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Kenyans have been highly affected by aflatoxicosis for a long time because of excessive exposure to high aflatoxin containing maize-based products. Maize has been the staple food in Kenya which is more highly consumed than any other cereal product. Many countries with strict aflatoxin threshold application, have consumers who still consume maize-based products, which has not gone through testing. The more remote and lower income areas are more affected by untested maize, ending up exposing themselves to Hepatocellular carcinoma which is a health hazard. The study was designed to determine the exposure of aflatoxin in Kiandutu slum which is a marginalized area in Thika, Kiambu County, Kenya. Ninety seven households were used in the study where number of maize-based products obtained from each household was sampled. Quantitative analysis was used to determine the aflatoxin levels by use of ELISA method. Questionnaires were used to collect the consumption data and sampling of maize- based products was done purposively. Aflatoxins were found in 30.93% of maize flour at between 0 to 34.19 [micro]g /kg, 29.33% of composite flour at between 0 to 30.06 [micro]g /kg, 18.67% of maize grain at between 0 and 20.92 [micro]g /kg and 6.97% of Muthokoi at between 0 to 7.14 [micro]g /kg. Across all sampled households, daily consumption of maize-based products in kilograms per body weight was found to be highest in maize flour, followed by whole maize grains, composite flour and muthokoi in that order. Monte Carlo risk simulation was used to generate the quantitative exposure data. Daily maize flour consumption was higher than other maize-based products with a mean of 0.0038 kg/kg bw/day. It also had the highest daily aflatoxin exposure at a mean of 0.0301 [micro]g/kg/bw/day. The percentage level of the health risk was found to be highest through maize flour consumption at 68.65. Results showed that the frequency of consumption of maize-based products is an important contributor to dietary exposure risk. Key words: Aflatoxin, Exposure, Slum, Food safety, Maize-based products, Households, population, INTRODUCTION In Kenya, maize grains are an important staple food in every household [1]. Their daily consumption is at an average of 400g per person while 98kg has been estimated [...]

Objective To estimate the incidence of, and trends in, catastrophic health expenditure in sub-Saharan Africa. Methods We systematically reviewed the scientific and grey literature to identify population-based studies on catastrophic health expenditure in sub-Saharan Africa published between 2000 and 2021. We performed a meta-analysis using two definitions of catastrophic health expenditure: 10% of total household expenditure and 40% of household non-food expenditure. The results of individual studies were pooled by pairwise meta-analysis using the random-effects model. Findings We identified 111 publications covering a total of 1 040 620 households across 31 sub-Saharan African countries. Overall, the pooled annual incidence of catastrophic health expenditure was 16.5% (95% confidence interval, CI: 12.9-20.4; 50 datapoints; 462 151 households; [I.sup.2] = 99.9%) for a threshold of 10% of total household expenditure and 8.7% (95% CI: 7.2-10.3; 84 datapoints; 795 355 households; [I.sup.2] = 99.8%) for a threshold of 40% of household non-food expenditure. Countries in central and southern sub-Saharan Africa had the highest and lowest incidence, respectively. A trend analysis found that, after initially declining in the 2000s, the incidence of catastrophic health expenditure in sub-Saharan Africa increased between 2010 and 2020. The incidence among people affected by specific diseases, such as noncommunicable diseases, HIV/AIDS and tuberculosis, was generally higher. Conclusion Although data on catastrophic health expenditure for some countries were sparse, the data available suggest that a non-negligible share of households in sub-Saharan Africa experienced catastrophic expenditure when accessing health-care services. Stronger financial protection measures are needed. Objectif Evaluer le taux d'incidence et les tendances liees aux depenses de sante catastrophiques en Afrique subsaharienne. Methodes Nous avons procede a une revue systematique de la litterature scientifique et de la litterature grise afin d'identifier les etudes relatives aux depenses de sante catastrophiques, menees aupres des populations d'Afrique subsaharienne entre 2000 et 2021. Nous avons ensuite effectue une meta-analyse en definissant ces depenses de deux manieres: 10% des depenses totales d'un menage et 40% de ses depenses non alimentaires. Les resultats de chaque etude ont ete regroupes par paires de meta-analyses a l'aide d'un modele a effets aleatoires. Resultats Nous avons selectionne 111 publications representant un total de 1 040 620 menages repartis dans 31 pays d'Afrique subsaharienne. Globalement, le taux d'incidence annuel combine des depenses de sante catastrophiques s'elevait a 16,5% (intervalle de confiance de 95%, IC: 12,9-20,4; 50 points de donnees; 462 151 menages; [I.sup.2] = 99,9%) pour un seuil de 10% des depenses totales d'un menage, et a 8,7% (IC de 95%: 7,2-10,3; 84 points de donnees; 795 355 menages; [I.sup.2] = 99,8%) pour un seuil de 40% de ses depenses non alimentaires. Les pays situes au centre de l'Afrique subsaharienne presentaient le taux d'incidence le plus eleve, tandis que ceux situes dans la region meridionale affichaient le taux d'incidence le moins eleve. Une analyse des tendances a permis de decouvrir qu'apres une baisse initiale survenue durant les annees 2000, le taux d'incidence des depenses de sante catastrophiques a augmente entre 2010 et 2020 en Afrique subsaharienne. En outre, chez les personnes souffrant de pathologies specifiques comme les maladies non transmissibles, le VIH/SIDA ou la tuberculose, ce taux d'incidence etait generalement plus eleve. Conclusion Malgre le manque de donnees disponibles a ce propos dans certains pays, les informations en notre possession semblent indiquer qu'une part non negligeable des menages d'Afrique subsaharienne est confrontee a des depenses catastrophiques en matiere d'acces aux soins de sante. Des mesures de protection financiere renforcees sont donc necessaires. Objetivo Estimar la tasa de incidencia y las tendencias de los gastos sanitarios catastroficos en el Africa subsahariana. Metodos Se reviso sistematicamente la literatura cientifica y gris para identificar los estudios poblacionales sobre el gasto sanitario catastrofico en el Africa subsahariana que fueron publicados entre 2000 y 2021. Se realizo un metanalisis empleando dos definiciones de gasto sanitario catastrofico: 10 % del gasto total del hogar y 40 % del gasto no alimentario del hogar. Los resultados de los estudios individuales se agruparon mediante un metanalisis por pares utilizando el modelo de efectos aleatorios. Resultados Se identificaron 111 publicaciones que incluian un total de 1 040 620 hogares en 31 paises del Africa subsahariana. En general, la tasa de incidencia anual conjunta de los gastos sanitarios catastroficos fue del 16,5 % (intervalo de confianza del 95 %, IC: 12,920,4; 50 observaciones estadisticas; 462 151 hogares; [I.sup.2] = 99,9 %) para un umbral del 10 % del gasto total del hogar y del 8,7 % (IC del 95 %: 7,2-10,3; 84 observaciones estadisticas; 795 355 hogares; [I.sup.2] = 99,8 %) para un umbral del 40 % del gasto no alimentario del hogar. Los paises del centro y del sur del Africa subsahariana presentaron la mayor y la menor tasa de incidencia, respectivamente. Un analisis de la tendencia revelo que, tras disminuir inicialmente en la decada de 2000, la tasa de incidencia de los gastos sanitarios catastroficos en el Africa subsahariana aumento entre 2010 y 2020. La tasa de incidencia entre las personas afectadas por enfermedades especificas, como las enfermedades no transmisibles, el VIH/SIDA y la tuberculosis, fue en general mayor. Conclusion Aunque los datos sobre los gastos sanitarios catastroficos de algunos paises fueron escasos, los datos disponibles sugieren que una parte significativa de los hogares del Africa subsahariana sufrieron gastos catastroficos al acceder a los servicios sanitarios. Por lo tanto, se requieren medidas de proteccion financiera mas solidas. [phrase omitted], Introduction In 2019, over 930 million people worldwide experienced financial hardship while obtaining health care and, annually, about 100 million people were impoverished. (1) Out-of-pocket payments, the predominant form of [...]

Introduction High childhood vaccine adherence is critical for disease prevention, and poverty is a key barrier to vaccine uptake. Interventions like microfinance programs that aim to lift individuals out of poverty could thus improve vaccine adherence of the children in the household. BIGPIC Family Program in rural Western Kenya provides group-based microfinance services while working to improve access to healthcare and health screenings for the local community. The aim of the present paper is to evaluate the association between household participation in BIGPIC's microfinance program and vaccine adherence among children in the household. We hypothesize that microfinance group participation will have a positive impact on vaccine adherence among children in the household. Methods From 2018 to 2019, we surveyed a sample of 300 participants from two rural communities in Western Kenya, some of whom were participants in the BIGPIC Family's microfinance program. The primary outcome of interest was vaccine adherence of children in the household. Log-binomial models were used to estimate the relationship between microfinance group participation and vaccine adherence, adjusted for key covariates. We also assessed whether the relationship differed by gender of the adult respondent. Results Microfinance group members were more likely to have all children in their households fully vaccinated [aPR (95% CI): 1.68 (1.20,2.35)] compared to non-microfinance group members. Further, the association was stronger when women were the microfinance members [PR (95% CI): 1.87 (1.27,2.76)] compared to men [PR (95% CI): 1.24 (0.81,1.90)]. Conclusions Microfinance participation was associated with higher childhood vaccine adherence in rural Western Kenya. Microfinance interventions should be further explored as strategies to improve child health and well-being in low- and middle-income countries., Author(s): Jessica E. Deyoe [sup.1] , James Akiruga Amisi [sup.2] [sup.9] , Daria Szkwarko [sup.2] [sup.3] [sup.4] , Dan N. Tran [sup.2] [sup.5] , Maya Luetke [sup.1] , Sina Kianersi [...]

Objective To investigate trends in out-of-pocket health-care payments and catastrophic health expenditure In India by household age composition. Methods We obtained data from four national consumer expenditure surveys and three health-care utilization surveys conducted between 1993 and 2014. Households were divided into five groups by age composition. We defined catastrophic health expenditure as out-of-pocket payments equalling or exceeding 10% of household expenditure. Factors associated with catastrophic expenditure were identified by multivariable analysis. Findings Overall, the proportion of catastrophic health expenditure increased 1.47-fold between the 1993-1994 expenditure survey (12.4%) and the 2011-2012 expenditure survey (18.2%) and 2.24-fold between the 1995-1996 utilization survey (11.1%) and the 2014 utilization survey (24.9%). The proportion increased more in the poorest than the richest quintile: 3.00-fold versus 1.74-fold, respectively, across the utilization surveys. Catastrophic expenditure was commonest among households comprising only people aged 60 years or older: the adjusted odds ratio (aOR) was 3.26 (95% confidence interval, CI:2.76-3.84) compared with households with no older people or children younger than 5 years. The risk was also increased among households with both older people and children (aOR: 2.58; 95% CI: 2.31-2.89), with a female head (aOR: 1.32; 95% CI: 1.19-1.47) and with a rural location (aOR: 1.27; 95% CI: 1.20-1.35). Conclusion The proportion of households experiencing catastrophic health expenditure in India increased over the past two decades. Such expenditure was highest among households with older people. Financial protection mechanisms are needed for population groups at risk for catastrophic health expenditure. Objectif Etudier les tendances en matiere de paiement direct des frais de sante et de depenses de sante catastrophiques en Inde selon la repartition par age des menages. Methodes Nous avons utlllse les donnees de quatre enquetes nationales sur les depenses des consommateurs et de trois enquetes sur le recours aux soins, menees entre 1993 et 2014. Les menages ont ete divises en dnq groupes suivant leur repartition par age. Nous avons defini les depenses de sante catastrophiques comme les paiements directs egaux ou superleurs a 10% des depenses des menages. Les facteurs associes a des depenses catastrophiques ont ete determines par analyse multivariable. Resultats Globalement, la proportion de depenses de sante catastrophiques a ete multlpllee par 1,47 entre l'enquete sur les depenses de 1993-1994 (12,4%) et celle de 2011-2012 (18,2%), et par 2,24 entre l'enquete sur le recours aux soins de 1995-1996 (11,1%) et celle de meme type de 2014 (24,9%). Cette proportion a davantage augmente dans le quintile le plus pauvre que dans le plus riche, puisquelle a ete multipliee respectlvement par 3,00 et par 1,74, selon les enquetes sur le recours aux soins. Les depenses catastrophiques etaient plus courantes dans les foyers composes uniquement de personnes de 60 ans ou plus: le rapport des cotes ajuste (RCa) etait de 3,26 (intervalle de confiance de 95%, IC: 2,76-3,84) par rapport aux foyers sans personnes agees ou avec des enfants de molns de 5 ans. Le risque etait egalement plus eleve pour les foyers composes de personnes agees et d'enfants (RCa: 2,58; IC 95%: 2,31-2,89), pour ceux qui avaient une femme comme chef de famllle (RCa: 1,32; IC 95%: 1,19-1,47) et pour ceux vivant en zone rurale (RCa: 1,27; IC 95%: 1,20-1,35). Conclusion En Inde, la proportion de menages faisant face a des depenses de sante catastrophiques a augmente au cours des deux dernleres decennies, Ces depenses etaient plus elevees pour les menages qui comprenalent des personnes agees. Il est necessalre de mettre en place des mecanismes de protection financiere pour les groupes de population qui courent un risque d'etre confrontes a des depenses de sante catastrophiques. Objetivo Investigar las tendencias en los pagos directos en los servicios sanitarios y el gasto sanitario catastrofico en la India segun la composicion por edad en el hogar. Metodos Se obtuvieron datos de cuatro encuestas nacionales sobre los gastos de los consumidores y tres encuestas de uso de los servicios sanitarios realizadas entre 1993 y 2014. Los hogares se dividieron en cinco grupos segun la composicion por edad. Se definio el gasto sanitario catastrofico como los pagos directos que igualan o superan el 10% del gasto domestico. Los factores asociados con el gasto catastrofico se Identificaron mediante un analisis multivariable. Resultados En general, la proporcion del gasto sanitario catastrofico aumento 1,47 veces entre la encuesta de gastos de 1993-1994 (12,4%) y la encuesta de gastos de 2011-2012 (18,2%) y 2,24 veces entre la encuesta de uso de 1995-1996 (11,1%) y la encuesta de uso de 2014 (24.9%). La proporcion aumento mas en el sector mas pobre que el mas rico: 3,00 veces frente a 1,74 veces, respectivamente, en todas las encuestas de uso. El gasto catastrofico fue mas comun en los hogares en los que solo habia personas de 60 anos o mas: el coeficiente de posibilidades ajustado, (CPa) fue de 3,26 (intervalo de confidencia (IC) del 95%: 2,76-3,84) en comparacion con los hogares sin personas mayores o ninos menores de 5 anos. El riesgo tambien aumento en los hogares con personas mayores y ninos (CPa: 2,58; IC del 95%: 2,31-2,89), con una mujer como cabeza de familia (CPa: 1,32; IC del 95%: 1,19-1,47), y en una zona rural (CPa: 1,27; IC del 95%: 1,20-1,35). Conclusion La proporcion de hogares con un gasto sanitario catastrofico en la India aumento en las ultimas dos decadas.Tal gasto fue mayor en los hogares con personas mayores. Los mecanismos de proteccion financiera son necesarios en los grupos de poblacion en riesgo de gasto sanitario catastrofico., Introduction Financial catastrophe, or severe financial hardship, can occur in all countries at all income levels. However, its effect is greatest in low-income countries and is more severe in middle- [...]

Objective To describe the processes, outcomes and costs of implementing a multi-component, community-based intervention for hypertension among adults aged > 35 years in a large slum in Nairobi, Kenya. Methods The intervention in 2012-2013 was based on four components: awareness-raising; improved access to screening; standardized clinical management of hypertension; and long-term retention in care. Using multiple sources of data, including administrative records and surveys, we described the inputs and outputs of each intervention activity and estimated the outcomes of each component and the impact of the intervention. We also estimated the costs associated with implementation, using a top-down costing approach. Findings The intervention reached 60% of the target population (4049/6780 people), at a cost of 17 United States dollars (US$) per person screened and provided access to treatment for 68% (660/976) of people referred, at a cost of US$ 123 per person with hypertension who attended the clinic. Of the 660 people who attended the clinic, 27% (178) were retained in care, at a cost of US$ 194 per person retained; and of those patients, 33% (58/178) achieved blood pressure control. The total intervention cost per patient with blood pressure controlled was US$ 3205. Conclusion With moderate implementation costs, it was possible to achieve hypertension awareness and treatment levels comparable to those in high-income settings. However, retention in care and blood pressure control were challenges in this slum setting. For patients, the costs and lack of time or forgetfulness were barriers to retention in care. [TEXT NOT REPRODUCIBLE IN ASCII] Objectif Decrire les processus, les resultats et les couts de la mise en oeuvre d'une intervention communautaire a composantes multiples contre l'hypertension aupres d'adultes de 35 ans et plus, dans un grand bidonville de Nairobi, au Kenya. Methodes Cette intervention, menee en 2012-2013, s'est articulee autour de quatre composantes: sensibilisation, amelioration de l'acces au depistage, prise en charge clinique standardisee de l'hypertension; et retention dans les soins sur le long terme. A partir de plusieurs sources de donnees, notamment des registres administratifs et des enquetes, nous avons decrit les intrants et extrants de chaque activite constitutive de cette intervention et avons evalue les resultats de chaque composante ainsi que l'impact general de l'intervention. Nous avons egalement estime les couts associes a la mise en oeuvre, en utilisant une approche de chiffrage descendante. Resultats Cette intervention a touche 60% de la population ciblee (4049/6780 personnes), pour un cout de 17 dollars des Etats-Unis ($US) par personne depistee, et a permis le traitement de 68% (660/976) des personnes orientees vers une clinique, pour un cout de 123 $US par personne hypertendue s'etant rendue a l'une des cliniques. Sur les 660 personnes s'etant rendues a une clinique, 27% (178) ont ete maintenues dans le continuum de soins, pour un cout de 194 $US par personne, et parmi ces patients, 33% (58/178) ont reussi a reguler leur pression arterielle. Le couttotal de l'Intervention par patient ayant reussi a reguler sa pression arterielle a ete estime a 3 205 $US. Conclusion Avec des couts de mise en oeuvre moderes, il a ete possible d'atteindre des niveaux de sensibilisation et de traitement comparables a ceux obtenus dans les pays a revenu eleve. Cependant, la retention dans le continuum de soins et la regulation de la pression arterielle ont constitue de reels defis dans le contexte de ce bidonville. Pour les patients, les couts, le manque de temps et l'oubli des rendez-vous medicaux ont ete des freins pour poursuivre le continuum de soins. [TEXT NOT REPRODUCIBLE IN ASCII] Objetivo Describirlos procesos, resultadosy costes de la Implementacion de una intervencion de varios componentes basada en la comunidad para la hipertension en adultos de > 35 anos en un gran barrio pobre de Nairobi, Kenya. Metodos La intervencion realizada en 2012-2013 se basaba en cuatro elementos: toma de conciencia; acceso mejorado a revisiones; gestion clinica de la hipertension estandarizada; y recepcion de atencion a largo plazo. Utilizando numerosas fuentes de datos, incluidos expedientes administrativos y encuestas, se describieron las contribuciones y el rendimiento de cada actividad de intervencion y se calcularon los resultados de todos los componentes, asi como el impacto de la intervencion. Tambien se calcularon los costes relacionados con la implementacion utilizando un enfoque de gastos descendente. Resultados La intervencion llego al 60% de la poblacion objetivo (4049/6 780 personas), con un coste de 17 dolares estadounidenses (USD) por persona examinada y un acceso al tratamiento del 68% (660/976) de las personas, con un coste de 123 USD por persona con hipertension que acudio a la clinica. De las 660 que acudieron a la clinica, el 27% (178) recibieron atencion, con un coste de 194 USD por persona atendida; y de dichos pacientes, el 33% (58/178) lograron controlar la tension arterial. El coste total de la intervencion por paciente con tension arterial controlada fue de 3 205 USD. Conclusion Con costes moderados de implementacion, fue posible lograr una toma de conciencia sobre la hipertension y niveles de tratamiento comparables con aquellos de lugares con ingresos altos. No obstante, la recepcion de atencion y el control de la tension arterial fueron muy complicados en este barrio pobre. Para los pacientes, el coste y la falta de tiempo o el olvido fueron obstaculos para recibir atencion medica., Introduction Cardiovascular diseases are the leading cause of death globally, killing 17.5 million people per year and 80% of deaths from these diseases occur in low- and middle-income countries. (1,2) [...]

Introduction: The availability of specialized HIV services is limited in rural areas of sub-Saharan Africa where the need is the greatest. Where HIV services are available, people living with HIV (PLHIV) must overcome large geographic, economic and social barriers to access healthcare. The objective of this study was to understand the unique barriers PLHIV face when accessing healthcare compared with those not living with HIV in a rural area of sub-Saharan Africa with limited availability of healthcare infrastructure. Methods: We conducted a population-based cross-sectional study of 447 heads of household on Bugala Island, Uganda. Multiple linear regression models were used to compare travel time, cost and distance to access healthcare, and log binomial models were used to test for associations between HIV status and access to nearby health services. Results: PLHIV travelled an additional 1.9 km (95% CI (0.6, 3.2 km), p =0.004) to access healthcare compared with those not living with HIV, and they were 56% less likely to access healthcare at the nearest health facility to their residence, so long as that facility lacked antiretroviral therapy (ART) services (aRR =0.44, 95% CI (0.24 to 0.83), p =0.011). We found no evidence that PLHIV travelled further for care if the nearest facility supplies ART services (aRR =0.95, 95% CI (0.86 to 1.05), p =0.328). Among those who reported uptake of care at one of two facilities on the island that provides ART (81% of PLHIV and 68% of HIV-negative individuals), PLHIV tended to seek care at a higher tiered facility that provides ART, even when this facility was not their closest facility (30% of PLHIV travelled further than the closest ART facility compared with 16% of HIV-negative individuals), and travelled an additional 2.2 km (p = 0.001) to access that facility, relative to HIV-negative individuals (aRR = 1.91, 95% CI (1.00 to 3.65), p =0.05). Among PLHIV, residential distance was associated with access to facilities providing ART (RR = 0.78, 95% CI (0.61 to 0.99), p = 0.044, comparing residential distances of 3-5 km to 0-2 km; RR = 0.71, 95% CI (0.58 to 0.87), p = 0.001, comparing residential distances of 6-10 km to 0-2 km). Conclusions: PLHIV travel longer distances for care, a phenomenon that may be driven by both the limited availability of specialized HIV services and preference for higher tiered facilities. Keywords: health systems; access to HIV services; HIV antiretroviral drugs; Uganda; spatial analysis; geographic information systems., Introduction Rural regions of sub-Saharan Africa have some of the highest rates of HIV globally, yet the availability of specialized HIV services in those areas is often sparse or non-existent. [...]

Introduction: The availability of specialized HIV services is limited in rural areas of sub‐Saharan Africa where the need is the greatest. Where HIV services are available, people living with HIV (PLHIV) must overcome large geographic, economic and social barriers to access healthcare. The objective of this study was to understand the unique barriers PLHIV face when accessing healthcare compared with those not living with HIV in a rural area of sub‐Saharan Africa with limited availability of healthcare infrastructure. Methods: We conducted a population‐based cross‐sectional study of 447 heads of household on Bugala Island, Uganda. Multiple linear regression models were used to compare travel time, cost and distance to access healthcare, and log binomial models were used to test for associations between HIV status and access to nearby health services. Results: PLHIV travelled an additional 1.9 km (95% CI (0.6, 3.2 km), p=0.004) to access healthcare compared with those not living with HIV, and they were 56% less likely to access healthcare at the nearest health facility to their residence, so long as that facility lacked antiretroviral therapy (ART) services (aRR=0.44, 95% CI (0.24 to 0.83), p=0.011). We found no evidence that PLHIV travelled further for care if the nearest facility supplies ART services (aRR=0.95, 95% CI (0.86 to 1.05), p=0.328). Among those who reported uptake of care at one of two facilities on the island that provides ART (81% of PLHIV and 68% of HIV‐negative individuals), PLHIV tended to seek care at a higher tiered facility that provides ART, even when this facility was not their closest facility (30% of PLHIV travelled further than the closest ART facility compared with 16% of HIV‐negative individuals), and travelled an additional 2.2 km (p=0.001) to access that facility, relative to HIV‐negative individuals (aRR=1.91, 95% CI (1.00 to 3.65), p=0.05). Among PLHIV, residential distance was associated with access to facilities providing ART (RR=0.78, 95% CI (0.61 to 0.99), p=0.044, comparing residential distances of 3–5 km to 0–2 km; RR=0.71, 95% CI (0.58 to 0.87), p=0.001, comparing residential distances of 6–10 km to 0–2 km). Conclusions: PLHIV travel longer distances for care, a phenomenon that may be driven by both the limited availability of specialized HIV services and preference for higher tiered facilities., Introduction Rural regions of sub‐Saharan Africa have some of the highest rates of HIV globally, yet the availability of specialized HIV services in those areas is often sparse or non‐existent. [...]