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Ferrari G, Torres-Rueda S, Michaels-Igbokwe C, Watts C, Jewkes R, Vassall A. Economic Evaluation of Public Health Interventions: An Application to Interventions for the Prevention of Violence Against Women and Girls Implemented by the "What Works to Prevent Violence Against Women and Girls?" Global Program. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP11392-NP11420. [PMID: 31702407 PMCID: PMC8581711 DOI: 10.1177/0886260519885118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Violence against women and girls (VAWG) has important social, economic, and public health impacts. Governments and international donors are increasing their investment in VAWG prevention programs, yet clear guidelines to assess the "value for money" of these interventions are lacking. Improved costing and economic evaluation of VAWG prevention can support programming through supporting priority setting, justifying investment, and planning the financing of VAWG prevention services. This article sets out a standardized methodology for the economic evaluation of complex, that is, multicomponent and/or multiplatform, programs designed to prevent VAWG in low- and middle-income countries (LMICs). It outlines an approach that can be used alongside the most recent guidance for the economic evaluation of public health interventions in LMICs. It defines standardized methods of data collection and analysis, outcomes, and unit costs (i.e., average costs per person reached, output or service delivered), and provides guidance to investigate the uncertainty in cost-effectiveness estimates and report results. The costing approach has been developed and piloted as part of the "What Works to Prevent Violence Against Women and Girls?" (What Works?) program in five countries. This article and its supplementary material can be used by both economists and non-economists to contribute to the generation of new cost-effectiveness data on VAWG prevention, and ultimately improve the allocative efficiency and financing across VAWG programs.
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Affiliation(s)
- Giulia Ferrari
- London School of Hygiene & Tropical Medicine, UK
- University of Bristol, UK
| | | | | | - Charlotte Watts
- London School of Hygiene & Tropical Medicine, UK
- Department for International Development, London, UK
| | - Rachel Jewkes
- South African Medical Research Council, Pretoria, South Africa
- University of the Witwatersrand, Johannesburg, South Africa
| | - Anna Vassall
- London School of Hygiene & Tropical Medicine, UK
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Mashamba-Thompson TP, Drain PK, Kuupiel D, Sartorius B. Impact of Implementing Antenatal Syphilis Point-of-Care Testing on Maternal Mortality in KwaZulu-Natal, South Africa: An Interrupted Time Series Analysis. Diagnostics (Basel) 2019; 9:diagnostics9040218. [PMID: 31835603 PMCID: PMC6963181 DOI: 10.3390/diagnostics9040218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 11/29/2019] [Accepted: 12/05/2019] [Indexed: 12/19/2022] Open
Abstract
Background: Syphilis infection has been associated with an increased risk of HIV infection during pregnancy which poses greater risk for maternal mortality, and antenatal syphilis point-of-care (POC) testing has been introduced to improve maternal and child health outcomes. There is limited evidence on the impact of syphilis POC testing on maternal outcomes in high HIV prevalent settings. We used syphilis POC testing as a model to evaluate the impact of POC diagnostics on the improvement of maternal mortality in KwaZulu-Natal, South Africa. Methods: We extracted 132 monthly data points on the number of maternal deaths in facilities and number of live births in facilities for 12 tertiary healthcare facilities in KwaZulu-Natal (KZN), South Africa from 2004 to 2014 from District Health Information System (DHIS) health facility archived. We employed segmented Poisson regression analysis of interrupted time series to assess the impact of the exposure on maternal mortality ratio (MMR) before and after the implementation of antenatal syphilis POC testing. We processed and analyzed data using Stata Statistical Software: Release 13. (Stata, Corp LP, College Station, TX, USA). Results: The provincial average annual maternal mortality ratio (MMR) was estimated at 176.09 ± 43.92 ranging from a minimum of 68.48 to maximum of 225.49 per 100,000 live births. The data comprised 36 temporal points before the introduction of syphilis POC test exposure and 84 after the introduction in primary health care clinics in KZN. The average annual MMR for KZN from 2004 to 2014 was estimated at 176.09 ± 43.92. A decrease in MMR level was observed during 2008 after syphilis POC test implementation, followed by a rise during 2009. Analysis of the MMR trend estimates a significant 1.5% increase in MMR trends during the period before implementation and 1.3% increase after implementation of syphilis POC testing (p < 0.001). Conclusion: Although our finding suggests a brief reduction in the MMR trend after the implementation of antenatal syphilis POC testing, a continued increase in syphilis rates is seen in KwaZulu-Natal, South Africa. The study used one of the most powerful quasi-experimental research methods, segmented Poisson regression analysis of interrupted time series to model the impact of syphilis POC on maternal outcome. The study finding requires confirmation by use of more rigorous primary study design.
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Affiliation(s)
- Tivani P. Mashamba-Thompson
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa; (T.P.M.-T.); (B.S.)
| | - Paul K. Drain
- International Clinical Research Center, Department of Global Health, University of Washington, Seattle, WA 98195-7965, USA;
- Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA 98195-7965, USA
- Department of Epidemiology, University of Washington, Seattle, WA 98195-7965, USA
- Department of Surgery, Harvard University, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Desmond Kuupiel
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa; (T.P.M.-T.); (B.S.)
- Correspondence:
| | - Benn Sartorius
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa; (T.P.M.-T.); (B.S.)
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
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Nabukenya AM, Matovu JKB. Correlates of HIV status awareness among older adults in Uganda: results from a nationally representative survey. BMC Public Health 2018; 18:1128. [PMID: 30223821 PMCID: PMC6142637 DOI: 10.1186/s12889-018-6027-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 09/09/2018] [Indexed: 11/16/2022] Open
Abstract
Background Recent evidence suggests that HIV prevalence is generally higher among older than younger persons. However, few studies have explored issues regarding HIV testing and awareness of HIV status among older persons. We explored the correlates of HIV status awareness among older adults (aged 45+ years) in Uganda. Methods This paper is based on secondary analysis of existing data on persons aged between 45 and 59 years from a nationally representative Uganda AIDS Indicator Survey which was conducted between February and September 2011. Records on the socio-demographics and HIV/AIDS-specific indicators for 2472 persons were extracted for analysis. Individuals were considered to be aware of their HIV status if they reported that they had tested and received their HIV test results within the past 12 months. Data analyses were done using the sample survey procedures to take into account the sampling structure of the data. Odds ratios were used to quantify the associations between receipt of HIV test results and potential factors. Results Of the 2472 respondents, 48% had ever tested and received their HIV test results while 23% tested and received their HIV results in the past 12 months or already knew that they are HIV positive. Individuals with the following characteristics had higher odds of being aware of their HIV status: being female (adjusted Odds Ratio (AOR) = 1.26; 95% CI: (1.04, 1.53), having high comprehensive knowledge of HIV/AIDS (AOR = 1.28; 95% CI: 1.04, 1.58), having attended secondary school education (AOR = 2.10; 95% CI: 1.47, 2.99) and engagement in high risk sexual behaviors (AOR = 1.53; 95% CI: (1.11, 2.10). A high level of stigma (holding at least three stigmatizing attitudes toward people living with HIV) was negatively correlated with awareness of HIV status (AOR =0.60; 95% CI: (0.45, 0.78). Conclusion Less than a quarter of older Ugandans are aware of their current HIV status. High levels of stigma and low comprehensive knowledge of HIV/AIDS remained critical barriers to HIV testing and awareness of HIV status. These findings suggest a need for innovative HIV testing strategies to increase HIV status awareness among older adults in Uganda.
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Affiliation(s)
- Anne M Nabukenya
- MakSPH-CDC Fellowship Program, Makerere University School of Public Health, Kampala, Uganda
| | - Joseph K B Matovu
- MakSPH-CDC Fellowship Program, Makerere University School of Public Health, Kampala, Uganda. .,Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda.
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Ngangue P, Gagnon MP, Bedard E. Challenges in the delivery of public HIV testing and counselling (HTC) in Douala, Cameroon: providers perspectives and implications on quality of HTC services. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2017; 17:9. [PMID: 28390398 PMCID: PMC5385024 DOI: 10.1186/s12914-017-0118-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/29/2017] [Indexed: 11/12/2022]
Abstract
Background The Cameroon government has made HIV testing and counselling (HTC) a priority in its HIV/AIDS strategic plan. However, there is a dearth of literature on the perspectives of providers on the quality of HTC services. The aim of this study was to explore challenges in the provision of HTC services and their implications on quality of HTC services in Douala’s district hospitals. Methods Two primary data collection methods supported by the Donabedian’s model of healthcare were used to explain the challenges in the provision of HTC services and their implications on quality of HTC services. This consisted of semi-structured individual interviews with 6 nurses and 16 lay counsellors and a non-participant observation of the physical environment for HTC by site. The study sites were the prevention and voluntary testing and counselling centre (PVTCC) of the six district hospitals of the city of Douala. Results The study reveals concerns about confidentiality and privacy during the counselling sessions due to inadequate and limited space. An absence of consent, even verbal, was reported in one PVTCC. There is no specific accredited training curriculum that leads to a formal registration as a PVTCC staff, and some lay counsellors work without training. Lay counsellors carry the burden of HIV counselling, but the majority of them work for many years without remuneration and recognition. Another quality challenge is the high workload in the district hospitals’ lab, which leads to long waiting times for HIV test results, thus contributing to failure to return for results. Conclusion The findings of this study highlighted some issues such as lack of adequate space and equipment for HIV testing and counselling that hinder the quality of HTC services and should challenge the health authorities of Cameroon on the need to reorganize HTC services and create a national HIV quality assurance program. Electronic supplementary material The online version of this article (doi:10.1186/s12914-017-0118-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Patrice Ngangue
- Faculty of Nursing Sciences, Laval University, 1050, avenue de la medicine, Pavillon Vandry, Québec, Québec, G1V0A6, Canada. .,Population Health and Optimal Health Practices, CHU de Québec Research Center, 10, Rue de l'Espinay, D6, Québec, Québec, G1L 3L5, Canada.
| | - Marie-Pierre Gagnon
- Faculty of Nursing Sciences, Laval University, 1050, avenue de la medicine, Pavillon Vandry, Québec, Québec, G1V0A6, Canada.,Population Health and Optimal Health Practices, CHU de Québec Research Center, 10, Rue de l'Espinay, D6, Québec, Québec, G1L 3L5, Canada
| | - Emmanuelle Bedard
- Université du Québec à Rimouski (UQAR), 1595 Boul. Alphonse-Desjardins, UQAR, Campus de Lévis, Lévis, Québec, Canada
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Uccella I, Petrelli A, Vescio MF, De Carolis S, Fazioli C, Pezzotti P, Rezza G. HIV rapid testing in the framework of an STI prevention project on a cohort of vulnerable Italians and immigrants. AIDS Care 2017; 29:996-1002. [PMID: 28107787 DOI: 10.1080/09540121.2017.1281876] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Uptake of HIV tests is a challenging issue in vulnerable populations including immigrants, normally using standard diagnostic tools. Objectives of this study were to evaluate the acceptability of HIV rapid test; estimate the percentage of newly HIV diagnoses and evaluate knowledge, attitudes and perception (KAP) about HIV/AIDS and other STIs in a specific set of immigrants and vulnerable population in Rome (Italy). METHODS All immigrant and Italian people, aged 16-70 years, attending the infectious disease outpatient clinic of the National Institute for Health, Migration and Poverty (INMP) in Rome (Italy), during the period December 2012 to December 2013 were enrolled. HIV rapid testing was provided for free and patients were asked to fill in a questionnaire evaluating KAP about HIV/STIs. All patients with risky sexual behaviours or with a recent diagnosis of STIs were invited to come back after 3-6 months and a post-counselling questionnaire was offered. RESULTS Out of the total sample, 99.2% (n = 825) accepted the "rapid test" and 10 new HIV diagnoses were found (1.22%; 95% CI 0.58%-2.22%). Three hundred and eighty-five participants (47%) answered the entry questionnaire and 58 (15%) completed the follow-up. Overall, we found high knowledge about HIV/AIDS; however, lower educational level and immigrant status were associated with poor knowledge about HIV, other STIs and prevention methods. Immigrants have lower perception of sexual risk and higher prejudice than Italians. CONCLUSIONS Our study showed high acceptance of rapid test in this specific vulnerable population and this allowed to identify new HIV diagnoses in unaware people. Socioeconomic inequalities observed in the KAP questionnaire suggest the need for actions to support the reduction of cultural differences in knowledge of HIV/AIDS and for policies aimed at improving access to health services and preventions programmes of marginalized populations.
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Affiliation(s)
- Ilaria Uccella
- a INMP National Institute for Health, Migration and Poverty , Rome , Italy
| | - Alessio Petrelli
- a INMP National Institute for Health, Migration and Poverty , Rome , Italy
| | - Maria Fenicia Vescio
- b Department of Infectious Diseases , Istituto Superiore di Sanità, National Institute of Health , Rome , Italy
| | - Silvia De Carolis
- a INMP National Institute for Health, Migration and Poverty , Rome , Italy
| | - Cecilia Fazioli
- a INMP National Institute for Health, Migration and Poverty , Rome , Italy
| | - Patrizio Pezzotti
- b Department of Infectious Diseases , Istituto Superiore di Sanità, National Institute of Health , Rome , Italy
| | - Gianni Rezza
- b Department of Infectious Diseases , Istituto Superiore di Sanità, National Institute of Health , Rome , Italy
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Mwisongo A, Peltzer K, Mohlabane N, Tutshana B. The quality of rapid HIV testing in South Africa: an assessment of testers' compliance. Afr Health Sci 2016; 16:646-654. [PMID: 27917195 PMCID: PMC5111989 DOI: 10.4314/ahs.v16i3.2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the quality of rapid HIV testing in South Africa. METHOD A two-stage sampling procedure was used to select HCT sites in eight provinces of South Africa. The study employed both semi-structured interviews with HIV testers and observation of testing sessions as a means of data collection. In total, 63 HCT sites (one HIV tester per site) were included in the survey assessing qualification, training, testing practices and attitudes towards rapid tests. Quantitative data was analysed using descriptive statistics and qualitative data was content analysed. RESULTS Of the 63 HIV testers, 20.6% had a nursing qualification, 14.3% were professional counsellors, 58.7% were lay HIV counsellors and testers and 6.4% were from other professions. Most HIV testers (87.3%) had had a formal training in testing, which ranged between 10-14 days, while 6 (9.5%) had none. Findings revealed sub-standard practices in relation to testing. These were mainly related to non-adherence to testing algorithms, poor external quality control practices, poor handling and communication of discordant results. CONCLUSION Quality of HIV rapid testing may be highly compromised through poor adherence to guidelines as observed in our study.
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Affiliation(s)
- Aziza Mwisongo
- HIV/AIDS/STIs/and TB (HAST), Human Sciences Research Council, Pretoria, Durban, South Africa
| | - Karl Peltzer
- HIV/AIDS/STIs/and TB (HAST), Human Sciences Research Council, Pretoria, Durban, South Africa
- Department of Research & Innovation, University of Limpopo, Turfloop Campus, Private Bag X1106, Sovenga 0727, South Africa
- ASEAN Institute for Health Development, Madidol University, Salaya, Phutthamonthon, Nakhonpathom, Thailand, 73170
| | - Neo Mohlabane
- HIV/AIDS/STIs/and TB (HAST), Human Sciences Research Council, Pretoria, Durban, South Africa
| | - Bomkazi Tutshana
- HIV/AIDS/STIs/and TB (HAST), Human Sciences Research Council, Pretoria, Durban, South Africa
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Mee P, Kahn K, Kabudula C, Wagner R, Gómez-Olivé FX, Madhavan S, Collinson MA, Tollman S, Byass P. The development of a localised HIV epidemic and the associated excess mortality burden in a rural area of South Africa. Glob Health Epidemiol Genom 2016; 1:e7. [PMID: 29302331 PMCID: PMC5738674 DOI: 10.1017/gheg.2016.3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 02/12/2016] [Accepted: 02/16/2016] [Indexed: 01/25/2023] Open
Abstract
The human immunodeficiency virus (HIV) epidemic in South Africa rapidly developed into a major pandemic. Here we analyse the development of the epidemic in a rural area of the country. The data used were collected between 1992 and 2013 in a longitudinal population survey, the Agincourt Health and Demographic Surveillance Study, in the northeast of the country. Throughout the period of study mortality rates were similar in all villages, suggesting that there were multiple index cases evenly spread geographically. These were likely to have been returning migrant workers. For those aged below 39 years the HIV mortality rate was higher for women, above this age it was higher for men. This indicates the protective effect of greater access to HIV testing and treatment among older women. The recent convergence of mortality rates for Mozambicans and South Africans indicates that the former refugee population are being assimilated into the host community. More than 60% of the deaths occurring in this community between 1992 and 2013 could be attributed directly or indirectly to HIV. Recently there has been an increasing level of non-HIV mortality which has important implications for local healthcare provision. This study demonstrates how evidence from longitudinal analyses can support healthcare planning.
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Affiliation(s)
- P. Mee
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
- Department of Population Health, Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London,UK
| | - K. Kahn
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
- International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana
| | - C.W. Kabudula
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana
| | - R.G. Wagner
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
- International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana
| | - F. X. Gómez-Olivé
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana
| | - S. Madhavan
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of African-American Studies, University of Maryland-College Park, College Park, MD, USA
| | - Mark A. Collinson
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
- International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana
| | - S.M. Tollman
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
- International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana
| | - P. Byass
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
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Mee P, Wagner RG, Gómez-Olivé FX, Kabudula C, Kahn K, Madhavan S, Collinson M, Byass P, Tollman SM. Changing use of traditional healthcare amongst those dying of HIV related disease and TB in rural South Africa from 2003 - 2011: a retrospective cohort study. Altern Ther Health Med 2014; 14:504. [PMID: 25515165 PMCID: PMC4325963 DOI: 10.1186/1472-6882-14-504] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 11/20/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND In 2011 there were 5.5 million HIV infected people in South Africa and 71% of those requiring antiretroviral therapy (ART) received it. The effective integration of traditional medical practitioners and biomedical providers in HIV prevention and care has been demonstrated. However concerns remain that the use of traditional treatments for HIV-related disease may lead to pharmacokinetic interactions between herbal remedies and ART drugs and delay ART initiation. Here we analyse the changing prevalence and determinants of traditional healthcare use amongst those dying of HIV-related disease, pulmonary tuberculosis and other causes in a rural South African community between 2003 and 2011. ART was made available in this area in the latter part of this period. METHODS Data was collected during household visits and verbal autopsy interviews. InterVA-4 was used to assign causes of death. Spatial analyses of the distribution of traditional healthcare use were performed. Logistic regression models were developed to test associations of determinants with traditional healthcare use. RESULTS There were 5929 deaths in the study population of which 47.7% were caused by HIV-related disease or pulmonary tuberculosis (HIV/AIDS and TB). Traditional healthcare use declined for all deaths, with higher levels throughout for those dying of HIV/AIDS and TB than for those dying of other causes. In 2003-2005, sole use of biomedical treatment was reported for 18.2% of HIV/AIDS and TB deaths and 27.2% of other deaths, by 2008-2011 the figures were 49.9% and 45.3% respectively. In bivariate analyses, higher traditional healthcare use was associated with Mozambican origin, lower education levels, death in 2003-2005 compared to the later time periods, longer illness duration and moderate increases in prior household mortality. In the multivariate model only country of origin, time period and illness duration remained associated. CONCLUSIONS There were large decreases in reported traditional healthcare use and increases in the sole use of biomedical treatment amongst those dying of HIV/AIDS and TB. No associations between socio-economic position, age or gender and the likelihood of traditional healthcare use were seen. Further qualitative and quantitative studies are needed to assess whether these figures reflect trends in healthcare use amongst the entire population and the reasons for the temporal changes identified.
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Bloch EM, Shah A, Kaidarova Z, Laperche S, Lefrere JJ, van Hasselt J, Zacharias P, Murphy EL. A pilot external quality assurance study of transfusion screening for HIV, HCV and HBsAG in 12 African countries. Vox Sang 2014; 107:333-42. [PMID: 25052195 DOI: 10.1111/vox.12182] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 06/30/2014] [Accepted: 06/30/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Serologic screening for the major transfusion transmissible viruses (TTV) is critical to blood safety and has been widely implemented. However, actual performance as measured by proficiency testing has not been well studied in sub-Saharan Africa. Therefore, we conducted an external quality assessment of laboratories engaged in transfusion screening in the region. MATERIALS AND METHODS Blinded test panels, each comprising 25 serum samples that were pedigreed for HIV, HBsAg, HCV and negative status, were sent to participating laboratories. The panels were tested using the laboratories' routine donor screening methods and conditions. Sensitivity and specificity were calculated, and multivariable analysis was used to compare performance against mode of testing, country and infrastructure. RESULTS A total of 12 African countries and 44 laboratories participated in the study. The mean (range) sensitivities for HIV, HBsAg and HCV were 91·9% (14·3-100), 86·7% (42·9-100) and 90·1% (50-100), respectively. Mean specificities for HIV, HBsAg and HCV were 97·7%, 97% and 99·5%, respectively. After adjusting for country and infrastructure, rapid tests had significantly lower sensitivity than enzyme immunoassays for both HBsAg (P < 0·0001) and HCV (P < 0·05). Sensitivity also varied by country and selected infrastructure variables. CONCLUSION While specificity was high, sensitivity was more variable and deficient in a substantial number of testing laboratories. These findings underscore the importance of proficiency testing and quality control, particularly in Africa where TTV prevalence is high.
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Affiliation(s)
- E M Bloch
- Blood Systems Research Institute (BSRI), San Francisco, CA, USA; University of California, San Francisco, San Francisco, CA, USA
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Mee P, Collinson MA, Madhavan S, Root ED, Tollman SM, Byass P, Kahn K. Evidence for localised HIV related micro-epidemics associated with the decentralised provision of antiretroviral treatment in rural South Africa: a spatio-temporal analysis of changing mortality patterns (2007-2010). J Glob Health 2014; 4:010403. [PMID: 24976962 PMCID: PMC4073250 DOI: 10.7189/jogh.04.010403] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background In this study we analysed the spatial and temporal changes in patterns of mortality over a period when antiretroviral therapy (ART) was rolled out in a rural region of north–eastern South Africa. Previous studies have identified localised concentrated HIV related sub–epidemics and recommended that micro–level analyses be carried out in order to direct focused interventions. Methods Data from an ongoing health and socio–demographic surveillance study was used in the analysis. The follow–up was divided into two periods, 2007–2008 and 2009–2010, representing the times immediately before and after the effects on mortality of the decentralised ART provision from a newly established local health centre would be expected to be evident. The study population at the start of the analysis was approximately 73 000 individuals. Data were aggregated by village and also using a 2 × 2 km grid. We identified villages, grid squares and regions in the site where mortality rates within each time period or rate ratios between the periods differed significantly from the overall trends. We used clustering techniques to identify cause–specific mortality hotspots. Findings Comparing the two periods, there was a 30% decrease in age and gender standardised adult HIV–related and TB (HIV/TB) mortality with no change in mortality due to other causes. There was considerable spatial heterogeneity in the mortality patterns. Areas separated by 2 to 4 km with very different epidemic trajectories were identified. There was evidence that the impact of ART in reducing HIV/TB mortality was greatest in communities with higher mortality rates in the earlier period. Conclusions This study shows the value of conducting high resolution spatial analyses in order to understand how local micro–epidemics contribute to changes seen over a wider area. Such analyses can support targeted interventions.
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Affiliation(s)
- Paul Mee
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa ; Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Mark A Collinson
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa ; Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden ; INDEPTH Network, Kanda, Accra, Ghana
| | - Sangeetha Madhavan
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa ; Department of African-American Studies, University of Maryland, Maryland, USA
| | - Elisabeth Dowling Root
- Department of Geography and Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, USA
| | - Stephen M Tollman
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa ; Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden ; INDEPTH Network, Kanda, Accra, Ghana
| | - Peter Byass
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa ; WHO Collaborating Centre for Verbal Autopsy, Umeå Centre for Global Health Research, Umeå University, 90187 Umeå, Sweden ; Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Kathleen Kahn
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa ; Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden ; INDEPTH Network, Kanda, Accra, Ghana
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Geary RS, Gómez-Olivé FX, Kahn K, Tollman S, Norris SA. Barriers to and facilitators of the provision of a youth-friendly health services programme in rural South Africa. BMC Health Serv Res 2014; 14:259. [PMID: 24934095 PMCID: PMC4067688 DOI: 10.1186/1472-6963-14-259] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 06/09/2014] [Indexed: 11/23/2022] Open
Abstract
Background Youth-friendly health services are a key strategy for improving young people’s health. This is the first study investigating provision of the Youth Friendly Services programme in South Africa since the national Department of Health took over its management in 2006. In a rural area of South Africa, we aimed to describe the characteristics of the publicly-funded primary healthcare facilities, investigate the proportion of facilities that provided the Youth Friendly Services programme and examine healthcare workers’ perceived barriers to and facilitators of the provision of youth-friendly health services. Methods Semi-structured interviews were conducted with nurses of all eight publicly-funded primary healthcare facilities in Agincourt sub-district, Mpumalanga Province, South Africa. Thematic analysis of interview transcripts was conducted and data saturation was reached. Results Participants largely felt that the Youth Friendly Services programme was not implemented in their primary healthcare facilities, with the exception of one clinic. Barriers to provision reported by nurses were: lack of youth-friendly training among staff and lack of a dedicated space for young people. Four of the eight facilities did not appear to uphold the right of young people aged 12 years and older to access healthcare independently. Breaches in young people’s confidentiality to parents were reported. Conclusions Participants reported that provision of the Youth Friendly Services programme is limited in this sub-district, and below the Department of Health’s target that 70% of primary healthcare facilities should provide these services. Whilst a dedicated space for young people is unlikely to be feasible or necessary, all facilities have the potential to be youth-friendly in terms of staff attitudes and actions. Training and on-going support should be provided to facilitate this; the importance of such training is emphasised by staff. More than one member of staff per facility should be trained to allow for staff turnover. As one of a few countrywide, government-run youth-friendly clinic programmes in a low or middle-income country, these results may be of interest to programme managers and policy makers in such settings.
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Affiliation(s)
- Rebecca Sally Geary
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.
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12
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Lemos EF, Alves AMDS, Oliveira GDC, Rodrigues MP, Martins NDG, Croda J. Health-service performance of TB treatment for indigenous and non-indigenous populations in Brazil: a cross-sectional study. BMC Health Serv Res 2014; 14:237. [PMID: 24885134 PMCID: PMC4049501 DOI: 10.1186/1472-6963-14-237] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 05/07/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Health-service evaluation studies are fundamental for proposing interventions and ensuring improvements in healthcare quality. The present study assesses the performance of health services for indigenous and non-indigenous populations with regard to tuberculosis (TB) control. METHODS Interviews with TB patients who underwent treatment between 2009 and 2011 were conducted using the Primary Care Assessment Tool adapted for TB care in Brazil. RESULTS Primary healthcare (PHC) was the first treatment for most patients at symptom onset, and the diagnoses were typically performed by specialized services. Many patients experienced delayed TB diagnoses that required more than three medical appointments (51% and 47% for indigenous and non-indigenous populations, respectively). Indigenous people received social support, such as basic-needs grocery packages (2.19 ± 1.63 vs. 1.13 ± 0.49 for non-indigenous people, p < 0.01) and home visits from health professionals, with an emphasis on the performance of directly observed treatment strategies (DOT; 4.57 ± 0.89 vs. 1.68 ± 1.04 for non-indigenous people, p < 0.01). CONCLUSIONS Regardless of the differences between indigenous and non-indigenous populations, the time needed to receive a TB diagnosis was unsatisfactory for both groups. Furthermore, DOT must be performed with better coverage among non-indigenous patients.
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Affiliation(s)
- Everton Ferreira Lemos
- Faculdade de Ciências da Saúde, Universidade Federal da Grande Dourados, Rodovia Dourados – Itaúm. Km 12, Dourados, Mato Grosso do Sul 79804-970, Brazil
| | - Aline Mara da Silva Alves
- Faculdade de Ciências da Saúde, Universidade Federal da Grande Dourados, Rodovia Dourados – Itaúm. Km 12, Dourados, Mato Grosso do Sul 79804-970, Brazil
| | - Giovana de Castro Oliveira
- Faculdade de Ciências da Saúde, Universidade Federal da Grande Dourados, Rodovia Dourados – Itaúm. Km 12, Dourados, Mato Grosso do Sul 79804-970, Brazil
| | - Marcella Paranhos Rodrigues
- Faculdade de Ciências da Saúde, Universidade Federal da Grande Dourados, Rodovia Dourados – Itaúm. Km 12, Dourados, Mato Grosso do Sul 79804-970, Brazil
| | - Natália Daiane Garoni Martins
- Faculdade de Ciências da Saúde, Universidade Federal da Grande Dourados, Rodovia Dourados – Itaúm. Km 12, Dourados, Mato Grosso do Sul 79804-970, Brazil
| | - Julio Croda
- Faculdade de Ciências da Saúde, Universidade Federal da Grande Dourados, Rodovia Dourados – Itaúm. Km 12, Dourados, Mato Grosso do Sul 79804-970, Brazil
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Feasibility of performing multiple point of care testing for HIV anti-retroviral treatment initiation and monitoring from multiple or single fingersticks. PLoS One 2013; 8:e85265. [PMID: 24376873 PMCID: PMC3869909 DOI: 10.1371/journal.pone.0085265] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 11/25/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Point of Care testing (POCT) provides on-site, rapid, accessible results. With current South African anti-retroviral treatment guidelines, up to 4 fingersticks /patient/clinic visit could be required if utilizing POC. We determined the feasibility and accuracy of a nurse performing multiple POCT on multiple fingersticks followed by simplification of the process by performance of multiple POC on a single fingerstick. METHOD AND FINDINGS Random HIV positive adult patients presenting at a HIV treatment clinic in South Africa, for ART initiation/ monitoring, were approached to participate in the study between April-June 2012. Phase I: n=150 patients approached for multiple POCT on multiple fingersticks. Phase II: n=150 patients approached for multiple POCT on a single fingerstick. The following POC tests were performed by a dedicated nurse: PIMA (CD4), HemoCue (hemoglobin), Reflotron (alanine aminotransferase, creatinine). A venepuncture specimen was taken for predicate laboratory methodology. Normal laboratory ranges and Royal College of Pathologists Australasia (RCPA) allowable differences were used as guidelines for comparison. In 67% of participants, ≥3 tests were requested per visit. All POCT were accurate but ranged in variability. Phase I: Hemoglobin was accurate (3.2%CV) while CD4, alanine aminotransferase and creatinine showed increased variability (16.3%CV; 9.3%CV; 12.9%CV respectively). PIMA generated a misclassification of 12.4%. Phase II: Hemoglobin, alanine aminotransferase and creatinine showed good accuracy (3.2%CV, 8.7%CV, 6.4%CV respectively) with increased variability on CD4 (12.4%CV) but low clinical misclassification (4.1%). No trends were observed for the sequence in which POC was performed on a single fingerstick. Overall, PIMA CD4 generated the highest error rate (16-19%). CONCLUSIONS Multiple POCT for ART initiation and/or monitoring can be performed practically by a dedicated nurse on multiple fingersticks. The process is as accurate as predicate methodology and can be simplified using a single fingerstick.
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Risenga PR, Davhana-Maselesele M, Obi CL. Voluntary counselling and testing for young adults in Limpopo Province – Counsellors’ perceptions. Health SA 2013. [DOI: 10.4102/hsag.v18i1.615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Counselling and testing services for HIV have long been a component of HIV prevention and care programmes in developed countries and have proved to be a cost-effective way of reducing risky behaviours. It is, therefore, important to document the perceptions of voluntary counselling and testing counsellors towards the use of counselling and testing amongst young adults. The purpose of the study was to describe the perceptions of these counsellors dealing with young adults in Vhembe District, Limpopo Province, where the study was conducted. Two themes emerged from the findings of the voluntary counselling and testing counsellors, namely that they feel that the programmes are inaccessible to young adults and that there are difficulties which might impact on the programmes’ efficacy. The findings of this study should contribute to the reduction of HIV by promoting voluntary counselling and testing uptake by young adults. Berading- en toestingsdienste vir HIV is lankal reeds ‘n geintegreerde deel van die voorkoming en versorgingsprogramme van HIV in ontwikkelde lande en dit is bewys dat dit ’n koste-effektieve manier is om gevaarlike gedrag te verminder. Dit is dus belangrik om die persepsies van vrywillige berading en toesting deur beraders ten opsigte van die gebruik van beraders onder jong volwassenes, te staaf. Die doel van hierdie studie was om die persepsies van hierdie beraders wat met jong volwassenes in die Vhembe distrik, Limpopo provinsie, werk, te beskryf. Twee temas het uit die bevindinge te voorskyn gekom, naamlik: dat die programme ontoeganglik vir jong mense is, en dat daar moontlike probleme is wat op die doeltreffenheid van die programme inslaan. Die bevindinge van hiedie studie behoort ’n bydrae te maak tot die vermindering van HIV deur die vrywillige berading en toesting by jong mense aan te beveel.
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Anderson TN, Louw-Potgieter J. An implementation evaluation of a voluntary counselling and testing programme for the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). SA JOURNAL OF INDUSTRIAL PSYCHOLOGY 2012. [DOI: 10.4102/sajip.v38i1.944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Orientation: Employee wellness programmes have become standard interventions in most organisations. In South Africa, these programmes invariably contain an element to address the problem of the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) in the workplace.Research purpose: The purpose of this evaluation was to assess whether or not a Voluntary Counselling and Testing (VCT) programme for HIV and AIDS, at a South African university, was implemented as intended.Motivation for the study: The evaluators were motivated to explore indications in the existing literature about these programmes that participants in VCT programmes are often not the intended target population who live a high risk lifestyle.Research design, approach and method: A descriptive design was used to evaluate service utlisation, service delivery and organisational support. Questionnaire data from 285 respondents who participated in the programme and programme records supplied by the programme staff were consulted to answer the evaluation questions.Main findings: The evaluation showed that the highest uptake for the programme occurred amongst female students. The low uptake amongst men was a concern. It was found that the programme was delivered as intended and that there were enough resources to implement it according to standards set.Practical/managerial implications: The systematic report on the programme process provided the programme managers with practical suggestions for programme improvement.Contribution/value-add: This was the first implementation evaluation of a VCT programme in a South African university context. As such it aimed to educate programme managers to think evaluatively about introducing new or continuing existing programmes.
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Topp SM, Chipukuma JM, Chiko MM, Wamulume CS, Bolton-Moore C, Reid SE. Opt-out provider-initiated HIV testing and counselling in primary care outpatient clinics in Zambia. Bull World Health Organ 2011; 89:328-335A. [PMID: 21556300 DOI: 10.2471/blt.10.084442] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 02/11/2011] [Accepted: 02/13/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To increase case-finding of infection with human immunodeficiency virus (HIV) in Zambia and their referral to HIV care and treatment by supplementing existing client-initiated voluntary counselling and testing (VCT), the dominant mode of HIV testing in the country. METHODS Lay counsellors offered provider-initiated HIV testing and counselling (PITC) to all outpatients who attended primary clinics and did not know their HIV serostatus. Data on counselling and testing were collected in registers. Outcomes of interest included HIV testing coverage, the acceptability of testing, the proportion testing HIV-positive (HIV+), the proportion enrolling in HIV care and treatment and the time between testing and enrolment. FINDINGS After the addition of PITC to VCT, the number tested for HIV infection in the nine clinics was twice the number undergoing VCT alone. Over 30 months, 44,420 patients were counselled under PITC and 31,197 patients, 44% of them men, accepted testing. Of those tested, 21% (6572) were HIV+; 38% of these HIV+ patients (2515) enrolled in HIV care and treatment. The median time between testing and enrolment was 6 days. The acceptability of testing rose over time. CONCLUSION The introduction of routine PITC using lay counsellors into health-care clinics in Lusaka, Zambia, dramatically increased the uptake and acceptability of HIV testing. Moreover, PITC was incorporated rapidly into primary care outpatient departments. Maximizing the number of patients who proceed to HIV care and treatment remains a challenge and warrants further research.
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Affiliation(s)
- Stephanie M Topp
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
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Mugisha E, van Rensburg GH, Potgieter E. Factors Influencing Utilization of Voluntary Counseling and Testing Service in Kasenyi Fishing Community in Uganda. J Assoc Nurses AIDS Care 2010; 21:503-11. [DOI: 10.1016/j.jana.2010.02.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 02/15/2010] [Indexed: 12/01/2022]
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Rauf WN. Do health care providers discuss HIV with older female patients? S Afr Fam Pract (2004) 2010. [DOI: 10.1080/20786204.2010.10874049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Challenges Faced by People Living with HIV/AIDS in Cape Town, South Africa: Issues for Group Risk Reduction Interventions. AIDS Res Treat 2010; 2010:420270. [PMID: 21490904 PMCID: PMC3065817 DOI: 10.1155/2010/420270] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 06/07/2010] [Accepted: 07/16/2010] [Indexed: 11/18/2022] Open
Abstract
This paper presents the findings of an exploratory study to investigate the challenges faced by people living with HIV/AIDS (PLWHA) in communities in Cape Town, South Africa. The primary goal of the study was to gather data to inform the adaptation of a group risk reduction intervention to the South African context. Qualitative methods were used to examine the experiences of PLWHA. Eight focus group discussions (FGDs) were conducted with 83 HIV-positive participants and 14 key informants (KIs) involved in work with PLWHA were interviewed. Findings revealed that AIDS-related stigma was still pervasive in local communities. This was associated with the difficulty of disclosure of their status for fear of rejection. Also notable was the role of risky behaviours such as lack of condom use and that PLWHA considered their HIV/AIDS status as secondary to daily life stressors like poverty, unemployment, and gender-based violence. These findings have implications for the adaptation or development of behavioural risk reduction interventions for PLWHA.
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Chirawu P, Langhaug L, Mavhu W, Pascoe S, Dirawo J, Cowan F. Acceptability and challenges of implementing voluntary counselling and testing (VCT) in rural Zimbabwe: evidence from the Regai Dzive Shiri Project. AIDS Care 2010; 22:81-8. [PMID: 20390484 DOI: 10.1080/09540120903012577] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Voluntary counselling and testing (VCT) is an important component of HIV prevention and care. Little research exists on its acceptability and feasibility in rural settings. This paper examines the acceptability and feasibility of providing VCT using data from two sub-studies: (1) client-initiated VCT provided in rural health centres (RHCs) and (2) researcher-initiated VCT provided in a non-clinic community setting. Nurses provided client-initiated VCT in 39 RHCs in three Zimbabwean provinces (2004-2007). Demographic data and HIV status were collected. Qualitative data were also collected to assess rural communities' impressions of services. In a second study in 2007, VCT was offered to participants in a population-based HIV prevalence survey. Quantitative data from clinic-based VCT show that of 3585 clients aged > or =18, 79.4% (95% CI: 78.0-80.7%) were female; young people (aged 18-24) comprised 21.1%. Overall, 32.9% (95% CI: 31.4-34.5%) tested HIV positive. Young people were less likely to be HIV positive 13.5% (95% CI: 11.1-16.1%) vs. 38.1% (95% CI: 36.3-39.9%). In the second study conducted in a non-clinic setting, 27.0% (n=1368/5052) of participants opted to test. Young people were as likely to test as adults (27.3% vs. 26.9%) and an equal proportion of men and women tested. Overall during the second survey, 18.8% (95% CI: 16.7-21.0%) of participants tested positive (youth = 8.4% (95% CI: 6.4-10.7%); adults = 29.1% (95% CI: 25.7-32.7%)). Qualitative data, unique to clinics only, suggested that adults identify RHCs as acceptable VCT sites, whereas young people expressed reservations around these venues. Males reported considering VCT only after becoming ill. While VCT offered through RHCs is acceptable to women, it seems that men and youth are less comfortable with this venue. When VCT was offered in a non-clinic setting, numbers of men and women testing were similar. These data suggest that it may be possible to improve testing uptake in rural communities using non-clinic settings.
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Affiliation(s)
- Petronella Chirawu
- Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe.
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Pope DS, Atkins S, DeLuca AN, Hausler H, Hoosain E, Celentano DD, Chaisson RE. South African TB nurses' experiences of provider-initiated HIV counseling and testing in the Eastern Cape Province: a qualitative study. AIDS Care 2010; 22:238-45. [PMID: 20390502 DOI: 10.1080/09540120903040594] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study addressed factors that played a role in the limited but effective implementation of provider-initiated HIV counseling in tuberculosis (TB) clinics in the Eastern Cape Province, South Africa, as part of a clinical trial. The Eastern Cape is a region with some of the highest TB and HIV rates in the world. The parent study was a pragmatic, cluster-randomized trial designed to measure the impact of provider-initiated ("opt-out") counseling on the uptake of HIV counseling and testing in newly registered TB patients. Key informants were interviewed and clinic nurses who participated in the study were invited to participate in focus group discussions (FGDs). Thematic content analysis of transcriptions was conducted on data collected during interviews and FGDs. Three major themes regarding nurse experiences were derived from analysis, indicating that multiple structural and personal factors influence the success of provider-initiated HIV counseling of TB patients in primary care settings: (1) chronic frustration with knowing what TB tasks need to be accomplished but not having the resources, including staff, to accomplish them; (2) conflict between the appreciation of the need and importance of HIV counseling and testing and the health system's recognition of their difficulties implementing it; and (3) ambivalence in their roles as care providers and educators in the context of HIV counseling and testing. Innovative and coordinated strategies are needed in this environment to facilitate greater number of patients receiving HIV counseling and testing services.
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Affiliation(s)
- Diana S Pope
- Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, USA.
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Aarnio P, Olsson P, Chimbiri A, Kulmala T. Male involvement in antenatal HIV counseling and testing: exploring men's perceptions in rural Malawi. AIDS Care 2010; 21:1537-46. [PMID: 20024733 DOI: 10.1080/09540120902903719] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Antenatal care can act as an excellent tool to improve access to HIV counseling and testing services. This paper investigates an issue that may weaken its potential, namely lack of male involvement. We explored married men's perceptions of HIV in pregnancy and male involvement in antenatal HIV testing and counseling in Southern Malawi through 11 focus group discussions and a cross-sectional survey (n=388). The main findings were that men were largely unaware of available antenatal HIV testing and counseling services, and perceived it overall problematic to attend female-oriented health care. Most men supported provision of antenatal HIV testing. They perceived husbands to participate in the process indirectly through spousal communication, being faithful during pregnancy, and supporting the wife if found HIV-positive. Involvement of husbands was compromised by men's reluctance to learn their HIV status and the threat that HIV poses on marriage. Men stressed the importance of prior spousal agreement of antenatal HIV testing and considered HIV testing without their consent a valid reason for divorce. We suggest that male involvement in antenatal HIV testing requires refocusing of information and health services to include men. To avoid negative social outcomes for women, comprehensive and early involvement of men is essential.
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Affiliation(s)
- Pauliina Aarnio
- Department for International Health, Medical School, University of Tampere, Tampere, Finland.
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Christofides N, Jewkes R. Acceptability of universal screening for intimate partner violence in voluntary HIV testing and counseling services in South Africa and service implications. AIDS Care 2010; 22:279-85. [DOI: 10.1080/09540120903193617] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Nicola Christofides
- a Gender and Health Research Unit , Medical Research Council , Private Bag x385, Pretoria , 0001 , South Africa
- b School of Public Health , University of Witwatersrand , 7 York Rd, Johannesburg , South Africa
| | - Rachel Jewkes
- a Gender and Health Research Unit , Medical Research Council , Private Bag x385, Pretoria , 0001 , South Africa
- b School of Public Health , University of Witwatersrand , 7 York Rd, Johannesburg , South Africa
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MacPhail C, Pettifor A, Moyo W, Rees H. Factors associated with HIV testing among sexually active South African youth aged 15-24 years. AIDS Care 2009; 21:456-67. [PMID: 19401866 DOI: 10.1080/09540120802282586] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
HIV infection is high among South African youth but most report being unaware of their HIV status. We explored the correlates of HIV testing using data from youth aged 15-24 years old who reported being sexually experienced during a national survey conducted in South Africa in 2003 (N=7665). Among sexually experienced youth, 32.7% of females and 17.7% of males reported having been tested for HIV. In multivariable analysis, ever being pregnant (OR = 2.97; 95% CI 2.36-3.73), ever starting a conversation about HIV/AIDS (OR = 1.29; 95% CI 1.0-1.65) and urban residence (OR = 2.0; 95% CI 1.58-2.52) were independent correlates of HIV testing among sexually experienced females. Among sexually experienced males, HIV-positive status (OR = 1.76; 95% CI 1.14-2.73), personally knowing someone that died of AIDS (OR = 1.68; 95% CI 1.14-2.47), being aged 20-24 years (OR = 1.56; 95% CI 1.10-2.22) and having completed high school (OR = 1.58; 95% CI 1.17-2.12) were independent correlates of HIV testing. The following factors were significantly associated with HIV testing among both men and women; ever talking to parents about HIV/AIDS, ever participating in a loveLife programme, a higher frequency of visits to a clinic in the past 12 months and non-black race (p<0.05). There is a need to better understand the correlates of HIV testing to ensure that adolescent HIV prevention programmes actively promote HIV testing among this group. Specific attention needs to be paid to young women who do not access antenatal care and young men who are less regular users of routine clinical care. Communication is a significant predictor of having tested for HIV and should be encouraged with parents and through intervention programmes for adolescents. Finally, specific attention must be paid to increasing access to HIV testing for at-risk adolescents in rural communities.
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Affiliation(s)
- C MacPhail
- Reproductive Health and HIV Research Unit, Hillbrow, Johannesburg, South Africa.
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Negin J, Wariero J, Mutuo P, Jan S, Pronyk P. Feasibility, acceptability and cost of home-based HIV testing in rural Kenya. Trop Med Int Health 2009; 14:849-55. [PMID: 19552646 DOI: 10.1111/j.1365-3156.2009.02304.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To demonstrate the feasibility, acceptability and cost of home-based HIV testing and to examine the applicability of the model to high HIV prevalence settings. METHODS Quantitative, qualitative and cost data were collected during a home-based HIV testing program in a high-prevalence rural area of Kenya; data on age, gender and marital status along with HIV test results were collected. This was complemented with qualitative research including key informant interviews with counselors and program managers to highlight experiences and challenges. Direct costs of the interventions were estimated through the review of budgets and monthly expenditure sheets. RESULTS Of 3180 15-49-year olds exposed to a community awareness campaign, 2033 (63.9%) agreed to be visited by counselors, of whom 1984 (97.6%) agreed to be tested and receive the results. Adult HIV prevalence was 8.2% and married women were 4.8 times more likely to be HIV-positive than those never married. Counselors reported feeling welcomed and noted the enthusiasm of the community towards testing. The total cost of the exercise was $17,569. The program cost was $2.60 for each of the 6750 community members, $5.88 for each person tested, and $84 per positive case detected. CONCLUSION This study suggests that home-based HIV testing is feasible with high uptake, and has the potential to substantially expand access to HIV testing services. There is a strong economic case for the extension of such a screening program to other communities.
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Affiliation(s)
- Joel Negin
- School of Public Health, University of Sydney, Sydney, Australia.
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Peltzer K, Matseke G, Mzolo T, Majaja M. Determinants of knowledge of HIV status in South Africa: results from a population-based HIV survey. BMC Public Health 2009; 9:174. [PMID: 19500373 PMCID: PMC2700104 DOI: 10.1186/1471-2458-9-174] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Accepted: 06/05/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over 30% of women and men in the South African national HIV household of 2005 indicated that they had previously been tested for HIV (of which 91% were aware of their test results). This paper seeks to describe the associations between socio-demographic, behavioural and social characteristics and knowledge of HIV status among a nationally representative population in South Africa. METHODS A multistage probability sample involving 16395 male and female respondents, aged 15 years or older was selected. The sample was representative of the South African population by age, race, province and type of living area, e.g. urban formal, urban informal, etc. Respondents were interviewed on HIV knowledge, perceptions and behaviour and provided blood for research HIV testing. Bivariate and multivariate logistic regression was used to identify socio-demographic, social and behavioural factors associated with knowledge of HIV status. RESULTS From the total sample 27.6% ever and 7.8% knew their HIV status in the past 12 months. In multivariate analyses being female, the age group 25 to 34 years old, other than African Black population group (White, Coloured, Asian), higher educational level, being employed, urban residence, awareness of a place nearby where one could be tested for HIV, impact of HIV on the household and having had two of more sexual partners in the past year were associated with knowledge of HIV status. Among HIV positive persons awareness of a place nearby where one could be tested for HIV and impact of HIV on the household were associated knowledge of HIV status, and among HIV negative persons HIV risk behaviour (multiple partners, no condom use), awareness of a place nearby where one could be tested for HIV, higher knowledge score on HIV and knowledge of serodiscordance were associated knowledge of HIV status. CONCLUSION Education about HIV/AIDS and access to HIV counselling and testing (HCT) in rural areas, in particular among the Black African population group needs to be improved, in order to enhance the uptake of HIV counselling and testing services, an essential step for the initiation of treatment.
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Affiliation(s)
- Karl Peltzer
- Health Promotion Research Unit, Social Aspect of HIV/AIDS and Health, Human Sciences Research Council, Pretoria, South Africa.
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Mkhabela MPS, Mavundla TR, Sukati NA. Experiences of nurses working in Voluntary Counseling and Testing Services in Swaziland. J Assoc Nurses AIDS Care 2009; 19:470-9. [PMID: 19007725 DOI: 10.1016/j.jana.2008.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Accepted: 07/08/2008] [Indexed: 10/21/2022]
Abstract
Swaziland is among the countries in the sub-Saharan Africa with high rates of HIV infection. The Swazi Government established Voluntary Counseling and Testing Services (VCT) as part of its response to the epidemic. This study describes the day-to-day experiences of nurses working in VCT services in Swaziland in order to answer the question, "What is it like to work at VCT services." Data were obtained through in-depth interviews. The sample consisted of 6 nurses who were purposively selected from the 4 geographical regions of Swaziland. Data were analyzed through the steps suggested by Tesch (1990). Findings from the analysis revealed that nurses working in VCT services experienced constant stress. The stress was attributed to the complexity of HIV, staff shortages, lack of social support, lack of supportive practice environments, and constant exhaustion. The experience of constant stress lead these nurses to feel disempowered. Data suggest that nurses working in VCT services in Swaziland need programs to support their efforts and to empower them in their testing activities.
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Tsai AC, Chopra M, Pronyk PM, Martinson NA. Socioeconomic disparities in access to HIV/AIDS treatment programs in resource-limited settings. AIDS Care 2008; 21:59-63. [DOI: 10.1080/09540120802068811] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Alexander C. Tsai
- a Langley Porter Psychiatric Institute , University of California at San Francisco , San Francisco , CA , USA
| | - Mickey Chopra
- b Health Systems Research Unit , Medical Research Council , Tygerberg , South Africa
| | - Paul M. Pronyk
- c Department of Infectious and Tropical Diseases , London School of Hygiene and Tropical Medicine , London , UK
- d Rural AIDS and Development Action Research Programme , School of Public Health, University of the Witwatersrand , Acornhoek , South Africa
| | - Neil A. Martinson
- e Perinatal HIV Research Unit , University of the Witwatersrand , Soweto , South Africa
- f Johns Hopkins University Center for Tuberculosis Research , Baltimore , MD , USA
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Pappas-DeLuca KA, Kraft JM, Galavotti C, Warner L, Mooki M, Hastings P, Koppenhaver T, Roels TH, Kilmarx PH. Entertainment-education radio serial drama and outcomes related to HIV testing in Botswana. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2008; 20:486-503. [PMID: 19072525 DOI: 10.1521/aeap.2008.20.6.486] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Makgabaneng is an entertainment-education radio serial drama written and produced in Botswana to promote prevention of HIV. This effort is part of the national response to HIV/AIDS. Broadcast of the serial drama began in August 2001, and two new 15-minute episodes air each week. We examined associations between exposure to Makgabaneng and outcomes related to HIV testing, including stigmatizing attitudes, intention to be tested, talking with a partner about testing, and testing for HIV, among 555 sexually active respondents. The four measures of exposure to Makgabaneng were frequency of listening, duration of listening, talking about the program, and attentiveness to and identification with relevant characters. Data were collected approximately 18 months after the drama began airing. We found positive associations between exposure to the program and intermediate outcomes, including lower level of stigmatizing attitudes, stronger intention to have HIV testing, and talking to a partner about testing. Although associations were identified with all four measures of exposure, increased duration of listening was associated with more positive outcomes than the other measures. This finding suggests that longer term exposure to entertainment-education programming may be important for behavior change.
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Affiliation(s)
- Katina A Pappas-DeLuca
- Centers for Disease Control and Prevention, Division of Reproductive Health, Women's Health and Fertility Branch, 4770 Buford Hwy. NE, Mailstop K-34, Atlanta, GA, USA.
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Bwambale FM, Ssali SN, Byaruhanga S, Kalyango JN, Karamagi CA. Voluntary HIV counselling and testing among men in rural western Uganda: implications for HIV prevention. BMC Public Health 2008; 8:263. [PMID: 18664301 PMCID: PMC2529297 DOI: 10.1186/1471-2458-8-263] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Accepted: 07/30/2008] [Indexed: 11/16/2022] Open
Abstract
Background Voluntary HIV counselling and testing (VCT) is one of the key strategies in the prevention and control of HIV/AIDS in Uganda. However, the utilization of VCT services particularly among men is low in Kasese district. We therefore conducted a study to determine the prevalence and factors associated with VCT use among men in Bukonzo West health sub-district, Kasese district. Methods A population-based cross-sectional study employing both quantitative and qualitative techniques of data collection was conducted between January and April 2005. Using cluster sampling, 780 men aged 18 years and above, residing in Bukonzo West health sub-district, were sampled from 38 randomly selected clusters. Data was collected on VCT use and independent variables. Focus group discussions (4) and key informant interviews (10) were also conducted. Binary logistic regression was performed to determine the predictors of VCT use among men. Results Overall VCT use among men was 23.3% (95% CI 17.2–29.4). Forty six percent (95% CI 40.8–51.2) had pre-test counselling and 25.9% (95%CI 19.9–31.9) had HIV testing. Of those who tested, 96% returned for post-test counselling and received HIV results. VCT use was higher among men aged 35 years and below (OR = 2.69, 95%CI 1.77–4.07), the non-subsistence farmers (OR = 2.37, 95%CI 2.37), the couple testing (OR = 2.37, 95%CI 1.02–8.83) and men with intention to disclose HIV test results to sexual partners (OR = 1.64, 95%CI 1.04–2.60). The major barriers to VCT use among men were poor utilization of VCT services due to poor access, stigma and confidentiality of services. Conclusion VCT use among men in Bukonzo West, Kasese district was low. In order to increase VCT use among men, the VCT programme needs to address HIV stigma and improve access and confidentiality of VCT services. Among the more promising interventions are the use of routine counselling and testing for HIV of patients seeking health care in health units, home based VCT programmes, and mainstreaming of HIV counselling and testing services in community development programmes.
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Affiliation(s)
- Francis M Bwambale
- Clinical Epidemiology Unit, Makerere University, POBox 7072, Kampala, Uganda.
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Bassett IV, Giddy J, Nkera J, Wang B, Losina E, Lu Z, Freedberg KA, Walensky RP. Routine voluntary HIV testing in Durban, South Africa: the experience from an outpatient department. J Acquir Immune Defic Syndr 2007; 46:181-6. [PMID: 17667332 PMCID: PMC2140230 DOI: 10.1097/qai.0b013e31814277c8] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the yield of a routine voluntary HIV testing program compared with traditional provider-referred voluntary counseling and testing (VCT) in a hospital-affiliated outpatient department (OPD) in Durban, South Africa. DESIGN AND METHODS In a prospective 14-week "standard of care" period, we compared OPD physician logs documenting patient referrals to the hospital VCT site with HIV test registers to measure patient completion of HIV test referral. The standard of care period was followed by a 12-week intervention during which all patients who registered at the OPD were given an educational intervention and offered a rapid HIV test at no charge as part of routine care. RESULTS During the standard of care period, OPD physicians referred 435 patients aged > or = 18 years for HIV testing; 137 (31.5%) of the referred patients completed testing at the VCT site within 4 weeks. Among those tested, 102 (74.5%) were HIV infected. During the intervention period, 1414 adults accepted HIV testing and 1498 declined. Of those tested, 463 (32.7%, 95% confidence interval: 30.3 to 35.3) were HIV infected. Routine HIV testing in the OPD identified 39 new HIV cases per week compared with 8 new cases per week with standard of care testing based on physician referral to a VCT site (P < 0.0001). CONCLUSIONS Routine voluntary HIV testing in an OPD in South Africa leads to significantly higher rates of detection of HIV disease. This strategy should be implemented more widely in high HIV prevalence areas where treatment is available.
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Affiliation(s)
- Ingrid V Bassett
- Division of Infectious Disease, Massachusetts General Hospital, Boston, MA 02114, USA.
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Telles-Dias PR, Westman S, Fernandez AE, Sanchez M. Impressões sobre o teste rápido para o HIV entre usuários de drogas injetáveis no Brasil. Rev Saude Publica 2007; 41 Suppl 2:94-100. [DOI: 10.1590/s0034-89102007000900015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Accepted: 06/20/2007] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Descrever as impressões, experiências, conhecimentos, crenças e a receptividade de usuários de drogas injetáveis para participar das estratégias de testagem rápida para HIV. MÉTODOS: Estudo qualitativo exploratório foi conduzido entre usuários de drogas injetáveis, de dezembro de 2003 a fevereiro de 2004, em cinco cidades brasileiras, localizadas em quatro regiões do País. Um roteiro de entrevista semi-estruturado contendo questões fechadas e abertas foi usado para avaliar percepções desses usuários sobre procedimentos e formas alternativas de acesso e testagem. Foram realizadas 106 entrevistas, aproximadamente 26 por região. RESULTADOS: Características da população estudada, opiniões sobre o teste rápido e preferências por usar amostras de sangue ou saliva foram apresentadas junto com as vantagens e desvantagens associadas a cada opção. Os resultados mostraram a viabilidade do uso de testes rápidos entre usuários de drogas injetáveis e o interesse deles quanto à utilização destes métodos, especialmente se puderem ser equacionadas questões relacionadas à confidencialidade e confiabilidade dos testes. CONCLUSÕES: Os resultados indicam que os testes rápidos para HIV seriam bem recebidos por essa população. Esses testes podem ser considerados uma ferramenta valiosa, ao permitir que mais usuários de drogas injetáveis conheçam sua sorologia para o HIV e possam ser referidos para tratamento, como subsidiar a melhoria das estratégias de testagem entre usuários de drogas injetáveis.
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Affiliation(s)
| | - S Westman
- Centers for Disease Control and Prevention, USA
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Plate DK. Evaluation and implementation of rapid HIV tests: the experience in 11 African countries. AIDS Res Hum Retroviruses 2007; 23:1491-8. [PMID: 18160006 DOI: 10.1089/aid.2007.0020] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Rapid HIV testing enables HIV prevention and care services to expand to settings with limited laboratory infrastructure. The World Health Organization recommends that prior to their implementation, rapid HIV tests first be evaluated at a reference laboratory and then at points-of-service, and that measures to ensure quality of testing be in place. We describe the experience of 11 African countries that implemented rapid HIV testing using this process. A questionnaire regarding rapid test evaluations and quality assurance measures was administered to personnel in ministries of health, reference laboratories, and Centers for Disease Control and Prevention programs in 11 African countries. In reference laboratory evaluations, median sensitivity was above 99% for 10 of 15 rapid tests and median specificity was above 99% for 13 of 15 rapid tests. Similar results were observed in evaluations at point-of-service sites. Rapid testing algorithms have been implemented in over 600 sites in nine of the countries. Concordance between point-of-service rapid testing and reference laboratory retesting of samples ranged from 95.7% to 99.5% (median: 98.7%). A systematic approach to the evaluation and implementation of rapid HIV tests was useful in ensuring accurate, decentralized testing even when conducted by persons with limited laboratory experience.
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Affiliation(s)
- David K. Plate
- Global AIDS Program, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333
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Arthur G, Nduba V, Forsythe S, Mutemi R, Odhiambo J, Gilks C. Behaviour change in clients of health centre-based voluntary HIV counselling and testing services in Kenya. Sex Transm Infect 2007; 83:541-6. [PMID: 17991688 DOI: 10.1136/sti.2007.026732] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To explore behaviour change, baseline risk behaviour, perception of risk, HIV disclosure and life events in health centre-based voluntary counselling and testing (VCT) clients. DESIGN AND SETTING Single-arm prospective cohort with before-after design at three (one urban and two rural) government health centres in Kenya; study duration 2 years, 1999-2001. SUBJECTS Consecutive eligible adult clients. MAIN OUTCOME MEASURES Numbers of sexual partners, partner type, condom use, reported symptoms of sexually transmitted infection, HIV disclosure and life events. RESULTS High rates of enrollment and follow-up provided a demographically representative sample of 401 clients with mean time to follow-up of 7.5 months. Baseline indicators showed that clients were at higher risk than the general population, but reported a poor perception of risk. Clients with multiple partners showed a significant reduction of sexual partners at follow-up (16% to 6%; p<0.001), and numbers reporting symptoms of sexually transmitted infection decreased significantly also (from 40% to 15%; p<0.001). Condom use improved from a low baseline. Low rates of disclosure (55%) were reported by HIV-positive clients. Overall, no changes in rates of life events were seen. CONCLUSION This study suggests that significant prevention gains can be recorded in clients receiving health centre-based VCT services in Africa. Prevention issues should be considered when refining counselling and testing policies for expanding treatment programmes.
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Affiliation(s)
- G Arthur
- Camden Primary Care Trust, The Mortimer Market Centre, London WC1E, UK.
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Obermeyer CM, Osborn M. The utilization of testing and counseling for HIV: a review of the social and behavioral evidence. Am J Public Health 2007; 97:1762-74. [PMID: 17761565 PMCID: PMC1994175 DOI: 10.2105/ajph.2006.096263] [Citation(s) in RCA: 272] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2006] [Indexed: 01/31/2023]
Abstract
Against the background of debates about expanding HIV testing and counseling, we summarize the evidence on the social and behavioral dimension of testing and its implications for programs. The discrepancy between acceptance of testing and returning for results and the difficulties of disclosure are examined in light of research on risk perceptions and the influence of gender and stigma. We also summarize the evidence on the provision of testing and counseling, the implementation of practices regarding confidentiality and consent, and the results of interventions. We demonstrate that social factors have a considerable impact on testing, show that the services linked to testing are key determinants of utilization, and consider the implications of these findings for HIV testing programs.
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Kahn K, Tollman SM, Collinson MA, Clark SJ, Twine R, Clark BD, Shabangu M, Gómez-Olivé FX, Mokoena O, Garenne ML. Research into health, population and social transitions in rural South Africa: data and methods of the Agincourt Health and Demographic Surveillance System. Scand J Public Health 2007; 69:8-20. [PMID: 17676498 PMCID: PMC2826136 DOI: 10.1080/14034950701505031] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
RATIONALE FOR STUDY Vital registration is generally lacking in infrastructurally weak areas where health and development problems are most pressing. Health and demographic surveillance is a response to the lack of a valid information base that can provide high-quality longitudinal data on population dynamics, health, and social change to inform policy and practice. DESIGN AND MEASUREMENT PROCEDURES Continuous demographic monitoring of an entire geographically defined population involves a multi-round, prospective community study, with annual recording of all vital events (births, deaths, migrations). Status observations and special modules add value to particular research areas. A verbal autopsy is conducted on every death to determine its probable cause. A geographic surveillance system supports spatial analyses, and strengthens field management. POPULATION AND SAMPLE SIZE CONSIDERATIONS Health and demographic surveillance covers the Agincourt sub-district population, sited in rural north-eastern South Africa, of some 70,000 people (nearly a third are Mozambican immigrants) in 21 villages and 11,700 households. Data enumerated are consistent or more detailed when compared with national sources; strategies to improve incomplete data, such as counts of perinatal deaths, have been introduced with positive effect. Basic characteristics: A major health and demographic transition was documented over a 12-year period with marked changes in population structure, escalating mortality, declining fertility, and high levels of temporary migration increasing particularly amongst women. A dual burden of infectious and non-communicable disease exists against a background of dramatically progressing HIV/AIDS. POTENTIAL AND RESEARCH QUESTIONS Health and demographic surveillance sites - fundamental to the INDEPTH Network - generate research questions and hypotheses from empirical data, highlight health, social and population priorities, provide cost-effective support for diverse study designs, and track population change and the impact of interventions over time.[image omitted].
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Affiliation(s)
- Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of Witwatersrand, South Africa.
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Daftary A, Padayatchi N, Padilla M. HIV testing and disclosure: a qualitative analysis of TB patients in South Africa. AIDS Care 2007; 19:572-7. [PMID: 17453600 DOI: 10.1080/09540120701203931] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In South Africa, more than 60% of TB patients have HIV co-infection. Voluntary counseling and testing (VCT) is critical to effective HIV prevention, and TB facilities are optimal venues for delivery of these services. This study employed qualitative research methods to explore the decision-making processes for HIV testing and serostatus disclosure by 21 patients hospitalized with multi/extensively-drug resistant TB (M/XDR-TB) in Durban, KwaZulu Natal. Data collected from in-depth interviews characterized 3 broad themes: HIV testing history, experiences and perceptions of stigma and disclosure, and the relationship between TB and HIV/AIDS. Fear of AIDS-related stigma, the singular stress of TB infection, the absence of partner's consent, asymptomatic or incurable disease, and uncertainty about subsequent eligibility for antiretroviral treatment while still receiving TB treatment were identified as potential barriers to the uptake of VCT. HIV serostatus disclosure was impeded by the felt stigma of a 'discreditable' infection, manifested by social rejection and discrimination. The public disclosure of TB illness helped relieve some co-infected patients' overall burden of stigma through a process of 'covering'. HIV prevention [corrected] measures such as VCTare likely to be more effective within TB facilities if greater sensitivity is paid to TB patients' specific social issues and perceptions. These patients are not only at greater risk for HIV co-infection but also for experiencing the double stigma of TB and HIV/AIDS.
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Affiliation(s)
- A Daftary
- Department of Public Health Sciences, University of Toronto, Canada.
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Mahmoud MM, Nasr AM, Gassmelseed DEA, Abdalelhafiz MA, Elsheikh MA, Adam I. Knowledge and attitude toward HIV voluntary counseling and testing services among pregnant women attending an antenatal clinic in Sudan. J Med Virol 2007; 79:469-73. [PMID: 17385672 DOI: 10.1002/jmv.20850] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Human immunodeficiency virus (HIV) infection and the development of the acquired immunodeficiency syndrome (AIDS) are increasing at an alarming rate especially in the sub-Saharan region. Pregnant women susceptible to HIV and its transmission to the fetus provide a unique opportunity for implementing preventive strategy against HIV infection of newborn babies. During the period of August-December 2005 a cross-sectional study was conducted at the Fath-Elrahman Elbashir antenatal clinic, Khartoum Teaching Hospital, to investigate pregnant women's basic knowledge and attitude toward HIV and mother to child transmission as well as voluntary counseling and testing. Pre-tested structured questionnaires were given to antenatal attendants by professional counselors. Their basic socio-demographic and obstetric characteristics were obtained. Respondents' knowledge about HIV and mother to child transmission were tested. In addition, their willingness toward HIV testing was also reported. Out of the 1,005 women investigated, 79% had basic knowledge about HIV. Those who were resident in Khartoum and whose age was > or =26.1 years and their education level was secondary and above were found to be more knowledgeable about HIV. More than half of respondents were aware of mother to child transmission. Older (> or =26.1 years), educated, and working mothers were found to be more knowledgeable about mother to child transmission. Willingness to undergo the test was demonstrated in 72.8% of respondents. However, only 30.3% had the test done. Older women, primigravidae, and Muslims have higher acceptance of voluntary counseling and testing. There is a need to extend the voluntary counseling and testing program in all antenatal clinics. In addition, there is a need to increase the level of education and raise health awareness about HIV and mother to child transmission.
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Ginsburg AS, Miller A, Wilfert CM. Diagnosis of pediatric human immunodeficiency virus infection in resource-constrained settings. Pediatr Infect Dis J 2006; 25:1057-64. [PMID: 17072130 DOI: 10.1097/01.inf.0000243157.16405.f0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The majority of children infected with human immunodeficiency virus live in resource-constrained settings and die without an established diagnosis. Definitive laboratory diagnosis in children younger than 12-18 months requires virologic testing; however, antibody testing is often the only option available. Antibody testing provides a definitive diagnosis in older children but is frequently not used. Children meeting clinical criteria should be treated regardless of availability of laboratory diagnoses.
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Affiliation(s)
- Amy Sarah Ginsburg
- Elizabeth Glaser Pediatric AIDS Foundation, Santa Monica, CA 90405, USA.
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Delva W, Mutunga L, Quaghebeur A, Temmerman M. Quality and quantity of antenatal HIV counselling in a PMTCT programme in Mombasa, Kenya. AIDS Care 2006; 18:189-93. [PMID: 16546777 DOI: 10.1080/09540120500456425] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A recent report from a PMTCT implementation study in Mombasa, Kenya, points at an important gap between the efficacy in clinical trial circumstances and the effectiveness of PMTCT programmes when implemented in real life. Hence, the quality and quantity of antenatal HIV counselling in a routine setting were appraised. The counsellors' social and communicative skills, duration and topics covered during pre- and post-test counselling sessions were assessed by means of the VCT assessment tools published by UNAIDS. A total of 14 group educational sessions, 66 pre-test counselling sessions and 50 post-test counselling sessions were observed and assessed. In general, the frequency and duration of the counselling was low. Crucial topics such as window period and partner involvement and follow-up support were covered haphazardly. The counsellor's social and communicative skills were given high marks, yet information was rarely repeated or summarized. The limited time dedicated to women receiving antenatal VCT contrasts with the heavy and comprehensive load of health information and advice they are supposed to receive. Ample pre- and post-test counselling including follow-up should be pursued for optimal effectiveness of PMTCT. We propose a number of health system interventions preceded and guided by ongoing audit.
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Mola OD, Mercer MA, Asghar RJ, Gimbel-Sherr KH, Gimbel-Sherr S, Micek MA, Gloyd SS. Condom use after voluntary counselling and testing in central Mozambique. Trop Med Int Health 2006; 11:176-81. [PMID: 16451341 DOI: 10.1111/j.1365-3156.2005.01548.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the efficacy of voluntary counselling and testing (VCT) for HIV/AIDS in changing risky sexual behaviour in central Mozambique. METHOD Longitudinal cohort study of men and women aged at least 18 years from October 2002 to June 2003. We interviewed 622 participants in VCT groups and 598 in non-VCT groups. The interviews occurred before counselling and 4 and 6 months afterwards. RESULTS Reported use of condoms while having sex with a friends/prostitute increased over each time period in the VCT group and between baseline and first visit in the non-VCT group. Both men and women in the VCT group increased their condom use over time, but the women in the non-VCT group did not. Reported always/sometimes use of condoms for both literate and illiterate subjects was higher and rose over time in the VCT group. CONCLUSION People who undergo voluntary counselling and testing fro HIV/AIDS change their behaviour, presumably as a result of their counselling.
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Affiliation(s)
- O D Mola
- Ministry of Health, Beira, Mozambique
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Arthur GR, Ngatia G, Rachier C, Mutemi R, Odhiambo J, Gilks CF. The role for government health centers in provision of same-day voluntary HIV counseling and testing in Kenya. J Acquir Immune Defic Syndr 2005; 40:329-35. [PMID: 16249708 DOI: 10.1097/01.qai.0000166376.23846.38] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore the role of primary health centers in provision of voluntary counseling and testing (VCT) in Kenya. DESIGN AND SETTING Prospective service evaluation at 3 (1 urban and 2 rural) government health centers. SUBJECTS Consecutive adult clients. MAIN OUTCOME MEASURES Uptake of services, user characteristics, quality of service. RESULTS Counseling services received 2315 new clients over 26 months. The last quarter averaged 101 clients per clinic. More than 80% of clients lived locally. Overall 93% opted to test, 91% receiving results, 82% on the same day. Most clients tested HIV negative (81%). Youth and men were well represented. Few couples (10%) attended. Seventeen percent of women were pregnant. Self-referral was common and illness was an uncommon reason for testing (<20%). Thirty-one percent of clients were referred from VCT to other health center services. Counseling was perceived as high quality by users and providers. Validation of the test algorithm showed a sensitivity of 98.0% and specificity of 98.7%. CONCLUSION Government health centers in Kenya can be appropriate providers of VCT. This pilot helped initiate a new strategy of health center-based VCT in Kenya and this has facilitated rapid expansion and more equitable provision for Kenyans.
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Affiliation(s)
- Gilly R Arthur
- Department of Genitourinary Medicine, Camden Primary Care Trust, The Mortimer Market Centre, London, UK.
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Hesketh T, Duo L, Li H, Tomkins AM. Attitudes to HIV and HIV testing in high prevalence areas of China: informing the introduction of voluntary counselling and testing programmes. Sex Transm Infect 2005; 81:108-12. [PMID: 15800085 PMCID: PMC1764667 DOI: 10.1136/sti.2004.009704] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To assess knowledge and attitudes towards HIV and its testing among pregnant women and health professionals in Yunnan Province, south west China, to inform the introduction of voluntary counselling and testing (VCT) programmes. METHODS The study design was a cross sectional survey using self completion questionnaires. It was carried out in 12 hospitals in four high prevalence areas of Yunnan Province. Questionnaires were completed under examination conditions by health professionals, and at the routine antenatal examination by pregnant women. RESULTS Completed questionnaires were obtained from 840 pregnant women and 780 health professionals. Knowledge of HIV and its modes of transmission were good in health professionals but patchy in pregnant women. The weakest area in both groups was knowledge of maternal to child transmission. There was strong support for compulsory testing in pregnancy and at the premarital examination. But attitudes towards HIV/AIDS were negative: 23% of health professionals and 45% of pregnant women thought HIV was a disease of "low class and illegal" people, 48% of health professionals and 59% of pregnant women thought that HIV positive individuals should not be allowed to get married, and 30% of the health professionals were not willing to treat an HIV positive individual. Levels of knowledge were higher and attitudes more positive in younger health professionals and better educated pregnant women. CONCLUSIONS Community education programmes and intensive training of health workers must precede or accompany VCT programmes. They must particularly address negative attitudes towards people with HIV. Pilot VCT programmes are now under way in two of the areas studied.
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Affiliation(s)
- T Hesketh
- Centre for International Child Health, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
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