Implementing an integrated community based health systems strengthening approach to improve HIV survival in Northern Togo

Kevin P. Fiori, Hayley M. Belli, Molly E. Lauria, Lisa R. Hirschhorn, Jennifer Schechter, Emily Hansman, Nandita Rajshekhar, Venance Katin, Sesso Gbeleou, Meskerem Grunitsky-Bekele, Vincent Palokinam Pitche

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Abstract

To disseminate lessons learned from the implementation experience of a public-private sector partnership, we describe a comprehensive HIV/AIDS program including 5-year survival outcomes for individuals who initiated antiretroviral therapy (ART) treatment in Togo from 2010 to 2015. A retrospective case study analysis was conducted from a cohort of patients receiving ART at an HIV/AIDS care clinic in Kara Region, Togo. Kaplan-Meier curves with Log rank tests were used to compare estimated survival curves by demographic and clinical characteristics. Associations were described between survival probability and age, gender, World Health Organization (WHO) disease stage, and timing of ART initiation. Cox proportional hazard model was used to determine predictors of mortality. After approximately five-years since ART initiation (1780 days), there were 114 deaths, with a survival probability of 75.3% (95% CI: 70.3–80.6%). Participants with advanced WHO disease stage were more likely at risk of death relative to patients categorized as WHO Stage 1, with Stage 4 approximately 9 times more likely (aHR 9.22, 95% CI 4.29–19.84). Our study suggests that delivering comprehensive HIV care through a private-public partnership may serve as a model to expand and improve HIV/AIDS care as well as high quality primary care.

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Community Health Planning
Togo
WHO
HIV
AIDS
Survival
Public-Private Sector Partnerships
health
Acquired Immunodeficiency Syndrome
community
Disease
death
public private partnership
Therapeutics
Quality of Health Care
private sector
Proportional Hazards Models
mortality
Primary Health Care
Retrospective Studies

Keywords

  • community health workers
  • Health systems strengthening
  • HIV/AIDS
  • Togo

ASJC Scopus subject areas

  • Health(social science)
  • Social Psychology
  • Public Health, Environmental and Occupational Health

Cite this

Implementing an integrated community based health systems strengthening approach to improve HIV survival in Northern Togo. / Fiori, Kevin P.; Belli, Hayley M.; Lauria, Molly E.; Hirschhorn, Lisa R.; Schechter, Jennifer; Hansman, Emily; Rajshekhar, Nandita; Katin, Venance; Gbeleou, Sesso; Grunitsky-Bekele, Meskerem; Pitche, Vincent Palokinam.

In: AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 01.01.2019.

Research output: Contribution to journalArticle

Fiori, Kevin P. ; Belli, Hayley M. ; Lauria, Molly E. ; Hirschhorn, Lisa R. ; Schechter, Jennifer ; Hansman, Emily ; Rajshekhar, Nandita ; Katin, Venance ; Gbeleou, Sesso ; Grunitsky-Bekele, Meskerem ; Pitche, Vincent Palokinam. / Implementing an integrated community based health systems strengthening approach to improve HIV survival in Northern Togo. In: AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV. 2019.
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