Showing papers by "Cheryl Johnson published in 2023"

Abstract A102: Developing faith-based messaging and materials for colorectal cancer screening: Application of boot camp translation within the African Methodist Episcopal Church

Abstract: Introductory sentences: We use boot camp translation (BCT), a validated community based participatory strategy, to elicit input from African Methodist Episcopal (AME) congregants, leadership, and healthcare systems in Atlanta, Georgia to create culturally appropriate and locally relevant colorectal cancer (CRC) faith-based screening messages and materials for AME church communities. Brief description of pertinent experimental procedures: In the United States, CRC is the third-leading cause of cancer death and disproportionately impacts African Americans, highlighting the need for timely screening within this community. African American adults have higher annual rates of new CRC cases and are diagnosed with CRC at younger ages when compared to White adults. Regular CRC screening is pertinent to increasing the chance of early diagnosis and survival, however, African Americans are less likely to get screened for CRC than Whites. Church-based educational programs have been successful in promoting cancer screening, including CRC screening, in various racial and ethnic groups. Churches can serve as key partners in delivering health information as they are among the most trusted institutions within the African American community. As part of a collaboration among the American Cancer Society, the Centers for Disease Control and Prevention, AME churches and Atlanta-based healthcare systems, we will apply BCT to develop and disseminate messaging to promote CRC screening within the AME community. The BCT session aims are twofold: 1) to identify the role of the church in bringing CRC information to the AME community and 2) to define the content and format of effective faith-based CRC messages tailored for the AME community. Summary of new, unpublished data: The BCT workshops will occur in July 2022.Statement of conclusions: We anticipate preliminary findings and materials to be ready by September 2022. Citation Format: Priyanka Gautom, Jamie H. Thompson, Cheryl A. Johnson, Jennifer S. Rivelli, Gloria D. Coronado. Developing faith-based messaging and materials for colorectal cancer screening: Application of boot camp translation within the African Methodist Episcopal Church [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A102.

The future of HIV testing in eastern and southern Africa: Broader scope, targeted services

Abstract: In this Policy Forum, Anna Grimsrud and colleagues discuss the future of HIV testing in eastern and southern Africa, using insights gleaned from a 2021 expert consultation.

Maintaining HIV testing and treatment services in Zambia during COVID-19: a story of success and resilience

Abstract: ABSTRACT Background Coronavirus disease 2019 (COVID-19) is caused by a virus called severe acute respiratory syndrome coronavirus. As countries struggled to control the spread of the virus through among other measures closure of health facilities, repurposing of health care workers, and restrictions on people’s movement, HIV service delivery was affected. Objectives To assess the impact of COVID-19 on HIV service delivery in Zambia by comparing uptake of HIV services before and during COVID-19. Methods We used repeated cross-sectional quarterly and monthly data on HIV testing, HIV positivity rate, people living with HIV initiating ART and use of essential hospital services from July 2018 to December 2020. We assessed quarterly trends and measured proportionate changes comparing periods before and during COVID-19 divided into three different comparison time frames: (1) annual comparison 2019 versus 2020; (2) April to December 2019 versus same period in 2020; and (3) Quarter 1 of 2020 as base period versus each of the other quarters of year 2020. Results Annual HIV testing dropped by 43.7% (95%CI 43.6–43.7) in 2020 compared to 2019 and was similar by sex. Overall, annual recorded number of newly diagnosed PLHIV fell by 26.5% (95% CI 26.37–26.73) in 2020 compared to 2019, but HIV positivity rate was higher in 2020, 6.44% (95%CI 6.41–6.47) compared to 4.94% (95% CI 4.92–4.96) in 2019. Annual ART initiation dropped by 19.9% (95%CI 19.7–20.0) in 2020 compared to 2019 while use of essential hospital services dropped during the early months of COVID-19 April to August 2020 but picked up later in the year. Conclusion While COVID-19 had a negative impact on health service delivery, its impact on HIV service delivery was not huge. HIV policies that were implemented before COVID-19 on testing made it easier to adopt COVID-19 control measures and to continue providing HIV testing services without much disruption.

Cost-effectiveness of Hepatitis C virus self-testing in four settings

Abstract: Globally, there are approximately 58 million people with chronic hepatitis C virus infection (HCV) but only 20% have been diagnosed. HCV self-testing (HCVST) could reach those who have never been tested and increase uptake of HCV testing services. We compared cost per HCV viraemic diagnosis or cure for HCVST versus facility-based HCV testing services. We used a decision analysis model with a one-year time horizon to examine the key drivers of economic cost per diagnosis or cure following the introduction of HCVST in China (men who have sex with men), Georgia (men 40–49 years), Viet Nam (people who inject drugs, PWID), and Kenya (PWID). HCV antibody (HCVAb) prevalence ranged from 1%-60% across settings. Model parameters in each setting were informed by HCV testing and treatment programmes, HIV self-testing programmes, and expert opinion. In the base case, we assume a reactive HCVST is followed by a facility-based rapid diagnostic test (RDT) and then nucleic acid testing (NAT). We assumed oral-fluid HCVST costs of $5.63/unit ($0.87-$21.43 for facility-based RDT), 62% increase in testing following HCVST introduction, 65% linkage following HCVST, and 10% replacement of facility-based testing with HCVST based on HIV studies. Parameters were varied in sensitivity analysis. Cost per HCV viraemic diagnosis without HCVST ranged from $35 2019 US dollars (Viet Nam) to $361 (Kenya). With HCVST, diagnosis increased resulting in incremental cost per diagnosis of $104 in Viet Nam, $163 in Georgia, $587 in Kenya, and $2,647 in China. Differences were driven by HCVAb prevalence. Switching to blood-based HCVST ($2.25/test), increasing uptake of HCVST and linkage to facility-based care and NAT testing, or proceeding directly to NAT testing following HCVST, reduced the cost per diagnosis. The baseline incremental cost per cure was lowest in Georgia ($1,418), similar in Viet Nam ($2,033), and Kenya ($2,566), and highest in China ($4,956). HCVST increased the number of people tested, diagnosed, and cured, but at higher cost. Introducing HCVST is more cost-effective in populations with high prevalence.

Demand creation for HIV testing services: A systematic review and meta-analysis

Abstract: Background HIV testing services (HTS) are the first steps in reaching the UNAIDS 95-95-95 goals to achieve and maintain low HIV incidence. Evaluating the effectiveness of different demand creation interventions to increase uptake of efficient and effective HTS is useful to prioritize limited programmatic resources. This review was undertaken to inform World Health Organization (WHO) 2019 HIV testing guidelines and assessed the research question, “Which demand creation strategies are effective for enhancing uptake of HTS?” focused on populations globally. Methods and findings The following electronic databases were searched through September 28, 2021: PubMed, PsycInfo, Cochrane CENTRAL, CINAHL Complete, Web of Science Core Collection, EMBASE, and Global Health Database; we searched IAS and AIDS conferences. We systematically searched for randomized controlled trials (RCTs) that compared any demand creation intervention (incentives, mobilization, counseling, tailoring, and digital interventions) to either a control or other demand creation intervention and reported HTS uptake. We pooled trials to evaluate categories of demand creation interventions using random-effects models for meta-analysis and assessed study quality with Cochrane’s risk of bias 1 tool. This study was funded by the WHO and registered in Prospero with ID CRD42022296947. We screened 10,583 records and 507 conference abstracts, reviewed 952 full texts, and included 124 RCTs for data extraction. The majority of studies were from the African (N = 53) and Americas (N = 54) regions. We found that mobilization (relative risk [RR]: 2.01, 95% confidence interval [CI]: [1.30, 3.09], p < 0.05; risk difference [RD]: 0.29, 95% CI [0.16, 0.43], p < 0.05, N = 4 RCTs), couple-oriented counseling (RR: 1.98, 95% CI [1.02, 3.86], p < 0.05; RD: 0.12, 95% CI [0.03, 0.21], p < 0.05, N = 4 RCTs), peer-led interventions (RR: 1.57, 95% CI [1.15, 2.15], p < 0.05; RD: 0.18, 95% CI [0.06, 0.31], p < 0.05, N = 10 RCTs), motivation-oriented counseling (RR: 1.53, 95% CI [1.07, 2.20], p < 0.05; RD: 0.17, 95% CI [0.00, 0.34], p < 0.05, N = 4 RCTs), short message service (SMS) (RR: 1.53, 95% CI [1.09, 2.16], p < 0.05; RD: 0.11, 95% CI [0.03, 0.19], p < 0.05, N = 5 RCTs), and conditional fixed value incentives (RR: 1.52, 95% CI [1.21, 1.91], p < 0.05; RD: 0.15, 95% CI [0.07, 0.22], p < 0.05, N = 11 RCTs) all significantly and importantly (≥50% relative increase) increased HTS uptake and had medium risk of bias. Lottery-based incentives and audio-based interventions less importantly (25% to 49% increase) but not significantly increased HTS uptake (medium risk of bias). Personal invitation letters and personalized message content significantly but not importantly (<25% increase) increased HTS uptake (medium risk of bias). Reduced duration counseling had comparable performance to standard duration counseling (low risk of bias) and video-based interventions were comparable or better than in-person counseling (medium risk of bias). Heterogeneity of effect among pooled studies was high. This study was limited in that we restricted to randomized trials, which may be systematically less readily available for key populations; additionally, we compare only pooled estimates for interventions with multiple studies rather than single study estimates, and there was evidence of publication bias for several interventions. Conclusions Mobilization, couple- and motivation-oriented counseling, peer-led interventions, conditional fixed value incentives, and SMS are high-impact demand creation interventions and should be prioritized for programmatic consideration. Reduced duration counseling and video-based interventions are an efficient and effective alternative to address staffing shortages. Investment in demand creation activities should prioritize those with undiagnosed HIV or ongoing HIV exposure. Selection of demand creation interventions must consider risks and benefits, context-specific factors, feasibility and sustainability, country ownership, and universal health coverage across disease areas.

Missed opportunities for HIV testing among those who accessed sexually transmitted infection (STI) services, tested for STIs and diagnosed with STIs: a systematic review and meta‐analysis

Abstract: Of 37.7 million people living with HIV in 2020, 6.1 million still do not know their HIV status. We synthesize evidence on concurrent HIV testing among people who tested for other sexually transmitted infections (STIs).

Use of indirect evidence from HIV self-testing to inform the WHO hepatitis C self-testing recommendation

Abstract: Correspondence to Dr Virginia A Fonner; gfonner@ fhi360. org © World Health Organization 2023. Licensee BMJ. INTRODUCTION Evidence appraisal is a critical component of global health normative guidelines development by the World Health Organization (WHO). Since 2007, WHO’s handbook for guidelines development has outlined a structured and transparent process to ensure guidelines are informed by the latest evidence on intervention effectiveness, feasibility of implementation and considerations on other important elements such as values and preferences of users and providers, resource use, equity and human rights. Typically, guidelines development involves a systematic review of evidence, appraisal of the certainty of evidence in accordance with the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) framework and formulation of recommendations by an independent guidelines development group of experts. These guidelines groups typically comprise providers, academics, programme managers and affected populations with gender and geographical representation. Here, we present an example of a guidelines development process for a WHO recommendation on hepatitis C virus (HCV) selftesting with application of indirect evidence from HIV selftesting (HIVST). 4 Selftesting is a process whereby an individual collects their own specimen, performs a simple rapid test and interprets their own result. WHO first recommended HIVST in 2016. As of July 2022, 98 countries have national policies supportive of HIVST and 52 countries are routinely implementing HIVST to help achieve national and global goals. For HCV, despite recent advances in effective and affordable treatment, globally only 26% of the estimated 58 million people with chronic HCV infection were diagnosed as of 2021. New interventions and additional approaches, such as hepatitis C virus selftesting (HCVST), may help address this diagnosis gap so that more individuals can benefit from lifesaving treatment. To support the rapid development of WHO guidelines on HCVST, complementary sources of information were used, including: (1) a systematic review on the effectiveness of HCVST; (2) an update to a previous systematic review on the effectiveness of HIVST that informed the 2019 WHO recommendation on HIVST; (3) communitybased HCVST usability and acceptability studies and community values and preferences; and (4) HCVST costeffectiveness modelling. Below we outline the process and use of evidence sources with a focus on application of indirect evidence of intervention effectiveness in WHO guidelines development process.

The Future of Pre-Exposure Prophylaxis (PrEP) for HIV Prevention: A Global Qualitative Consultation on Provider Perspectives on New Products and Differentiated Service Delivery.

Abstract: Differentiated service delivery and new products, such as long-acting injectable cabotegravir (CAB-LA) and the dapivirine vaginal ring (DVR), could increase uptake and use of pre-exposure prophylaxis (PrEP) for HIV prevention. We explored PrEP provider perspectives on differentiated PrEP service delivery and new PrEP products to inform World Health Organization (WHO) guidelines and programme implementation. 150 PrEP providers who participated in a WHO survey were randomly selected and 67 were invited for interviews based on geographic representation, provider cadre, gender, experience with community-based PrEP service delivery, and familiarity with new PrEP products. Semi-structured interviews were conducted virtually. Key themes were inductively extracted relating to differentiated service delivery and benefits and concerns regarding new PrEP products. 30 PrEP providers from 24 countries were interviewed. Across regions, providers were supportive of differentiated service delivery to respond to clients' needs and preferences, maintain services during COVID-19, and ensure access for priority populations that may face access challenges. Providers welcomed prospects of offering CAB-LA to their clients but had concerns about HIV testing, costs, and the need for clinic-based services, including staff who can administer injections. Providers felt the DVR was potentially important for some cisgender women, especially young clients and female sex workers, and raised fewer concerns compared to injectable PrEP. Providers' views are critical for the development of guidelines and implementing programmes that will best serve PrEP users. Understanding areas where provider capacities and biases may create barriers can define opportunities for training and support to ensure that providers can deliver effective programmes.