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Objective: Retention in HIV care, particularly among postpartum women, is a challenge to national antiretroviral therapy programs. Retention estimates may be underestimated because of unreported transfers. We explored mobility and clinic switching among patients considered lost to follow-up (LTFU). Design: Observational cohort study. Methods: Of 788 women initiating antiretroviral therapy during pregnancy at 6 public clinics in Johannesburg, South Africa, 300 (38.1%) were LTFU (no visit ≥3 months). We manually searched for these women in the South African National Health Laboratory Services database to assess continuity of HIV care. We used geographic information system tools to map mobility to new facilities. Results: Over one-third (37.6%) of women showed evidence of continued HIV care after LTFU. Of these, 67.0% continued care in the same province as the origin clinic. Compared with those who traveled outside of the province for care, these same-province "clinic shoppers" stayed out-of-care longer {median 373 days [interquartile range (IQR): 175-790] vs. 175.5 days (IQR: 74-371)} and had a lower CD4+ cell count on re-entry [median 327 cells/µL (IQR: 196-576) vs. 493 cells/mL (IQR: 213-557). When considering all women with additional evidence of care as engaged in care, cohort LTFU dropped from 38.1% to 25.0%. Conclusions: We found evidence of continued care after LTFU and identified local and national clinic mobility among postpartum women. Laboratory records do not show all clinic visits and manual matching may have been under- or overestimated. A national health database linked to a unique identifier is necessary to improve reporting and patient care among highly mobile populations. [ABSTRACT FROM AUTHOR]

Health communication is a broad term that applies to the fundamental need for practitioners, policy makers, patients, and community members to understand one another around health promotion and health care issues. Whether in a consultation between nurse and patient, a health clinic director's engagement with the health ministry, or a community campaign for encouraging HIV testing, all have critical health communication elements. When people's needs are not perceived by them to be addressed or clients/ patients do not understand what is being communicated, they are unmotivated to engage. Health communication may be deployed at multiple levels to encourage positive behavior change and affect HIV treatment outcomes. As countries move to treatment for all as soon as possible after testing, health communication can help address significant losses at each stage of the HIV continuum of care, thereby contributing to achieving the 90-90-90 global treatment goals. This JAIDS supplement presents compelling studies that are anchored on the health communication exigencies in highly diverse HIV and AIDS contexts in low and middle income settings. Our special focus is health communication needs and challenges within the HIV continuum of care. We introduce the supplement with thumbnails summaries of the work presented by an experienced array of public health, behavioral, and clinical scientists. [ABSTRACT FROM AUTHOR]

This special issue of JAIDS: Journal of Acquired Immune Deficiency Syndromes is devoted to health communication and its role in and impact on HIV prevention and care. The authors in this special issue have tackled a wide swath of topics, seeking to introduce a wider biomedical audience to core health communication principles, strategies, and evidence of effectiveness. Better awareness of health communication strategies and concepts can enable the broader biomedical community to partner with health communication experts in reducing the risk of HIV, sexually transmitted infections, and tuberculosis and maximize linkage and adherence to care. Interventions can be strengthened when biomedical and health communication approaches are combined in strategic and evidence-based ways. Several of the articles in this special issue present the current evidence for health communication's impact. These articles show how far we have come and yet how much further we have to go to document impact convincingly. Examples of the biomedical approaches to HIV control include treatment as prevention, voluntary medical male circumcision, preexposure prophylaxis, sterile needle exchange, opiate substitution therapy, and prevention of mother-to-child transmission. None will succeed without behavior change, which can be facilitated by effective health communication. [ABSTRACT FROM AUTHOR]

The HIV Prevention Trials Network (HPTN) is conducting the HPTN 071 (PopART) study in 21 communities in Zambia and South Africa with support from a consortium of funders. HPTN 071 (PopART) is a community-randomized trial of a combination prevention strategy to reduce HIV incidence in the context of the generalized epidemic of southern Africa. The full PopART intervention strategy is anchored in home-based HIV testing and facilitated linkage of HIV-infected persons to care through community health workers and universal antiretroviral therapy for seropositive persons regardless of CD4+ cell count or HIV viral load. To further reduce the risk of HIV acquisition among uninfected individuals, the study aims to expand voluntary medical male circumcision, diagnosis and treatment of sexually transmitted infections, behavioral counseling, and condom distribution. The full PopART intervention strategy also incorporates promotion of other interventions designed to reduce HIV and tuberculosis transmission, including optimization of the prevention of mother-to-child HIV transmission and enhanced individual and public health tuberculosis services. Success for the PopART strategy depends on the ability to increase coverage for the study interventions whose uptake is a necessary antecedent to a prevention effect. Processes will be measured to assess the degree of penetration of the interventions into the communities. A randomly sampled population cohort from each community will be used to measure the impact of the PopART strategy on HIV incidence over 3 years. We describe the strategy being tested and progress to date in the HPTN 071 (PopART) study. [ABSTRACT FROM AUTHOR]

Early achievements in biomedical approaches for HIV prevention included physical barriers (condoms), clean injection equipment (both for medical use and for injection drug users), blood and blood product safety, and prevention of mother-to-child transmission. In recent years, antiretroviral drugs to reduce the risk of transmission (when the infected person takes the medicines; treatment as prevention) or reduce the risk of acquisition (when the seronegative person takes them; preexposure prophylaxis) have proven to be efficacious. Circumcision of men has also been a major tool relevant for higher prevalence regions such as sub-Saharan Africa. Well-established prevention strategies in the control of sexually transmitted diseases and tuberculosis are highly relevant for HIV (ie, screening, linkage to care, early treatment, and contact tracing). Unfortunately, only slow progress is being made in some available HIV-prevention strategies such as family planning for HIV-infected women who do not want more children and prevention of mother-to-child HIV transmission. Current studies seek to integrate strategies into approaches that combine biomedical, behavioral, and structural methods to achieve prevention synergies. This review identifies the major biomedical approaches demonstrated to be efficacious that are now available. We also highlight the need for behavioral risk reduction and adherence as essential components of any biomedical approach. [ABSTRACT FROM AUTHOR]