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O'Laughlin KN, Greenwald K, Rahman SK, Faustin ZM, Ashaba S, Tsai AC, Ware NC, Kambugu A, Bassett IV. A Social-Ecological Framework to Understand Barriers to HIV Clinic Attendance in Nakivale Refugee Settlement in Uganda: a Qualitative Study. AIDS Behav 2021; 25:1729-1736. [PMID: 33263892 PMCID: PMC8081685 DOI: 10.1007/s10461-020-03102-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 12/21/2022]
Abstract
The social-ecological model proposes that efforts to modify health behaviors are influenced by constraints and facilitators at multiple levels. We conducted semi-structured interviews with 47 clients in HIV care and 8 HIV clinic staff to explore how such constraints and facilitators (individual, social environment, physical environment, and policies) affect engaging in HIV clinical care in Nakivale Refugee Settlement in Uganda. Thematic analysis revealed that participants were motivated to attend the HIV clinic because of the perceived quality of services and the belief that antiretroviral therapy improves health. Barriers to clinic attendance included distance, cost, unemployment, and climate. Those that disclosed their status had help in overcoming barriers to HIV care. Nondisclosure and stigma disrupted community support in overcoming these obstacles. Interventions to facilitate safe disclosure, mobilize social support, and provide more flexible HIV services may help overcome barriers to HIV care in this setting.
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Affiliation(s)
- Kelli N O'Laughlin
- Departments of Emergency Medicine and Global Health, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA.
| | - Kelsy Greenwald
- Harvard Affiliated Emergency Medicine Residency, Boston, MA, USA
| | | | | | | | - Alexander C Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Norma C Ware
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Andrew Kambugu
- Makerere University, Infectious Diseases Institute, Kampala, Uganda
| | - Ingrid V Bassett
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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Beia T, Kielmann K, Diaconu K. Changing men or changing health systems? A scoping review of interventions, services and programmes targeting men's health in sub-Saharan Africa. Int J Equity Health 2021; 20:87. [PMID: 33789688 PMCID: PMC8011198 DOI: 10.1186/s12939-021-01428-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/17/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Sex and gender have been shown to influence health literacy, health seeking behaviour, and health outcomes. However, research examining the links between gender and health has mainly focused on women's health, which is a long-standing global health priority. We examine literature focused on the 'missing men' in global health research, in particular empirical studies that document interventions, programmes, and services targeting men's health issues in Sub-Saharan Africa. Within these studies, we identify dominant conceptualisations of men and men's health and how these have influenced the design of men's health interventions and services. METHODS This is a scoping review of published and grey literature. Following comprehensive searches, we included 56 studies in the review. We conducted a bibliographic analysis of all studies and used inductive methods to analyse textual excerpts referring to conceptualizations of men and service design. An existing framework to categorise services, interventions, or programs according to their gender-responsiveness was adapted and used for the latter analysis. RESULTS From the included studies, we distinguished four principal ways in which men were conceptualized in programs and interventions: men are variously depicted as 'gatekeepers'; 'masculine' men, 'marginal' men and as 'clients. Additionally, we classified the gender-responsiveness of interventions, services or programmes described in the studies within the following categories: gender-neutral, -partnering, -sensitive and -transformative. Interventions described are predominantly gender-neutral or gender-partnering, with limited data available on transformative interventions. Health systems design features - focused mainly on achieving women's access to, and uptake of services - may contribute to the latter gap leading to poor access and engagement of men with health services. CONCLUSION This review highlights the need for transformation in sub-Saharan African health systems towards greater consideration of men's health issues and health-seeking patterns.
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Affiliation(s)
- Thierry Beia
- Health Services Department, Copperbelt University, Jambo Drive, Riverside, Kitwe, Zambia.
| | - Karina Kielmann
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Musselburgh, EH21 6UU, Scotland, UK
| | - Karin Diaconu
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Musselburgh, EH21 6UU, Scotland, UK
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Poku OB, Ho-Foster AR, Entaile P, Misra S, Mehta H, Rampa S, Goodman M, Arscott-Mills T, Eschliman E, Jackson V, Melese T, Becker TD, Eisenberg M, Link B, Go V, Opondo PR, Blank MB, Yang LH. 'Mothers moving towards empowerment' intervention to reduce stigma and improve treatment adherence in pregnant women living with HIV in Botswana: study protocol for a pragmatic clinical trial. Trials 2020; 21:832. [PMID: 33028387 PMCID: PMC7542742 DOI: 10.1186/s13063-020-04676-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/12/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND With high rates of HIV and multiple vulnerable subgroups across diverse settings, there is a need for culturally based, HIV stigma reduction interventions. Pregnant women who are living with HIV are especially in need of services to protect not only their own but also their children's lives. Uptake of HIV services worldwide is hindered by stigma towards persons living with HIV/AIDS. While cultural context plays a key role in shaping HIV stigma, these insights have not yet been fully integrated into stigma reduction strategies. By utilizing the "What Matters Most" stigma framework, we propose that an intervention to counter culturally salient aspects of HIV stigma will improve treatment adherence and other relevant outcomes. A pragmatic clinical trial in Botswana will evaluate the "Mothers Moving towards Empowerment" (MME) intervention, which seeks to address HIV stigma in Botswana and to specifically engage pregnant mothers so as to promote antiretroviral therapy (ART) adherence in the postpartum period. METHODS This study will test MME against treatment as usual (TAU) among pregnant mothers diagnosed with HIV and their infants. Outcomes will be assessed during pregnancy and 16 weeks postpartum. Women who meet eligibility criteria are assigned to MME or TAU. Women assigned to MME are grouped with others with similar estimated delivery dates, completing up to eight intervention group sessions scheduled before week 36 of their pregnancies. Primary outcomes among mothers include (i) reducing self-stigma, which is hypothesized to mediate improvements in (ii) psychological outcomes (quality of life, depression and social functioning), and (iii) adherence to antenatal care and ART. We will also examine a set of follow-up infant birth outcomes (APGAR score, preterm delivery, mortality (at < 16 weeks), birth weight, vaccination record, and HIV status). DISCUSSION Our trial will evaluate MME, a culturally based HIV stigma reduction intervention using the "What Matters Most" framework, to reduce stigma and improve treatment adherence among pregnant women and their infants. This study will help inform further refinement of MME and preparation for a future large-scale, multisite, randomized controlled trial (RCT) in Botswana. TRIAL REGISTRATION ClinicalTrials.gov NCT03698981 . Registered on October 8, 2018.
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Affiliation(s)
- Ohemaa B Poku
- Johns Hopkins University, Baltimore, MD, United States.
| | - Ari R Ho-Foster
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- University of Botswana, Gaborone, Botswana
| | | | | | | | | | | | - Tonya Arscott-Mills
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- University of Botswana, Gaborone, Botswana
| | | | - Valerie Jackson
- University of California San Francisco, San Francisco, CA, United States
| | | | - Timothy D Becker
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Bruce Link
- University of California Riverside, Riverside, CA, USA
| | - Vivian Go
- University of North Carolina at Chapel Hill, Chapel Hil, NC, USA
| | | | | | - Lawrence H Yang
- New York University, New York, NY, United States
- Columbia University Mailman School of Public Health, New York, NY, USA
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Ndakidemi E, Emerson C, Medley A, Ngowi B, Ng'eno B, Munuo G, Kohi W, Modi S. Health care worker perspectives on TB case finding and HIV services among pediatric TB patients in Tanzania. Int J Tuberc Lung Dis 2020; 23:811-816. [PMID: 31439112 DOI: 10.5588/ijtld.18.0445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Tuberculosis (TB) and human immunodeficiency virus (HIV) infection in children are of concern due to the high morbidity and mortality they engender. Tanzania is working to improve TB and HIV case identification and treatment, as well as linkage of TB and HIV care in pediatric patients.METHODS: In-depth interviews were conducted in March 2016 at 10 high TB burden clinics in five districts of Tanzania to identify the barriers to pediatric TB diagnosis and HIV care. Health care workers (HCWs) at TB clinics who provided informed consent were administered interviews which were analyzed.RESULTS: Of 41 HCWs interviewed, 26 reported receiving pediatric TB training. Barriers to TB diagnosis included low community awareness, stigma and late presentation to the clinic. Barriers to HIV testing included children attending the TB clinic with someone who was not their parent/guardian and shortages of HIV rapid test kits. HCWs stressed the need for improved community education because it was perceived that some caregivers did not understand the importance of prompt TB and HIV treatment in children (although most were eager for a resolution of their child's illness).CONCLUSIONS: Efforts are needed to ensure effective TB and HIV diagnosis and treatment of children, provision of broader HCW and community education, enhanced TB-HIV contact tracing, and ensuring a continuous supply of HIV rapid test kits.
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Affiliation(s)
- E Ndakidemi
- Infosmart Research and Consulting Tanzania, Dar es Salaam, Tanzania
| | - C Emerson
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - A Medley
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - B Ngowi
- National Institute for Medical Research Muhimbili Research Centre, Dar es Salaam
| | - B Ng'eno
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - W Kohi
- Community Development, Gender, Elderly and Children; National Tuberculosis and Leprosy Programme, Tanzania Ministry of Health, Dar es Salaam, Tanzania
| | - S Modi
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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Fleming PJ, Rosen JG, Wong VJ, Carrasco MA. Shedding light on a HIV blind spot: Factors associated with men's HIV testing in five African countries. Glob Public Health 2019; 14:1241-1251. [PMID: 30794471 DOI: 10.1080/17441692.2019.1583266] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Men's relatively low rates of HIV testing has been termed the 'HIV blind spot' and recently declared by UNAIDS as a top priority. This study uses data from five nationally representative Demographic and Health Surveys in Kenya, Malawi, Mozambique, Zambia, and Zimbabwe to explore factors associated with men's lifetime HIV testing. Between 29.3% and 34.9% of men ages 15-49 in these countries had never tested for HIV and men who held accepting attitudes towards gender-based violence, who lacked HIV knowledge, and who held stigmatising views of HIV were more likely to report never testing for HIV. Findings are interpreted, including a discussion of the possible unintended consequences of current 90-90-90 targets on men's relatively low testing rates. The results point to possible intervention opportunities to increase HIV testing among men in high-HIV prevalence settings in Eastern and Southern Africa and emphasise the importance of changing men's perceptions related to stigma and gender norms.
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Affiliation(s)
- Paul J Fleming
- a Department of Health Behavior and Health Education , University of Michigan School of Public Health , Ann Arbor , MI , USA
| | - Joseph G Rosen
- b Office of HIV/AIDS , United States Agency for International Development , Washington , DC , USA
| | - Vincent J Wong
- b Office of HIV/AIDS , United States Agency for International Development , Washington , DC , USA
| | - Maria Augusta Carrasco
- b Office of HIV/AIDS , United States Agency for International Development , Washington , DC , USA
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Sileo KM, Fielding-Miller R, Dworkin SL, Fleming PJ. What Role Do Masculine Norms Play in Men's HIV Testing in Sub-Saharan Africa?: A Scoping Review. AIDS Behav 2018; 22:2468-2479. [PMID: 29777420 DOI: 10.1007/s10461-018-2160-z] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Men living with HIV/AIDS in sub-Saharan Africa are less likely to test for HIV than women. We conducted a scoping review in May of 2016 to identify how masculine norms influence men's HIV testing in sub-Saharan Africa. Our review yielded a total of 13 qualitative studies from 8 countries. Masculine norms create both barriers and facilitators to HIV testing. Barriers included emotional inexpression, gendered communication, social pressures to be strong and self-reliant, and the fear that an HIV positive result would threaten traditional social roles (i.e., husband, father, provider, worker) and reduce sexual success with women. Facilitators included perceptions that HIV testing could restore masculinity through regained physical strength and the ability to re-assume the provider role after accessing treatment. Across sub-Saharan Africa, masculinity appears to play an important role in men's decision to test for HIV and further research and interventions are needed to address this link.
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Affiliation(s)
- Katelyn M Sileo
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA.
- Division of Global Health, School of Medicine, University of California San Diego, San Diego, CA, USA.
- Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, Suite 200, New Haven, CT, USA.
| | - Rebecca Fielding-Miller
- Division of Global Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Shari L Dworkin
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Paul J Fleming
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Jacques-Aviñó C, García de Olalla P, González Antelo A, Fernández Quevedo M, Romaní O, Caylà JA. The theory of masculinity in studies on HIV. A systematic review. Glob Public Health 2018; 14:601-620. [PMID: 29972098 DOI: 10.1080/17441692.2018.1493133] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study aimed to describe the methodological characteristics of publications on HIV and masculinity, to identify possible information gaps and determine the main thematic areas. A systematic review was conducted of gender, masculinity, HIV infection and other sexually-transmitted infections in original articles published between 1992 and 2015. Original studies published from Pubmed and Scopus were included. A total of 303 articles were identified, of which 187 were selected. Most of the studies were qualitative and the most widely used technique was the interview. Twenty-nine-point five percent of studies were performed in South Africa, 20.8% in the USA, and 3.2% in Europe. Fifteen percent of the studies were performed in heterosexuals, 12.8% in men who have sex with men, and 60% did not specify the sexual orientation of the population. Eight thematic areas were defined, the most frequent being sexuality and risk behaviours, defined by men's need to demonstrate they were sexually active and a breadwinner. Most studies on HIV and masculinity show a gender bias by not specifying the sexual identity of the population. Studies should consider diversity in sexual and cultural identity in different contexts, including in Europe, to carry out more effective HIV interventions from a masculinity perspective.
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Affiliation(s)
- Constanza Jacques-Aviñó
- a Servicio de Epidemiología , Agència de Salud Pública de Barcelona , Barcelona , Spain.,b Universitat Rovira i Virgili (URV) , Tarragona , Spain
| | - Patricia García de Olalla
- a Servicio de Epidemiología , Agència de Salud Pública de Barcelona , Barcelona , Spain.,c Epidemiología y Salud Pública , CIBER , Spain
| | - Alicia González Antelo
- d Servicio Medicina Preventiva y Epidemiología , Hospital Vall d'Hebrón , Barcelona , Spain
| | | | - Oriol Romaní
- c Epidemiología y Salud Pública , CIBER , Spain.,e Medical Anthropology Research Center (MARC- URV) , Tarragona , Spain
| | - Joan A Caylà
- a Servicio de Epidemiología , Agència de Salud Pública de Barcelona , Barcelona , Spain.,c Epidemiología y Salud Pública , CIBER , Spain
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Warren EA, Paterson P, Schulz WS, Lees S, Eakle R, Stadler J, Larson HJ. Risk perception and the influence on uptake and use of biomedical prevention interventions for HIV in sub-Saharan Africa: A systematic literature review. PLoS One 2018; 13:e0198680. [PMID: 29902205 PMCID: PMC6002067 DOI: 10.1371/journal.pone.0198680] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 05/23/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Risk perception has been found to be a crucial factor explaining inconsistent or non-use of HIV prevention interventions. Considerations of risk need to expand beyond risk of infection to also include the personal, social, emotional, and economic risks associated with prevention intervention use. OBJECTIVES This systematic review of qualitative peer-reviewed literature from sub-Saharan Africa examines perceptions of risk associated with HIV infection and HIV prevention intervention use. DATA SOURCES We searched Medline, Embase, PsychInfo, Africa Wide Info, CINAHL, and Global Health for publications and screened them for relevance. STUDY ELIGIBILITY CRITERIA Peer-reviewed qualitative studies published since 2003 were eligible for inclusion if they examined risk perception or uncertainty in the context of a medically regulated intervention. Only studies focusing on adults were included. STUDY APPRAISAL AND SYNTHESIS METHODS Included publications were quality assessed using the Hawker method and coded thematically. RESULTS 10318 unique papers were identified, of which 29 are included. Among the themes identified, a particularly salient one was the potential of HIV prevention interventions to threaten the stability of a relationship and impact on how and when people may-or may not-choose to use prevention interventions. LIMITATIONS This literature review excludes grey-literature, which may have distinct valuable insights. We also excluded quantitative studies that may have challenged or triangulated our findings. CONCLUSIONS AND IMPLICATIONS When considering the risk of HIV acquisition, it is insufficient to examine biological risk in isolation from the personal, relational and economic costs associated with intervention use. This loss of emotional, physical, or material support may be perceived as more consequential than the prevention of a potential infection.
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Affiliation(s)
- Emily A. Warren
- Department of Public Health, Environments, and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Pauline Paterson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - William S. Schulz
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Shelley Lees
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Robyn Eakle
- Department of Public Health, Environments, and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Jonathan Stadler
- Department of Anthropology and Development Studies, University of Johannesburg, Johannesburg, South Africa
| | - Heidi J. Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Global Health, University of Washington, Seattle, United States of America
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Abstract
Supplemental Digital Content is Available in the Text. Background: As test and treat rolls out, effective interventions are needed to address the determinants of outcomes across the HIV treatment continuum and ensure that people infected with HIV are promptly tested, initiate treatment early, adhere to treatment, and are virally suppressed. Communication approaches offer viable options for promoting relevant behaviors across the continuum. Conceptual Framework: This article introduces a conceptual framework, which can guide the development of effective health communication interventions and activities that aim to impact behaviors across the HIV treatment continuum in low- and medium-income countries. The framework includes HIV testing and counseling, linkage to care, retention in pre-antiretroviral therapy and antiretroviral therapy initiation in one single-stage linkage to care and treatment, and adherence for viral suppression. The determinants of behaviors vary across the continuum and include both facilitators and barriers with communication interventions designed to focus on specific determinants presented in the model. At each stage, relevant determinants occur at the various levels of the social–ecological model: intrapersonal, interpersonal, health services, community, and policy. Effective health communication interventions have mainly relied on mHealth, interpersonal communication through service providers and peers, community support groups, and treatment supporters. Discussion: The conceptual framework and evidence presented highlight areas across the continuum where health communication can significantly impact treatment outcomes to reach the 90-90-90 goals by strategically addressing key behavioral determinants. As test and treat rolls out, multifaceted health communication approaches will be critical.
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Serapelwane MG, Davhana-Maselesele M, Masilo GM. Experiences of patients having tuberculosis (TB) regarding the use of Directly Observed Treatment Short-Course (DOTS) in the North West Province, South Africa. Curationis 2016; 39:e1-e9. [PMID: 27796102 PMCID: PMC6091630 DOI: 10.4102/curationis.v39i1.1629] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 07/28/2016] [Accepted: 08/06/2016] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) management remains a major challenge despite the implementation of Directly Observed Treatment Short-Course (DOTS). Some of the challenges include defaulting treatment, low TB cure rates and relapse after patients had been treated under DOTS. OBJECTIVES This study explored and described experiences of patients having TB regarding the use of DOTS in Doctor Ruth Segomotsi Mompati District of North West Province, South Africa. The study describes and recommends support required by patients having TB who are using DOTS. METHODS A qualitative, exploratory, descriptive and contextual design was used. The population consisted of all patients having TB under DOTS who had taken treatment for 2 months and more in one of the community health centres in Doctor Ruth Segomotsi Mompati District. Purposive sampling technique was applied to select participants receiving DOTS service. In-depth unstructured individual interviews were conducted, and data saturation occurred after having interviewed 15 participants. Ethical considerations were ensured throughout the study, and data were analysed using Tesch's method of coding and analysis. RESULTS Two themes emerged from data and these are discussed as concerns related to ineffective use of DOTS and lack of resources as contributory factor to ineffective use of DOTS. Among other categories, poor nurse-patient relationships and difficulties in accessing the community health centre emerged as consistent themes related to default and inconsistent use of DOTS. CONCLUSION Ineffective use of DOTS contributed to TB treatment default and low cure rate. Therefore, recommendations focused on strengthening effective use of DOTS for the management of TB.
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Kwobah CM, Braitstein P, Koech JK, Simiyu G, Mwangi AW, Wools-Kaloustian K, Siika AM. Factors Associated with Late Engagement to HIV Care in Western Kenya: A Cross-Sectional Study. J Int Assoc Provid AIDS Care 2015; 15:505-511. [PMID: 25589304 DOI: 10.1177/2325957414567682] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Late presentation of patients contributes significantly to the high mortality reported in HIV -care and treatment programs in sub-Saharan Africa. METHODS A cross-sectional study was conducted to assess factors associated with late engagement to HIV care at the Academic Model Providing Access to Healthcare in western Kenya. Late engagement was defined as baseline CD4 ≤100 cells/mm3. RESULTS Of the 10 533 participants included in the analysis, 67% were female and mean age was 36.7 years. Overall, 23% of the participants presented late. Factors associated with late engagement included male gender (adjusted odds ratio [AOR]: 1.54, 95% confidence interval [CI]: 1.35-1.75), older age (AOR: 1.62, 95% CI: 1.02-2.56), and longer travel time to clinic (AOR: 1.18, 95% CI: 1.04-1.34). CONCLUSION Nearly one-quarter of HIV-infected patients in our setting present with advanced immune suppression at initial encounter. Being male, older age, and living further away from clinic are associated with late engagement to care.
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Affiliation(s)
- Charles Meja Kwobah
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya .,Department of Medicine, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Medicine, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,University of Toronto, Dalla Lana School of Public Health, Toronto, Canada
| | - Julius K Koech
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Gilbert Simiyu
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Ann W Mwangi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Behavioral Sciences, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Kara Wools-Kaloustian
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Abraham M Siika
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Medicine, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
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Hensen B, Taoka S, Lewis JJ, Weiss HA, Hargreaves J. Systematic review of strategies to increase men's HIV-testing in sub-Saharan Africa. AIDS 2014; 28:2133-45. [PMID: 25062091 PMCID: PMC4819892 DOI: 10.1097/qad.0000000000000395] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 06/27/2014] [Accepted: 07/02/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This systematic review summarizes evidence on the effectiveness of strategies to increase men's HIV-testing in sub-Saharan Africa. METHODS Medline, EmBase, Africa-Wide Information and Global Health were searched. Cluster and individually randomized trials evaluating interventions to increase the proportion of adults (≥ 15 years) testing for HIV were eligible if they were conducted in sub-Saharan Africa, included men in the study population, and reported HIV-testing data by sex. References were independently screened. RESULTS Of the 1852 references, 15 papers including 16 trials were eligible. Trials were judged too heterogeneous to combine in meta-analysis. Three interventions invited men to attend antenatal care-based HIV-testing via pregnant partners, of which two showed a significant effect on partner-testing. One intervention invited men to HIV-test through pregnant partners and showed an increase in HIV-testing when it was offered in bars compared with health facilities. A trial of notification to partners of newly diagnosed HIV-positive patients showed an increase in testing where notification was by healthcare providers compared with notification by the patient. Three interventions reached men already at health facilities and eight reported the effects of community-based HIV testing. Mobile-testing had a significant effect on HIV-testing compared with standard voluntary counselling and testing. Home-based testing also had a significant effect, but reached smaller numbers of men than mobile-testing. DISCUSSION Interventions to encourage HIV-testing can increase men's levels of HIV testing. Community-based programmes in particular had a large effect on population levels of HIV-testing. More data on costs and potential population impact of these approaches over different time-horizons would aid policy-makers in planning resource allocation to increase male HIV-testing.
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Affiliation(s)
- Bernadette Hensen
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine
| | | | - James J. Lewis
- MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen A. Weiss
- MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health
| | - James Hargreaves
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, London, UK
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Seeling S, Mavhunga F, Thomas A, Adelberger B, Ulrichs T. Barriers to access to antiretroviral treatment for HIV-positive tuberculosis patients in Windhoek, Namibia. Int J Mycobacteriol 2014; 3:268-75. [PMID: 26786626 DOI: 10.1016/j.ijmyco.2014.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 07/05/2014] [Indexed: 11/27/2022] Open
Abstract
SETTING Namibia faces a high burden of tuberculosis (TB) and HIV-infection. In 2011, 50% of the TB patients were co-infected with HIV. While all patients co-infected with TB and HIV are eligible for antiretroviral treatment (ART), only 54% were reported to have received ART according to national data. OBJECTIVE To explore the perspective of healthcare professionals on barriers to access to ART for HIV-positive TB patients. DESIGN Nine semi-structured qualitative interviews were conducted with healthcare professionals from TB and HIV services in Windhoek in 2012 to investigate access barriers to ART for HIV-positive TB patients in Namibia. RESULTS Many barriers known from other African countries were also present in Namibia. The barriers rated as most important were: staff shortage (health system level); limited training (healthcare worker level); and fear of stigma and discrimination (patient/community level). Direct treatment costs and limited availability of antiretroviral medication were not observed as barriers. Interference with TB treatment and ART by some Pentecostal churches was revealed as an important barrier that has not yet received sufficient attention. CONCLUSION The study identified access barriers to ART for HIV-positive TB patients and their relevance in Namibia. The findings provide evidence for tailored interventions to increase ART-uptake among HIV-positive TB patients.
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Affiliation(s)
- Stefanie Seeling
- Charité-Universitätsmedizin Berlin, Berlin School of Public Health, Seestr. 73, 13347 Berlin, Germany.
| | - Farai Mavhunga
- Ministry of Health and Social Services, Ministerial Bldg, Harvey Street, P/Bag: 13198, Windhoek, Namibia.
| | - Albertina Thomas
- Ministry of Health and Social Services, Ministerial Bldg, Harvey Street, P/Bag: 13198, Windhoek, Namibia.
| | - Bettina Adelberger
- Charité-Universitätsmedizin Berlin, Berlin School of Public Health, Seestr. 73, 13347 Berlin, Germany.
| | - Timo Ulrichs
- Koch-Metchnikov-Forum, Langenbeck-Virchow-Haus, Luisenstr. 58/59, 10117 Berlin, Germany; Akkon College of Human Sciences, Am Köllnischen Park 1, 10179 Berlin, Germany.
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Gutin SA, Cummings B, Jaiantilal P, Johnson K, Mbofana F, Dawson Rose C. Qualitative evaluation of a Positive Prevention training for health care providers in Mozambique. EVALUATION AND PROGRAM PLANNING 2014; 43:38-47. [PMID: 24291214 PMCID: PMC4552037 DOI: 10.1016/j.evalprogplan.2013.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 10/19/2013] [Accepted: 10/29/2013] [Indexed: 06/02/2023]
Abstract
The rapid scale-up of HIV care and treatment in Mozambique has provided an opportunity to reach people living with HIV (PLHIV) with prevention interventions in HIV care and treatment settings. A three-day Positive Prevention (PP) training intervention for health care providers that focused on pressing issues for PLHIV in Mozambique was adapted and delivered at sites in three provinces. In-depth interviews were conducted with 31 providers trained in the PP curriculum. Qualitative data were used to assess the appropriateness of the training materials and approach, which lessons providers learned and were able to implement and which PP messages were still difficult to deliver. Providers reported gaining numerous insights from the training, including how to conduct a risk assessment and client-centered counseling, negotiating disclosure, partner testing, condom use, PMTCT, treatment adherence and approaches for positive living. Training topics not commonly mentioned included discordance counseling, STIs, family planning, alcohol and drug use, and frank sexual risk discussions. While areas for improvement exist, the PP training was useful in transferring skills to providers and is a viable component of HIV care. This evaluation helps identify areas where future PP trainings and specific strategies and messages can be refined for the Mozambican context.
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Affiliation(s)
- Sarah A Gutin
- UCSF, Department of Community Health Systems, School of Nursing, United States.
| | - Beverley Cummings
- Global AIDS Program, Centers for Disease Control and Prevention, Mozambique
| | | | - Kelly Johnson
- UCSF, Prevention and Public Health Group, Global Health Sciences, United States
| | | | - Carol Dawson Rose
- UCSF, Department of Community Health Systems, School of Nursing, United States
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Musheke M, Ntalasha H, Gari S, McKenzie O, Bond V, Martin-Hilber A, Merten S. A systematic review of qualitative findings on factors enabling and deterring uptake of HIV testing in Sub-Saharan Africa. BMC Public Health 2013; 13:220. [PMID: 23497196 PMCID: PMC3610106 DOI: 10.1186/1471-2458-13-220] [Citation(s) in RCA: 285] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 03/06/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite Sub-Saharan Africa (SSA) being the epicenter of the HIV epidemic, uptake of HIV testing is not optimal. While qualitative studies have been undertaken to investigate factors influencing uptake of HIV testing, systematic reviews to provide a more comprehensive understanding are lacking. METHODS Using Noblit and Hare's meta-ethnography method, we synthesised published qualitative research to understand factors enabling and deterring uptake of HIV testing in SSA. We identified 5,686 citations out of which 56 were selected for full text review and synthesised 42 papers from 13 countries using Malpass' notion of first-, second-, and third-order constructs. RESULTS The predominant factors enabling uptake of HIV testing are deterioration of physical health and/or death of sexual partner or child. The roll-out of various HIV testing initiatives such as 'opt-out' provider-initiated HIV testing and mobile HIV testing has improved uptake of HIV testing by being conveniently available and attenuating fear of HIV-related stigma and financial costs. Other enabling factors are availability of treatment and social network influence and support. Major barriers to uptake of HIV testing comprise perceived low risk of HIV infection, perceived health workers' inability to maintain confidentiality and fear of HIV-related stigma. While the increasingly wider availability of life-saving treatment in SSA is an incentive to test, the perceived psychological burden of living with HIV inhibits uptake of HIV testing. Other barriers are direct and indirect financial costs of accessing HIV testing, and gender inequality which undermines women's decision making autonomy about HIV testing. Despite differences across SSA, the findings suggest comparable factors influencing HIV testing. CONCLUSIONS Improving uptake of HIV testing requires addressing perception of low risk of HIV infection and perceived inability to live with HIV. There is also a need to continue addressing HIV-related stigma, which is intricately linked to individual economic support. Building confidence in the health system through improving delivery of health care and scaling up HIV testing strategies that attenuate social and economic costs of seeking HIV testing could also contribute towards increasing uptake of HIV testing in SSA.
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Affiliation(s)
- Maurice Musheke
- Zambia AIDS-related TB Research Project, University of Zambia, Lusaka, Zambia.
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O'Laughlin KN, Rouhani SA, Faustin ZM, Ware NC. Testing experiences of HIV positive refugees in Nakivale Refugee Settlement in Uganda: informing interventions to encourage priority shifting. Confl Health 2013; 7:2. [PMID: 23409807 PMCID: PMC3645965 DOI: 10.1186/1752-1505-7-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 02/10/2013] [Indexed: 11/10/2022] Open
Abstract
Background Recent initiatives by international health and humanitarian aid organizations have focused increased attention on making HIV testing services more widely available to vulnerable populations. To realize potential health benefits from new services, they must be utilized. This research addresses the question of how utilization of testing services might be encouraged and increased for refugees displaced by conflict, to make better use of existing resources. Methods Open-ended interviews were conducted with HIV-infected refugees (N=73) who had tested for HIV and with HIV clinic staff (N=4) in Nakivale Refugee Settlement in southwest Uganda. Interviews focused on accessibility of HIV/AIDS-related testing and care and perspectives on how to improve utilization of testing services. Data collection took place at the Nakivale HIV/AIDS Clinic from March to July of 2011. An inductive approach to data analysis was used to identify factors related to utilization. Results In general, interviewees report focusing daily effort on tasks aimed at meeting survival needs. HIV testing is not prioritized over these responsibilities. Under some circumstances, however, HIV testing occurs. This happens when: (a) circumstances realign to trigger a temporary shift in priorities away from daily survival-related tasks; (b) survival needs are temporarily met; and/or (c) conditions shift to alleviate barriers to HIV testing. Conclusion HIV testing services provided for refugees must be not just available, but also utilized. Understanding what makes HIV testing possible for refugees who have tested can inform interventions to increase testing in this population. Intervening by encouraging priority shifts toward HIV testing, by helping ensure survival needs are met, and by eliminating barriers to testing, may result in refugees making better use of existing testing services.
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Affiliation(s)
- Kelli N O'Laughlin
- Brigham & Women's Hospital, 75 Francis Street, Boston, Massachusetts, 02115, USA.
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Njozing BN, Edin KE, San Sebastián M, Hurtig AK. Voices from the frontline: counsellors' perspectives on TB/HIV collaborative activities in the Northwest Region, Cameroon. BMC Health Serv Res 2011; 11:328. [PMID: 22129222 PMCID: PMC3248870 DOI: 10.1186/1472-6963-11-328] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 11/30/2011] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The overlapping epidemiology of tuberculosis (TB) and human immunodeficiency virus (HIV) infections prompted the World Health Organisation in 2004 to recommend collaboration between national TB and HIV programmes. The goal of this collaboration is to decrease the burden of both infections in the population. This policy was subsequently adopted by the national TB and HIV programmes in Cameroon with TB and HIV nurses/counsellors acting as frontline implementers of the collaborative activities in the 10 regions of the country. METHODS Qualitative research interviews were conducted with 30 nurses/counsellors in four approved treatment centres providing comprehensive TB and HIV/AIDS services in the Northwest region of Cameroon. The aim was to explore their experiences in counselling, in delivering joint TB and HIV services, and the constraints to effective collaboration between TB and HIV services. To complement the findings from the counsellors' interviews, as part of an emergent design, further interviews with 2 traditional healers and non-participant observations in two HIV support group meetings were conducted. RESULTS According to the respondents, counselling was regarded as a call to serve humanity irrespective of the reasons for choosing the profession. In addition, the counselling training and supervision received, and the skills acquired, have altogether contributed to build patients' trust in the healthcare system. Teamwork among healthcare workers and other key stakeholders in the community involved in TB/HIV prevention and control was used as a strategy to improve joint service delivery and patients' uptake of services. Several constraints to effective collaboration between TB and HIV services were identified, including shortage of human resources, infrastructure and drug supplies, poor patients' adherence to treatment and the influence of traditional healers who relentlessly dissuade patients from seeking mainstream medical care. CONCLUSIONS In order to achieve a sustainable collaboration between TB and HIV services, adequate planning, investment and strengthening of the health system including human resources, infrastructure and ensuring uninterrupted supplies of medicines are essential. A multidisciplinary approach to service delivery particularly focusing on harnessing the enormous potentials of traditional healers in TB/HIV prevention and control would also be indispensible.
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Affiliation(s)
- Barnabas N Njozing
- St, Mary Soledad Catholic Hospital, Mankon, Bamenda, PO Box 157, Cameroon.
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Njozing BN, Edin KE, Sebastián MS, Hurtig AK. "If the patients decide not to tell what can we do?"- TB/HIV counsellors' dilemma on partner notification for HIV. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2011; 11:6. [PMID: 21639894 PMCID: PMC3119031 DOI: 10.1186/1472-698x-11-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 06/03/2011] [Indexed: 11/21/2022]
Abstract
Background There is a global consensus towards universal access to human immunodeficiency virus (HIV) services consequent to the increasing availability of antiretroviral therapy. However, to benefit from these services, knowledge of one's HIV status is critical. Partner notification for HIV is an important component of HIV counselling because it is an effective strategy to prevent secondary transmission, and promote early diagnosis and prompt treatment of HIV patients' sexual partners. However, counsellors are often frustrated by the reluctance of HIV-positive patients to voluntarily notify their sexual partners. This study aimed to explore tuberculosis (TB)/HIV counsellors' perspectives regarding confidentiality and partner notification. Methods Qualitative research interviews were conducted in the Northwest Region of Cameroon with 30 TB/HIV counsellors in 4 treatment centres, and 2 legal professionals between September and December 2009. Situational Analysis (positional map) was used for data analysis. Results Confidentiality issues were perceived to be handled properly despite concerns about patients' reluctance to report cases of violation due to apprehension of reprisals from health care staffs. All the respondents encouraged voluntary partner notification, and held four varying positions when confronted with patients who refused to voluntarily notify their partners. Position one focused on absolute respect of patients' autonomy; position two balanced between the respect of patients' autonomy and their partners' safety; position three wished for protection of sexual partners at risk of HIV infection and legal protection for counsellors; and position four requested making HIV testing and partner notification routine processes. Conclusion Counsellors regularly encounter ethical, legal and moral dilemmas between respecting patients' confidentiality and autonomy, and protecting patients' sexual partners at risk of HIV infection. This reflects the complexity of partner notification and demonstrates that no single approach is optimal, but instead certain contextual factors and a combination of different approaches should be considered. Meanwhile, adopting a human rights perspective in HIV programmes will balance the interests of both patients and their partners, and ultimately enhance universal access to HIV services.
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Affiliation(s)
- Barnabas N Njozing
- St, Mary Soledad Catholic Hospital, Mankon, Bamenda, P,O,Box 157, Cameroon.
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