Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-9 (of 9 Records) |
Query Trace: Kebaabetswe P[original query] |
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Barriers and facilitators to linkage to care and ART initiation in the setting of high ART coverage in Botswana
Kebaabetswe P , Manyake K , Kadima E , Auletta-Young C , Chakalisa U , Sekoto T , Dintwa OM , Mmalane M , Makhema J , Lebelonyane R , Bachanas P , Plank R , Gaolathe T , Lockman S , Holme MP . AIDS Care 2019 32 (6) 1-7 We conducted a qualitative study using focus groups and in-depth interviews to explore barriers to and facilitators of linkage-to-care and antiretroviral treatment (ART) initiation in Botswana. Participants were selected from communities receiving interventions through the Ya Tsie Study. Fifteen healthcare providers and 49 HIV-positive individuals participated. HIV-positive participants identified barriers including stigma, discrimination and overcrowded clinics, and negative staff attitudes; personal factors, such as a lack of acceptance of one's HIV status, non-disclosure, and gender differences; along with lack of social/family support, and certain religious beliefs. Healthcare providers cited delayed test results, poverty, and transport difficulties as additional barriers. Major facilitators were support from healthcare providers, including home visits, social support, and knowing the benefits of ART. Participants were highly supportive of universal ART as a personal health measure. Our results highlighted a persistent structural health facility barrier: HIV-positive patients expressed strong discontent with HIV care/treatment being delivered differently than routine healthcare, feeling inconvenienced and stigmatized by separately designated locations and days of service. This barrier was particularly problematic for highly mobile persons. Addressing this structural barrier, which persists even in the context of high ART uptake, could bring gains in willingness to initiate ART and improved adherence in Botswana and elsewhere. |
Evaluation of sexual risk behavior among study participants in the TDF2 PrEP study among heterosexual adults in Botswana
Gust DA , Soud F , Hardnett F , Malotte CK , Rose C , Kebaabetswe P , Makgekgenene L , Henderson F , Paxton L , Segolodi T , Kilmarx PH . J Acquir Immune Defic Syndr 2016 73 (5) 556-563 OBJECTIVE: Among participants of a clinical trial to test the efficacy of tenofovir/emtricitabine in protecting heterosexual men and women living in Botswana from HIV infection, determine 1) if sexual risk behavior, specifically condomless sex acts and number of sex partners, changed over time, 2) factors associated with condomless sex acts and number of sex partners and 3) the effect of participant treatment arm perception on risk behavior to address the possibility of risk compensation. METHODS: A longitudinal modeling of rates of risk behaviors was used to determine if the rate of condomless sex acts (#acts/person) and rate of sex partners (#partners/person) changed over time and which factors were associated with behavior change. RESULTS: 1200 participants were analyzed over 1 year. There was a 25% decrease in the rate of sex partners among participants sexually active in the last 30 days. The rate of reported condomless sex acts was greater for males (RR=1.34, CI=1.07-1.67) and participants whose sexual debut in years was ≤ 15 years of age (RR=1.65, CI=1.14-2.38) and 16-17 (RR=1.68, CI=1.22-2.31) compared to ≥20 years. Rate of reported sex partners was greater for males (RR=3.67, CI=2.86-4.71) and participants whose age at sexual debut in years was ≤15 (RR=2.92, CI=2.01-4.22) and 16-17 (RR=2.34, CI=1.69-3.24) compared to ≥20. There was no effect of participant treatment arm perception on risk behavior. CONCLUSIONS: Our study of PrEP to prevent HIV infection found no evidence of risk compensation which may have been due to participants' motivations to reduce their risk behaviors and risk-reduction counseling. |
Impact of health system inputs on health outcome: A multilevel longitudinal analysis of Botswana National Antiretroviral Program (2002-2013)
Farahani M , Price N , El-Halabi S , Mlaudzi N , Keapoletswe K , Lebelonyane R , Fetogang EB , Chebani T , Kebaabetswe P , Masupe T , Gabaake K , Auld AF , Nkomazana O , Marlink R . PLoS One 2016 11 (8) e0160206 OBJECTIVE: To measure the association between the number of doctors, nurses and hospital beds per 10,000 people and individual HIV-infected patient outcomes in Botswana. DESIGN: Analysis of routinely collected longitudinal data from 97,627 patients who received ART through the Botswana National HIV/AIDS Treatment Program across all 24 health districts from 2002 to 2013. Doctors, nurses, and hospital bed density data at district-level were collected from various sources. METHODS: A multilevel, longitudinal analysis method was used to analyze the data at both patient- and district-level simultaneously to measure the impact of the health system input at district-level on probability of death or loss-to-follow-up (LTFU) at the individual level. A marginal structural model was used to account for LTFU over time. RESULTS: Increasing doctor density from one doctor to two doctors per 10,000 population decreased the predicted probability of death for each patient by 27%. Nurse density changes from 20 nurses to 25 nurses decreased the predicted probability of death by 28%. Nine percent decrease was noted in predicted mortality of an individual in the Masa program for every five hospital bed density increase. CONCLUSION: Considerable variation was observed in doctors, nurses, and hospital bed density across health districts. Predictive margins of mortality and LTFU were inversely correlated with doctor, nurse and hospital bed density. The doctor density had much greater impact than nurse or bed density on mortality or LTFU of individual patients. While long-term investment in training more healthcare professionals should be made, redistribution of available doctors and nurses can be a feasible solution in the short term. |
Trends and determinants of survival for over 200 000 patients on antiretroviral treatment in the Botswana National Program: 2002-2013
Farahani M , Price N , El-Halabi S , Mlaudzi N , Keapoletswe K , Lebelonyane R , Fetogang EB , Chebani T , Kebaabetswe P , Masupe T , Gabaake K , Auld A , Nkomazana O , Marlink R . AIDS 2016 30 (3) 477-85 OBJECTIVES: To determine the incidence and risk factors of mortality for all HIV-infected patients receiving antiretroviral treatment at public and private healthcare facilities in the Botswana National HIV/AIDS Treatment Programme. DESIGN: We studied routinely collected data from 226 030 patients enrolled in the Botswana National HIV/AIDS Treatment Programme from 2002 to 2013. METHODS: A person-years (P-Y) approach was used to analyse all-cause mortality and follow-up rates for all HIV-infected individuals with documented antiretroviral therapy initiation dates. Marginal structural modelling was utilized to determine the effect of treatment on survival for those with documented drug regimens. Sensitivity analyses were performed to assess the robustness of our results. RESULTS: Median follow-up time was 37 months (interquartile range 11-75). Mortality was highest during the first 3 months after treatment initiation at 11.79 (95% confidence interval 11.49-12.11) deaths per 100 P-Y, but dropped to 1.01 (95% confidence interval 0.98-1.04) deaths per 100 P-Y after the first year of treatment. Twelve-month mortality declined from 7 to 2% of initiates during 2002-2012. Tenofovir was associated with lower mortality than stavudine and zidovudine. CONCLUSION: The observed mortality rates have been declining over time; however, mortality in the first year, particularly first 3 months of antiretroviral treatment, remains a distinct problem. This analysis showed lower mortality with regimens containing tenofovir compared with zidovudine and stavudine. CD4 cell count less than 100 cells/mul, older age and being male were associated with higher odds of mortality. |
Knowledge, attitudes, and experiences of HIV pre-exposure prophylaxis (PrEP) trial participants in Botswana
Toledo L , McLellan-Lemal E , Henderson FL , Kebaabetswe PM . World J AIDS 2015 5 (2) 10-20 Recent clinical trials have shown that a daily dose of oral TDF/FTC pre-exposure prophylaxis (PrEP) is effective in reducing human immunodeficiency (HIV) risk. Understanding trial participants' perspectives about retention and PrEP adherence is critical to inform future PrEP trials and the scale-up and implementation of PrEP programs. We analyzed 53 in-depth interviews conducted in April 2010 with participants in the TDF2 study, a Phase 3, randomized, double-blind, placebo-controlled clinical trial of daily oral TDF/FTC with heterosexual men and women in Francistown and Gaborone, Botswana. We examined participants' knowledge, attitudes, and experiences of the trial, identified facilitators and barriers to enrollment and retention, and compared participant responses by study site, sex, and study drug adherence. Our findings point to several factors to consider for participant retention and adherence in PrEP trials and programs, including conducting pre-enrollment education and myth reduction counseling, providing accurate estimates of participant obligations and side effect symptoms, ensuring participant understanding of the effects of non-adherence, gauging personal commitment and interest in study outcomes, and developing a strong external social support network for participants. |
Variation in attrition at sub-national level: review of the Botswana National HIV/AIDS Treatment (Masa) Program data (2002-2013)
Farahani M , Price N , El-Halabi S , Mlaudzi N , Keapoletswe K , Lebelonyane R , Fetogang EB , Chebani T , Kebaabetswe P , Masupe T , Gabaake K , Auld A , Nkomazana O , Marlink R . Trop Med Int Health 2015 21 (1) 18-27 OBJECTIVE: To evaluate the variation in all-cause attrition (mortality and loss to follow-up (LTFU)) among HIV-infected individuals in Botswana by health district during the rapid and massive scale-up of the National Treatment Program. METHODS: Analysis of routinely collected longitudinal data from 226,030 patients who received ART through the Botswana National HIV/AIDS Treatment Program across all 24 health districts from 2002 to 2013. A time-to-event analysis was used to measure crude mortality and loss to follow-up rates (LTFU). A marginal structural model was used to evaluate mortality and LTFU rates by district over time, adjusted for individual-level risk factors (e.g., age, gender, baseline CD4, year of treatment initiation, and antiretroviral regimen). RESULTS: Mortality rates in the districts ranged from the lowest 1.0 (95% CI 0.9-1.1) in Selibe-Phikwe, to the highest 5.0 (95% CI 4.0-6.1), in Mabutsane. There was a wide range of overall LTFU across districts, including rates as low as 4.6 (95% CI 4.4-4.9) losses per 100 person-years in Ngamiland, and 5.9 (95% CI 5.6-6.2) losses per 100 person-years in South East, to rates as high as 25.4 (95% CI 23.08-27.89) losses per 100 person-years in Mabutsane and 46.3 (95% CI 43.48-49.23) losses per 100 person-years in Okavango. Even when known risk factors for mortality and LTFU were adjusted for, district was a significant predictor of both mortality and LTFU rates CONCLUSION: We found statistically significant variation in attrition (mortality and LTFU) and data quality among districts. These findings suggest that district-level contextual factors affect retention in treatment. Further research needs to investigate factors that can potentially cause this variation. |
Factors associated with adherence and concordance between measurement strategies in an HIV daily oral tenofovir/emtricitibine as pre-exposure prophylaxis (Prep) clinical trial, Botswana, 2007-2010
Kebaabetswe PM , Stirratt MJ , McLellan-Lemal E , Henderson FL , Gray SC , Rose CE , Williams T , Paxton LA . AIDS Behav 2014 19 (5) 758-69 This study examined study product adherence and its determinants in the Botswana oral pre-exposure prophylaxis efficacy trial. Among the 1,219 participants, the mean adherence by pill count and 3-day self-report was 94 % for each. In multivariable models, pill count adherence was significantly associated with adverse events (nausea, dizziness, vomiting) (RR 0.98 95 % CI 0.98-1.00; p = 0.03) and side effect concerns (RR 0.98 95 % CI 0.96-0.99; p = 0.01). Self-reported adherence was significantly associated with having an HIV-positive partner (RR 1.02 95 % CI 1.00-1.04; p = 0.02) and Francistown residence (RR 0.98 95 % CI 0.96, 0.99; p = 0.0001). Detectable drug concentrations showed modest associations with self-report and pill count adherence, and drug levels were higher among those self-reporting 100 % adherence than those reporting <100 %. Most common adherence barriers involved refill delays and other logistic challenges; cellphone alarm reminder use was the most common facilitator. |
Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana
Thigpen MC , Kebaabetswe PM , Paxton LA , Smith DK , Rose CE , Segolodi TM , Henderson FL , Pathak SR , Soud FA , Chillag KL , Mutanhaurwa R , Chirwa LI , Kasonde M , Abebe D , Buliva E , Gvetadze RJ , Johnson S , Sukalac T , Thomas VT , Hart C , Johnson JA , Malotte CK , Hendrix CW , Brooks JT . N Engl J Med 2012 367 (5) 423-34 BACKGROUND: Preexposure prophylaxis with antiretroviral agents has been shown to reduce the transmission of human immunodeficiency virus (HIV) among men who have sex with men; however, the efficacy among heterosexuals is uncertain. METHODS: We randomly assigned HIV-seronegative men and women to receive either tenofovir disoproxil fumarate and emtricitabine (TDF-FTC) or matching placebo once daily. Monthly study visits were scheduled, and participants received a comprehensive package of prevention services, including HIV testing, counseling on adherence to medication, management of sexually transmitted infections, monitoring for adverse events, and individualized counseling on risk reduction; bone mineral density testing was performed semiannually in a subgroup of participants. RESULTS: A total of 1219 men and women underwent randomization (45.7% women) and were followed for 1563 person-years (median, 1.1 years; maximum, 3.7 years). Because of low retention and logistic limitations, we concluded the study early and followed enrolled participants through an orderly study closure rather than expanding enrollment. The TDF-FTC group had higher rates of nausea (18.5% vs. 7.1%, P<0.001), vomiting (11.3% vs. 7.1%, P=0.008), and dizziness (15.1% vs. 11.0%, P=0.03) than the placebo group, but the rates of serious adverse events were similar (P=0.90). Participants who received TDF-FTC, as compared with those who received placebo, had a significant decline in bone mineral density. K65R, M184V, and A62V resistance mutations developed in 1 participant in the TDF-FTC group who had had an unrecognized acute HIV infection at enrollment. In a modified intention-to-treat analysis that included the 33 participants who became infected during the study (9 in the TDF-FTC group and 24 in the placebo group; 1.2 and 3.1 infections per 100 person-years, respectively), the efficacy of TDF-FTC was 62.2% (95% confidence interval, 21.5 to 83.4; P=0.03). CONCLUSIONS: Daily TDF-FTC prophylaxis prevented HIV infection in sexually active heterosexual adults. The long-term safety of daily TDF-FTC prophylaxis, including the effect on bone mineral density, remains unknown. (Funded by the Centers for Disease Control and Prevention and the National Institutes of Health; TDF2 ClinicalTrials.gov number, NCT00448669 .). |
Process maps in clinical trial quality assurance
Rosen DH , Johnson S , Kebaabetswe P , Thigpen M , Smith DK . Clin Trials 2009 6 (4) 373-7 BACKGROUND: A process map is a diagram showing the sequential steps and decisions used to accomplish a procedure from start to finish. Process maps are a standard tool in continuous improvement efforts. They have not been used routinely in clinical trials although they are well suited to display trial processes. PURPOSE: We present the use of process maps as a tool to visualize and to monitor the correctness of trial work flows. We show that process maps can be used to assure that trial processes are conducted according to the SOP. METHODS: We describe how a process map is made. We then derive process maps from two sources: the SOP and trial procedures as currently implemented. We compare these maps to each other, using the SOP maps as the gold standard, to check that work is done according to the written procedures. RESULTS: Eight process maps were produced from each source. 172 differences were found between the SOP maps and the walkthrough maps. Differences included the addition of extra steps, order errors, step mistakes, and ambiguities. LIMITATIONS: These process maps focused only on clinic procedures, so interactions with other trial components were not considered. The maps were made after the trial started, which may have biased their content and use. CONCLUSION: Process maps are a simple tool to check if clinical trial processes are operating as designed and offer an effective means to identify and correct such divergences. Further research should focus on using process maps in the design phase of trials, analyzing the cost to benefit ratio for process maps, and linking the analysis of the process map to monitor queries to quantify the improvement gained from using this technique. |
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