Knowledge and attitudes of caregivers of HIV-infected children toward antiretroviral treatment in Ethiopia

Effect and implementation experience of intensive adherence counseling in a public HIV care center in Uganda: a mixed-methods study

Background

Intensive adherence counseling (IAC) is an intervention recommended by the World Health Organization to improve anti-retroviral therapy (ART) adherence among people living with HIV on ART with unsuppressed viral load; and in 2016, the intervention was implemented in Uganda. This study evaluated the effect and experiences of providing IAC in an urban HIV care center in Kampala, Uganda.

Methods

This was a sequential explanatory mixed-method study that compared viral load suppression during IAC implementation (intervention) to the period before IAC at Kisenyi Health centre IV. Data were abstracted from patient files and viral load register. The effect of IAC on viral load suppression and associated factors were analyzed using modified Poisson regression with robust standard errors. Using in-depth interviews and an inductive analysis approach in Atlas-ti 8. We also explored experiences of providing IAC among healthcare workers.

Results

A total of 500 records were sampled: 249 (49.8%) in the intervention period and 251 (51.2%) in the pre-intervention period. The mean age was lower during the intervention period 33.1 (± 12.0) than 36.5 (± 13.4) in the pre- intervention period, p = 0.002. More clients were currently on Protease-based regimen in the pre-intervention period 179 (71.3%) than 135 (54.2%) in the intervention period, p ≤ 0.001. In the intervention period, all eligible clients received IAC [249/249 (100.0%)]. Overall, 325 (65.0%) received IAC and of these, 143 (44.1%) achieved viral load suppression compared to 46 (26.3%) who received regular counseling. Receiving IAC significantly increased viral load suppression by 22% (aPR 1.22, 95% CI 1.01–1.47). Clients on Protease-based regimen were less likely to suppress than those on Efavirenz or Nevirapine-based regimens (aPR 0.11, 95% CI 0.08–0.15). All the interviewed healthcare workers lauded IAC for improving ART adherence. However, patient and health care system related factors hindered adherence during IAC.

Conclusions

The full potential of IAC in achieving viral load suppression in this setting has not been reached due to a combination of the patient and health care system related factors. Provision of adequate IAC necessities and use of patient centered approach should be emphasized to obtain the maximum benefit of the intervention.

Adherence to antiretroviral therapy of Brazilian HIV-infected children and their caregivers

BACKGROUND

Successful treatment of HIV-positive children requires a high level of adherence (at least 95%) to highly active antiretroviral therapy. Adherence is influenced by factors related to the child and caregivers.

OBJECTIVES

To evaluate children and caregivers characteristics associated to children's adherence.

METHODS

Cross-sectional study, from September 2013 to June 2015, comprising a sample of caregivers of perinatally HIV-infected children, in the age group of 1-12 years, under antiretroviral therapy for at least 6 months and on follow-up in two AIDS reference centers in Salvador, Bahia. Caregiver self-reports were the sole source of 4 days adherence and sociodemographic information. Study participants who reported an intake >95% of prescribed medication were considered adherents. A variable, ("Composed Adherence"), was created to better evaluate adherence.

RESULTS

We included 77 children and their caregivers. 88.3% of the caregivers were female, the median age was 38.0 years (IQR 33.5-47.5), 48.1% were white or mixed, 72.7% lived in Salvador and 53.2% had no fixed income. The 4 days child's adherence was associated only to caregivers that received less than a minimum salary (p<0.05), 70.1% of the caregivers had less than four years of formal education, 81.8% were children's relative and 53.2% of the caregivers were HIV positive. The caregiver's pharmacy refill, long-term adherence and 4 days adherence, were significantly associated with composed adherence (p<0.05). Child's long-term adherence was strongly associated to the 4 days child's adherence referred by caregiver (p<0.001).

CONCLUSIONS

Our results suggest the need of improvement in HIV-infected children adherence, through reinforcement of the caregivers own adherence.

Knowledge, attitudes and perceptions of occupational hazards and safety practices in Nigerian healthcare workers

Background

By profession, healthcare workers (HCWs) attend to clients and patients through a variety of preventive and curative services. However, while their attention is focused on providing care, they are vulnerable to hazards that could be detrimental to their health and well-being. This is especially true in developing countries where health service delivery is fraught with minimal protective precautions against exposures to numerous fomites and infectious agents. This study assessed the workplace hazards and safety practices by selected HCWs in a typical health care facility (HCF) in Nigeria.

Methods

The study utilized a descriptive cross-sectional design and stratified sampling technique to identify 290 respondents. The study used mixed methodology and collected data by validated instruments with resulting data analyzed by IBM-SPSS, version 20.

Results

The results showed that over half of the respondents were registered nurses, female, married (61.7 %) with 5 years median work experience (70.3 %). Most respondents (89 %) were knowledgeable about hazards in HCFs, identified recapping used needles as a risky practice (70 %) and recognized that effective hand washing prior to, and after every clinical procedure in preventing cross infection (100 %). Also, most respondents (96.2 %) believed they were at risk of occupational hazards while about two-thirds perceived the risk as high. In addition, only 64.2 and 87.2 % had completed Hepatitis B and Tetanus immunizations, respectively. Only 52.1 % “always” complied with standard procedures and most (93.8 %) practice safe disposal of sharps (93.8 %) while those that did not (40 %) generally implicated lack of basic safety equipment. In this study, the practice of hand washing by respondents was not influenced by occupation and education.

Conclusions

The high level of knowledge demonstrated by respondents was at variance with practice, therefore, measures aimed at promoting safety practices and, minimizing exposure to hazards such as; provision of safety equipment, pre-placement and routine training of staff on safety practices and adequate reinforcement of staff capacity and capability through drills in all HCFs should be institutionalized and made mandatory. The protocol of the safety training and drills should be responsive to evidence-based emerging and sectoral safety challenges.

Electronic supplementary material

The online version of this article (doi:10.1186/s13104-016-1880-2) contains supplementary material, which is available to authorized users.

Missed Doses and Missed Appointments: Adherence to ART among Adult Patients in Uganda

Background. Missed doses and appointments are predictors of incomplete adherence among patients on ART. The AIDSRelief model emphasizes treatment preparation and continuous treatment support for ART patients including community followup. Methods. In August 2008, a survey was conducted among patients on antiretroviral therapy (ART) (interquartile range for duration of ART = 29-46 months, median = 33 months, n = 763, age >16 years), in 15 health facilities in Uganda. Missed doses and appointments among adult patients on ART and the factors most associated with these were identified. Reasons for missed doses were also explored. Results. The survey revealed that 97% of the patients had not missed their doses in the last week while 93% had not missed their appointments in the last three months. For those who had missed their doses, the most common reasons were travel (48%) and forgetfulness (28%). There was a significant association between missing doses and missing appointments (P = 0.0004) and between alcohol use and missed doses (P < 0.005). Conclusions. The level of adherence to medication and clinic appointments for patients on ART in the study population was very high. It is important to strengthen adherence strategies at both facility and community levels to assist patients that are likely to miss their doses or appointments.

Determinants of Adherence to Antiretroviral Therapy among HIV-Infected Patients in Africa

Background. There are only a few comprehensive studies of adherence to ART and its challenges in Africa. This paper aims to assess the evidence on the challenges and prospects of ART adherence in sub-Saharan Africa. Methods. The authors reviewed original and review articles involving HIV-positive individuals that measured adherence to ART and its predictors in the past decade. Findings. Against expectations, sub-Saharan Africa patients have similar or higher adherence levels compared to those of developed countries. The challenges to ART adherence include factors related to patients and their families, socioeconomic factors, medication, and healthcare systems. Conclusion. Despite good adherence and program-related findings, antiretroviral treatment is challenged by a range of hierarchical and interrelated factors. There is substantial room for improvement of ART programs in sub-Sahara African countries.