Last data update: Sep 23, 2024. (Total: 47723 publications since 2009)
Records 1-6 (of 6 Records) |
Query Trace: Grabbe KL [original query] |
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Technical assistance needs for successful implementation of couples HIV testing and counseling (CHTC) intervention for male couples at US HIV testing sites
Stephenson R , Grabbe KL , Sidibe T , McWilliams A , Sullivan PS . AIDS Behav 2015 20 (4) 841-7 The African couples HIV testing and counseling (CHTC) model, which focuses on heterosexual couples, was adapted for same-sex male couples in the US. This paper presents the results of a follow-up survey conducted with representatives of the agencies that received CHTC training. The paper aims to understand the post-training implementation and identify critical technical assistance gaps. There are clear needs for continual learning opportunities, focused on the key skills required for CHTC, and for resources aimed at tackling agency-level concerns about service provision and integration. Central to this is the need for implementation science research that can identify the messages that are effective in encouraging couples to utilize CHTC and test models of service integration. |
Re-testing and seroconversion among HIV testing and counseling clients in Lesotho
Grabbe KL , Courtenay-Quirk C , Baughman AL , Djomand G , Pedersen B , Lerotholi M , Nkonyana J , Ramphalla-Phatela P , Marum E . AIDS Educ Prev 2015 27 (4) 350-61 HIV testing and counseling (HTC) is an essential component of comprehensive HIV programs. Retrospective HTC program data from 2006 to 2010 were examined to determine patterns of re-testing and seroconversion in Lesotho. Among 104,662 initially negative clients, 6,777 (6.5%) were re-testers. Predictors of re-testing included being male, age ≥ 25 years, divorced/separated, having more than a high school education, being tested as a couple, testing in the year 2006, testing in the capital city, and awareness of partner's recent testing behavior. Among re-testers who seroconverted (N = 259), predictors included being female and having less than a high school education. There is a critical need for more effectively targeting HIV retesting messages to align with WHO (2010) guidelines and identify persons at highest risk for HIV, to increase timely diagnoses and link persons to appropriate HIV prevention, care, and treatment services. |
Universal voluntary HIV testing in antenatal care settings: a review of the contribution of provider-initiated testing & counselling
Hensen B , Baggaley R , Wong VJ , Grabbe KL , Shaffer N , Lo YR , Hargreaves J . Trop Med Int Health 2011 17 (1) 59-70 OBJECTIVE: To assess the contribution of provider-initiated testing and counselling (PITC) to achieving universal testing of pregnant women and, from available data on components of PITC, assess whether PITC adoption adheres to pre-test information, post-test counselling procedures and linkage to treatment. METHODS: Systematic review of published literature. Findings were collated and data extracted on HIV testing uptake before and after the adoption of a PITC model. Data on pre- and post-test counselling uptake and linkage to anti-retrovirals, where available, were also extracted. RESULTS: Ten eligible studies were identified. Pre-intervention testing uptake ranged from 5.5% to 78.7%. Following PITC introduction, testing uptake increased by a range of 9.9% to 65.6%, with testing uptake ≥85% in eight studies. Where reported, pre-test information was provided to between 91.5% and 100% and post-test counselling to between 82% and 99.8% of pregnant women. Linkage to ARVs for prevention of mother to child transmission (PMTCT) was reported in five studies and ranged from 53.7% to 77.2%. Where reported, PITC was considered acceptable by ANC attendees. CONCLUSION: Our review provides evidence that the adoption of PITC within ANC can facilitate progress towards universal voluntary testing of pregnant women. This is necessary to increase the coverage of PMTCT services and facilitate access to treatment and prevention interventions. We found some evidence that PITC adoption does not undermine processes inherent to good conduct of testing, with high levels of pre-test information and post-test counselling, and two studies suggesting that PITC is acceptable to ANC attendees. |
The contribution of HIV-discordant relationships to new HIV infections in Rakai, Uganda
Grabbe KL , Medley A , Bachanas P , Bock N , Marum E . AIDS 2011 25 (15) 1931-2 In their recent research letter entitled ‘The contribution of HIV-discordant relationships to new HIV infections in Rakai, Uganda’, Gray et al. [1] argue that targeting HIV testing and counseling efforts to HIV serodiscordant couples will have limited impact for HIV prevention. We disagree with this argument for several reasons. | Gray et al. [1] underestimate the true contribution to overall HIV incidence from serodiscordant couples in two ways. First, they focus only on study participants identified as both married and serodiscordant. Yet approximately one-third of married couples had a partner of unknown HIV status (36 and 33% in the pre- and post-antiretroviral therapy (ART) intervals, respectively). It is likely that some of these couples were in fact HIV serodiscordant. Likewise, among those who were not currently married, some were likely in long-term serodiscordant relationships. Thus, the number of infections that occurred among serodiscordant couples is unknown but likely higher than could be reported with the available data. | Second, although the authors state that acceptance of couples counseling has been low in their cohort, it is unclear from the letter what proportion of the couples identified as serodiscordant in the database were actually aware of their serodiscordant status or had received couples HIV testing and counseling (CHTC). Thus, the contribution of serodiscordant couples to new HIV infections may have been low because of mutual disclosure of HIV status or other effective interventions that reduce sexual risk behaviors and transmission [2–7]. |
Reframing HIV prevention in sub-Saharan Africa using couple-centered approaches
Grabbe KL , Bunnell R . JAMA 2010 304 (3) 346-7 Despite modest prevention successes, 2.7 million new human immunodeficiency virus (HIV) infections occurred worldwide in 2008 and there were at least 2 million HIV-associated deaths.1 Nearly 3 million persons in sub-Saharan Africa are now taking antiretroviral therapy (ART)1—an impressive accomplishment. The urgency of sustaining treatment for these patients, and reaching more than 15 million persons with unmet care and treatment needs,1 underscores the need to reduce HIV incidence. HIV testing and counseling among serodiscordant couples has been associated with reduced transmission, increased condom use, and reduction in sex acts with outside partners2,3 as well as increased ART uptake among pregnant women in antenatal clinics.4 Reframing HIV prevention using a couple-centered approach could help enhance current prevention efforts. | Sexual HIV transmission occurs within couples. Couple types vary widely and may be polygamous or monogamous; casual or formal; between cohabiting or noncohabiting partners; among heterosexual, same-sex, or transgender persons; and among low-risk or higher-risk individuals such as injecting drug users and sex workers. Yet, to best identify viable HIV prevention options, all couple members should know the answers to 2 questions: what is my HIV status and what is my partner's HIV status? | Fundamental as these questions are for HIV prevention, few individuals can answer them. Among responding countries in sub-Saharan Africa, only 22% of adults aged 15 to 49 years know their HIV status.5 Cohabitation ranges from 56% in South Africa to more than 70% of adults in East Africa, and condom use within regular partnerships is very low.6 In East Africa, nearly half of cohabiting HIV-infected individuals are in an HIV-discordant relationship,7 and modeling suggests that 55% to 93% of new HIV infections occur within cohabiting relationships.3,8 Most transmissions occur within couples unaware of their HIV status. |
Increasing access to HIV counseling and testing through mobile services in Kenya: strategies, utilization, and cost-effectiveness
Grabbe KL , Menzies N , Taegtmeyer M , Emukule G , Angala P , Mwega I , Musango G , Marum E . J Acquir Immune Defic Syndr 2010 54 (3) 317-23 INTRODUCTION: This study compares client volume, demographics, testing results, and costs of 3 "mobile" HIV counseling and testing (HCT) approaches with existing "stand-alone" HCT in Kenya. A retrospective cohort of 62,173 individuals receiving HCT between May 2005 and April 2006 was analyzed. Mobile HCT approaches assessed were community-site mobile HCT, semimobile container HCT, and fully mobile truck HCT. Data were obtained from project monitoring data, project accounts, and personnel interviews. RESULTS: Mobile HCT reported a higher proportion of clients with no prior HIV test than stand-alone (88% vs. 58%). Stand-alone HCT reported a higher proportion of couples than mobile HCT (18% vs. 2%) and a higher proportion of discordant couples (12% vs. 4%). The incremental cost-effectiveness of adding mobile HCT to stand-alone services was $14.91 per client tested (vs. $26.75 for stand-alone HCT); $16.58 per previously untested client (vs. $43.69 for stand-alone HCT); and $157.21 per HIV-positive individual identified (vs. $189.14 for stand-alone HCT). CONCLUSIONS: Adding mobile HCT to existing stand-alone HCT seems to be a cost-effective approach for expanding HCT coverage for reaching different target populations, including women and young people, and for identifying persons with newly diagnosed HIV infection for referral to treatment and care. |
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