and young women who are at inordinate risk of HIV acquisition. Equally important is the provision of targeted interventions for specific key and priority groups like men who have sex with men and female sex workers, who often face significant barriers in accessing health services due to stigma, discrimination, and legal and human rights issues.</p><p>Another critical area of focus is supporting continuity of care for people living with HIV who have been linked to HIV services. Across PEPFAR programmes, over 450,000 persons experienced interruptions in treatment at some point in the third quarter of 2023 [<span>6</span>]. As such, supporting clients to stay engaged in lifelong care necessitates the identification and implementation of a tailored mix of
{"title":"Programme Science in PEPFAR: a pathway to a sustainable HIV response","authors":"Michael J. A. Reid, Rebecca Bunnell, Emily Kainne Dokubo, John Nkengasong","doi":"10.1002/jia2.26244","DOIUrl":"10.1002/jia2.26244","url":null,"abstract":"<p>Since its inception, the President's Emergency Plan For AIDS Relief (PEPFAR) has had an unprecedented impact on the global HIV epidemic. In the past 20 years, PEPFAR has saved more than 25 million lives, supporting over 20 million people with life-saving treatment across 55 countries [<span>1</span>]. From the beginning, its programmes have relied on the best scientific insights and biomedical discoveries to advance the strategic HIV agenda. Moving forward, PEPFAR faces numerous important challenges in supporting partner countries to achieve the UNAIDS targets of ensuring that 95% of people with HIV know their status, 95% of those are on treatment and 95% of those are virologically suppressed [<span>2</span>], and achieving its goal of ending the HIV pandemic as a public health threat by 2030. As such, it is important to consider how Programme Science—<i>an approach that emphasizes the need for context-specific evidence and knowledge generated on an ongoing basis, to inform the timely and strategic programmatic decisions</i> [<span>3, 4</span>]—can help ensure that PEPFAR programmes implement the right set of context-specific interventions to achieve and sustain the changes essential for HIV prevention and treatment outcomes. In this paper, we detail (1) the evolving challenges and opportunities PEPFAR faces in achieving 95-95-95, (2) how <i>Programme Science</i> can be strategically applied to overcome these challenges, and (3) the necessary adaptations needed to sustain HIV programmes, informed by the best, contextually relevant science.</p><p>As PEPFAR and its partners intensify efforts to achieve the UNAIDS targets and sustain the progress achieved, they face a range of complex and urgent health challenges. Addressing these challenges requires a Programme Science approach that is responsive to diverse real-world contexts—be they geographical, organizational or sociological [<span>5</span>].</p><p>One of the most urgent challenges PEPFAR programmes face is reaching those populations that are not effectively covered by existing services. This is especially true in many countries with high HIV burden, where there is a pressing and urgent need to devise innovative approaches to engage adolescents and young women who are at inordinate risk of HIV acquisition. Equally important is the provision of targeted interventions for specific key and priority groups like men who have sex with men and female sex workers, who often face significant barriers in accessing health services due to stigma, discrimination, and legal and human rights issues.</p><p>Another critical area of focus is supporting continuity of care for people living with HIV who have been linked to HIV services. Across PEPFAR programmes, over 450,000 persons experienced interruptions in treatment at some point in the third quarter of 2023 [<span>6</span>]. As such, supporting clients to stay engaged in lifelong care necessitates the identification and implementation of a tailored mix of","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 S2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11233845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141562205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Leigh M. McClarty, Kalada Green, Stella Leung, Chukwuebuka Ejeckam, Adediran Adesina, Souradet Y. Shaw, Bronwyn Neufeld, Shajy Isac, Faran Emmanuel, James F. Blanchard, Gambo Aliyu
<div> <section> <h3> Introduction</h3> <p>Effective HIV prevention programme coverage is necessary to achieve Nigeria's goal of ending the epidemic by 2030. Recent evidence highlights gaps in service coverage and utilization across the country. The Effective Programme Coverage framework is a Programme Science tool to optimize a programme's population-level impact by examining gaps in programme coverage using data generated through programme-embedded research and learning. We apply the framework using Integrated Biological and Behavioural Surveillance Survey (IBBSS) data from Nigeria to examine coverage of four prevention interventions—condoms, HIV testing, and needle and syringe programmes (NSP)—among four key population groups—female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID) and transgender people.</p> </section> <section> <h3> Methods</h3> <p>Data from Nigeria's 2020 IBBSS, implemented in 12 states, were analysed to examine HIV prevention programme coverage among key populations. For each key population group and prevention intervention of interest, weighted IBBSS data were used to retrospectively generate coverage cascades that identify and quantify coverage gaps. Required coverage targets were informed by targets articulated in Nigeria's National HIV/AIDS Strategic Framework or, in their absence, by guidelines from policy normative bodies. Availability-, outreach- and utilization coverage proxy indicators were defined using variables from IBBSS data collection tools. Sankey diagrams are presented to visualize pathways followed by participants between coverage cascade steps.</p> </section> <section> <h3> Results</h3> <p>Required coverage targets were missed for HIV testing and NSP among all key population groups. Condom availability coverage surpassed required coverage targets among FSW and MSM, while utilization coverage only among FSW exceeded the 90% required coverage target. Outreach coverage was low for all key population groups, falling below all required coverage targets.</p> </section> <section> <h3> Conclusions</h3> <p>Our findings identify critical gaps in HIV prevention programme coverage for key populations in Nigeria and demonstrate non-linear movement across coverage cascades, signalling the need for innovative solutions to optimize coverage of prevention services. Programme-embedded research is required to better understand how key population groups in Nigeria access and use different HIV prevention services so that programmes, policies and resource allocation decisions can be optimized to
{"title":"Advancing Programme Science approaches to understand gaps in HIV prevention programme coverage for key populations in 12 Nigerian states: findings from the 2020 Integrated Biological and Behavioural Surveillance Survey","authors":"Leigh M. McClarty, Kalada Green, Stella Leung, Chukwuebuka Ejeckam, Adediran Adesina, Souradet Y. Shaw, Bronwyn Neufeld, Shajy Isac, Faran Emmanuel, James F. Blanchard, Gambo Aliyu","doi":"10.1002/jia2.26269","DOIUrl":"10.1002/jia2.26269","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Effective HIV prevention programme coverage is necessary to achieve Nigeria's goal of ending the epidemic by 2030. Recent evidence highlights gaps in service coverage and utilization across the country. The Effective Programme Coverage framework is a Programme Science tool to optimize a programme's population-level impact by examining gaps in programme coverage using data generated through programme-embedded research and learning. We apply the framework using Integrated Biological and Behavioural Surveillance Survey (IBBSS) data from Nigeria to examine coverage of four prevention interventions—condoms, HIV testing, and needle and syringe programmes (NSP)—among four key population groups—female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID) and transgender people.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from Nigeria's 2020 IBBSS, implemented in 12 states, were analysed to examine HIV prevention programme coverage among key populations. For each key population group and prevention intervention of interest, weighted IBBSS data were used to retrospectively generate coverage cascades that identify and quantify coverage gaps. Required coverage targets were informed by targets articulated in Nigeria's National HIV/AIDS Strategic Framework or, in their absence, by guidelines from policy normative bodies. Availability-, outreach- and utilization coverage proxy indicators were defined using variables from IBBSS data collection tools. Sankey diagrams are presented to visualize pathways followed by participants between coverage cascade steps.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Required coverage targets were missed for HIV testing and NSP among all key population groups. Condom availability coverage surpassed required coverage targets among FSW and MSM, while utilization coverage only among FSW exceeded the 90% required coverage target. Outreach coverage was low for all key population groups, falling below all required coverage targets.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings identify critical gaps in HIV prevention programme coverage for key populations in Nigeria and demonstrate non-linear movement across coverage cascades, signalling the need for innovative solutions to optimize coverage of prevention services. Programme-embedded research is required to better understand how key population groups in Nigeria access and use different HIV prevention services so that programmes, policies and resource allocation decisions can be optimized to ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 S2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26269","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141578387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
James R Hargreaves, Solange Baptiste, Parinita Bhattacharjee, Frances M Cowan, Michael E Herce, Krista Lauer, Izukanji Sikazwe, Elvin Geng
Introduction
“Programme science” deploys scientific methods to address questions that are a priority to support the impact of public health programmes. As such, programme science responds to the challenges of making such studies: (1) feasible to undertake, (2) useful, (3) rigorous, (4) real-world-relevant, (5) informative, and undertaken by (6) equitable partnerships. The acronym “FURRIE” is proposed to describe this set of six challenges. This paper discusses selected HIV/STI (sexually transmitted infection) programme science case studies to illustrate how programme science rises to the FURRIE challenges.
Discussion
One way in which programme science is made more feasible is through the analysis and interpretation of data collected through service delivery. For some questions, these data can be augmented through methods that reach potential clients of services who have not accessed services or been lost to follow-up. Process evaluation can enhance the usefulness of programme science by studying implementation processes, programme−client interactions and contextual factors. Ensuring rigour by limiting bias and confounding in the real-world context of programme science studies requires methodological innovation. Striving for scientific rigour can also have the unintended consequence of creating a gap between what happens in a study, and what happens in the “real-world.” Community-led monitoring is one approach to grounding data collection in the real-world experience of clients. Evaluating complex, context-specific strategies to strengthen health outcomes in a way that is informative for other settings requires clear specification of the intervention packages that are planned and delivered in practice. Programme science provides a model for equitable partnership through co-leadership between programmes, researchers and the communities they serve.
Conclusions
Programme science addresses the FURRIE challenges, thereby improving programme impact and ultimately health outcomes and health equity. The adoption and adaptation of the types of novel programme science approaches showcased here should be promoted within and beyond the HIV/STI field.
{"title":"Programme science methodologies and practices that address “FURRIE” challenges: examples from the field","authors":"James R Hargreaves, Solange Baptiste, Parinita Bhattacharjee, Frances M Cowan, Michael E Herce, Krista Lauer, Izukanji Sikazwe, Elvin Geng","doi":"10.1002/jia2.26283","DOIUrl":"10.1002/jia2.26283","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>“Programme science” deploys scientific methods to address questions that are a priority to support the impact of public health programmes. As such, programme science responds to the challenges of making such studies: (1) feasible to undertake, (2) useful, (3) rigorous, (4) real-world-relevant, (5) informative, and undertaken by (6) equitable partnerships. The acronym “FURRIE” is proposed to describe this set of six challenges. This paper discusses selected HIV/STI (sexually transmitted infection) programme science case studies to illustrate how programme science rises to the FURRIE challenges.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>One way in which programme science is made more feasible is through the analysis and interpretation of data collected through service delivery. For some questions, these data can be augmented through methods that reach potential clients of services who have not accessed services or been lost to follow-up. Process evaluation can enhance the usefulness of programme science by studying implementation processes, programme−client interactions and contextual factors. Ensuring rigour by limiting bias and confounding in the real-world context of programme science studies requires methodological innovation. Striving for scientific rigour can also have the unintended consequence of creating a gap between what happens in a study, and what happens in the “real-world.” Community-led monitoring is one approach to grounding data collection in the real-world experience of clients. Evaluating complex, context-specific strategies to strengthen health outcomes in a way that is informative for other settings requires clear specification of the intervention packages that are planned and delivered in practice. Programme science provides a model for equitable partnership through co-leadership between programmes, researchers and the communities they serve.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Programme science addresses the FURRIE challenges, thereby improving programme impact and ultimately health outcomes and health equity. The adoption and adaptation of the types of novel programme science approaches showcased here should be promoted within and beyond the HIV/STI field.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 S2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26283","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141578390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marissa L. Becker, Maryam Shahmanesh, Sevgi O. Aral
<p>Tremendous progress has been made in managing the global HIV epidemic, both in terms of reducing new HIV acquisitions and in improving coverage of treatment for people living with HIV [<span>1</span>]. However, these gains have not been achieved everywhere, nor equitably for all people [<span>2, 3</span>]. In a context where funding is increasingly limited, we need to progress faster, better and more efficiently to have the greatest impact on both the HIV epidemic and other sexually transmitted and blood-borne infections (STBBIs) globally [<span>3, 4</span>]. How do we achieve this? There is a need for transformative action for science-led HIV and STBBI programming in order to reduce inequities, improve outcomes and realize the global goal of “leaving no one behind.”</p><p>Advances in biomedical, behavioural and social sciences have led to many new and effective innovations, for example in HIV diagnostics, treatment and prevention and through approaches such as community mobilization, decentralized care and structural interventions. While these tools and approaches have been implemented, too often they have proven ineffective on their own in reducing HIV acquisitions [<span>5-8</span>]. Important questions remain as to whether, and how, these interventions can lead to population-level impact [<span>9, 10</span>]. In addition, there are many comprehensive prevention programmes with good coverage but which have not resulted in population-level impact, often as a result of not reaching the right populations, in the right places, at the right time or with the right programme components and intensity [<span>11-16</span>]. In order to maximize population-level impact by reducing inequities in programme coverage and health outcomes, science which is embedded in programmes is needed, which generates new knowledge that can be applied by programmes to ensure their progress in achieving impact in a timely manner.</p><p>Knowledge generation, learning and monitoring are an integral part of programmes but what is often missing is an organized and systematic process of gathering, analysing and using this knowledge in a continual and iterative manner to not only inform and optimize programmes but also to generate new knowledge which is generalizable and transferable to other contexts, and which can move scientific knowledge forward. This requires transdisciplinary approaches which embrace, rather than control for the complexity within public health [<span>17</span>]. Programme Science is an approach to public health programming and research that aims to improve the design, implementation and monitoring of public health programmes through the systematic application of theoretical and empirical scientific knowledge that is generated through programme-embedded research and learning process [<span>18, 19</span>]. Programme Science is concerned with the totality of a public health programme and its context. It emphasizes getting research out of practice [<span>20<
{"title":"Programme Science: a route to transformative change to improve population-level impact for global HIV and sexually transmitted infections","authors":"Marissa L. Becker, Maryam Shahmanesh, Sevgi O. Aral","doi":"10.1002/jia2.26300","DOIUrl":"10.1002/jia2.26300","url":null,"abstract":"<p>Tremendous progress has been made in managing the global HIV epidemic, both in terms of reducing new HIV acquisitions and in improving coverage of treatment for people living with HIV [<span>1</span>]. However, these gains have not been achieved everywhere, nor equitably for all people [<span>2, 3</span>]. In a context where funding is increasingly limited, we need to progress faster, better and more efficiently to have the greatest impact on both the HIV epidemic and other sexually transmitted and blood-borne infections (STBBIs) globally [<span>3, 4</span>]. How do we achieve this? There is a need for transformative action for science-led HIV and STBBI programming in order to reduce inequities, improve outcomes and realize the global goal of “leaving no one behind.”</p><p>Advances in biomedical, behavioural and social sciences have led to many new and effective innovations, for example in HIV diagnostics, treatment and prevention and through approaches such as community mobilization, decentralized care and structural interventions. While these tools and approaches have been implemented, too often they have proven ineffective on their own in reducing HIV acquisitions [<span>5-8</span>]. Important questions remain as to whether, and how, these interventions can lead to population-level impact [<span>9, 10</span>]. In addition, there are many comprehensive prevention programmes with good coverage but which have not resulted in population-level impact, often as a result of not reaching the right populations, in the right places, at the right time or with the right programme components and intensity [<span>11-16</span>]. In order to maximize population-level impact by reducing inequities in programme coverage and health outcomes, science which is embedded in programmes is needed, which generates new knowledge that can be applied by programmes to ensure their progress in achieving impact in a timely manner.</p><p>Knowledge generation, learning and monitoring are an integral part of programmes but what is often missing is an organized and systematic process of gathering, analysing and using this knowledge in a continual and iterative manner to not only inform and optimize programmes but also to generate new knowledge which is generalizable and transferable to other contexts, and which can move scientific knowledge forward. This requires transdisciplinary approaches which embrace, rather than control for the complexity within public health [<span>17</span>]. Programme Science is an approach to public health programming and research that aims to improve the design, implementation and monitoring of public health programmes through the systematic application of theoretical and empirical scientific knowledge that is generated through programme-embedded research and learning process [<span>18, 19</span>]. Programme Science is concerned with the totality of a public health programme and its context. It emphasizes getting research out of practice [<span>20<","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 S2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11233853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141562210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Krista J. Lauer, Melikhaya Soboyisi, Carol Ameera Kassam, Dennis Mseu, Gemma Oberth, Solange L. Baptiste
Introduction
Programme Science (PS) and community-led monitoring (CLM) intersect in unexpected and promising ways. This commentary examines a CLM initiative in Malawi and South Africa to highlight the crucial role of CLM in bolstering the PS framework. By leveraging data sources often overlooked by conventional research and evaluation approaches, CLM emerges as a pivotal element in enhancing programme effectiveness. This paper delineates the fundamental principles of CLM, presents programme outcomes derived from CLM methodologies and contextualizes these findings within the broader framework of PS.
Discussion
The Citizen Science Project implements CLM continuously at 33 health facilities: 14 in Malawi (eight in Kasungu District and six in Dedza District), and 19 in South Africa (all in the West Rand District), representing a total catchment area of 989,848 people. Monitoring indicators are developed in an iterative process with community groups. The indicators are unique to each country, but both focus on the uptake of health services (quantitative) and barriers to access (qualitative). Monthly clinic records surveys capture 34 indicators in Malawi and 20 in South Africa and are supplemented by qualitative interviews with care recipients and healthcare workers. Qualitative interviews provide additional granularity and help confirm and explain the more macro trends in service coverage as described in quantitative data. The resulting data analysis reveals key themes that help stakeholders and decision-makers to solve problems collaboratively. Noteworthy outcomes include a substantial increase in multi-month dispensing of antiretroviral therapy (ART) during COVID-19 (from 6% to 31%) with a subsequent recovery surpassing of HIV service benchmarks in Malawi post-pandemic.
Conclusions
While quantifying direct impact remains challenging due to the project's design, CLM proves to be a robust methodology that generates credible data and produces impactful outcomes. Its potential extends beyond the health sector, empowering community leadership and fostering interventions aligned with community needs. As CLM continues to evolve, its integration into PS promises to improve relevance, quality and impact across diverse disciplines.
{"title":"Defining community-led monitoring and its role in programme-embedded learning: lessons from the Citizen Science Project in Malawi and South Africa","authors":"Krista J. Lauer, Melikhaya Soboyisi, Carol Ameera Kassam, Dennis Mseu, Gemma Oberth, Solange L. Baptiste","doi":"10.1002/jia2.26277","DOIUrl":"10.1002/jia2.26277","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Programme Science (PS) and community-led monitoring (CLM) intersect in unexpected and promising ways. This commentary examines a CLM initiative in Malawi and South Africa to highlight the crucial role of CLM in bolstering the PS framework. By leveraging data sources often overlooked by conventional research and evaluation approaches, CLM emerges as a pivotal element in enhancing programme effectiveness. This paper delineates the fundamental principles of CLM, presents programme outcomes derived from CLM methodologies and contextualizes these findings within the broader framework of PS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The Citizen Science Project implements CLM continuously at 33 health facilities: 14 in Malawi (eight in Kasungu District and six in Dedza District), and 19 in South Africa (all in the West Rand District), representing a total catchment area of 989,848 people. Monitoring indicators are developed in an iterative process with community groups. The indicators are unique to each country, but both focus on the uptake of health services (quantitative) and barriers to access (qualitative). Monthly clinic records surveys capture 34 indicators in Malawi and 20 in South Africa and are supplemented by qualitative interviews with care recipients and healthcare workers. Qualitative interviews provide additional granularity and help confirm and explain the more macro trends in service coverage as described in quantitative data. The resulting data analysis reveals key themes that help stakeholders and decision-makers to solve problems collaboratively. Noteworthy outcomes include a substantial increase in multi-month dispensing of antiretroviral therapy (ART) during COVID-19 (from 6% to 31%) with a subsequent recovery surpassing of HIV service benchmarks in Malawi post-pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While quantifying direct impact remains challenging due to the project's design, CLM proves to be a robust methodology that generates credible data and produces impactful outcomes. Its potential extends beyond the health sector, empowering community leadership and fostering interventions aligned with community needs. As CLM continues to evolve, its integration into PS promises to improve relevance, quality and impact across diverse disciplines.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 S2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26277","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141578389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rodenie Arnaiz Olete, Carol Strong, Katerina Leyritana, Adam Bourne, Nai-Ying Monica Ko
Introduction
Chemsex, the use of psychotropic drugs before or during sexual intercourse, is associated with various HIV risk factors, including condomless sex and reduced adherence to pre-exposure prophylaxis or antiretroviral therapy (ART). In the Philippines, there are still limited studies exploring the associations between chemsex, HIV status and ART adherence. This study aims to compare recent and lifetime chemsex engagement in association with self-reported HIV status among Filipino men who have sex with men (MSM). We further explored the association between chemsex and ART adherence among people living with HIV engaged in chemsex.
Methods
A cross-sectional online survey of 479 Filipino MSM was conducted from 3 August to 1 December 2019. Demographic profiles, sexual behaviours, drug use, history of sexually transmitted infections (STIs), chemsex engagement and HIV status were collected and analysed. Bivariable and multivariable logistic regression were employed to assess the association between self-reported HIV status and chemsex engagement.
Results
Among the 479 respondents, Filipino MSM engaged in drug use and chemsex were generally older compared to those not engaged in drug use and chemsex (average age 31−33 vs. 29 years old; p<0.05). Methamphetamine was the most common drug for people who reported using drugs. An HIV-positive status was associated with recent chemsex engagement (aOR = 5.18, p<0.05) and a history of STIs (aOR = 2.09, p<0.05). The subgroup analysis showed that 79% (166/200) of persons living with HIV were adherent to ART. There was no significant association found between chemsex and ART adherence in the logistic regression analyses.
Conclusions
Chemsex behaviour, particularly recent chemsex engagement, is significantly associated with self-reported HIV status. The emerging data on MSM engaged in chemsex require integration of a more person-centred, comprehensive and robust harm reduction programmes into the existing combination prevention strategies in the country. Health education for Filipino MSM engaged in chemsex should prioritize raising awareness about methamphetamine effects and overdose risks, alongside proper medical management.
{"title":"ChemsexPH: The association between chemsex, HIV status and adherence to antiretroviral therapy among men who have sex with men in the Philippines","authors":"Rodenie Arnaiz Olete, Carol Strong, Katerina Leyritana, Adam Bourne, Nai-Ying Monica Ko","doi":"10.1002/jia2.26323","DOIUrl":"10.1002/jia2.26323","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Chemsex, the use of psychotropic drugs before or during sexual intercourse, is associated with various HIV risk factors, including condomless sex and reduced adherence to pre-exposure prophylaxis or antiretroviral therapy (ART). In the Philippines, there are still limited studies exploring the associations between chemsex, HIV status and ART adherence. This study aims to compare recent and lifetime chemsex engagement in association with self-reported HIV status among Filipino men who have sex with men (MSM). We further explored the association between chemsex and ART adherence among people living with HIV engaged in chemsex.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional online survey of 479 Filipino MSM was conducted from 3 August to 1 December 2019. Demographic profiles, sexual behaviours, drug use, history of sexually transmitted infections (STIs), chemsex engagement and HIV status were collected and analysed. Bivariable and multivariable logistic regression were employed to assess the association between self-reported HIV status and chemsex engagement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 479 respondents, Filipino MSM engaged in drug use and chemsex were generally older compared to those not engaged in drug use and chemsex (average age 31−33 vs. 29 years old; <i>p</i><0.05). Methamphetamine was the most common drug for people who reported using drugs. An HIV-positive status was associated with recent chemsex engagement (aOR = 5.18, <i>p</i><0.05) and a history of STIs (aOR = 2.09, <i>p</i><0.05). The subgroup analysis showed that 79% (166/200) of persons living with HIV were adherent to ART. There was no significant association found between chemsex and ART adherence in the logistic regression analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Chemsex behaviour, particularly recent chemsex engagement, is significantly associated with self-reported HIV status. The emerging data on MSM engaged in chemsex require integration of a more person-centred, comprehensive and robust harm reduction programmes into the existing combination prevention strategies in the country. Health education for Filipino MSM engaged in chemsex should prioritize raising awareness about methamphetamine effects and overdose risks, alongside proper medical management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 7","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11233270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141562201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号