Browsing by Author "Shaikh, Najma"

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    The effectiveness and cost-effectiveness of community-based support for adolescents receiving antiretroviral treatment: an operational research study in South Africa
    (Wiley Open Access, 2018) Fatti, Geoffrey; Jackson, Debra; Goga, Ameena; Shaikh, Najma; Eley, Brian; Nachega, Jean B.; Grimwood, Ashraf
    INTRODUCTION: Adolescents and youth receiving antiretroviral treatment (ART) in sub-Saharan Africa have high attrition and inadequate ART outcomes, and evaluations of interventions improving ART outcomes amongst adolescents are very limited. Sustainable Development Goal (SDG) target 3c is to substantially increase the health workforce in developing countries. We measured the effectiveness and cost-effectiveness of community-based support (CBS) provided by lay health workers for adolescents and youth receiving ART in South Africa. METHODS: A retrospective cohort study including adolescents and youth who initiated ART at 47 facilities. Previously unemployed CBS-workers provided home-based ART-related education, psychosocial support, symptom screening for opportunistic infections and support to access government grants. Outcomes were compared between participants who received CBS plus standard clinic-based care versus participants who received standard care only. Cumulative incidences of all-cause mortality and loss to follow-up (LTFU), adherence measured using medication possession ratios (MPRs), CD4 count slope, and virological suppression were analysed using multivariable Cox, competing-risks regression, generalized estimating equations and mixedeffects models over five years of ART. An expenditure approach was used to determine the incremental cost of CBS to usual care from a provider perspective. Incremental cost-effectiveness ratios were calculated as annual cost per patient-loss (through death or LTFU) averted. RESULTS: Amongst 6706 participants included, 2100 (31.3%) received CBS. Participants who received CBS had reduced mortality, adjusted hazard ratio (aHR) = 0.52 (95% CI: 0.37 to 0.73; p < 0.0001). Cumulative LTFU was 40% lower amongst participants receiving CBS (29.9%) compared to participants without CBS (38.9%), aHR = 0.60 (95% CI: 0.51 to 0.71); p < 0.0001). The effectiveness of CBS in reducing attrition ranged from 42.2% after one year to 35.9% after five years. Virological suppression was similar after three years, but after five years 18.8% CBS participants versus 37.2% non-CBS participants failed to achieve viral suppression, adjusted odds ratio = 0.24 (95% CI: 0.06 to 1.03). There were no significant differences in MPR or CD4 slope. The cost of CBS was US$49.5/patient/year. The incremental cost per patient-loss averted was US$600 and US$776 after one and two years, respectively. CONCLUSIONS: CBS for adolescents and youth receiving ART was associated with substantially reduced patient attrition, and is a low-cost intervention with reasonable cost-effectiveness that can aid progress towards several health, economic and equality- related SDG targets.
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    Low HIV incidence in pregnant and postpartum women receiving a community-based combination HIV prevention intervention in a high HIV incidence setting in South Africa
    (Public Library of Science, 2017) Fatti, Geoffrey; Shaikh, Najma; Jackson, Debra; Goga, Ameena; Nachega, Jean B.; Eley, Brian; Grimwood, Ashraf
    BACKGROUND Young Southern African women have the highest HIV incidence globally. Pregnancy doubles the risk of HIV acquisition further, and maternal HIV acquisition contributes significantly to the paediatric HIV burden. Little data on combination HIV prevention interventions during pregnancy and lactation are available. We measured HIV incidence amongst pregnant and postpartum women receiving a community-based combination HIV prevention intervention in a high HIV incidence setting in South Africa. METHODS A cohort study that included HIV-uninfected pregnant women was performed. Lay community- based workers provided individualized HIV prevention counselling and performed three-monthly home and clinic-based individual and couples HIV testing. Male partners were referred for circumcision, sexually transmitted infections or HIV treatment as appropriate. Kaplan-Meier analyses and Cox's regression were used to estimate HIV incidence and factors associated with HIV acquisition. RESULTS The 1356 women included (median age 22.5 years) received 5289 HIV tests. Eleven new HIV infections were detected over 828.3 person-years (PY) of follow-up, with an HIV incidence rate of 1.33 infections/100 PY (95% CI: 0.74±2.40). Antenatally, the HIV incidence rate was 1.49 infections/100 PY (95% CI: 0.64±2.93) and postnatally the HIV incidence rate was 1.03 infections/100 PY (95% CI: 0.33±3.19). 53% of male partners received HIV testing and 66% of eligible partners received referral for circumcision. Women within known serodiscordant couples, and women with newly diagnosed HIV-infected partners, adjusted hazard ratio (aHR) = 32.7 (95% CI: 3.8±282.2) and aHR = 126.4 (95% CI: 33.8±472.2) had substantially increased HIV acquisition, respectively. Women with circumcised partners had a reduced risk of incident HIV infection, aHR = 0.22 (95% CI: 0.03±1.86). CONCLUSIONS Maternal HIV incidence was substantially lower than previous regional studies. Communitybased combination HIV prevention interventions may reduce high maternal HIV incidence in resource-poor settings. Expanded roll-out of home-based couples HIV testing and initiating pre-exposure prophylaxis for pregnant women within serodiscordant couples is needed in Southern Africa.
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    Oral manifestations of HIV infection : implications for delivery of oral health care service
    (University of the Western Cape, 2001) Shaikh, Najma; Moola, U.H.; Hamekar, S.
    The prevalence and determinants of oral lesions related to Human Immunodeficiency Virus (HIV) infection were examined in the context of the delivery of oral health care services. This was complemented by an examination of the perceptions and experiences of oral health workers and HIV infected patients with regard to oral health care services. Method: A cross sectional study was carried out on 239 patients who attended a HIV outpatient clinic. participants' dental history and perceptions were determined through structured interviews, whilst clinical and medical details were obtained from physical examinations and clinical records. A qualitative study of oral health care workers was carried out to assess their perceptions and experiences with regard to service provision. A costing exercise was done to determine the average cost of care per visit. Results: Oral HIV lesions presented in 68.6% of the sample. Significant determinants of oral lesions presence included, CD4 cell counts <2OO (OR 2.07), smoking (OR 2.74, presence of calculus (OR 4.27) and poor access to oral care (OR 6.36). The majority of the patients sought dental care from the public sector services (670lo) and the prime reason was for emergency care (/0olo). The main barriers to care from the patient perspective were cost (337"), fear of pain (21%) and rejection (16%). The majority (87%) of the oral health care workers were in favour of providing comprehensive care at primary level. The main concerns of the oral health care providers were the management of needle-siick injuries and their skills deficiency in managing complex @ses. The average cost of care per visit was R130.73. Conclusion: Oral Iesions presented in more than two thirds of the sample. Barriers to care, lowered immune status, smoking and high calculus deposits were significantly associated with the presence of lesions. The most commonly reported barriers to seeking care were cost and fear of pain. Patients' perception of oral health and their health seeking behaviour were influenced by oral symptoms. The rising cost of treating oral lesions will impact on the delivery of health care services. Oral morbidity related to HIV infection can be reduced with the application of simple preventative, health promotive measures such as promoting smoking cessation and good oral hygiene, removal of local tooth deposits and improved acess to health services.