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Article ; Online: Enhanced Integration of TB Services in Reproductive Maternal Newborn and Child Health (RMNCH) Settings in Eswatini.

Hartsough, Kieran / Teasdale, Chloe A / Shongwe, Siphesihle / Geller, Amanda / Pimentel De Gusmao, Eduarda / Dlamini, Phumzile / Mafukidze, Arnold / Pasipamire, Munyaradzi / Ao, Trong / Ryan, Caroline / Modi, Surbhi / Abrams, Elaine J / Howard, Andrea A

PLOS global public health

2022 Volume 2, Issue 4, Page(s) e0000217

Abstract: Tuberculosis (TB) primarily affects women during their reproductive years and contributes to maternal mortality and poor pregnancy outcomes. For pregnant women living with HIV (WLHIV), TB is the leading cause of non-obstetric maternal mortality, and ... ...

Abstract	Tuberculosis (TB) primarily affects women during their reproductive years and contributes to maternal mortality and poor pregnancy outcomes. For pregnant women living with HIV (WLHIV), TB is the leading cause of non-obstetric maternal mortality, and pregnant WLHIV with TB are at increased risk of transmitting both TB and HIV to their infants. TB diagnosis among pregnant women, particularly WLHIV, remains challenging, and TB preventive treatment (TPT) coverage among pregnant WLHIV is limited. This project aimed to strengthen integrated TB and reproductive, maternal, neonatal and child health (RMNCH) services in Eswatini to improve screening and treatment for TB disease, TPT uptake and completion among women receiving RMNCH services. The project was conducted from April-December 2017 at four health facilities in Eswatini and introduced enhanced monitoring tools and on-site technical support in RMNCH services. We present data on TB case finding among women, and TPT coverage and completion among eligible WLHIV. A questionnaire (S1 Appendix) measured healthcare provider perspectives on the project after three months of project implementation, including feasibility of scaling-up integrated TB and RMNCH services. A total of 5,724 women (HIV-negative or WLHIV) were screened for active TB disease while attending RMNCH services; 53 (0.9%) were identified with presumptive TB, of whom 37 (70%) were evaluated for TB disease and 6 (0.1% of those screened) were diagnosed with TB. Among 1,950 WLHIV who screened negative for TB, 848 (43%) initiated TPT and 462 (54%) completed. Forty-three healthcare providers completed the questionnaire, and overall were highly supportive of integrated TB and RMNCH services. Integration of TB/HIV services in RMNCH settings was feasible and ensured high TB screening coverage among women of reproductive age, however, symptom screening identified few TB cases, and further studies should explore various screening algorithms and diagnostics that optimize case finding in this population. Interventions should focus on working with healthcare providers and patients to improve TPT initiation and completion rates.
Language	English
Publishing date	2022-04-20
Publishing country	United States
Document type	Journal Article
ISSN	2767-3375
ISSN (online)	2767-3375
DOI	10.1371/journal.pgph.0000217
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Patient feedback surveys among pregnant women in Eswatini to improve antenatal care retention.

Teasdale, Chloe A / Geller, Amanda / Shongwe, Siphesihle / Mafukidze, Arnold / Choy, Michelle / Magaula, Bhekinkhosi / Yuengling, Katharine / King, Katherine / De Gusmao, Eduarda Pimentel / Ryan, Caroline / Ao, Trong / Callahan, Tegan / Modi, Surbhi / Abrams, Elaine J

PloS one

2021 Volume 16, Issue 3, Page(s) e0248685

Abstract: Background: Uptake and retention in antenatal care (ANC) is critical for preventing adverse pregnancy outcomes for both mothers and infants.: Methods: We implemented a rapid quality improvement project to improve ANC retention at seven health ... ...

Abstract	Background: Uptake and retention in antenatal care (ANC) is critical for preventing adverse pregnancy outcomes for both mothers and infants. Methods: We implemented a rapid quality improvement project to improve ANC retention at seven health facilities in Eswatini (October-December 2017). All pregnant women attending ANC visits were eligible to participate in anonymous tablet-based audio assisted computer self-interview (ACASI) surveys. The 24-question survey asked about women's interactions with health facility staff (HFS) (nurses, mentor mothers, receptionists and lab workers) with a three-level symbolic response options (agree/happy, neutral, disagree/sad). Women were asked to self-report HIV status. Survey results were shared with HFS at monthly quality improvement sessions. Chi-square tests were used to assess differences in responses between months one and three, and between HIV-positive and negative women. Routine medical record data were used to compare retention among pregnant women newly enrolled in ANC two periods, January-February 2017 ('pre-period') and January-February 2018 ('post-period') at two of the participating health facilities. Proportions of women retained at 3 and 6 months were compared using Cochran-Mantel-Haenszel and Wilcoxon tests. Results: A total of 1,483 surveys were completed by pregnant women attending ANC, of whom 508 (34.3%) self-reported to be HIV-positive. The only significant change in responses from month one to three was whether nurses listened with agreement increasing from 88.3% to 94.8% (p<0.01). Overall, WLHIV had significantly higher proportions of reported satisfaction with HFS interactions compared to HIV-negative women. A total of 680 pregnant women were included in the retention analysis; 454 (66.8%) HIV-negative and 226 (33.2%) WLHIV. In the pre- and post-periods, 59.4% and 64.6%, respectively, attended at least four ANC visits (p = 0.16). The proportion of women retained at six months increased from 60.9% in the pre-period to 72.7% in the post-period (p = 0.03). For HIV-negative women, pre- and post-period six-month retention significantly increased from 56.6% to 71.6% (p = 0.02); however, the increase in WLHIV retained at six months from 70.7% (pre-period) to 75.0% (post-period) was not statistically significant (p = 0.64). Conclusion: The type of rapid quality improvement intervention we implemented may be useful in improving patient-provider relationships although whether it can improve retention remains unclear.
MeSH term(s)	Adult ; Cohort Studies ; Eswatini ; Female ; HIV Infections/epidemiology ; Humans ; Patient Satisfaction/statistics & numerical data ; Pregnancy ; Pregnant Women/psychology ; Prenatal Care/statistics & numerical data ; Retention in Care/statistics & numerical data ; Surveys and Questionnaires
Language	English
Publishing date	2021-03-24
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0248685
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Paediatric tuberculosis preventive treatment preferences among HIV-positive children, caregivers and healthcare providers in Eswatini: a discrete choice experiment.

Hirsch-Moverman, Yael / Strauss, Michael / George, Gavin / Mutiti, Anthony / Mafukidze, Arnold / Shongwe, Siphesihle / Dube, Gloria Sisi / El Sadr, Wafaa M / Mantell, Joanne E / Howard, Andrea A

BMJ open

2021 Volume 11, Issue 10, Page(s) e048443

Abstract: Objective: Isoniazid preventive therapy initiation and completion rates are suboptimal among children. Shorter tuberculosis (TB) preventive treatment (TPT) regimens have demonstrated safety and efficacy in children and may improve adherence but are not ... ...

Abstract	Objective: Isoniazid preventive therapy initiation and completion rates are suboptimal among children. Shorter tuberculosis (TB) preventive treatment (TPT) regimens have demonstrated safety and efficacy in children and may improve adherence but are not widely used in high TB burden countries. Understanding preferences regarding TPT regimens' characteristics and service delivery models is key to designing services to improve TPT initiation and completion rates. We examined paediatric TPT preferences in Eswatini, a high TB burden country. Design: We conducted a sequential mixed-methods study utilising qualitative methods to inform the design of a discrete choice experiment (DCE) among HIV-positive children, caregivers and healthcare providers (HCP). Drug regimen and service delivery characteristics included pill size and formulation, dosing frequency, medication taste, treatment duration and visit frequency, visit cost, clinic wait time, and clinic operating hours. An unlabelled, binary choice design was used; data were analysed using fixed and mixed effects logistic regression models, with stratified models for children, caregivers and HCP. Setting: The study was conducted in 20 healthcare facilities providing TB/HIV care in Manzini, Eswatini, from November 2018 to December 2019. Participants: Ninety-one stakeholders completed in-depth interviews to inform the DCE design; 150 children 10-14 years, 150 caregivers and 150 HCP completed the DCE. Results: Despite some heterogeneity, the results were fairly consistent among participants, with palatability of medications viewed as the most important TPT attribute; fewer and smaller pills were also preferred. Additionally, shorter waiting times and cost of visit were found to be significant drivers of choices. Conclusion: Palatable medication, smaller/fewer pills, low visit costs and shorter clinic wait times are important factors when designing TPT services for children and should be considered as new paediatric TPT regimens in Eswatini are rolled out. More research is needed to determine the extent to which preferences drive TPT initiation, adherence and completion rates.
MeSH term(s)	Ambulatory Care Facilities ; Caregivers ; Child ; Eswatini ; HIV Infections/drug therapy ; HIV Infections/prevention & control ; Health Personnel ; Humans ; Tuberculosis/drug therapy ; Tuberculosis/prevention & control
Language	English
Publishing date	2021-10-22
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2020-048443
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Article ; Online: Birth Testing for Infant HIV Diagnosis in Eswatini: Implementation Experience and Uptake Among Women Living With HIV in Manzini Region.

Teasdale, Chloe A / Tsiouris, Fatima / Mafukidze, Arnold / Shongwe, Siphesihle / Choy, Michelle / Nhlengetfwa, Hlengiwe / Simelane, Samkelisiwe / Mthethwa, Simangele / Ao, Trong / Ryan, Caroline / Dale, Helen / Rivadeneira, Emilia / Abrams, Elaine J

The Pediatric infectious disease journal

2020 Volume 39, Issue 9, Page(s) e235–e241

Abstract: Introduction: HIV testing at birth of HIV-exposed infants (HEIs) may improve the identification of infants infected with HIV in utero and accelerate antiretroviral treatment (ART) initiation.: Methods: ICAP at Columbia University supported ... ...

Abstract	Introduction: HIV testing at birth of HIV-exposed infants (HEIs) may improve the identification of infants infected with HIV in utero and accelerate antiretroviral treatment (ART) initiation. Methods: ICAP at Columbia University supported implementation of a national pilot of HIV testing at birth (0-7 days) in Eswatini at 2 maternity facilities. Dried blood spot (DBS) samples from neonates of women living with HIV (WLHIV) were collected and processed at the National Molecular Reference Laboratory using polymerase chain reaction (PCR). Mothers received birth test results at community health clinics. We report data on HIV birth testing uptake and outcomes for HIV-positive infants from the initial intensive phase (October 2017-March 2018) and routine support phase (April-December 2018). Results: During the initial intensive pilot phase, 1669 WLHIV delivered 1697 live-born HEI at 2 health facilities and 1480 (90.3%) HEI received birth testing. During the routine support phase, 2546 WLHIV delivered and 2277 (93.5%) HEI received birth testing. Overall October 2017-December 2018, 22 (0.6%) infants of 3757 receiving birth testing had a positive PCR test, 15 (68.2%) of whom were successfully traced and linked for confirmatory testing (2 infants were reported by caregivers to have negative follow-up HIV tests). Median time from birth test to receipt of results by the caregiver was 13 days (range: 8-23). Twelve (60.0%) of 20 infants confirmed to be HIV-positive started ART at median age of 17.5 days (12-43). One mother of an HIV-positive infant who was successfully traced refused ART following linkage to care and another child died after ART initiation. Three infants (15.0%) had died by the time their mothers were reached and 4 (15.0%) infants were never located. Conclusion: This pilot of universal birth testing in Eswatini demonstrates the feasibility of using a standard of care approach in a low resource and high burden setting. We document high uptake of testing for newborns among HIV-positive mothers and very few infants were found to be infected through birth testing.
MeSH term(s)	Adolescent ; Adult ; Anti-Retroviral Agents/therapeutic use ; Eswatini/epidemiology ; Female ; HIV Infections/diagnosis ; HIV Infections/drug therapy ; HIV Infections/epidemiology ; HIV-1 ; Health Plan Implementation/statistics & numerical data ; Humans ; Infant, Newborn ; Infectious Disease Transmission, Vertical/statistics & numerical data ; Male ; Mothers ; Neonatal Screening/methods ; Neonatal Screening/standards ; Pilot Projects ; Pregnancy ; Pregnancy Complications, Infectious/epidemiology ; Pregnancy Complications, Infectious/virology ; Young Adult
Chemical Substances	Anti-Retroviral Agents
Language	English
Publishing date	2020-05-26
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	392481-6
ISSN	1532-0987 ; 0891-3668
ISSN (online)	1532-0987
ISSN	0891-3668
DOI	10.1097/INF.0000000000002734
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Engagement in care among women and their infants lost to follow-up under Option B+ in eSwatini.

Reidy, William / Nuwagaba-Biribonwoha, Harriet / Shongwe, Siphesihle / Sahabo, Ruben / Hartsough, Kieran / Wu, Yingfeng / Gachuhi, Averie / Mthethwa-Hleta, Simangele / Abrams, Elaine J

PloS one

2019 Volume 14, Issue 10, Page(s) e0222959

Abstract: Background: Universal antiretroviral treatment (ART) for pregnant women with HIV, Option B+, has been adopted widely for prevention of mother-to-child HIV transmission (PMTCT). Some evidence shows high loss to follow-up (LTF) under this model. However, ... ...

Abstract	Background: Universal antiretroviral treatment (ART) for pregnant women with HIV, Option B+, has been adopted widely for prevention of mother-to-child HIV transmission (PMTCT). Some evidence shows high loss to follow-up (LTF) under this model. However, gaps in data systems limit this evidence. We collected additional information for women and infants LTF from Option B+ in Eswatini to assess more accurate outcomes. Methods: LTF at 6-months postpartum was assessed using facility data. Additional data was gathered from: 1) the national ART database and paper records; 2) patient tracing; and 3) interviews and abstraction from patient-held records. Engagement in care was defined as any clinic visit within 91 days before or after 6-months postpartum or completion of a documented transfer; or, for those traced but not completing study interviews, visits at 6-months postpartum or later (for infants), or visits within 3-months of tracing (for women). Multivariable loglinear models were used to identify correlates of engagement. Results: One-hundred-ninety-four (44.7%) of 434 LTF women had outcomes ascertained, including 122 (62.9%) women engaged in care. Among 510 LTF infants, 265 (52.0%) had ascertained outcomes, including 143 (54.0%) engaged in care, 47 (17.7%) pregnancy losses, and 18 (6.8%) deaths. Seventy-two of 189 live infants (38.1%) with ascertained outcomes had a 6-week early infant diagnostic (EID) test. Among women with ascertained outcomes, gestational age of 20+ weeks (vs. fewer than 20 weeks, aRR 0.80; 95% CI 0.68-0.94) and age 25-29 years (vs. 15-24 years, aRR 0.81; 95% CI 0.67-0.97), were associated with lower engagement; initiating ART after first ANC visit was associated with higher engagement (vs. at first ANC visit, aRR 1.12; 95% CI 1.04-1.21). Among infants with ascertained outcomes, mother not initiating ART was associated with lower engagement (vs. ART at first ANC visit, aRR 0.71; 95% CI 0.54-0.91). Conclusion: Substantial numbers of women and infants classified as LTF under Option B+ were engaged in care, though a suboptimal level of 6-week EID testing was observed. These findings highlight a need to improve coverage of routine EID testing, and improve data systems to better capture PMTCT patient outcomes.
MeSH term(s)	Adult ; Antiretroviral Therapy, Highly Active ; Female ; HIV Infections/drug therapy ; HIV Infections/pathology ; HIV Infections/virology ; Humans ; Infant ; Infectious Disease Transmission, Vertical ; Mothers ; Postpartum Period/physiology ; Pregnancy ; Pregnancy Complications, Infectious/drug therapy ; Pregnancy Complications, Infectious/pathology ; Pregnancy Complications, Infectious/virology
Language	English
Publishing date	2019-10-30
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0222959
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Healthcare worker experiences with Option B+ for prevention of mother-to-child HIV transmission in eSwatini: findings from a two-year follow-up study.

DiCarlo, Abby L / Gachuhi, Averie Baird / Mthethwa-Hleta, Simangele / Shongwe, Siphesihle / Hlophe, Thabo / Peters, Zachary J / Zerbe, Allison / Myer, Landon / Langwenya, Nontokozo / Okello, Velephi / Sahabo, Ruben / Nuwagaba-Biribonwoha, Harriet / Abrams, Elaine J

BMC health services research

2019 Volume 19, Issue 1, Page(s) 210

Abstract: Background: Prevention of mother-to-child transmission (PMTCT) across sub-Saharan Africa has rapidly shifted towards Option B+, an approach in which all HIV+ pregnant and breastfeeding women initiate lifelong antiretroviral therapy (ART) independent of ... ...

Abstract	Background: Prevention of mother-to-child transmission (PMTCT) across sub-Saharan Africa has rapidly shifted towards Option B+, an approach in which all HIV+ pregnant and breastfeeding women initiate lifelong antiretroviral therapy (ART) independent of CD4+ count. Healthcare workers (HCW) are critical to the success of Option B+, yet little is known regarding HCW acceptability of Option B+, particularly over time. Methods: Ten health facilities in the Manzini and Lubombo regions of eSwatini transitioned from Option A to Option B+ between 2013 and 2014 as part of the Safe Generations study examining PMTCT retention. Fifty HCWs (5 per facility) completed questionnaires assessing feasibility and acceptability: (1) prior to transitioning to Option B+, (2) two months post transition, and (3) approximately 2 years post Option B+ transition. This analysis describes HCW perceptions and experiences two years after transitioning to Option B+. Results: Two years after transition, 80% of HCWs surveyed reported that Option B+ was easy for HCWs, noting that it was particularly easy to explain and coordinate. Immediate ART initiation also reduced delays by eliminating need for laboratory tests prior to ART initiation. Additionally, HCWs reported ease of patient follow-up (58%), documentation (56%), and counseling (58%) under Option B+. Findings also indicate that a majority of HCWs reported that their workloads increased under Option B+. Sixty-eight percent of HCWs at two years post-transition reported more work under Option B+, specifically noting increased involvement in adherence counseling, prescribing/monitoring medications, and appointment scheduling/tracking. Some HCWs attributed their higher workloads to increased client loads, now that all HIV-positive women were initiated on ART. New barriers to patient uptake, and issues related to retention, adherence, and follow-up were also noted as challenges face by HCW when implementing Option B+. Conclusions: Overall, HCWs found Option B+ to be acceptable and feasible while providing critical insights into the practical issues of universal ART. Further strengthening of the healthcare system may be necessary to alleviate worker burden and to ensure effective monitoring of client retention and adherence. HCW perceptions and experiences with Option B+ should be considered more broadly as countries implement Option B+ and consider universal treatment for all HIV+ individuals. Trial registration: http://clinicaltrials.gov NCT01891799 , registered on July 3, 2013.
MeSH term(s)	Adult ; Anti-HIV Agents/therapeutic use ; Breast Feeding/statistics & numerical data ; Female ; Follow-Up Studies ; HIV Infections/drug therapy ; HIV Infections/prevention & control ; Health Personnel ; Humans ; Infant ; Infant, Newborn ; Infectious Disease Transmission, Vertical/prevention & control ; Mothers/psychology ; Patient Acceptance of Health Care/statistics & numerical data ; Pregnancy ; Pregnancy Complications, Infectious/drug therapy ; Pregnancy Complications, Infectious/prevention & control
Chemical Substances	Anti-HIV Agents
Language	English
Publishing date	2019-04-02
Publishing country	England
Document type	Journal Article
ISSN	1472-6963
ISSN (online)	1472-6963
DOI	10.1186/s12913-019-3997-1
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Enhanced Integration of TB Services in Reproductive Maternal Newborn and Child Health (RMNCH) Settings in Eswatini.

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Article ; Online: Patient feedback surveys among pregnant women in Eswatini to improve antenatal care retention.

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Article ; Online: Paediatric tuberculosis preventive treatment preferences among HIV-positive children, caregivers and healthcare providers in Eswatini: a discrete choice experiment.

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Article ; Online: Birth Testing for Infant HIV Diagnosis in Eswatini: Implementation Experience and Uptake Among Women Living With HIV in Manzini Region.

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Article ; Online: Engagement in care among women and their infants lost to follow-up under Option B+ in eSwatini.

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Article ; Online: Healthcare worker experiences with Option B+ for prevention of mother-to-child HIV transmission in eSwatini: findings from a two-year follow-up study.

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