Browsing by Author "Nanyangwe M"

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    Preferences for transitional HIV care among people living with HIV recently released from prison in Zambia: a discrete choice experiment.
    (2021-Oct) Ostermann J; Yelverton V; Smith HJ; Nanyangwe M; Kashela L; Chisenga P; Mai V; Mwila C; Herce ME; Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.; Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.; School of Public Health & Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.; Center for Health Policy & Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina, USA.; Institute for Global Health & Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.; South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, South Carolina, USA.
    INTRODUCTION: No studies from sub-Saharan Africa have attempted to assess HIV service delivery preferences among incarcerated people living with HIV as they transition from prisons to the community ("releasees"). We conducted a discrete choice experiment (DCE) to characterize releasee preferences for transitional HIV care services in Zambia to inform the development of a differentiated service delivery model to promote HIV care continuity for releasees. METHODS: Between January and October 2019, we enrolled a consecutive sample of 101 releasees from a larger cohort prospectively following 296 releasees from five prisons in Zambia. We administered a DCE eliciting preferences for 12 systematically designed choice scenarios, each presenting three hypothetical transitional care options. Options combined six attributes: (1) clinic type for post-release HIV care; (2) client focus of healthcare workers; (3) transitional care model type; (4) characteristics of transitional care provider; (5) type of transitional care support; and (6) HIV status disclosure support. We analysed DCE choice data using a mixed logit model, with coefficients describing participants' average ("mean") preferences for each option compared to the standard of care and their distributions describing preference variation across participants. RESULTS: Most DCE participants were male (n = 84, 83.2%) and had completed primary school (n = 54, 53.5%), with 29 (28.7%) unemployed at follow-up. Participants had spent an average of 8.2 months in the community prior to the DCE, with 18 (17.8%) reporting an intervening episode of re-incarceration. While we observed significant preference variation across participants (p < 0.001 for most characteristics), releasees were generally averse to clinics run by community-based organizations versus government antiretroviral therapy clinics providing post-release HIV care (mean preference = -0.78, p < 0.001). On average, releasees most preferred livelihood support (mean preference = 1.19, p < 0.001) and HIV care support (mean preference = 1.00, p < 0.001) delivered by support groups involving people living with HIV (mean preference = 1.24, p < 0.001). CONCLUSIONS: We identified preferred characteristics of transitional HIV care that can form the basis for differentiated service delivery models for prison releasees. Such models should offer client-centred care in trusted clinics, provide individualized HIV care support delivered by support groups and/or peer navigators, and strengthen linkages to programs providing livelihood support.