The role of costing in the introduction and scale-up of HIV

Attached are the 12 articles with the links to each one and the Literature Review Instructions to how the paper should be outlined.

Article Citation in APA FormatPurposeSampleMeasuresMethods(or Intervention)ResultsStrengthsLimitations
Mugwanya KK, Pintye J, Kinuthia J, Abuna F, Lagat H, Begnel ER, et al. (2019) Integrating preexposure prophylaxis delivery in routine family planning clinics: A feasibility programmatic evaluation in Kenya. PLoS Med 16(9): e1002885. https://doi.org/10.1371/journal.pmed.1002885The purpose of the study was to test the usefulness of implementing Prep within Family Planning clinics to reach at risk adolescents girls and young women in high risk settings.women aged 15 to 45 from the general population seeking FP services at 8 public health clinics were universally screened for HIV behavioral risk factors and offered PrEP .1,271 uninfected women were screened. Out of the 1,271 only 278 started Prep and only 114 came back in a month for a refill.Monthly follow up for refills in clinic.Women initiated on PrEP were followed as per the Kenya national guidelines for PrEP, which include initiation, month 1, and then 3 monthly visits for clinical review.The continuation of PrEP use at 1, 3, and 6 months post initiation was 41%, 24%, and 15%Early continuation of Prep resulted in reported male partner hiv statusReasons for discontinuing Prep were low perceived risk of HIVFocus was on girls and young women.integration of universal screening and counseling for PrEP in FP clinics was feasible, making this platform a potential “one-stop” location for FP and PrEPGreater efforts to support PrEP normalization and persistence for African women are needed to help women navigate their decisions about HIV preventionlimitations include lack of qualitative work to provide insights into women’s decision-making on PrEP uptake and continuationa nonrandomized design limiting definitive ascertainment of the robustness of a PrEP-dedicated nurse-led implementation strategy.
Eakle, R., Gomez, G. B., Naicker, N., Bothma, R., Mbogua, J., Cabrera Escobar, M. A., … Rees, H. (2017). HIV pre-exposure prophylaxis and early antiretroviral treatment among female sex workers in South Africa: Results from a prospective observational demonstration project. PLoS Medicine, 14(11). https://doi.org/10.1371/journal.pmed.1002444Purpose of this study was to test interventions among femal sex workers in two urban clinics in S.AfricaPrEP as part of combination prevention for HIV – FSWs and Early ART for FSW’s that were HIV +Program retention at 12 months of f/upOf those enrolled, 22% on PrEP (n = 49/219) and 60% on early ART (n = 83/139) were seen at 12 months; observed high rates of loss to follow-upFocusing on a high risk population of Female workers and fast tracking prevention or treatment.study include the lack of a control groupclinical study requirements imposed when PrEP was not approved through the regulatory system, which could have affected uptake; and the timing of the implementation of a national sex worker HIV programme, which could have also affected uptake and retention
Mansoor, L. E., Yende‐Zuma, N., Baxter, C., Mngadi, K. T., Dawood, H., Gengiah, T. N., Samsunder, N., Schwartz, J. L., Doncel, G. F. and Abdool Karim, Q. Integrated provision of topical pre‐exposure prophylaxis in routine family planning services in South Africa: a non‐inferiority randomized controlled trial. J Int AIDS Soc. 2019; 22( 9):e25381Purpose of this was to integrate Prep into family planning service for high risk populations to assist with prevention.In urban and rural areas in S. Africa HIV-negative eligible women (n = 372) from the parent trial were randomized to receive tenofovir gel either through intervention (FP clinics, n = 189) or control clinics (CAPRISA research clinics, n = 183).Women in intervention clinics had monthly visits for the first three months post‐enrolment, thereafter gel provision and monitoring was scheduled to coincide with each woman’s routine FP visit.Women assigned to control clinics received gel applicators monthly, irrespective of frequency or formulation of contraception.Women received monthly visits throughout the study for 1st 3 months while in intervention clinic and in the control clinic received monthly f/upwomen in intervention and control clinics were comparable and retention rates were 92.1% and 92.3% respectivelyWomen in intervention clinics and control clinics returned on average 5.2 (95% confidence interval (CI): 4.7 to 5.7) and 5.7 (CI: 5.2 to 6.2) used gel applicators per month respectively, with a mean difference of -0.47The supplying of topical PrEP as part of an integrated family planning service achieved higher adherence, and was as useful, acceptable and effective in preventing HIV as provision through a research settingNo Limitations
Adolescent Health Providers’ Willingness to Prescribe Pre-Exposure Prophylaxis (PrEP) to Youth at Risk of HIV Infection in the United StatesHart-Cooper, Geoffrey D. et al.Journal of Adolescent Health, Volume 63, Issue 2, 242 – 244HIV disproportionately affects young men who have sex with men. Pre-exposure prophylaxis (PrEP) can prevent HIV acquisition; however, youth access to PrEP is limited by provider willingness to prescribe PrEP.An online survey of clinicians working with adolescents (aged 13-17 years) and young adults (aged 18-26 years) in the United States through the Society of Adolescent Health and MedicineNo Measuresmultivariate logistic regression to assess provider beliefs associated with willingness to provide PrEP.Nearly all (93.2%) providers had heard of PrEP, and 57 (35.2%) had prescribed PrEP. While almost all providers (95%) agreed that PrEP prevents HIV, fewer were willing to prescribe to young adults (77.8%) or adolescents (64.8%). Willingness to prescribe PrEP was strongly associated with the belief that providers had enough knowledge to safely provide PrEP to adolescents and that adolescents would be adherentAlmost all providers had heard of PrEP and most providers were willing to prescribe PrEP. Provider education and tools to promote provider self-efficacy and adolescent adherence might improve provider willingness to provide PrEP.Number of clinicians not indicated who participated in the survey nor the number of participants in the age groups were indicatedNo timeline of how long this survey was conducted for
Primary Care Physician Attitudes and Intentions Toward the Use of HIV Pre-exposure Prophylaxis in Adolescents in One Metropolitan RegionMullins, Tanya L. Kowalczyk et al.Journal of Adolescent Health, Volume 64, Issue 5, 581 – 588The purpose of this study is to understand the attitudes of physicians toward the use of pre-exposure prophylaxis (PrEP) for HIV prevention among youth is critical to improving access to PrEP. We examined PrEP-related attitudes among physicians who provide primary care to 13- to 21-year-old adolescents.Semi-structured interviews were conducted with 38 physicians from adolescent medicine, family practice, internal medicine/medicine-pediatrics, obstetrics/gynecology, and pediatrics who care for any adolescents younger than 18 years.No MeasuresInterviews assessed familiarity with PrEP, perceived benefits and barriers to providing PrEP to adolescents, facilitating factors for prescribing PrEP, and likelihood of recommending and prescribing PrEP to adolescents.Mean age was 44.6 years Fourteen physicians (37%) reported being somewhat or very familiar with PrEP. Perceived benefits of prescribing PrEP included decreased acquisition/rates of HIV, improved provision of sexual health services, and improved patient awareness of HIV risk. Barriers to PrEP were reported at the patient (e.g., lack of acceptability to patients), provider (e.g., concerns about patient adherence, safety/side effects, parents as a barrier to PrEP use), and system (e.g., high cost) levels. Facilitating factors for prescribing PrEP included low cost/coverage by insurance, physician education about PrEP, patient educational materials, and clinical guidelines for PrEP use in youth. A higher proportion of physicians reported being highly or somewhat likely to recommend (N = 16, 42%) than prescribe PrEP (N = 13, 34%).In this study of primary care physician attitudes toward PrEP prescribing for adolescents, physicians identified numerous barriers to providing PrEP. Addressing these barriers may increase adolescents’ access to PrEPAge group of participants were only 18 years and younger.Only semi-structured interviews were held not in-depth ones with providers.
Giovenco, D., Pettifor, A., MacPhail, C., Kahn, K., Wagner, R., Piwowar-Manning, E., … Hughes, J. P. (2019). Assessing risk for HIV infection among adolescent girls in South Africa: an evaluation of the VOICE risk score (HPTN 068). Journal of the International AIDS Society, 22(7), e25359. doi:10.1002/jia2.25359Purpose of this study is aimed at evaluating the utility of the risk score in predicting HIV incidence among a cohort of adolescent girls in rural South Africa.Data utilized from HIV Prevention Trials Network (HPTN) 068, a phase III randomized controlled trial conducted in rural Mpumalanga provinceSchool-attending young women aged 13 to 20 years were enrolled into the trial from 2011 to 2012 and followed for up to three years. A risk score based on individual-level risk factors measured at enrolment was calculated for HPTN 068 participants who completed a one-year follow-up visit and were HIV seronegative at enrolment.A proportional hazards model was then used to determine if risk score at enrolment was predictive of incident HIV infection at follow-up and an area under the curve analysis was used to examine the predictive ability of the score.The risk score had limited variability in the HPTN 068 sampleThe risk score did not predict HIV incidence after one year of follow-up and showed poor predictive abilityThe VOICE risk score demonstrated low utility to predict HIV incidence in the HPTN 068 sample. Findings highlight the need for an age and developmentally appropriate tool for assessing risk for HIV infection among adolescents.
Castel, A. D., Feaster, D. J., Tang, W., Willis, S., Jordan, H., Villamizar, K., … Metsch, L. R. (2015). Understanding HIV Care Provider Attitudes Regarding Intentions to Prescribe PrEP. Journal of acquired immune deficiency syndromes (1999), 70(5), 520–528.Purpose of the study was to determine whether certain subgroups of HIV providers were more likely to intend to prescribe PrEP.Surveys were administered to HIV providers in Miami, Florida and Washington, District of Columbia.Composite scores were developed to measure PrEP knowledge, experience, and likelihood of prescribing.Latent class analysis was used to stratify provider attitudes toward PrEP.Among 142 HIV providers, 73.2% had cared for more than 20 HIV-infected patients in the previous 3 months; 17% had ever prescribed PrEP.Latent class analysis identified 2 classes of providers found PrEP less effective and perceived barriers to prescribing it; Class 2 perceived PrEP as moderately effective and perceived fewer barriers to prescribing it. Compared with class 2, class 1 had significantly less experience with PrEP delivery and was significantly less likely to intend to prescribe to patients with multiple sex partnersHIV providers found PrEP to be effectiveProviders with less knowledge and experience were less likely to prescribe.
Subramanian S, Edwards P, Roberts ST, Musheke M, Mbizvo MIntegrated Care Delivery for HIV Prevention and Treatment in Adolescent Girls and Young Women in Zambia: Protocol for a Cluster-Randomized Controlled TrialPurpose of the study is to test a multilevel package of interventions at the community and health system levels in Zambia in order to connect AGYW with a source of regular care, which will in turn allow for sustainable, successful implementation of regular HIV testing and adherence to antiretroviral treatment.Zambian AGYW of 10-24 years of age and their families and to create community-based youth clubs to foster peer support.perform formative research, including focus groups and in-depth interviews, among AGYW, caregivers, and stakeholders to help inform the development and tailoring of the interventions.will use in-depth interviews and surveys to collect staff and stakeholder feedback after the trial.We will adapt prior tools to create the SHIELD (Support for HIV Integrated Education, Linkages to Care, and Destigmatization) intervention to educate and empower Zambian AGYW.Acluster-randomized controlled trial will be implemented in Lusaka, with six clinic catchment areas randomized into three groups: zones with integrated wellness care clinics and SHIELD intervention, zones with only SHIELD intervention, and control zones with no intervention.We will assess HIV testing among the HIV-negative or unknown (HIV-/u) cohort, and retention in care along with viral load suppression will be evaluated in the HIV-positive (HIV+) cohort.Interim results are expected in 2021, and the final results are expected in 2022. If this multilevel intervention is successful in establishing a comprehensive care continuum for HIV-affected AGYW, the Zambian Ministry of Health may advocate for expansion to additional settings to support national scale-up.This integrated service delivery model can also be a platform to implement additional preventive services, so HIV-/u and HIV+ AGYW can receive comprehensive, integrated services.No Limitations
Roberts, D. A., Barnabas, R. V., Abuna, F., Lagat, H., Kinuthia, J., Pintye, J., … Levin, C. (2019). The role of costing in the introduction and scale-up of HIV pre-exposure prophylaxis: evidence from integrating PrEP into routine maternal and child health and family planning clinics in western Kenya. Journal of the International AIDS Society, 22 Suppl 4(Suppl Suppl 4), e25296. doi:10.1002/jia2.25296Purpose of the study is to provide PrEP through maternal and child health and family planning clinics offers a promising strategy to reach women in high HIV burden settings.We obtained input costs from programme budgets, expenditure records and staff interviews.estimated changes in costs if creatinine testing were postponed from initiation to first follow-up visit and if PrEP were prioritized to clients at high HIV risk using a behavioural risk assessment tool.Conducted a costing study from the provider perspective within the PrEP Implementation for Young Women and Adolescents programme in western Kenya.For an annual programme output of 24,005 screenings, 4198 PrEP initiations and 4427 follow-up visits, the average cost per client-month of PrEP dispensed in the study was $26.52. Personnel, drugs and laboratory tests comprised 43%, 25% and 14% of programme costs respectively. Postponing creatinine testing and prioritizing PrEP delivery to clients at high HIV risk reduced total programme costs by 8% and 14% respectively. In the MOH scenario assuming no changes in outputs, the projected cost per client-month of PrEP dispensed decreased to $16.54 and total programme costs decreased by 38%.Incremental PrEP costs are sensitive to the service delivery strategy used to engage priority populations. Postponing creatinine testing and prioritizing PrEP delivery to clients at high HIV risk may reduce costs.No Limitations
Sales JM, Escoffery C, Hussen SA, Haddad LB, Phillips A, Filipowicz T, Sanchez M, McCumber M, Rupp B, Kwiatkowski E, Psioda MA, Sheth AN Pre-Exposure Prophylaxis Integration into Family Planning Services at Title X Clinics in the Southeastern United States: A Geographically-Targeted Mixed Methods StudyPurpose of this study is to assess the inner and outer context factors (barriers and facilitators) that may influence the adoption of PrEP prescription and treatment services in Title X clinics serving AYAW in the Southern United States.To overcome potential implementation challenges for AYAW, Title X clinics in the Southern United States are uniquely positioned to be focal sites for conceptually informed and thoroughly evaluated PrEP implementation science studies.informant interviews among a purposively selected subset of responders to more comprehensively assess inner and outer context factors that may influence adoption and implementation of PrEP in Title X FP clinics in the South.Phase 1 of Planning4PrEP is an explanatory sequential, mixed methods study consisting of a geographically-targeted Web-based survey of Title X clinic administrators and providers in the Southern United StatesPhase 1 of Planning 4PrEP research activities began in October 2017 and are ongoing. To date, survey and key informant interview administration is near completion, with quantitative and qualitative data analysis scheduled to begin soon after data collection completion.Data gained from this study will inform a type 1 hybrid effectiveness implementation study, which will evaluate the multilevel factors associated with successful PrEP implementation while evaluating the degree of PrEP uptake, continuation, and adherence among women seen in Title X clinics.
Closson, K., Chown, S., Armstrong, H. L., Wang, L., Bacani, N., Ho, D., … Lachowsky, N. J. (2019). HIV leadership programming attendance is associated with PrEP and PEP awareness among young, gay, bisexual, and other men who have sex with men in Vancouver, Canada. BMC public health, 19(1), 429.Purpose of this study is to understand differences in HIV prevention awareness, health care access, and service utilizationYoung gay, bisexual, and other men who have sex with men aged between youth (16-29 years) and adult (≥30 year)Participants completed an in-person computer-assisted self-interview every 6 months, up to February 2017, with questions on sociodemographic factors, awareness of biomedical HIV prevention strategies, and an HIV treatment optimism-skepticism scale.Sexually-active GBM were recruited using respondent-driven sampling (RDS) from February 2012 to February 2015.Of 698 GBM who enrolled in the longitudinal study, 36.8% were less than 30 years old at the first study visit.After controlling for gender identification, sexual orientation, HIV status, and income in the past 6 months, younger GBM (n = 257/698) had lower awareness of biomedical HIV prevention strategies and less HIV treatment optimism compared with older GBM (n = 441/698).attending peer-based HIV-leadership programs ameliorates age-disparities in HIV-prevention knowledge and treatment optimism.Younger GBM, who are disproportionately affected by the HIV epidemicare less aware of new prevention technologies than older GBM
Hu, Y., Zhong, X. N., Peng, B., Zhang, Y., Liang, H., Dai, J. H., … Huang, A. L. (2018). Associations between perceived barriers and benefits of using HIV pre-exposure prophylaxis and medication adherence among men who have sex with men in Western China. BMC infectious diseases, 18(1), 575. doi:10.1186/s12879-018-3497-7Purpose of this study to investigate the associations between the perceived barriers and benefits of using HIV pre-exposure prophylaxis medicationMSM were recruited in western China from April 2013 to October 2014.oral tenofovir (TDF) was administered daily and followed up every 12 weeks for 2 years.At each follow-up, the medication rate was calculated based on the self-reported number of missed doses over 2 weeks, and then, the medication adherence was evaluated. The barriers and benefits perceived during medication were obtained by a self-administered questionnaire, and their effects on medication adherence were analysed by linear mixed models.A total of 411 participants were enrolled in this study, and 1561 follow-up observation points were obtained.The average medication rate was 0.62 ± 0.37, and the medication rate increased with longer follow-up (P < 0.05). The medication rate was higher among MSM who were divorced (compared to those who were unmarried, P < 0.0001).How to obtain and maintain high medication adherence among MSM is the key to the PrEP intervention strategy for effective reduction of HIV infection.dislike of taking the drugs and the burden perceived during medication had no effects on the actual medication rate of taking TDF

HIV pre-exposure prophylaxis and early antiretroviral treatment among female sex workers in South Africa: Results from a prospective observational demonstration project.

Link:https://www-ncbi-nlm-nih-gov.libproxy.temple.edu/pubmed/29161256

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Integrated provision of topical pre-exposure prophylaxis in routine family planning services in South Africa: a non-inferiority randomized controlled trial.

Link: https://www-ncbi-nlm-nih-gov.libproxy.temple.edu/pubmed/31507088

Integrating preexposure prophylaxis delivery in routine family planning clinics: A feasibility programmatic evaluation in Kenya.

Link:https://www-ncbi-nlm-nih-gov.libproxy.temple.edu/pubmed/31479452

Primary Care Physician Attitudes and Intentions Toward the Use of HIV Pre-exposure Prophylaxis in Adolescents in One Metropolitan Region.

Link: https://www.ncbi.nlm.nih.gov/pubmed/30578115

Adolescent Health Providers’ Willingness to Prescribe Pre-Exposure Prophylaxis (PrEP) to Youth at Risk of HIV Infection in the United States.

Link:https://www.ncbi.nlm.nih.gov/pubmed/29843969

Assessing risk for HIV infection among adolescent girls in South Africa: an evaluation of the VOICE risk score (HPTN 068).

Link: https://www.ncbi.nlm.nih.gov/pubmed/31353814

Understanding HIV Care Provider Attitudes Regarding Intentions to Prescribe PrEP.

Link: https://www.ncbi.nlm.nih.gov/pubmed/26247895

Integrated Care Delivery for HIV Prevention and Treatment in Adolescent Girls and Young Women in Zambia: Protocol for a Cluster-Randomized Controlled Trial.

Link: https://www.ncbi.nlm.nih.gov/pubmed/31584004

The role of costing in the introduction and scale-up of HIV pre-exposure prophylaxis: evidence from integrating PrEP into routine maternal and child health and family planning clinics in western Kenya.

HIV leadership programming attendance is associated with PrEP and PEP awareness among young, gay, bisexual, and other men who have sex with men in Vancouver, Canada.

Link: https://www.ncbi.nlm.nih.gov/pubmed/31014296

Pre-Exposure Prophylaxis Integration into Family Planning Services at Title X Clinics in the Southeastern United States: A Geographically-Targeted Mixed Methods Study (Phase 1 ATN 155).

Link: https://www.ncbi.nlm.nih.gov/pubmed/31199344

Associations between perceived barriers and benefits of using HIV pre-exposure prophylaxis and medication adherence among men who have sex with men in Western China.

Link: https://www.ncbi.nlm.nih.gov/pubmed/30442106

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