Health Communication Leads to Better Outcomes for Those Receiving HIV Treatment

Effective health communication helps keep people in treatment throughout the HIV continuum of care, thus leading to more positive health outcomes, according to a new supplement of the Journal of Acquired Immune Deficiency Syndromes (JAIDS).

jaids-cover-002The just-published JAIDS supplement follows the July 2014 edition (Health Communication Strategies in Combination HIV Prevention and Care Programs) that provided evidence of health communication’s positive impact on HIV prevention, care and treatment. Both supplements were sponsored by the Health Communication Capacity Collaborative (HC3), a five-year global communication project funded by the U.S. Agency for International Development (USAID) through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and based at Johns Hopkins Center for Communication Programs (CCP).

The HIV continuum of care begins with HIV testing, linking those who test positive to care, treatment initiation and ongoing adherence and retention in care with the aim of achieving viral suppression. Health communication plays an important role at every step to keep people living with HIV engaged in care and healthy.

“Health communication can motivate people to get tested, get treated and stay on treatment for the rest of their lives. That’s because health communication seeks to address frankly the complex behaviors that influence HIV-related decision-making in the context of HIV,” said the supplement’s co-guest editor, Sten Vermund, MD, PhD, professor and director of Vanderbilt University’s Institute for Global Health. Helen Struthers, PhD, chief operating officer at Anova Health Institute in Johannesburg, South Africa, served as the other co-guest editor.

Health communication can help minimize significant losses at each stage of the HIV continuum of care, thereby contributing to achieving the 90-90-90 global treatment goal set by the Joint United Nations Program on HIV/AIDS and supported by PEPFAR. As the World Health Organization recommendation of treatment for all as soon as possible after testing positive rolls out, the role of health communication will continue to play a crucial role in reaching those most in need and supporting them along their treatment journey.

This JAIDS supplement presents a series of 10 articles that make the case for using health communication in highly diverse HIV contexts in low and middle income settings. The opening article – by lead author Stella Babalola, PhD, Associate Professor at Johns Hopkins Bloomberg School of Public Health – provides a foundation for understanding why health communication leads to successful outcomes along the HIV continuum of care.

Subsequent articles provide real-world examples from Kenya, Lesotho, Mozambique, Senegal, South Africa, Tanzania and Uganda where health communication made a measurable difference in HIV treatment outcomes.

For example, The Potential Impact of Integrated Stigma Mitigation Interventions in Improving HIV/AIDS Service Delivery and Uptake for Key Populations in Senegal – by Carrie Lyons, MPH, and Stefan Baral, MD, MPH, MBA, both with the Bloomberg School – demonstrates how a program aimed at mitigating HIV stigma in Senegal led to less fear in seeking health services over time among men who have sex with men and female sex workers. Other authors include Sosthenes Ketende, MSc, Benjamin Liestman, MSPH, and Karleen Coly, MA, all with the Bloomberg School.

Another article entitled Effective Interpersonal Health Communication for Linkage to Care following HIV Diagnosis in South Africa evaluated a program in South Africa that promoted “precision health communication” between health care providers and clients to address individual client concerns about accessing care. The article was written by Tonderai Mabuto and Salome Charalambous, both with The Aurum Institute and University of the Witwatersrand School of Public Health in Johannesburg, South Africa, along with co-author Chris Hoffmann, MD, MPH, with the Johns Hopkins University School of Medicine and the Bloomberg School.

Several other articles in the supplement may be accessed directly here: http://journals.lww.com/jaids/toc/2017/01011.

USAID-funded HC3 is designed to strengthen capacity to implement state-of-the-art health communication programs. Among the important health areas addressed by HC3 are family planning and reproductive health; maternal, neonatal and child health; HIV; malaria; and infectious diseases such as Zika and Ebola. It is led by CCP in collaboration with Management Sciences for Health, NetHope, Population Services International, Ogilvy Public Relations and Internews. HC3 is also linked to a network of organizations throughout Africa, Asia and Latin America.

An event was held on December 13 with selected authors from the supplement. More information and a link to the recorded event can be found here.

Articles Included in the Supplement:

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Health Communication and the HIV Continuum of Care

First Author: Sten H. Vermund, MD, PhD,  Vanderbilt School of Medicine @VUSM

Additional Authors: Elizabeth C. Mallalieu, MPH, Johns Hopkins Center for Communication Programs @JohnsHopkinsSPH, @HealthCommCap

Lynn M. Van Lith, MPA, Johns Hopkins Center for Communication Programs @JohnsHopkinsSPH, @HealthCommCap

Helen E. Struthers, PhD, ANOVA Health Institute @AnovaHealthSA

This manuscript is the introductory piece to the supplement. Sten H. Vermund, MD, PhD and Helen E. Struthers, PhD are the guest editors.

A framework for health communication across HIV continuum of care and treatment tweet-graphic-4

First Author: Stella Babaloa, Johns Hopkins Bloomberg School of Public Health, @JohnsHopkinsSPH, @HealthCommCap

Additional Authors:

Lynn M. Van Lith, MPA, Johns Hopkins Center for Communication Programs @JohnsHopkinsCCP@HealthCommCap

Elizabeth C. Mallalieu, MPH Johns Hopkins Center for Communication Programs @JohnsHopkinsCCP@HealthCommCap

Zoe R. Packman, BS, Johns Hopkins Center for Communication Programs @JohnsHopkinsCCP

Emily Myers, MPH, Johns Hopkins Center for Communication Programs @JohnsHopkinsCCP, @HealthCommCap

Kim Siefert Ahanda, MPH, United States Agency for International Development @USAIDGH

Emily Harris, MA, United States Agency for International Development @USAIDGH

Tilly Gurman, PhD, Johns Hopkins Center for Communication Programs @JohnsHopkinsCCP, @HealthCommCap

Maria-Elena Figueroa, PhD, Johns Hopkins Center for Communication Programs @JohnsHopkinsCCP, @HealthCommCap

This manuscript introduces a conceptual framework, which can guide the development of effective health communication interventions and activities that aim to impact behaviors across the HIV treatment continuum in low and medium-income countries. The framework includes HIV testing and counseling, linkage to care, and retention in pre-ART and ART initiation in one single stage – linkage to care and treatment, and adherence for viral suppression.

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Counseling framework for HIV-serodiscordant couples on the integrated use of antiretroviral therapy and pre-exposure prophylaxis for HIV prevention

First Author: Jennifer F. Morton, MSW, MPH, Department of Global Health, University of Washington @uwghrc

Additional Authors:

Connie Celum, MD, MPH, Departments of Global Health, Epidemiology, and Medicine, University of Washington @uwghrc

John Njoroge, MSc, Centres for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya @KEMRI_Kenya

Agnes Nakyanzi, BS, Infectious Disease Institute, Makerere University, Kampala, Uganda @IDIMakerere

Imeldah Wakhungu, CO, Centres for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya @KEMRI_Kenya

Edna Tindimwebwa, DMSCH, Kabwohe Clinical Research Center, Kabwohe, Uganda

Snaidah Ongachi, BS, Centres for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya @KEMRI_Kenya

Eric Sedah, BS, Centres for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya @KEMRI_Kenya

Emmanuel Okwero, BS, Infectious Disease Institute, Makerere University, Kampala, Uganda @IDIMakerere

Kenneth Ngure, MPH, PhD, Department of Public and Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya @KEMRI_Kenya

Josephine Odoyo, MPH, Centres for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya @KEMRI_Kenya

Nulu Bulya, MBChB, Infectious Disease Institute, Makerere University, Kampala, Uganda @IDIMakerere

Jessica E. Haberer, MD, MS, Massachusetts General Hospital and Harvard Medical School, Boston, USA @MassGeneralNews @harvardmed

Jared M. Baeten, MD, PhD, Departments of Global Health, Epidemiology, and Medicine, University of Washington @uwghrc

Renee Heffron, PhD, MPH, Partners Demonstration Project Team, Departments of Global Health and Epidemiology, University of Washington @uwghrc

Within the Partners Demonstration Project, a prospective interventional project among serodiscordant couples in Kenya and Uganda,  ART was offered to eligible HIV-positive partners and PrEP to HIV-negative partners prior to ART initiation and through the HIV-positive partner’s first six months of ART use. Individual and group discussions were conducted with counseling staff to elicit the health communication framework and key messages about ART and PrEP delivered to couples.

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Effective interpersonal health communication for linkage following HIV diagnosis in South Africa

First Author: Tonderai Mabuto, MPH, The Aurum Institute, Johannesburg, South Africa; The University of the Witwatersrand School of Public Health, Johannesburg, South Africa @WitsUniversity

Additional Authors: Salome Charalambous, PhD, MBBCh, The Aurum Institute, Johannesburg, South Africa; The University of the Witwatersrand School of Public Health, Johannesburg, South Africa @WitsUniversity

Chris Hoffmann, MD, MPH, The Aurum Institute, Johannesburg, South Africa; Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD @HopkinsMedicine@JohnsHopkinsSPH

This article describes how a strategy of interpersonal communication allows for precision health communication to influence behavior regarding care engagement. The team analyzed one to five transcripts from clients participating in longitudinal counseling sessions from a communication strategy arm of a randomized trial to accelerate entry into care in South Africa.

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Feasibility and acceptability of health communication interventions within a combination intervention strategy for improving linkage and retention in HIV care in Mozambique

First Author: Roberta B. SuttonMPH, ICAP at Columbia University, Mailman School of Public Health, New York, NY @ICAP_ColumbiaU@ColumbiaMSPH

Additional Authors: Maria Lahuerta, PhD, MPH, ICAP at Columbia University and Department of Epidemiology, Mailman School of Public Health, New York, NY @cuepidemiology@ColumbiaMSPH

Fatima Abacassamo, PhD, Center for Collaboration in Health, Maputo, Mozambique

Laurence Ahoua, MD, MSc, MPH, ICAP at Columbia University, Mailman School of Public Health, New York, NY @ICAP_ColumbiaU@ColumbiaMSPH

Maria Tomo, MD, Center for Collaboration in Health, Maputo, Mozambique

Matthew Lamb, PhD, MPH, ICAP at Columbia University and Department of Epidemiology, Mailman School of Public Health, New York, NY @ICAP_ColumbiaU, @cuepidemiology

Batya Elul, PhD, MSc, ICAP at Columbia University and Department of Epidemiology, Mailman School of Public Health, New York, NY @ICAP_ColumbiaU@cuepidemiology

The Engage4Health study assessed the effectiveness of a combination intervention strategy to increase linkage and retention among adults newly diagnosed with HIV in Mozambique. The study included two health communication interventions and three structural interventions. A process evaluation framework was used to assess dose delivered —extent each intervention was delivered as planned—and dose received—participant acceptability — of health communication versus structural interventions in the effectiveness study to under- stand associated benefits and challenges.

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Using m-health for HIV/TB treatment support in Lesotho: Enhancing patient-provider communication in the START study

First Author: Yael Hirsch-Moverman, PhD, MPH, MS, Columbia University, Mailman School of Public Health, Department of Epidemiology @ColumbiaMSPH@cuepidemiology

Additional Authors:

Amrita Daftary, PhD, MPH, Columbia University Mailman School of Public Health, McGill University, University of KwaZulu-Natal, Centre for the AIDS Programme of AIDS Research in South Africa (CAPRISA), Nelson R. Mandela School of Medicine, Durban, South Africa @ColumbiaMSPH@McGillU@UKZN@CAPRISAOfficial

Katharine A. Yuengling, MPH, Columbia University, Mailman School of Public Health, Department of Epidemiology @ColumbiaMSPH@cuepidemiology

Suzue Saito, MPhil, MIA, MA, Columbia University, Mailman School of Public Health, Department of Epidemiology @ColumbiaMSPH@cuepidemiology

Moeketsi Ntoane, BSc, Columbia University, Mailman School of Public Health @ColumbiaMSPH

Koen Frederix, MBBS, MPH, Columbia University, Mailman School of Public Health @ColumbiaMSPH

Llang B. Maama, MD, MIPH, Lesotho Ministry of Health, National Tuberculosis Program

Andrea A. Howard, MD, MS, Columbia University, Mailman School of Public Health, Department of Epidemiology @ColumbiaMSPH@cuepidemiology

mHealth is a promising means of supporting adherence to treatment. The Start TB patients on ART and Retain on Treatment study included real-time adherence support using short-text messaging service (SMS) text messaging and trained village health workers (VHWs). In this article the use and acceptability of mHealth by patients with HIV/tuberculosis and health care providers is described.

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Community mobilization for HIV testing uptake: results from a community randomized trial of a theory-based intervention in rural South Africa Outcomes

First Author: Sheri Lippman, MPH, PhD, Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa @UCSFCAPS@WitsUniversity

Additional Authors:

Torsten Neilands, PhD, Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco @UCSFCAPS

Catherine MacPhail, PhD, School of Rural Medicine, University of New England, Armidale, New South Wales, Australia; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa @UniNewEngland@WitsRHI

Dean Peacock, MSW, Sonke Gender Justice, Cape Town, and School of Public Health, University of Cape Town @SonkeTogether@UCT_news

Suzanne Maman, MHS, PhD, Gillings School of Global Public Health, University of North Carolina at Chapel Hill @UNCpublichealth

Dumisani Rebombo, BA, Sonke Gender Justice, Cape Town, and School of Public Health, University of Cape Town @SonkeTogether@UCT_news

Rhian Twine, MPH, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa @WitsUniversity

Amanda Selin, MHS, Gillings School of Global Public Health, University of North Carolina at Chapel Hill @UNCpublichealth

Hannah Leslie, MPH, PhD, Division of Epidemiology, School of Public Health, University of California, Berkeley @UCBerkeleySPH

Kathleen Kahn, MD, PhD, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden @WitsUniversity@UCGHR

Audrey Pettifor, MPH, PhD, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Gillings School of Global Public Health, University of North Carolina at Chapel Hill @WitsUniversity@UNCpublichealth

HIV testing uptake in South Africa is below optimal levels. Community mobilization (CM) may increase and sustain demand for HIV testing, however, little rigorous evidence exists regarding the effect of CM interventions on HIV testing and the mechanisms of action.

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Characterizing the potential impact of integrated stigma mitigation interventions in improving HIV/AIDS service delivery for key populations in Senegal

First Author: Carrie Lyons, MPH, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health @CPHHR@JohnsHopkinsSPH

Additional Authors:

Sosthenes Ketende, MSc, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health @CPHHR@JohnsHopkinsSPH

Daouda Diouf, MSc, Enda Sante, Dakar, Senegal

Fatou M. Drame, PhD, Enda Sante, Dakar, Senegal, Gaston Berger University, Saint-Louis, Senegal

Benjamin Liestman, MSPH, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health @CPHHR@JohnsHopkinsSPH

Karleen Coly, MA, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health @CPHHR@JohnsHopkinsSPH

Cheikh Ndour, MD, PhD, Division de La Lutte Contre Le Sida et Les IST, Ministry of Health, Senegal

Gnilane Turpin, BA, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health @CPHHR@JohnsHopkinsSPH

Souleymane Mboup, Pharm D, PhD, Laboratoire de Bacteriologie-Virologie, CHU Aristide Le Dantec, Dakar, Senegal

Karim Diop, PH, MPH, Division de La Lutte Contre Le Sida et Les IST, Ministry of Health, Senegal

Coumba Toure-Kane, PhD, USAID, Office of HIV/AIDS, Bureau for Global Health, Arlington, TX @USAIDGH

Delivette Castor, PhD, USAID, Office of HIV/AIDS, Bureau for Global Health, Arlington, TX @USAIDGH

Nafissatou Leye-Diouf, PhD, Laboratoire de Bacteriologie-Virologie, CHU Aristide Le Dantec, Dakar, Senegal

Stefan Baral, MPH, MD, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health @CPHHR@JohnsHopkinsSPH

Men who have sex with men (MSM) and female sex workers (FSW) are consistently shown to have a higher burden of HIV compared with other adults in Senegal. This study, HIV Prevention 2.0, evaluates the impact of the three-tiered integrated stigma mitigation interventions (ISMIs) approach to optimizing HIV service delivery for key populations in Senegal.

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Project Shikamana: Baseline findings from a community empowerment based combination HIV prevention trial among female sex workers in Iringa, Tanzania

First Author: Deanna Kerrigan, PhD, MPH, Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health @JohnsHopkinsSPH

Additional Authors: Jessie Mbwambo, MD, Muhimbili Univeristy of Health and Allied Sciences

Samuel Likindikoki, MD, Muhimbili Univeristy of Health and Allied Sciences

Sarah Beckham, PhD, MPH, Johns Hopkins Bloomberg School of Public Health @JohnsHopkinsSPH

Ard Mwampashi, BA, Muhimbili Univeristy of Health and Allied Sciences

Catherine Shembilu, BA, Muhimbili Univeristy of Health and Allied Sciences

Andrea Mantsios, MHS, Johns Hopkins Bloomberg School of Public Health @JohnsHopkinsSPH

Anna Leddy, MHS, Johns Hopkins Bloomberg School of Public Health @JohnsHopkinsSPH

Wendy Davis, EdM, Johns Hopkins Bloomberg School of Public Health @JohnsHopkinsSPH

Noya Galai, PhD, Johns Hopkins Bloomberg School of Public Health @JohnsHopkinsSPH

Community empowerment approaches have been found to be effective in corresponding to HIV among female sex workers (FSWs) in South Asia and Latin America. To date, limited rigorous evaluations of these approaches have been conducted in sub-Saharan Africa. A phase II community RCT is being conducted in Tanzania to evaluate the effectiveness of a community empowerment-based combination HIV prevention model among a stratified sample of HIV-infected and HIV-uninfected FSWs.

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Development of a National Campaign Addressing South African Men’s Fears about HIV Counseling and Testing and Antiretroviral Treatment

First Author: Neil Orr, MA, Centre for AIDS Development, Research and Evaluation (CADRE)

Additional Authors:

Helen Hajiyiannis, MSocSc, Centre for AIDS Development, Research and Evaluation (CADRE)

Laura Myers, MSW, Centre for AIDS Development, Research and Evaluation (CADRE)

Mzamani Benjamin Makhubele, MA, Centre for AIDS Development, Research and Evaluation (CADRE)

Tselisehang Matekane, BSocSc Hons, Centre for AIDS Development, Research and Evaluation (CADRE)

Richard Delate, MA, Centre for Communication Impact

Lusanda Mahlasela, BSc Hons, Centre for Communication Impact

Brenda Goldblatt, EMBA, Centre for Communication Impact

South African men are less likely to get tested for HIV than women and are more likely to commence antiretroviral treatment (ART) at later stages of disease, default on treatment, and to die from AIDS compared with women. The purpose of this study was to conduct formative research into the ideational and behavioral factors that enable or create obstacles to mens’ uptake of HIV counseling and testing (HCT) and ART. The study consulted men with a goal of developing a communication campaign aimed at improving the uptake of HIV testing and ART initiation among men.

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