Journal of Acquired Immune Deficiency Syndromes & Human Retrovirology

Hazim, Carmen E.; Coutinho, Joana; Crocker, Jonny; Asbjornsdottir, Kristjana; Cruz, Maria; Agostinho, Mery; Amaral, Fernando; de Fatima Cuembelo, Maria; Dinis, Aneth; Fernandes, Quinhas; Gimbel, Sarah; Inguane, Celso; Murgorgo, Filipe; Nassiaca, Regina; Ramiro, Isaias; Sherr, Kenneth

doi: 10.1097/qai.0000000000003510pmid: 39431503

Background:Following the conclusion of a stepped-wedge cluster randomized trial of the Systems Analysis and Improvement Approach (SAIA) to optimize the prevention of mother-to-child HIV transmission cascade in Manica Province, Mozambique, we conducted a natural experiment to test the sustainability of the delivery model with limited financial inputs.Methods:District nurse supervisors were encouraged to continue to facilitate SAIA cycles in subordinate health facilities and provided phone credit and tablet access to upload implementation data. No additional resources (eg, funds for transport, refreshments, or supplies) were provided. Barriers to implementation were collected via conversations with district supervisors.Results:Monthly facilitation of SAIA cycles continued in 11 of 12 (92%) districts and 13 of 36 (36%) facilities through 12 months posttrial, which declined to 10 districts and 10 facilities by the end of the 15-month posttrial period. Despite interest among district supervisors to continue implementation, logistical and financial barriers prevented visits to facilities not in close proximity to district management offices. Turnover of district supervisors resulted in replacements not having knowledge and experience facilitating SAIA. The lack of refreshments for facility staff and limited supplies (pens and papers) were cited as additional barriers.Conclusion:Despite the scalability of the SAIA model, it is susceptible to implementation decay without sufficient health system resources. Additional research is needed to test sustainment strategies that address identified barriers and enable continued delivery of the implementation strategy core components at a sufficient level of fidelity to maintain desired health system improvements and patient-level outcomes.

Wulandari, Luh Putu Lila; Negara, Srila Nirmithya Salita; Mashuri, Yusuf Ari; Wahyuningtias, Siska Dian; Putra, I. Wayan Cahyadi Surya Distira; Subronto, Yanri W.; Ahmad, Riris Andono; Thabrany, Hasbullah; Guy, Rebecca; Law, Matthew; Hammoud, Mohamed; Bavinton, Benjamin B.; Kaldor, John; Medland, Nicholas; Liverani, Marco; Probandari, Ari; Boettiger, David;

Chagomerana, Maganizo B.; Moser, Carlee B.; Kang, Minhee; Umbleja, Triin; Hughes, Michael D.; Campbell, Thomas B.; Krown, Susan E.; Borok, Margaret Z.; Samaneka, Wadzanai; Ngongondo, McNeil; Nyirenda, Mulinda; Langat, Deborah C.; Hoagland, Brenda; Burger, Henriette;

Zhabokritsky, Alice; Klein, Marina; Harris, Marianne; Loutfy, Mona; Guillemi, Silvia; Tan, Darrell H. S.; Falutz, Julian; Andany, Nisha; Guaraldi, Giovanni; Lovblom, Leif Erik; Walmsley, Sharon

doi: 10.1097/qai.0000000000003485pmid: 39431506

Background:Advancements in treatment have resulted in improved survival among people living with HIV. However, additional years of life are not necessarily spent in good health, as frailty tends to develop at a younger age among people living with HIV. We set out to examine the prevalence of frailty and its correlates among older adults living with HIV in Canada, with a primary interest in nadir CD4 count.Methods:We performed a cross-sectional analysis of the Correlates of Healthy Aging in Geriatric HIV (CHANGE HIV) study, a Canadian cohort of people living with HIV aged 65 years or older. Participants were assessed using the Fried Frailty Phenotype at cohort entry, and those meeting ≥3 criteria were characterized as frail. We used Poisson regression with robust standard errors to estimate the association between nadir CD4 count and frailty, as well as age, gender, time since HIV diagnosis, comorbidities, marital status, and loneliness.Results:Among 439 participants included in this analysis (median age 69 years, interquartile ranges 67–73), prevalence of frailty was 16.6%. Frailty was not associated with nadir CD4 count. Not being in a relationship (aRR 2.09, 95% CI 1.01 to 4.30) and greater degree of loneliness (aRR 1.25 per 10 point increase on UCLA loneliness scale, 95% CI 1.09 to 1.44) were associated with frailty.Conclusions:Frailty occurred in 16.6% of older adults living with HIV in this cohort. While nadir CD4 count did not correlate with frailty, being single and lonely did, highlighting the importance of recognizing and addressing these social vulnerabilities among people aging with HIV.

Chandran, Aruna; Feng, Xinyi; Coburn, Sally B.; Kasaie, Parastu; Malone, Jowanna; Horberg, Michael A.; Hogan, Brenna; Rebeiro, Peter F.; Gill, M. John; McGinnis, Kathleen A.; Silverberg, Michael J.; Karris, Maile Young; Napravnik, Sonia; Konkle-Parker, Deborah;

Humphrey, John; Kipchumba, Bett; Alera, Marsha; Sang, Edwin; Musick, Beverly; Muli, Lindah; Kipsang, Justin; Songok, Julia; Yiannoutsos, Constantin; Wools-Kaloustian, Kara

doi: 10.1097/qai.0000000000003487pmid: 39436797

Supplemental Digital Content is Available in the Text.

Lee, Chiara-lyse; Low, Andrea; Kreniske, Philip; Mugurungi, Owen; Ndagije, Felix; Tenthani, Lyson; Abrams, Elaine J.; Teasdale, Chloe A.

doi: 10.1097/qai.0000000000003489pmid: 39431508

Supplemental Digital Content is Available in the Text.

Leong, Trudy D.; Nel, Jeremy; Jamieson, Lise; Osih, Regina; Dawood, Halima; Subedar, Hasina; McCaul, Michael; Johnson, Leigh F.; Cohen, Karen

doi: 10.1097/qai.0000000000003496pmid: 39051791

Supplemental Digital Content is Available in the Text.

Comins, Carly A.; Mcingana, Mfezi; Genberg, Becky; Mulumba, Ntambue; Mishra, Sharmistha; Phetlhu, Deliwe R. ; Shipp, Lillian; Steingo, Joel; Hausler, Harry; Baral, Stefan; Schwartz, Sheree

Auld, Sara C.; Harrington, Kristin R. V.; Nguyen, Minh Ly T.; Colasanti, Jonathan A.; Marconi, Vincent C.; Staitieh, Bashar S.

doi: 10.1097/qai.0000000000003490pmid: 39431510

Supplemental Digital Content is Available in the Text.