1
|
Beznos B, Collins B, Tak C, Catalano H, Garcia N, Sleath B. Improving young patient - practitioner communication about sexual health during medical visits. Int J Adolesc Med Health 2024; 36:335-341. [PMID: 38946489 DOI: 10.1515/ijamh-2023-0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 06/11/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVES Young people face barriers that lead to gaps in sexual and reproductive health care communications. Issues such as discomfort discussing sexual health lead to inadequate delivery of services resulting in unintended pregnancies and STIs. Closing this communication gap between patients and health care practitioners would improve communication and health outcomes. The objective of this study was to gain feedback from focus groups about: (a) barriers and facilitators to communication surrounding sexual health and (b) the feasibility and acceptability of a question prompt list (QPL) and informational video emphasizing asking questions about sexual health during medical visits as tools young people could use to be more involved during visits. METHODS Three focus groups were conducted: two with young adults (n=14) and one with practitioners (n=5) of sexual/reproductive health care services. Practitioners were recruited from healthcare clinics. RESULTS Young adults were aged 18-22 years old. Participants identified barriers to communication such as embarrassment over sexual health topics and practitioner assumptions about patients' base of knowledge. A facilitator to communication was patient-friendly language. Focus group participants offered suggestions on how to improve the QPL as well as themes that should be covered in an educational video. Participants viewed the QPL and educational video as useful for encouraging conversations between patient and practitioner. CONCLUSIONS Many barriers obstruct communication between young adults and practitioners on topics relating to sexual health. Both the QPL and an educational video could be used to enhance patient-practitioner communication.
Collapse
Affiliation(s)
- Bethany Beznos
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brendan Collins
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Casey Tak
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Hannah Catalano
- School of Health and Applied Human Sciences, University of North Carolina Wilmington, Wilmington, NC, USA
| | - Nacire Garcia
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
2
|
Akila D, Oluwasegun A, Bose K, Omotoso O, Adefila A, Mwaikambo L. Improving the Quality of Adolescent and Youth-Friendly Health Services Through Integrated Supportive Supervision in Four Nigerian States. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2200169. [PMID: 38621816 PMCID: PMC11111107 DOI: 10.9745/ghsp-d-22-00169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 03/06/2023] [Indexed: 04/17/2024]
Abstract
BACKGROUND Although the unique sexual and reproductive health needs of adolescents and youth (AY) are widely recognized, the challenge remains how to integrate adolescent- and youth-friendly health services (AYFHS) effectively within a systems-based approach that is both feasible and scalable. This article provides preliminary evidence from 4 Nigerian states that sought to overcome this challenge by implementing capacity-strengthening approaches centered around a shortened quality assurance (QA) tool that has become part of the state health system's routine supportive supervision process and follow-up quality improvement (QI) activities. METHODS A shortened QA tool was administered to assess and track the performance of 130 high-volume health facilities across 5 domains to serve its AY population with quality contraceptive services. Facility-based providers (N=198) received training on adolescent and youth sexual and reproductive health, AYFHS, and long-acting reversible contraceptive methods. To corroborate checklist findings, we conducted exit interviews with 754 clients (aged 15-24 years) who accessed contraceptive services from the facilities that met the World Health Organization's minimum standards for quality AYFHS. RESULTS In the 4 states, the QA tool was applied at baseline and 2 rounds, accompanied by QI capacity strengthening after each round. At baseline, only 12% of the 130 facilities in the 4 states scored met the minimum quality standards for AYFHS. After 2 rounds, 88% of the facilities met the minimum standards. AY client volume increased over this same period. All 4 states showed great improvements; however, the achievements varied by state. The exit interview feedback supported client satisfaction with the services provided to AY. CONCLUSION Integrating QA followed by QI within Nigeria's family planning supportive supervision system is not only feasible but also impacts the quality of AYFHS and contraceptive uptake by clients aged 15-24 years.
Collapse
Affiliation(s)
- Dorcas Akila
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria.
| | - Akinola Oluwasegun
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria
| | - Krishna Bose
- The Challenge Initiative, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | - Olukunle Omotoso
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria
| | - Adewale Adefila
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria
| | - Lisa Mwaikambo
- The Challenge Initiative, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| |
Collapse
|
3
|
Hensen B, Floyd S, Phiri MM, Schaap A, Sigande L, Simuyaba M, Mwenge L, Zulu-Phiri R, Mwape L, Fidler S, Hayes R, Simwinga M, Ayles H. The impact of community-based, peer-led sexual and reproductive health services on knowledge of HIV status among adolescents and young people aged 15 to 24 in Lusaka, Zambia: The Yathu Yathu cluster-randomised trial. PLoS Med 2023; 20:e1004203. [PMID: 37083700 PMCID: PMC10121029 DOI: 10.1371/journal.pmed.1004203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 02/20/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND The growing population of adolescents and young people (AYP) aged 15 to 24 in sub-Saharan Africa face a high burden of HIV in many settings. Unintended pregnancies among adolescent girls in the region remain high. Nonetheless, the sexual and reproductive health (SRH) service needs of AYP have remained underserved. We conducted a cluster-randomised trial (CRT) to estimate the impact of community-based, peer-led SRH service provision on knowledge of HIV status and other SRH outcomes, including met need for contraceptives. METHODS AND FINDINGS Yathu Yathu was a cluster-randomised trial (CRT) conducted from 2019 to 2021 in 2 urban communities in Lusaka, Zambia. The communities were divided into 20 zones (approximately 2,350 AYP/zone) that were randomly allocated to the Yathu Yathu intervention or control arm. In each intervention zone, a community-based hub, staffed by peer support workers, was established to provide SRH services. In 2019, a census was conducted in all zones; all consenting AYP aged 15 to 24 were given a Yathu Yathu card, which allowed them to accrue points for accessing SRH services at the hub and health facility (intervention arm) or the health facility only (control arm). Points could be exchanged for rewards, thus acting as an incentive to use SRH services in both arms. We conducted a cross-sectional survey in 2021 to estimate the impact of Yathu Yathu on the primary outcome: knowledge of HIV status (self-reporting living with HIV or HIV testing in the last 12 months) and secondary outcomes, including use of pre-exposure prophylaxis (PrEP) in the last 12 months, current use of antiretroviral therapy (ART), and met need for contraceptive services. The sampling was stratified on sex and age group, and we analysed data at cluster-level using a two-stage process recommended for CRTs with <15 clusters/arm. A total of 1,989 AYP consented to participate in the survey (50% male); consent was similar across arms (63% consent/arm). Across zones, knowledge of HIV status ranged from 63.6% to 81.2% in intervention zones and 35.4% to 63.0% in control zones. Adjusting for age, sex, and community, knowledge of HIV status was higher in the intervention arm compared to control (73.3% versus 48.4%, respectively, adjusted prevalence ratio (PR) 1.53 95% CI 1.36, 1.72; p < 0.001). By age and sex, results were similar. There was no evidence for impact on any secondary outcomes, including current use of ART and met need for contraceptives. There were no adverse events reported in either arm. A key limitation of our trial is that approximately 35% of the AYP randomly selected for participation in the endline survey could not be reached. CONCLUSIONS Delivering community-based, peer-led SRH services increased knowledge of HIV status among AYP, both males and females, compared with the control arm. Scaling up the highly effective Yathu Yathu strategy has the potential to make a substantial contribution to increasing access to HIV prevention and care services for young people. However, additional implementation research is needed to understand how to improve uptake of broader SRH services, beyond uptake of HIV testing. TRIAL REGISTRATION ISRCTN75609016, clinicaltrials.gov number NCT04060420.
Collapse
Affiliation(s)
- Bernadette Hensen
- Department of Public Health, the Institute of Tropical Medicine, Antwerp, Belgium
- Department of Clinical Research, the London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sian Floyd
- Department of Infectious Disease Epidemiology, the London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Ab Schaap
- Department of Infectious Disease Epidemiology, the London School of Hygiene and Tropical Medicine, London, United Kingdom
- Zambart, Lusaka, Zambia
| | | | | | | | | | | | - Sarah Fidler
- Department of Infectious Disease, Imperial College London, United Kingdom
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, the London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Helen Ayles
- Department of Clinical Research, the London School of Hygiene and Tropical Medicine, London, United Kingdom
- Zambart, Lusaka, Zambia
| |
Collapse
|
4
|
Preferences for accessing sexual and reproductive health services among adolescents and young adults living with HIV/AIDs in Western Kenya: A qualitative study. PLoS One 2022; 17:e0277467. [PMID: 36383570 PMCID: PMC9668131 DOI: 10.1371/journal.pone.0277467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/27/2022] [Indexed: 11/17/2022] Open
Abstract
Despite the need, adolescents and young adults (AYAs) in resource-limited settings have limited access to sexual and reproductive health (SRH) care services for improved health outcomes. This is worse for AYAs living with HIV in resource-limited settings where much is unknown about contexts and issues inhibiting access to SRHs. We explored adolescents', healthcare workers, and caregivers' preferences for access to sexual and reproductive health services for adolescents and young adults living with HIV. We conducted 30 in-depth interviews and 8 focus group discussions among a subset of AYA aged 14-24 living with HIV, healthcare workers, and caregivers/parents. We recruited participants from Lumumba Sub-County Hospital (KLM) and Kisumu County Referral Hospitals in Kisumu County (KCH). Trained and experienced qualitative research assistants 5-10 years older than the adolescents conducted interviews and facilitated discussions using guides designed to elicit detailed views and perspectives on sex and sexuality, access to SRH services, challenges of AYA living with HIV, and potential interventions to improve access to SRH services. Audio files were transcribed verbatim and translated to English where necessary before coding and analysis. We applied constant comparative analysis for theme and content to arrive at our conclusions. Our analysis yielded two main themes: preferences for a venue for SRH services and choices for qualities of an SRH counsellor. We found that AYAs generally preferred receiving SRH services to be co-situated within clinical facilities. We also observed gender differences in the qualities of SRH providers, with male AYAs preferring older male service providers compared to females who preferred younger female providers close to their age. The study highlighted the preferences of AYAs for accessing SRH, which need to be considered when designing their health programs. Further, AYAs seem to endite health systems to individualize access to SRH for AYAs living with HIV by providing a combination of attributes that meet individual preferences.
Collapse
|
5
|
Vyas K, Louie-Poon S, Meherali S. Development of an adolescent advisory group to inform sexual and reproductive health research for first- and second-generation immigrant adolescents in Canada: A community-based participatory action research study. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:930314. [PMID: 36388150 PMCID: PMC9662937 DOI: 10.3389/frph.2022.930314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023] Open
Abstract
Background Despite the growing evidence supporting the benefit of engaging adolescents in research, the active engagement of immigrant adolescents in research is limited. Further, when exploring the sexual and reproductive health (SRH) needs of immigrant adolescents, utilization of adolescent advisory groups is finite. This study aimed to train and evaluate engagement of an adolescent advisory group (AAG) to inform SRH needs of immigrant adolescents in Canada. Methods Using purposive sampling, 13 AAG members were recruited into this study. Members were trained in content related to SRH needs of adolescents and various research methodologies such as conducting a scoping review and qualitative interviews with adolescent participants. After 10 months of member engagement, their experiences were evaluated to identify areas of success and areas for improvement. These data were collected using the Public and Patient Engagement Evaluation Tool, which consisted of a Likert survey and open-ended questions, and analyzed in accordance to the Patient Engagement in Research (PEIR) framework. Findings Ten members completed the evaluation survey. Likert survey responses were primarily positive. Majority of members showed positive demonstrations regarding various components of the PEIR framework, including contributions, support, research environment, and feeling valued. Conclusion Findings illustrated that immigrant AAGs are constructive to informing SRH research. Not only can research teams benefit, but members are also empowered. This study provided the foundation for future immigrant adolescent engagement in research and knowledge translation, and effective means of evaluating engagement by utilizing the PEIR framework.
Collapse
Affiliation(s)
| | | | - Salima Meherali
- Edmonton Clinic Health Academy, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
6
|
Shewarega ES, Fentie EA, Asmamaw DB, Negash WD, Fetene SM, Teklu RE, Aragaw FM, Alemu TG, Eshetu HB, Belay DG. Sexually transmitted infections related care-seeking behavior and associated factors among reproductive age women in East Africa: a multilevel analysis of demographic and health surveys. BMC Public Health 2022; 22:1714. [PMID: 36085047 PMCID: PMC9463758 DOI: 10.1186/s12889-022-14120-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 09/01/2022] [Indexed: 12/04/2022] Open
Abstract
Background Sexually transmitted infections are serious global public health issue, and their consequences contribute significantly to population morbidity and mortality, especially in Sub-Saharan Africa. However, there is limited information about the sexually transmitted infections related care-seeking behavior in East Africa. Therefore, this study aimed to assess the pooled prevalence of sexually transmitted infections related care-seeking behavior, and associated factors among reproductive-age women in East Africa using the recent Demographic and Health Survey. Methods This study was based on recent Demographic and Health Survey of 8 East African countries from 2008/09 to 2018/2019. A total weighted sample of 12,004 reproductive-age women who reported sexually transmitted infections or symptoms of sexually transmitted infections in the last 12 months wereincluded. A multi-level mixed-effect logistic regression model was used and a P-value of < 0.05 was considered a statistically significant level for identification of individual and community level factors and AOR with a 95% l CI was computed. Result The overall prevalence of sexually transmitted infections related care-seeking behavior among reproductive-age women in East African countries was 54.14% [95% CI: 53.25%, 55.03%]. In multilevel analysis: being age 25–34 [AOR = 1.27 95%CI: 1.15–1.41], 35–49 [AOR = 1.26 95%CI: 1.13–1.41], women who attained secondary or above education [AOR = 1.27, 95% CI: 1.09, 1.47], being in rich household [AOR = 1.27, 95% CI 1.14, 1.41], women who were currently pregnant [AOR = 1.29, 95% CI 1.13, 1.47], who had been tested for HIV [AOR = 1.99, 95% CI 1.70, 2.33], women who had one and more than one sexual partner [AOR = 1.18, 95% CI 1.05, 1.34], women who lived in urban area [AOR = 1.16, 95% CI: 1.03, 1.31] and who perceived distance from the health facility was not a big problem was [AOR = 1.13, 95% CI 1.04, 1.23] were significantly associated with sexually transmitted infections related care-seeking behavior. Conclusion sexually transmitted infections related care-seeking behavior is relatively low as compared with other studies.. This study revealed that individual-level variables such as women's age, educational status, household wealth index, pregnancy status, ever been tested for HIV, number of sexual partners, and community-level variables such as residence and distance from a health facility were associated with sexually transmitted infections related care-seeking behavior. Therefore, public health interventions targeting uneducated women, poor households, and adolescents, as well as improving counseling and awareness creation during HIV/AIDS testing and Antenatal care visits, are vital to improving sexually transmitted infections care seeking behavior.
Collapse
|
7
|
Bolarinwa OA, Boikhutso T. Mapping evidence on predictors of adverse sexual and reproductive health outcomes among young women in South Africa: A scoping review. Afr J Prim Health Care Fam Med 2021; 13:e1-e10. [PMID: 34797120 PMCID: PMC8661283 DOI: 10.4102/phcfm.v13i1.3091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/30/2021] [Accepted: 10/06/2021] [Indexed: 12/02/2022] Open
Abstract
Background Globally, most young women have an unmet need for sexual and reproductive health (SRH), which remains a public health concern. Identifying the predictors can help reduce this challenge. Aim This scoping review maps evidence on predictors of adverse sexual and reproductive health outcomes among young women in South Africa. Method Askey and O’Malley’s framework guided this review. We searched five databases from January 2000 to December 2020 using relevant keywords, Boolean terms and medical subject heading terms. All relevant extracted data were organised into the study themes, and summary of all the findings were reported in a narrative format. Results Nine studies met the inclusion criteria out of 1219 studies identified. Four out of the nine studies were national-based studies, while the remaining five studies were conducted in Western Cape (two), Eastern Cape (two) and KwaZulu-Natal (one). Out of the nine studies included, three reported predictors of unintended pregnancy, while six reported predictors of sexually transmitted infections and HIV among young women in South Africa. The most prevailing predictors of adverse sexual and reproductive health outcomes were gender-based violence and alcohol use, while other predictors were lower socio-economic status, place of residence, multiple sexual partnerships, low education and being between the ages of 20–24 years. Conclusion We conclude that gender-based violence and alcohol abuse are the most prevailing predictors of adverse sexual and reproductive health outcomes among young women in South Africa.
Collapse
Affiliation(s)
- Obasanjo A Bolarinwa
- Discipline of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban.
| | | |
Collapse
|
8
|
Obiezu-Umeh C, Nwaozuru U, Mason S, Gbaja-Biamila T, Oladele D, Ezechi O, Iwelunmor J. Implementation Strategies to Enhance Youth-Friendly Sexual and Reproductive Health Services in Sub-Saharan Africa: A Systematic Review. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:684081. [PMID: 36304027 PMCID: PMC9580831 DOI: 10.3389/frph.2021.684081] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/29/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction: Youth-friendly health service (YFHS) interventions are a promising, cost-effective approaches to delivering sexual and reproductive services that cater to the developmental needs of young people. Despite a growing evidence-base, implementation of such interventions into practice have proven to be challenging in sub-Saharan Africa (SSA). Thus, the purpose of this review is to synthesize existing evidence on YFHS implementation in SSA and understand which implementation strategies were used, in what context, how they were used, and leading to which implementation outcomes. Methods: A comprehensive literature search in PubMed, Embase, Scopus, and CINAHL, was conducted to identify peer-reviewed research articles published from database inception up until August 2020. Eligible studies were required to include young people (ages 10–24 years) in sub-Saharan Africa. Studies that described implementation strategies, as conceptualized by the Expert Recommendations for Implementing Change (ERIC) project, used to enhance the implementation of YFHS were included. Implementation outcomes were extracted using Proctor and colleagues' 8 taxonomy of implementation outcomes. Results: We identified 18 unique interventions (reported in 23 articles) from an initial search of 630 articles, including seven from East Africa, seven from South Africa, and four from West Africa. In most studies (n = 15), youth-friendly health services were delivered within the context of a health facility or clinic setting. The most frequently reported categories of implementation strategies were to train and educate stakeholders (n = 16) followed by infrastructure change (n = 10), to engage consumers (n = 9), the use of evaluative and iterative strategies (n = 8), support clinicians (n = 8), and providing interactive assistance (n = 6). The effectiveness of the strategies to enhance YFHS implementation was commonly measured using adoption (n = 15), fidelity (n = 7), acceptability (n = 5), and penetration (n = 5). Few studies reported on sustainability (n = 2), appropriateness (n = 1), implementation cost (n = 1) and feasibility (n = 0). Conclusion: Results of the review emphasize the need for further research to evaluate and optimize implementation strategies for promoting the scale-up and sustainability of evidence-based, YFHS interventions in resource-constrained settings. This review also highlights the need to design robust studies to better understand which, in what combination, and in what context, can implementation strategies be used to effectively enhance the implementation of YFHS interventions.
Collapse
Affiliation(s)
- Chisom Obiezu-Umeh
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States
| | - Ucheoma Nwaozuru
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States
| | - Stacey Mason
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States
| | - Titilola Gbaja-Biamila
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - David Oladele
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Oliver Ezechi
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Juliet Iwelunmor
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States
- *Correspondence: Juliet Iwelunmor
| |
Collapse
|
9
|
Aduh U, Ewa AU, Sam-Agudu NA, Urhioke O, Kusimo O, Ugwu C, Fadare OA, Anyaike C. Addressing gaps in adolescent tuberculosis programming and policy in Nigeria from a public health perspective. Int J Adolesc Med Health 2021; 33:41-51. [PMID: 33913304 DOI: 10.1515/ijamh-2020-0293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/01/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Tuberculosis (TB) is a leading infectious cause of death globally. Of the estimated 10 million people who developed active TB in 2019, 1.8 million (18%) were adolescents and young adults aged 15-24 years. Adolescents have poorer rates of TB screening, treatment initiation and completion compared to adults. Unfortunately, there is relatively less programme, research and policy focus on TB for adolescents aged 10-19 years. This article reviews the scope of health services and the relevant policy landscape for TB case notification and care/treatment, TB/HIV management, and latent TB infection for adolescents in Nigeria. Additionally, it discusses considerations for TB vaccines in this population. CONTENT All Nigeria Federal Ministry of Health policy documents relevant to adolescent health services and TB, and published between 2000 and 2020 underwent narrative review. Findings were reported according to the service areas outlined in the Objectives. SUMMARY AND OUTLOOK Nine policy documents were identified and reviewed. While multiple policies acknowledge the needs of adolescents in public health and specifically in TB programming, these needs are often not addressed in policy, nor in program integration and implementation. The lack of age-specific epidemiologic and clinical outcomes data for adolescents contributes to these policy gaps. Poor outcomes are driven by factors such as HIV co-infection, lack of youth-friendly health services, and stigma and discrimination. Policy guidelines and innovations should include adaptations tailored to adolescent needs. However, these adaptations cannot be developed without robust epidemiological data on adolescents at risk of, and living with TB. Gaps in TB care integration into primary reproductive, maternal-child health and nutrition services should be addressed across multiple policies, and mechanisms for supervision, and monitoring and evaluation of integration be developed to guide comprehensive implementation. Youth-friendly TB services are recommended to improve access to quality care delivered in a patient-centered approach.
Collapse
Affiliation(s)
- Ufuoma Aduh
- World Health Organisation, Abuja, Nigeria
- Texila American University, Georgetown, Guyana
| | - Atana Uket Ewa
- Department of Paediatrics, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Institute of Human Virology and Department of Pediatrics, University of Maryland School of Medicine, Baltimore, USA
| | - Ochuko Urhioke
- National TB and Leprosy Control Programme, Federal Ministry of Health, Abuja, Nigeria
| | | | | | | | - Chukwuma Anyaike
- National TB and Leprosy Control Programme, Federal Ministry of Health, Abuja, Nigeria
| |
Collapse
|
10
|
Vongxay V, Chaleunvong K, Essink DR, Durham J, Sychareun V. Knowledge of and attitudes towards abortion among adolescents in Lao PDR. Glob Health Action 2021; 13:1791413. [PMID: 32741348 PMCID: PMC7480451 DOI: 10.1080/16549716.2020.1791413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Adolescents are at high risk of unintended pregnancy and consequent unsafe abortion. Evidence from Lao PDR suggests a high but underreported prevalence of induced abortion, especially amongst adolescents. Research suggests adolescents are less likely to have an unsafe abortion when they have accurate knowledge about abortion and hold positive attitudes towards abortion. Objective The purpose of this study was to investigate awareness and attitudes towards abortion and associated factors in Lao PDR. Methods This study used a descriptive, cross-sectional design. The study was conducted between January and May 2019 in two different provinces within Lao PDR, namely, Khammouane and Champasack provinces. Participants included in- and out-of-school male and female adolescents (n = 800). Data were collected using a structured questionnaire and entered into the EPI Data version 3.1. All analysis was undertaken using STATA v.13. Univariate analysis and frequency distributions were used to study the pattern of responses and bivariate descriptive analysis to report attitudes and knowledge by participant characteristics. The association between participant characteristics and overall scores of attitudes towards abortion was evaluated using multiple logistic regression. Findings Most respondents (78.8%) were aware of the processes and potential consequences of becoming pregnant at a young age. One-third of respondents (31.5%), were aware of induced abortion. Of those, only 12.1% held positive attitudes towards induced abortion. Factors associated with positive attitudes towards abortion were ethnicity, mother’s education and ever having had sex. Conclusion In the case of unintended or unwanted pregnancy, adolescents must also have adequate knowledge and access to safe abortion and associated counselling services. This study suggests a need to increase sexual and reproductive health literacy including information about safe abortion. This requires a holistic approach to sexual education and needs the support and involvement of adolescents themselves as well as parents, community members and healthcare workers.
Collapse
Affiliation(s)
| | - Kongmany Chaleunvong
- Institute Research and Education Development, University of Health Sciences , Vientiane, Lao PDR
| | - Dirk R Essink
- Faculty of Earth and Life Sciences, Athena Institute for Research on Innovation and Communication in Health and Life Sciences , Vientiane, Lao PDR
| | - Jo Durham
- School of Public Health and Social Work, Queensland University of Technology , Brisbane, Australia
| | - Vanphanom Sychareun
- Faculty of Public Health, University of Health Sciences , Vientiane, Lao PDR
| |
Collapse
|
11
|
Kumi-Kyereme A. Sexual and reproductive health services utilisation amongst in-school young people with disabilities in Ghana. Afr J Disabil 2021; 10:671. [PMID: 33824858 PMCID: PMC8007993 DOI: 10.4102/ajod.v10i0.671] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/07/2021] [Indexed: 11/02/2022] Open
Abstract
Background Sexual and reproductive health (SRH) of young people including those with disabilities is a major public health concern globally. However, available evidence on their use of sexual and reproductive health services (SRHS) is inconsistent. Objective This study investigated utilisation of SRHS amongst the in-school young people with disabilities (YPWDs) in Ghana using the healthcare utilisation model. Methods Guided by the cross-sectional study design, a questionnaire was used to obtain data from 2114 blind and deaf pupils or students in the age group 10-24 years, sampled from 15 purposively selected special schools for the deaf and the blind in Ghana. Results About seven out of every 10 respondents had ever utilised SRHS. The proportion was higher amongst the males (67.8%) compared with the females (62.8%). Young persons with disabilities in the coastal (OR = 0.03, 95% CI = 0.01-0.22) and middle (OR = 0.06, 95% CI = 0.01-0.44) zones were less likely to have ever utilised SRHS compared with those in the northern ecological zone. The blind pupils or students were more likely to have ever utilised SRHS than the deaf (OR = 1.45, 95% CI = 1.26-3.11). Conclusions Generally, SRHS utilisation amongst the in-school YPWDs in Ghana is high but significantly associated with some predisposing, need and enabling or disabling factors. This underscores the need for policymakers to consider in-school YPWDs as a heterogeneous group in the design and implementation of SRHS programmes. The Ghana Education Service in collaboration with the Ghana Health Service should adopt appropriate pragmatic measures and targeted interventions in the special schools to address the SRH needs of the pupils or students.
Collapse
Affiliation(s)
- Akwasi Kumi-Kyereme
- Department of Population and Health, Faculty of Social Sciences, University of Cape Coast, Cape Coast, Ghana
| |
Collapse
|
12
|
Handebo S. Sexually transmitted infections related care-seeking behavior and associated factors among reproductive age women in Ethiopia: further analysis of the 2016 demographic and health survey. BMC Womens Health 2020; 20:274. [PMID: 33317494 PMCID: PMC7737365 DOI: 10.1186/s12905-020-01145-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 12/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) are the most common communicable diseases that affect the health and life of people. Even though there is little information on the prevalence of STIs in Ethiopia, the problem is likely similar to other developing countries. Therefore, the objective of this study was to measure STIs related care-seeking behavior and associated factors among reproductive-age women in Ethiopia. METHODS The study was based on the data from the 2016 Ethiopian Demographic and Health Survey (EDHS). Information on STIs related care-seeking was extracted from the individual women dataset. A total of 474 (weighted) reproductive age women (15-49 years) who reported STIs or STI symptoms were included in the study. Bivariate and multivariable logistic regression models were fitted to assess factors associated with STIs related care-seeking behavior. The adjusted odds ratio (AOR) with the corresponding 95% confidence intervals (CI) was used to show the strength of associations between the outcome and independent variables. Variables with a p value of less than 0.05 were considered statistically significant. RESULTS The prevalence of STIs related care-seeking behavior among women was 33.3% (95% CI 29.2-37.3%). STIs related care-seeking behavior was significantly associated with higher women educational status (AOR = 0.16, 95% CI 0.03, 0.87), having a husband working an unskilled job (AOR = 6.99, 95% CI 1.34, 36.48), women who did not know their husband's job (AOR = 12.79, 95% CI 2.24, 73.11), having an educated husband (AOR = 5.66, 95% CI 1.36, 23.51), being currently pregnant (AOR = 4.87, 95% CI 1.93, 12.28), being in the richer (AOR = 4.68, 95% CI 1.52, 14.39) and richest (AOR = 6.89, 95% CI 1.90, 24.81) wealth index. CONCLUSION STIs related care-seeking behavior was significantly low among Ethiopian women. Surprisingly, STIs related care-seeking behavior was lower among an educated woman. In contrast, having an educated husband, women who didn't know their husband's job, a husband working an unskilled job, being pregnant, and high wealth status were positively associated with STIs related care-seeking behavior.
Collapse
Affiliation(s)
- Simegnew Handebo
- Department of Health Education and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O.Box- 196, Gondar, Ethiopia.
| |
Collapse
|
13
|
Integration of HIV-Sexual Reproductive Health Services for Young People and the Barriers at Public Health Facilities in Mbarara Municipality, Southwestern Uganda: A Qualitative Assessment. Int J Reprod Med 2019; 2019:6725432. [PMID: 31093493 PMCID: PMC6481132 DOI: 10.1155/2019/6725432] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/22/2019] [Indexed: 11/18/2022] Open
Abstract
Background Sexual and Reproductive Health (SRH) and HIV risk behaviors for young people are intertwined. This rationalizes the need for integration of HIV and SRH services within the health care system, especially in countries with high HIV burden. In this study, we explored the current status of HIV-SRH integration for young people and barriers of integration from different stakeholders at public health facilities in Mbarara Municipality, southwestern Uganda. Methods We conducted an exploratory qualitative study at public health facilities in Mbarara district of southwestern Uganda. Data were collected among young people (n=48), health care providers (n=63), and key informants (n=11). We used in-depth interviews and focus group discussions to collect the data. Coding and analysis of qualitative data were done using Atlas.ti. Results Overall there was no differentiation of HIV-SRH services between adults and young people. Integration of HIV-SRH services was reported at all facility levels; however, there was poor differentiation of services for the young persons and adults. Integrated HIV and SRH services for young people were acknowledged to improve access to information and risk perception, improve continuity of care, and reduce cost of services and would also lead to improved client-health worker relationships. The potential barriers to achieving HIV-SRH integration included individual provider characteristics like lack of training and attitudes, generic health system challenges like low staffing levels, poor infrastructure with lack of space and privacy to deliver these services. At the policy level vertical programing and unclear policies and guidelines were identified as challenges. Conclusion Our study shows integration of HIV and SRH services exists in general but services for adults and young people are blended or poorly differentiated. Significant health system barriers need to be overcome to achieve differentiation of the services for young people and adults.
Collapse
|
14
|
Lundgren R, Burgess S, Chantelois H, Oregede S, Kerner B, Kågesten AE. Processing gender: lived experiences of reproducing and transforming gender norms over the life course of young people in Northern Uganda. CULTURE, HEALTH & SEXUALITY 2019; 21:387-403. [PMID: 29882476 DOI: 10.1080/13691058.2018.1471160] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 04/27/2018] [Indexed: 06/08/2023]
Abstract
The years between 10-19 represent a critical stage of human development during which boys and girls learn and embody socially constructed gender norms, with long-term implications for their sexual and reproductive health. This ethnographic cohort study sought to understand how gendered norms and practices develop during the transition from child to young adult in post-conflict northern Uganda. A total of 60 girls and boys aged 10-19 were selected using purposive sampling for in-depth interviews over a three-year period; 47 individuals completed all four interviews. Drawing on feminist theory and an ecological perspective, findings were used to create a conceptual framework displaying the experiences of young people navigating patriarchal and alternative norms, emphasising their lived processes of performing and negotiating norms within six key domains (work, puberty, family planning, intimate partner relations, child discipline and alcohol). The framework identifies: (1) personal factors (knowledge, agency and aspirations); (2) social factors (socialisation processes, capital, costs and consequences); and (3) structural factors (health/educational systems, religious institutions, government policies) which may encourage young people towards one norm or another as they age. These findings can inform policies and programmes to transform gender norms and promote equitable, healthy relationships.
Collapse
Affiliation(s)
- Rebecka Lundgren
- a Institute for Reproductive Health , Georgetown University , Washington , USA
| | - Sarah Burgess
- a Institute for Reproductive Health , Georgetown University , Washington , USA
- d Camber Collective , San Francisco , USA
| | - Heather Chantelois
- a Institute for Reproductive Health , Georgetown University , Washington , USA
| | - Susan Oregede
- b Pathfinder International , Kampala , Uganda
- e UN Women Uganda , Kampala , Uganda
| | | | - Anna E Kågesten
- a Institute for Reproductive Health , Georgetown University , Washington , USA
- f Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden
| |
Collapse
|
15
|
Merrill KG, Merrill JC, Hershow RB, Barkley C, Rakosa B, DeCelles J, Harrison A. Linking at-risk South African girls to sexual violence and reproductive health services: A mixed-methods assessment of a soccer-based HIV prevention program and pilot SMS campaign. EVALUATION AND PROGRAM PLANNING 2018; 70:12-24. [PMID: 29890449 PMCID: PMC6613633 DOI: 10.1016/j.evalprogplan.2018.04.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 03/27/2018] [Accepted: 04/29/2018] [Indexed: 05/06/2023]
Abstract
Grassroot Soccer developed SKILLZ Street-a soccer-based life skills program with a supplementary SMS platform-to support adolescent girls at risk for HIV, violence, and sexual and reproductive health challenges. We conducted a mixed-methods assessment of preliminary outcomes and implementation processes in three primary schools in Soweto, South Africa, from August to December 2013. Quantitative methods included participant attendance and SMS platform usage tracking, pre/post questionnaires, and structured observation. Qualitative data were collected from program participants, parents, teachers, and a social worker during 6 focus group discussions and 4 in-depth interviews. Of 394 participants enrolled, 97% (n = 382) graduated, and 217 unique users accessed the SMS platform. Questionnaires completed by 213 participants (mean age: 11.9, SD: 3.02 years) alongside qualitative findings showed modest improvements in participants' perceptions of power in relationships and gender equity, self-esteem, self-efficacy to avoid unwanted sex, communication with others about HIV and sex, and HIV-related knowledge and stigma. The coach-participant relationship, safe space, and integration of soccer were raised as key intervention components. Implementation challenges were faced around delivery of soccer-based activities. Findings highlight the relevance and importance of programs like SKILLZ Street in addressing challenges facing adolescent girls in South African townships. Recommendations for future programs are provided.
Collapse
Affiliation(s)
| | - Jamison C Merrill
- Grassroot Soccer, Cape Town, 38 Hout Street, Cape Town, 8001, South Africa.
| | - Rebecca B Hershow
- Grassroot Soccer, Cape Town, 38 Hout Street, Cape Town, 8001, South Africa.
| | - Chris Barkley
- Grassroot Soccer, Cape Town, 38 Hout Street, Cape Town, 8001, South Africa.
| | - Boitumelo Rakosa
- Grassroot Soccer, Soweto, Nike Football Training Center, 1096 Chris Hani Road, Soweto, Gauteng, 1809, South Africa.
| | - Jeff DeCelles
- Grassroot Soccer, Cape Town, 38 Hout Street, Cape Town, 8001, South Africa.
| | - Abigail Harrison
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S. Main Street, Providence, RI, 02903, United States.
| |
Collapse
|
16
|
Taquette SR, Monteiro DLM, Rodrigues NCP, Rozenberg R, Menezes DCS, Rodrigues ADO, Ramos JAS. Sexual and reproductive health among young people, Rio de Janeiro, Brazil. CIENCIA & SAUDE COLETIVA 2018; 22:1923-1932. [PMID: 28614512 DOI: 10.1590/1413-81232017226.22642016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 10/26/2016] [Indexed: 11/21/2022] Open
Abstract
We aimed to analyze the geographic distribution, the structure of healthcare services and the human resources of all units of the Sistema Único de Saúde (SUS - the Unified Health System) that provide sexual and reproductive health (SRH) services to the adolescent population in the second largest city in Brazil. We conducted a cross-sectional study with geographical mapping and data collection through a questionnaire applied in person with coordinators of the units or their representatives in 147 outpatient clinics in Rio de Janeiro that have SSR services. We found that in over 90% of the units, adolescents are treated together with the adult population, without particular shifts or rooms for this age group. In more than 10% of services, treatment is only provided with the presence of the guardian. In cases of sexual violence, this proportion is 34%. Specific educational activities for this age group are only carried out in 12.9% of units and less than one third of doctors had received some kind of training to deal with adolescent health. In conclusion, despite the wide geographic distribution of health facilities, the structure of care and the human resources do not meet the specific needs of adolescents.
Collapse
Affiliation(s)
- Stella Regina Taquette
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro. Av. Professor Manuel de Abreu, Maracanã. 20550-170 Rio de Janeiro RJ Brasil.
| | - Denise Leite Maia Monteiro
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro. Av. Professor Manuel de Abreu, Maracanã. 20550-170 Rio de Janeiro RJ Brasil.
| | - Nádia Cristina Pinheiro Rodrigues
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro. Av. Professor Manuel de Abreu, Maracanã. 20550-170 Rio de Janeiro RJ Brasil.
| | - Riva Rozenberg
- Instituto Fernandes Figueira, Fiocruz. Rio de Janeiro RJ Brasil
| | - Daniela Contage Siccardi Menezes
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro. Av. Professor Manuel de Abreu, Maracanã. 20550-170 Rio de Janeiro RJ Brasil.
| | - Adriana de Oliveira Rodrigues
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro. Av. Professor Manuel de Abreu, Maracanã. 20550-170 Rio de Janeiro RJ Brasil.
| | | |
Collapse
|
17
|
Newton-Levinson A, Leichliter JS, Chandra-Mouli V. Help and Care Seeking for Sexually Transmitted Infections Among Youth in Low- and Middle-Income Countries. Sex Transm Dis 2017; 44:319-328. [PMID: 28499280 PMCID: PMC5434953 DOI: 10.1097/olq.0000000000000607] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 01/30/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND The ability to seek help or medical care for sexually transmitted infections (STIs) is vital for sexually active youth; yet, their needs are often unmet. METHODS We conducted a qualitative systematic review of studies to assess youth and provider views about the behaviors of young people in help seeking and care seeking for STI services in low- and middle-income countries. We searched peer-reviewed literature for studies published between 2001 and 2014 with a study population of youth (age, 10-24 years) and/or health service providers. Eighteen studies were identified for inclusion from 18 countries. Thematic analyses identified key themes across the studies. RESULTS The majority of studies included discussion of youth not seeking treatment, resorting to self-treatment, or waiting to access care, suggesting that many youth still do not seek timely care for STIs. Youth desired more information on sexual health and cited barriers related to fear or taboos in obtaining help or information, especially from providers or parents. Many did not recognize symptoms or waited until symptoms worsened. However, many youth were able to identify a number of sources for STI related care including public and private clinics, pharmacies, alternative healers, and nongovernmental organizations. Youth's help seeking and care seeking preferences were frequently influenced by desires for confidentiality, friendliness, and cost. CONCLUSIONS Youth in low- and middle-income countries experience significant barriers in help seeking for STIs and often do not seek or postpone medical care. Improving uptake may require efforts to address clinic systems, provider attitudes, confidentiality, and cultural norms related to youth sexuality.
Collapse
Affiliation(s)
- Anna Newton-Levinson
- From the *Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University; †Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA; and ‡Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Jami S. Leichliter
- From the *Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University; †Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA; and ‡Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Venkatraman Chandra-Mouli
- From the *Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University; †Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA; and ‡Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| |
Collapse
|
18
|
Vu L, Burnett-Zieman B, Banura C, Okal J, Elang M, Ampwera R, Caswell G, Amanyire D, Alesi J, Yam E. Increasing Uptake of HIV, Sexually Transmitted Infection, and Family Planning Services, and Reducing HIV-Related Risk Behaviors Among Youth Living With HIV in Uganda. J Adolesc Health 2017; 60:S22-S28. [PMID: 28109336 DOI: 10.1016/j.jadohealth.2016.09.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 09/03/2016] [Accepted: 09/12/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To address barriers to care for youth living with HIV (YLHIV), the Link Up project implemented a peer-led intervention model that provided a comprehensive package of HIV and sexual and reproductive health and rights services through community-based peer support groups for YLHIV. Peer educators delivered targeted counseling and health education, and referred YLHIV to antiretroviral therapy (ART), and reproductive health services that were available at youth-oriented sexual and reproductive health and rights facilities. METHODS At baseline (October to November 2014), 37 peer support groups for YLHIV were established in Luwero and Nakasongola districts. During this same time period, we recruited a cohort of 473 support group members, aged 15-24 years. After a 9-month intervention period (January to September 2015), we completed the end-line survey with 350 members of the original cohort. Multivariate logistic regression analysis applied to longitudinal data was used to assess changes in key outcomes from baseline to end line. RESULTS Multivariate analyses showed significant increases at end line, compared with baseline, in self-efficacy (adjusted odds ratio [AOR]: 1.8 [1.3-2.6]), comprehensive HIV knowledge [AOR: 1.8 [1.3-2.6]), HIV disclosure (AOR: 1.6 [1.01-2.6]), condom use at last sex (AOR: 1.7 [1.2-2.5]), sexually transmitted infection uptake (AOR: 2.1 [1.5-2.9]), ART uptake (AOR: 2.5 [1.6-4.0]), ART adherence (AOR: 2.5 [1.3-4.9]), CD4 testing (AOR: 2.4 [1.5-3.6]), and current use of a modern contraceptive method (AOR: 1.7 [1.1-2.7]). CONCLUSIONS Link Up's intervention strategy likely contributed to observed increases in self-efficacy, knowledge of HIV, condom use, HIV disclosure ART utilization and adherence, CD4 testing, STI testing uptake, and use of modern family planning methods. This model shows promise and should be adapted for use among YLHIV in similar settings and evaluated further.
Collapse
Affiliation(s)
- Lung Vu
- Population Council, Washington, DC.
| | | | - Cecily Banura
- Child Health and Development Center, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Margret Elang
- Community Health Alliance Uganda (CHAU), Kampala, Uganda
| | | | | | - Diana Amanyire
- Marie Stopes International, Uganda (MSIU), Kampala, Uganda
| | - Jacquelyne Alesi
- Uganda Network of Young People Living with HIV and AIDS, Kampala, Uganda
| | | |
Collapse
|
19
|
Capurchande R, Coene G, Schockaert I, Macia M, Meulemans H. "It is challenging… oh, nobody likes it!": a qualitative study exploring Mozambican adolescents and young adults' experiences with contraception. BMC WOMENS HEALTH 2016; 16:48. [PMID: 27475909 PMCID: PMC4967333 DOI: 10.1186/s12905-016-0326-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/22/2016] [Indexed: 11/23/2022]
Abstract
Background By focusing upon formal sex education programmes, the Mozambican government has significantly enhanced the general health of adolescents and young adults. However, when it comes to contraception, little is known about how adolescents and young adults actually behave. Methods Based upon a qualitative study in two settings in Maputo province – Ndlavela and Boane – this paper explores the knowledge and practices of contraception among adolescents and young adults. A total of four focus group discussions, 16 in-depth interviews, four informal conversations, and observations were equally divided between both study sites. Results Discrepancies between what adolescents and young adults know and what they do quickly became evident. Ambivalent and contradictory practices concerning contraceptive use was the result. As well, young people had numerous interpretations of risk-taking when not using contraceptives. These inconsistencies are influenced by social and medical barriers such as restricted dialogue on sexuality among adolescents and young adults and their parents and peers. Additionally, ideas about indigenous contraceptives, notions of masculinity and femininity, misconceptions and fear of the side effects of contraceptives, make people of all ages wary of modern birth control. Other barriers include imposed contraceptive choice – meaning no choice, overly technical medical language used at clinics and the absence of healthcare workers more attuned to the needs of adolescents and young adults. Conclusions Adolescents and young adults have numerous – often erroneous – opinions about contraception, leading to inconsistent use as well as vague perceptions of risk-taking. Moreover, social norms and cultural gender roles often contradict and hinder risk-avoiding behaviour. Therefore, in order to improve young people’s health, policymakers must address the reasons behind this ambivalence and inconsistency.
Collapse
Affiliation(s)
- Rehana Capurchande
- Department of Sociology, Eduardo Mondlane University- Maputo, Campus Universitário Principal. CP 257, Maputo, Mozambique. .,Vrije Universiteit Brussel (Free University of Brussels), Centre for Research in Gender and Diversity, Department of Sociology, Faculty of Economic and Social Science, and Solvay Business School, Free University of Brussels, Pleinlaan 2, 1050, Brussels, Belgium.
| | - Gily Coene
- Vrije Universiteit Brussel (Free University of Brussels), Department of Philosophy and Ethics, Centre for Research in Gender and Diversity, Pleinlaan 2, B-1050, Brussels, Belgium
| | - Ingrid Schockaert
- Department of Sociology, Faculty of Economic and Social Science, and Solvay Business School, Free University of Brussels, Pleinlaan 5, 1050, Brussels, Belgium
| | - Manuel Macia
- Department of Sociology, Faculty of Arts and Social Sciences, Eduardo Mondlane University, Praça 25 de Junho, C. Postal 257, Maputo, Mozambique
| | - Herman Meulemans
- Universiteit Antwerpen (Antwerp University), Department of Sociology, Centre for Longitudinal and Life Course Studies, Sint-Jacobstraat 2, BE-2000, Antwerpen, Belgium.,Centre for Health Systems Research and Development (CHSR&D), University of the Free State, Bloemfontein, South Africa
| |
Collapse
|
20
|
Newton-Levinson A, Leichliter JS, Chandra-Mouli V. Sexually Transmitted Infection Services for Adolescents and Youth in Low- and Middle-Income Countries: Perceived and Experienced Barriers to Accessing Care. J Adolesc Health 2016; 59:7-16. [PMID: 27338664 PMCID: PMC5289742 DOI: 10.1016/j.jadohealth.2016.03.014] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/11/2016] [Accepted: 03/11/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE Access to sexual and reproductive health (SRH) services is vital for sexually active adolescents; yet, their SRH care needs are often unmet. METHODS We conducted a qualitative systematic review of mixed methods studies to assess adolescent and provider views of barriers to seeking appropriate medical care for sexually transmitted infection (STI) services for adolescents. We searched peer-reviewed literature for studies published between 2001 and 2014 with a study population of youth (aged 10-24 years) and/or health service providers. Nineteen studies were identified for inclusion from 15 countries. Thematic analyses identified key themes across the studies. RESULTS Findings suggest that youth lacked knowledge about STIs and services. In addition, youth experienced barriers related to service availability and a lack of integration of services. The most reported barriers were related to acceptability of services. Youth reported avoiding services or having confidentiality concerns based on provider demographics and some behaviors. Finally, experiences of shame and stigma were common barriers to seeking care. CONCLUSIONS Adolescents in low- and middle-income countries experience significant barriers in obtaining STI and SRH services. Improving uptake may require efforts to address clinic systems and provider attitudes, including confidentiality issues. Moreover, addressing barriers to STI services may require addressing cultural norms related to adolescent sexuality.
Collapse
Affiliation(s)
- Anna Newton-Levinson
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia; Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Jami S Leichliter
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | |
Collapse
|
21
|
Aninanya GA, Debpuur CY, Awine T, Williams JE, Hodgson A, Howard N. Effects of an adolescent sexual and reproductive health intervention on health service usage by young people in northern Ghana: a community-randomised trial. PLoS One 2015; 10:e0125267. [PMID: 25928562 PMCID: PMC4415997 DOI: 10.1371/journal.pone.0125267] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/22/2015] [Indexed: 11/29/2022] Open
Abstract
Background While many Ghanaian adolescents encounter sexual and reproductive health problems, their usage of services remains low. A social learning intervention, incorporating environment, motivation, education, and self-efficacy to change behaviour, was implemented in a low-income district of northern Ghana to increase adolescent services usage. This study aimed to assess the impact of this intervention on usage of sexual and reproductive health services by young people. Methods Twenty-six communities were randomly allocated to (i) an intervention consisting of school-based curriculum, out-of-school outreach, community mobilisation, and health-worker training in youth-friendly health services, or (ii) comparison consisting of community mobilisation and youth-friendly health services training only. Outcome measures were usage of sexually-transmitted infections (STIs) management, HIV counselling and testing, antenatal care or perinatal services in the past year and reported service satisfaction. Data was collected, at baseline and three years after, from a cohort of 2,664 adolescents aged 15–17 at baseline. Results Exposure was associated with over twice the odds of using STI services (AOR 2.47; 95%CI 1.78–3.42), 89% greater odds of using perinatal services (AOR 1.89; 95%CI 1.37–2.60) and 56% greater odds of using antenatal services (AOR 1.56; 95%CI 1.10–2.20) among participants in intervention versus comparison communities, after adjustment for baseline differences. Conclusions The addition of targeted school-based and outreach activities increased service usage by young people more than community mobilisation and training providers in youth-friendly services provision alone.
Collapse
Affiliation(s)
- Gifty Apiung Aninanya
- Navrongo Health Research Centre, Navrongo, Ghana
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- * E-mail:
| | | | | | | | - Abraham Hodgson
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Natasha Howard
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
22
|
Dawson A, Tran NT, Westley E, Mangiaterra V, Festin M. Workforce interventions to improve access to emergency contraception pills: a systematic review of current evidence in low- and middle-income countries and recommendations for improving performance. BMC Health Serv Res 2015; 15:180. [PMID: 25927734 PMCID: PMC4421921 DOI: 10.1186/s12913-015-0815-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 03/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emergency contraceptive pills (ECP) are one of the 13 essential commodities addressed by the UN Commission on Life-Saving Commodities for Women and Children. Although ECP have been available for 20 years, a number of barriers still limit women's access ECP in low and middle-income countries (LMIC). The workforce who prescribe or dispense ECP are diverse reflecting the varied contexts where ECP are available across the health, commercial and justice sectors and in the community. No reviews currently exist that examine the roles and experiences of the workforce that provide ECP in LMIC. METHOD We present a narrative synthesis of research to: identify provider factors that facilitate and constraint access to ECP; assess the effectiveness of associated interventions and; explore associated health system issues in LMIC. A search of bibliographic databases, meta-indexes and websites was undertaken to retrieve peer reviewed and grey literature. Literature was screened and identified documents examined to appraise quality. RESULTS Thirty-seven documents were included in the review. Studies focused on formal health workers revealing knowledge gaps concerning the role of private sector and non-health providers who increasingly provide ECP. Data from the findings section in the documents were coded under 4 themes: provider knowledge; provider attitudes and beliefs; provider practice and provider training. The analysis revealed provider knowledge gaps, less than favourable attitudes and practice issues. The findings provide limited insight into products prescribed and/or dispensed, the frequency of provision, and information and advice offered to consumers. Pre and in-service training needs were noted. CONCLUSION As the provision of ECPs shifts from the clinic-based health sector to increasing provision by the private sector, the limited understanding of provider performance and the practice gaps revealed in this review highlight the need to further examine provider performance to inform the development of appropriate workforce interventions. A standardized approach to assessing performance using agreed outcomes measures may serve to ensure a systematic way forward that is inclusive of the diverse workforce that deliver ECP. Recommendations are outlined to enhance the performance of providers to improve access to ECP. A framework is offered to help guide this process with indicators.
Collapse
Affiliation(s)
- Angela Dawson
- World Health Organization Collaborating Centre for Nursing, Midwifery and Health Development, Faculty of Health, University of Technology, Sydney (UTS), Jones Street, Sydney, NSW, Australia.
| | - Nguyen-Toan Tran
- School of Public Health and Community Medicine, University of New South Wales, High St, Sydney, 2052, Australia.
| | - Elizabeth Westley
- International Consortium for Emergency Contraception, 45 Broadway, New York, USA.
| | - Viviana Mangiaterra
- RMNCH and HSS Technical Advice & Partnerships Department The Global Fund to Fight AIDS, Tuberculosis and Malaria, Chemin de Blandonnet 8, 1214, Vernier, Geneva, Switzerland.
| | - Mario Festin
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia, Geneva, Switzerland.
| |
Collapse
|
23
|
Dawson A, Tran NT, Westley E, Mangiaterra V, Festin M. Improving access to emergency contraception pills through strengthening service delivery and demand generation: a systematic review of current evidence in low and middle-income countries. PLoS One 2014; 9:e109315. [PMID: 25285438 PMCID: PMC4186851 DOI: 10.1371/journal.pone.0109315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 09/10/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Emergency contraception pills (ECP) are among the 13 essential commodities in the framework for action established by the UN Commission on Life-Saving Commodities for Women and Children. Despite having been on the market for nearly 20 years, a number of barriers still limit women's access to ECP in low- and middle-income countries (LMIC) including limited consumer knowledge and poor availability. This paper reports the results of a review to synthesise the current evidence on service delivery strategies to improve access to ECP. METHODS A narrative synthesis methodology was used to examine peer reviewed research literature (2003 to 2013) from diverse methodological traditions to provide critical insights into strategies to improve access from a service delivery perspective. The studies were appraised using established scoring systems and the findings of included papers thematically analysed and patterns mapped across all findings using concept mapping. FINDINGS Ten papers were included in the review. Despite limited research of adequate quality, promising strategies to improve access were identified including: advance provision of ECP; task shifting and sharing; intersectoral collaboration for sexual assault; m-health for information provision; and scale up through national family planning programs. CONCLUSION There are a number of gaps in the research concerning service delivery and ECP in LMIC. These include a lack of knowledge concerning private/commercial sector contributions to improving access, the needs of vulnerable groups of women, approaches to enhancing intersectoral collaboration, evidence for social marketing models and investment cases for ECP.
Collapse
Affiliation(s)
- Angela Dawson
- World Health Organization Collaborating Centre for Nursing, Midwifery and Health Development, Faculty of Health, University of Technology, Sydney (UTS), Sydney, New South Wales, Australia
| | - Nguyen-Toan Tran
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Elizabeth Westley
- International Consortium for Emergency Contraception, New York, New York, United States of America
| | - Viviana Mangiaterra
- RMNCH and HSS Technical Advice & Partnerships Department, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Vernier-Geneva, Switzerland
| | - Mario Festin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| |
Collapse
|
24
|
Thin Zaw PP, Liabsuetrakul T, McNeil E, Htay TT. Gender differences in exposure to SRH information and risky sexual debut among poor Myanmar youths. BMC Public Health 2013; 13:1122. [PMID: 24304552 PMCID: PMC4235033 DOI: 10.1186/1471-2458-13-1122] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 11/27/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, the proportion of youths has been steadily increasing, especially in Asia. This vulnerable population has limited exposure to sexual and reproductive health (SRH) information leading to various reproductive health (RH) problems including risky sexual debut, unwanted pregnancy, unsafe abortion as well as STI/HIV infections. Among known social variations which influence youth's RH, gender differences are critical for planning necessary gender appropriate interventions. This study aimed to identify gender differences in exposure to SRH information and risky sexual debut as well as associated factors among Myanmar youths in poor suburban communities of Mandalay City. METHODS A total of 444 randomly selected youths (aged 15-24 years) from all poor, suburban communities in Mandalay City took part in our survey. Gender differences in exposure to SRH information and risky sexual debut were assessed by bivariate analysis. Multivariate logistic regression was used to confirm gender differences and identify independent factors associated with main outcomes separately for males and females as well as for both. RESULTS Of 444 youths interviewed, 215 were males and 229 were females. Gender differences were seen in both exposures to SRH information (p = 0.013) and risky sexual debut (p = 0.003). These gender differences were confirmed by multivariate analysis even after adjusting for other risk factors. For exposure to SRH information, only age group and schooling status were significant factors for females. As well as those two factors, media exposure and parental guardianship were significant factors among males. Only positive norm of premarital sex increased the likelihood of risky sexual debut among males. In contrast, unwillingness at sexual debut was a risk factor and a higher education level was a protective factor for risky sexual debut among females. CONCLUSIONS Limited exposure to SRH information and high risky sexual debut among poor youths were found. There were different influential factors for RH behaviors between males and females. Policy makers as well as local RH care providers should be aware of these differences. Dissemination of reliable SRH information among youths through possible mass media, especially among males, is an urgent issue.
Collapse
|
25
|
Abstract
The HIV/AIDS field is addressing how legal and policy restrictions affect access to health promotion and care, e.g., in relation to criminalization of HIV transmission, drug use and sex work. Work to address the reproductive rights of women living with HIV, particularly regarding unwanted pregnancy and abortion, has nevertheless lagged behind, despite its potential to contribute to broader advocacy for access to comprehensive reproductive health information and services for all women. It is in that context that this paper examines abortion in relation to the rights of women and girls living with HIV. The paper first presents findings from recent research on HIV-positive women's reasons for seeking abortions and experiences with abortion-related care. This is followed by a discussion of abortion in relation to human rights and how this has been both addressed and neglected in policy and guidance related to the reproductive health of women living with HIV. The concluding remarks offer recommendations for expanding efforts to provide comprehensive, human rights-based sexual and reproductive health care to women living with HIV by including abortion-related information and services.
Collapse
|
26
|
Akbari N, Ramezankhani A, Pazargadi M. Accelerators/decelerators of achieving universal access to sexual and reproductive health services: a case study of Iranian health system. BMC Health Serv Res 2013; 13:241. [PMID: 23816259 PMCID: PMC3750448 DOI: 10.1186/1472-6963-13-241] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 06/19/2013] [Indexed: 11/13/2022] Open
Abstract
Background At the 1994 International Conference on Population and Development (ICPD), held in Cairo, the global community agreed to the goal of achieving universal access to sexual and reproductive health (SRH) and rights by 2015. This research explores the accelerators and decelerators of achieving universal access to the sexual and reproductive health targets and accordingly makes some suggestions. Method We have critically reviewed the latest national reports and extracted the background data on each SRH indicator. The key stakeholders, both national and international, were visited and interviewed at two sites. A total of 55 in-depth interviews were conducted with religious leaders, policy-makers, senior managers, senior academics, and health care managers. Six focus-group discussions were also held among health care providers. The study was qualitative in nature. Results Obstacles on the road to achieving universal access to SRH can be viewed from two perspectives. One gap exists between current achievements and the targets. The other gap arises due to age, marital status, and residency status. The most recently observed trends in the indicators of the universal access to SRH shows that the achievements in the “unmet need for family planning” have been poor. Unmet need for family planning could directly be translated to unwanted pregnancies and unwanted childbirths; the former calls for sexual education to underserved people, including adolescents; and the latter calls for access to safe abortion. Local religious leaders have not actively attended international goal-setting programs. Therefore, they usually do not presume a positive attitude towards these goals. Such negative attitudes seem to be the most important factors hindering the progress towards universal access to SRH. Lack of international donors to fund for SRH programs is also another barrier. In national levels both state and the society are interactively playing their roles. We have used a cascade model for presenting the barriers at the state levels from the strategic planning to implementation. Social factors are to be considered as a background for other factors at all stages. Conclusion Accelerating universal access to SRH requires adequate funding, firm political commitment, creative programming, and the involvement of diverse actors, including faith-based, civil society, and private sector partners.
Collapse
Affiliation(s)
- Nahid Akbari
- Department of Midwifery and Reproductive Health, Nursing and Midwifery School, Shahid Beheshti University of Medical Science, Tehran, Iran
| | | | | |
Collapse
|
27
|
Lathrop E, Rochat R. The GEMMA Seminar: a graduate public health course on global elimination of maternal mortality from abortion. Contraception 2012; 87:6-10. [PMID: 23063340 DOI: 10.1016/j.contraception.2012.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 08/17/2012] [Accepted: 08/20/2012] [Indexed: 11/16/2022]
Affiliation(s)
- Eva Lathrop
- Emory University School of Medicine, Atlanta, GA 30322, USA.
| | | |
Collapse
|
28
|
Weigel R, Hosseinipour MC, Feldacker C, Gareta D, Tweya H, Chiwoko J, Gumulira J, Kalulu M, Mofolo I, Kamanga E, Mwale G, Kadzakumanja A, Jere E, Phiri S. Ensuring HIV-infected pregnant women start antiretroviral treatment: an operational cohort study from Lilongwe, Malawi. Trop Med Int Health 2012; 17:751-9. [PMID: 22487553 DOI: 10.1111/j.1365-3156.2012.02980.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES HIV-infected women identified through antenatal care (ANC) often fail to access antiretroviral treatment (ART), leaving them and their infants at risk for declining health or HIV transmission. We describe results of measures to improve uptake of ART among eligible pregnant women. METHODS Between October 2006 and December 2009, interventions implemented at ANC and ART facilities in urban Lilongwe aimed to better link services for women with CD4 counts <250/μl. A monitoring system followed women referred for ART to examine trends and improve practices in referral completion, on-time ART initiation and ART retention. RESULTS Six hundred and twelve women were ART eligible: 604 (99%) received their CD4 result, 344 (56%) reached the clinic, 286 (47%) started ART while pregnant and 261 (43%) were either alive on ART or transferred out after 6 months. Between 2006 and 2009, the median (IQR) time between CD4 blood draw and ART initiation fell from 41 days (17, 349) to 15 days (7,42) (P = 0.183); the proportion of eligible individuals starting ART while pregnant and retained for 6 months improved from 17% to 65% (P < 0.001). Delays generally shortened within the continuum of care from 2006 to 2009; however, time from CD4 blood draw to ART referral increased from 7 to 14 days. CONCLUSIONS Referrals between facilities and delays through CD4 count measurements create bottlenecks in patient care. Retention improved over time, but delays within the linkage process remained. ART initiation at ANC plus use of point-of-care CD4 tests may further enhance ART uptake.
Collapse
Affiliation(s)
- Ralf Weigel
- Lighthouse Trust at Kamuzu Central Hospital, Lilongwe, Malawi.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|