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Mobility and Treatment Outcomes Among People Living with HIV And/Or Tuberculosis in East African Cross-Border Regions

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Mobility and Treatment Outcomes Among People Living with HIV And/Or Tuberculosis in East African Cross-Border Regions Mobility and Treatment Outcomes among People Living with HIV and/or Tuberculosis in East African Cross-Border Regions March 2020 Mobility and Treatment Outcomes among People Living with HIV and/or Tuberculosis in East African Cross-Border Regions Jessie K. Edwards, Grace E. Mulholland, Milissa Markiewicz, Ubaldo Bahemuka, Janet Seeley, William Kidega, Jan De Bont, Zachary Kwena, Bertha Oketch, Brenda Okech, Gertrude Nanyonjo, Jeremiah Kidola, Elialilia Okello MEASURE Evaluation This publication was produced with the support of the United States Agency for International Development (USAID) under University of North Carolina at Chapel Hill the terms of MEASURE Evaluation cooperative agreement 123 West Franklin Street, Suite 330 AID-OAA-L-14-00004. MEASURE Evaluation is implemented by Chapel Hill, NC 27516 USA the Carolina Population Center, University of North Carolina Phone: +1 919-445-9350 at Chapel Hill in partnership with ICF International; John Snow, Inc.; Management Sciences for Health; Palladium; and [email protected] Tulane University. Views expressed are not necessarily those of www.measureevaluation.org USAID or the United States government. TR-20-412 ISBN: 978-1-64232-238-5 ACKNOWLEDGMENTS MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—thanks those agencies for their financial support for this work. We thank Wairimu Gakuo at the USAID/East Africa mission for her support and technical direction of this study. We are especially grateful to the staff of our local research partners—members of the Lake Victoria Consortium for Health Research: Uganda Virus Research Institute and the International AIDS Vaccine Initiative; Kenya Medical Research Institute; Medical Research Council/Uganda Virus Research Institute and the London School of Hygiene and Tropical Medicine; and the Mwanza Intervention Trials Unit. We are also indebted to our data collection teams in each country. We thank MEASURE Evaluation’s knowledge management team for editorial, design, and production services. Last, our sincere thanks to the gracious people of Kenya, Tanzania, and Uganda who participated in the interviews. Cover Fishing boats at Sio Port, Kenya. Photo: Khou Xiong, MEASURE Evaluation. Authors MEASURE Evaluation: Jessie K. Edwards, PhD; Grace E. Mulholland, MSPH; Milissa Markiewicz, MPH Uganda Virus Research Institute and the International AIDS Vaccine Initiative: Brenda Okech; Gertrude Nanyonjo; Jan De Bont; William Kidega Medical Research Council/Uganda Virus Research Institute and the London School of Hygiene and Tropical Medicine: Ubaldo Bahemuka; Janet Seeley Kenya Medical Research Institute: Zachary Kwena; Bertha Oketch Mwanza Intervention Trials Unit: Jeremiah Kidola; Elialilia Okello Suggested citation Edwards, J. K., Mulholland, G. E., Markiewicz, M., Bahemuka, U., Seeley, J., Kidega, W., De Bont, J., y Kwena, Z., Oketch, B., Oketch, B., Nanyonjo, G., Kidola, J., & Okello, E. (2020). Mobility and Treatment Outcomes among People Living with HIV and/or Tuberculosis in East African Cross-Border Regions. Chapel Hill, NC, USA: MEASURE Evaluation, University of North Carolina Mobility and Treatment Outcomes in East African Cross-Border Regions 5 CONTENTS Figures ................................................................................................................................................................................... 7 Tables .................................................................................................................................................................................... 8 Abbreviations ..................................................................................................................................................................... 10 Executive Summary ........................................................................................................................................................... 11 Methods ......................................................................................................................................................................... 11 Key Findings and Recommendations ........................................................................................................................ 12 Conclusion ..................................................................................................................................................................... 15 Introduction ....................................................................................................................................................................... 16 Objectives ...................................................................................................................................................................... 17 Methods .............................................................................................................................................................................. 18 Study Team .................................................................................................................................................................... 18 Study Sites ...................................................................................................................................................................... 18 Study Population and Data Collection Components .............................................................................................. 19 Fieldwork and Training................................................................................................................................................ 22 Sample ............................................................................................................................................................................ 23 Analysis .......................................................................................................................................................................... 24 Results ................................................................................................................................................................................. 28 1. Who was included in the study? ............................................................................................................................. 28 2. How mobile are people living with HIV and/or TB in East Africa? ............................................................... 34 3. What proportion of people in treatment for TB or TB/HIV have resistance to one or more TB drugs? ...................................................................................................................................................................... 49 4. What is the relationship between mobility and access to HIV- and TB-related services? ............................. 51 5. How strong is the association between mobility and HIV and TB treatment outcomes? ............................ 56 6. What is the feasibility and potential public health impact of a regional unique identifier system for people living with HIV, TB, and HIV/TB? ....................................................................................................... 65 7. Which health facilities serve mobile and migrant populations living with HIV, TB, and HIV/TB? ........... 77 Discussion ........................................................................................................................................................................... 79 Summary of Findings in Context ............................................................................................................................... 79 Limitations ..................................................................................................................................................................... 82 Strengths ........................................................................................................................................................................ 82 Conclusion .......................................................................................................................................................................... 83 References ........................................................................................................................................................................... 84 6 Mobility and Treatment Outcomes in East African Cross-Border Regions FIGURES Figure ES1. Health facilities included in the study ....................................................................................................... 11 Figure ES2. Overnight trips after TB and/or HIV diagnosis ..................................................................................... 13 Figure 1. Study sites ........................................................................................................................................................... 19 Figure 2. Proportion of each cohort (HIV, TB/HIV, and TB) born outside the country of the health facility where they were recruited, among 615 respondents to the quantitative survey ....................................................... 34 Figure 3. Proportion of each cohort (HIV, TB/HIV, and TB) born outside the country of the health facility where they were recruited, among 615 respondents to the quantitative survey,
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