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Browsing Protocols by Author "Chilongozi, Richard"

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    Valuation of impact of targeted community based HIV self-testing (HIVST) on uptake of antiretroviral therapy (ART) in health care facilities in Blantyre urban
    (Kamuzu University of Health Sciences, 2021-09-06) Chilongozi, Richard
    In 2016, the World Health Organization (WHO) recommended HIV self-testing (HIVST) as a safe, accurate and effective way to reach people who may not test otherwise.5 Studies have demonstrated that HIVST increases the uptake of HIV testing and is acceptable and feasible in a range of populations and settings, 6–8 however, important questions regarding linkage and impact of HIVST on ART remain. Continued scale up of HIVST hinges on strong evidence of its impact on achieving the second 90 and 95 treatment targets and the attainment of HIV epidemic control. A retrospective, quasi experimental study design used for evaluating longitudinal effects of interventions–the interrupted time series (ITS) study design will be conducted. The ITS will utilize ART data captured in MOH ART registers from Bangwe, Limbe and Ndirande Health Centers aggregated at time points, 12 months before and after start of community based HIVST program in Blantyre city. Broadly the study will investigate the impact of community based HIV self-testing implemented routinely at scale on ART uptake in Blantyre urban health facilities. Specifically the study will; 1. Compare ART initiations for clients’ ≥16 years and above at three selected treatment facilities in Blantyre urban 12 months before and after scale-up of HIVST distribution program. 2. Compare the percentage of clients ≥16 years and above initiating ART with advanced and severe HIV_ (WHO stage 3 and 4 respectively) and those with current TB before and after scale-up of HIVST distribution program. 3. Determine the proportion of ART initiations for clients ≥16 years and above attributable to HIVST as initial test establishing HIV+ status at three selected treatment facilities in Blantyre urban 12 months after scale up of HIVST distribution program. Data for clients ≥ 16 years and above, newly initiated on ART for the period of May 2017 to May 2019, will be abstracted from ART registers to study-specific data abstraction form. Counterfactuals will be constructed via a projection of the trendbefore the intervention was introduced into the time period after it was introduced. Level and trend of the pre-intervention segment will serve as control for the post intervention segment.9,10 Segmented regression analysis will be the main statistical method for estimating HIVST effect on ART initiation. For objective number 3, a questionnaire will be administered on a sample of 376 clients drawn from clients ≥16 years and above initiating ART 12 months after scale up of HIVST distribution program (i.e. between June 2018 to May 2019). Descriptive statistics will be used to calculate proportions; a t-test will check the statistical significance in the proportions in order to tell the effect of change from the intervention. The study expects to find significant increase in proportion of clients initiating ART and better clinical status at initiation (WHO clinical stage and TB status) after introduction of HIVST. Results of the study will be published and copies will be submitted to College of Medicine in partial fulfilment for the award of Masters in Public Health.