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Tran BX, Bui TM, Do AL, Boyer L, Auquier P, Nguyen LH, Nguyen AHT, Van Ngo T, Latkin CA, Zhang MWB, Ho CSH, Ho RCM. Changes in Quality of life Outcomes of Patients with HIV/AIDS Under a Theory-based Mobile Health Intervention. AIDS Behav 2023; 27:3905-3915. [PMID: 37306845 DOI: 10.1007/s10461-023-04105-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 06/13/2023]
Abstract
This study examined the effectiveness of a theory-based mHealth intervention on the quality of life (QOL) of people living with HIV. A randomized controlled trial was performed at two outpatient clinics in Hanoi, Vietnam. There were 428 patients with HIV/AIDs in selected clinics and were divided into the intervention arm (receiving HIV-assisted smartphone application and usual care) and the control arm (receiving only usual care). The WHOQOLHIV-BREF instrument was utilized to measure QOL. An intention-to-treat approach using Generalized Linear Mixed Model analysis was performed. The trial showed significant improvements in Physical health, Psychological health, and Level of Dependence among patients in the intervention arm compared to the control arm. However, the Environment and Spirituality/Personal beliefs improvements would require additional interventions, both individual, organizational, or governmental. This study explored the utility of a smartphone mobile application for individuals with HIV, and how the resultant application could improve the overall QOL.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, No. 1 Ton That Tung Street, Dong Da district, Hanoi, 100000, Vietnam.
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA.
| | - Thu Minh Bui
- Bach Mai Medical College, Bach Mai Hospital, Hanoi, 100000, Vietnam
| | - Anh Linh Do
- Institute of Health Economics and Technology, Hanoi, 100000, Vietnam
| | - Laurent Boyer
- Research Centre on Health Services and Quality of Life, Aix Marseille University, 27, boulevard Jean-Moulin, Marseille cedex 05, 13385, France
| | - Pascal Auquier
- Research Centre on Health Services and Quality of Life, Aix Marseille University, 27, boulevard Jean-Moulin, Marseille cedex 05, 13385, France
| | - Long Hoang Nguyen
- Department of Global Public Health, Karolinska Institutet, Stockholm, 17177, Sweden
| | | | - Toan Van Ngo
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, No. 1 Ton That Tung Street, Dong Da district, Hanoi, 100000, Vietnam
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Melvyn W B Zhang
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 50 Nanyang Ave, Singapore
| | - Cyrus S H Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - Roger C M Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, 119077, Singapore
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Mandlate FM, Greene MC, Pereira LF, Gouveia ML, Mari JJ, Cournos F, Duarte CS, Oquendo MA, Mello MF, Wainberg ML. Association between mental disorders and adherence to antiretroviral treatment in health facilities in two Mozambican provinces in 2018: a cross-sectional study. BMC Psychiatry 2023; 23:274. [PMID: 37081470 PMCID: PMC10116733 DOI: 10.1186/s12888-023-04782-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 04/13/2023] [Indexed: 04/22/2023] Open
Abstract
INTRODUCTION Lower adherence to antiretroviral treatment (ART) has been found among people with HIV (PWH) who have comorbid mental disorders like depression and alcohol use in Sub-Saharan African. However, there has been less exploration with regards to other mental disorders. METHODS This study assessed the association of multiple mental disorders and adherence to ART based on the data from primary/tertiary health care facilities in Maputo and Nampula, Mozambique. We administered a sociodemographic questionnaire, Mini International Neuropsychiatric Interview (MINI) Plus 4.0.0 adapted for use in Mozambique to assess mental conditions, and a 3-item self-report to measure ART adherence. RESULTS 395 HIV-positive (self-report) participants on ART, with an average age of 36.7 years (SD = 9.8), and 30.4% were male. The most common mental disorders were major depressive disorder (27.34%) followed by psychosis (22.03%), suicidal ideation/behavior (15.44%), and alcohol-use disorder (8.35%). Higher odds of missing at least one dose in the last 30 days (OR = 1.45, 95% CI: 1.01, 2.10) were found in participants with any mental disorder compared to those without a mental disorder. The highest levels of non-adherence were observed among those with drug use disorders and panic disorder. CONCLUSIONS In Mozambique, PWH with any co-occurring mental conditions had a lower probability of ART adherence. Integrating comprehensive mental health assessment and treatment and ART adherence interventions tailored to PWH with co-occurring mental disorders is necessary to attain optimal ART adherence and reach the UNAIDS ART target.
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Affiliation(s)
- Flavio M. Mandlate
- Department of Mental Health, Ministry of Health, Eduardo Mondlane Avenue, nr 1008, Postal Code 264 Maputo, Mozambique
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - M. Claire Greene
- Program on Forced Migration and Health, Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, USA
| | - Luis F. Pereira
- New York State Psychiatric Institute, Columbia University, New York, USA
| | - Maria Lidia Gouveia
- Department of Mental Health, Ministry of Health, Eduardo Mondlane Avenue, nr 1008, Postal Code 264 Maputo, Mozambique
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Jair Jesus Mari
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Francine Cournos
- New York State Psychiatric Institute, Columbia University, New York, USA
| | | | - Maria A. Oquendo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Marcelo Feijó Mello
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Milton L. Wainberg
- New York State Psychiatric Institute, Columbia University, New York, USA
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Nhemachena T, Späth C, Arendse KD, Lebelo K, Zokufa N, Cassidy T, Whitehouse K, Keene CM, Swartz A. Between empathy and anger: healthcare workers' perspectives on patient disengagement from antiretroviral treatment in Khayelitsha, South Africa - a qualitative study. BMC PRIMARY CARE 2023; 24:34. [PMID: 36698083 PMCID: PMC9878968 DOI: 10.1186/s12875-022-01957-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 12/23/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND & OBJECTIVES The benefits of long-term adherence to antiretroviral therapy (ART) are countered by interruptions in care or disengagement from care. Healthcare workers (HCWs) play an important role in patient engagement and negative or authoritarian attitudes can drive patients to disengage. However, little is known about HCWs' perspectives on disengagement. We explored HCWs' perspectives on ART disengagement in Khayelitsha, a peri-urban area in South Africa with a high HIV burden. METHOD Semi-structured interviews were conducted with 30 HCWs in a primary care HIV clinic to explore their perspectives of patients who disengage from ART. HCWs interviewed included clinical (doctors and nurses) and support staff (counsellors, social workers, data clerks, security guards, and occupational therapists). The interview guide asked HCWs about their experience working with patients who interrupt treatment and return to care. Transcripts were audio-recorded, transcribed, and analysed using an inductive thematic analysis approach. RESULTS Most participants were knowledgeable about the complexities of disengagement and barriers to sustaining engagement with ART, raising their concerns that disengagement poses a significant public health problem. Participants expressed empathy for patients who interrupted treatment, particularly when the challenges that led to their disengagement were considered reasonable by the HCWs. However, many also expressed feelings of anger and frustration towards these patients, partly because they reported an increase in workload as a result. Some staff, mainly those taking chronic medication themselves, perceived patients who disengage from ART as not taking adequate responsibility for their own health. CONCLUSION Lifelong engagement with HIV care is influenced by many factors including disclosure, family support, and HCW interactions. Findings from this study show that HCWs had contradictory feelings towards disengaged patients, experiencing both empathy and anger. Understanding this could contribute to the development of more nuanced interventions to support staff and encourage true person-centred care, to improve patient outcomes.
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Affiliation(s)
- Tsephiso Nhemachena
- grid.7836.a0000 0004 1937 1151School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Carmen Späth
- grid.7836.a0000 0004 1937 1151School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Kirsten D. Arendse
- grid.452731.60000 0004 4687 7174Médecins Sans Frontières, Khayelitsha Project, Cape Town, South Africa
| | - Keitumetse Lebelo
- grid.452731.60000 0004 4687 7174Médecins Sans Frontières, Khayelitsha Project, Cape Town, South Africa
| | - Nompumelelo Zokufa
- grid.452731.60000 0004 4687 7174Médecins Sans Frontières, Khayelitsha Project, Cape Town, South Africa
| | - Tali Cassidy
- grid.7836.a0000 0004 1937 1151School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa ,grid.452731.60000 0004 4687 7174Médecins Sans Frontières, Khayelitsha Project, Cape Town, South Africa
| | - Katherine Whitehouse
- grid.452731.60000 0004 4687 7174Médecins Sans Frontières, Southern African Medical Unit, Cape Town, South Africa
| | - Claire M. Keene
- grid.452731.60000 0004 4687 7174Médecins Sans Frontières, Khayelitsha Project, Cape Town, South Africa ,grid.4991.50000 0004 1936 8948Health Systems Collaborative, Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Alison Swartz
- grid.7836.a0000 0004 1937 1151School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa ,grid.8356.80000 0001 0942 6946Department of Psychosocial and Psychoanalytic Studies, University of Essex, Essex, England
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Taverne B, Laborde-Balen G, Sow K, Ndiaye NB, Diop K. Treatment success or failure in children and adolescents born with HIV in rural Senegal: An anthropological perspective. Soc Sci Med 2023; 317:115628. [PMID: 36571886 DOI: 10.1016/j.socscimed.2022.115628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 12/17/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
Due to the efficacy of antiretrovirals (ARVs), mortality and morbidity related to the AIDS epidemic has declined considerably in recent decades. Nevertheless in Africa, the persistence of new infections and the concerning development of ARV drug resistance reflect the challenges in preventing and treating HIV infection. These problems are especially affecting children and adolescents living with HIV (CALHIV). In 1998, Senegal was the first West African country to implement a government program for access to ARV drugs. However, care for CALHIV remains challenging. A national survey conducted in 2015 showed that 64% of CALHIV (0-19 years) in follow-up in sites outside of Dakar were in treatment failure. The article presents the results of an anthropological study that aims to examine the modalities of medical and social care for CALHIV, identify the various structural and social determinants of treatment failure or success, and ascertain their respective influence. The ethnographic survey was conducted between July 2020 and November 2021 in 11 of the 14 regions of Senegal and in 15 health facilities (11 health centers and 4 regional hospitals). The interviews and observations were conducted with 65 children and adolescents, 63 parents or guardians, and 47 health workers providing their care. The results show that situations of treatment failure or success are the result of favorable or unfavorable configurations that bring into play various actors-children, parents, health care professionals-and their interactions with and in varying sociocultural and structural contexts. This research underscores the contribution of anthropology to the analysis and understanding of care systems. From a public health perspective, our analyses argue for a differentiated approach to strengthening the skills of health facility staff, taking into account the specificity of each site.
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Affiliation(s)
- Bernard Taverne
- TransVIHMI (University of Montpellier, INSERM, IRD) 911, Avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France.
| | - Gabrièle Laborde-Balen
- TransVIHMI (University of Montpellier, INSERM, IRD) 911, Avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France.
| | - Khoudia Sow
- Regional Center for Research and Training in Fann Clinic; P.O. Box 45690, Dakar Fann, Senegal.
| | - Ndeye Bineta Ndiaye
- Division of AIDS/STI Control of the Ministry of Health, P.O. Box 7381, Dakar, Senegal.
| | - Karim Diop
- Regional Center for Research and Training in Fann Clinic; P.O. Box 45690, Dakar Fann, Senegal.
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Beja H, Daisy N, Edek MT, Kobusinge V, Akaki O, Owachgiu IO, Udho S. Barriers and Facilitators to Successful Intensive Adherence Counseling in Rural Northern Uganda: An Exploratory Interview with HIV-Positive Clients Using the COM-B Framework. HIV/AIDS - RESEARCH AND PALLIATIVE CARE 2022; 14:553-563. [DOI: 10.2147/hiv.s393093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022]
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Woolf-King SE, Sheinfil AZ, Ramos J, Foley JD, Moskal D, Firkey M, Kellen D, Maisto SA. A conceptual model of alcohol use and adherence to antiretroviral therapy: systematic review and theoretical implications for mechanisms of action. Health Psychol Rev 2022; 16:104-133. [PMID: 32757813 PMCID: PMC8972079 DOI: 10.1080/17437199.2020.1806722] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Alcohol consumption is one of the most prevalent correlates of antiretroviral therapy (ART) adherence, yet causal processes underlying this association remain largely unexplored. The goal of this systematic review was to develop a conceptual model that describes the causal effect of alcohol consumption on ART nonadherence. We reviewed 230 studies that examined the association between alcohol consumption and ART adherence with three primary aims: (1) to replicate and extend previous reviews of the literature, (2) to summarize and critique study designs capable of answering questions about temporal overlap and (3) to summarize potential mechanisms of action. A model of alcohol-associated ART nonadherence was proposed to guide future work, integrating general theories of ART adherence and theory on the psychological and behavioral effects of alcohol intoxication. The conceptual model describes two mechanistic processes-prospective memory impairment and interactive toxicity beliefs/avoidance behaviors-involved in alcohol-associated intentional and unintentional nonadherence, respectively. This model can be used to guide future research on the causal processes involved in the frequently observed correlation between alcohol consumption and adherence.
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Affiliation(s)
| | - Alan Z. Sheinfil
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Jeremy Ramos
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Jacklyn D. Foley
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Dezarie Moskal
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Madison Firkey
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - David Kellen
- Department of Psychology, Syracuse University, Syracuse, NY, USA
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The Situated Information, Motivation, and Behavioral Skills Model of HIV Antiretroviral Therapy Adherence Among Persons Living With HIV in Haiti: A Qualitative Study Incorporating Culture and Context. J Assoc Nurses AIDS Care 2022; 33:448-458. [PMID: 35239563 DOI: 10.1097/jnc.0000000000000329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT To inform a clinic-based adherence-promotion intervention, this qualitative study applied the Situated Information, Motivation, and Behavioral Skills Model of Care Initiation and Maintenance to elucidate cultural and contextual factors affecting antiretroviral therapy adherence in Haiti. From the 23 focus group discussions with patients (n = 58) and health care workers (n = 57), culturally specific themes emerged relating to Information (e.g., conflicts with allopathic medicine and heuristics about how treatment failure occurs), Motivation (e.g., protecting family members, health and physical appearance, material advantages, and relationships with health workers), and Behavioral Skills (e.g., managing food intake and side effects, navigating health services utilization, accessing medication, and advocating for care needs). Recommendations include: provide therapeutic education on HIV drug resistance; promote the concept of "undetectable = untransmittable"; develop treatment buddy relationships; invest in training and enforcement of patient privacy, transparency, and fairness in access to services and resources; and provide patient-centered behavioral skills counseling.
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Ajuna N, Tumusiime B, Amanya J, Awori S, Rukundo GZ, Asiimwe JB. Social Networks and Barriers to ART Adherence Among Young Adults (18-24 years) Living with HIV at Selected Primary Health Facilities of South-Western Uganda: A Qualitative Study. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2021; 13:939-958. [PMID: 34675686 PMCID: PMC8504700 DOI: 10.2147/hiv.s328643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/23/2021] [Indexed: 11/23/2022]
Abstract
Background Young adults living with HIV (YALWH) struggle to maintain high levels of adherence to antiretroviral therapy (ART) because of numerous barriers. This study describes the social networks of YALWH (18–24 years), their barriers to ART adherence, and the perceived role of social networks in overcoming those barriers. Methods This study used a qualitative descriptive research design. Twenty-three (23) YALWH who were on ART for a period of greater than one (1) month and had consented to participate in the study were purposively selected from two primary health care facilities in southwestern Uganda. We held four (4) focus group discussions with the YALWH over 5 weeks between the 24th of July and 7th September 2020. Data were audio recorded, transcribed, and entered in Microsoft word 2010. Using the content analysis techniques, data were inductively coded and categories or themes developed. Results Most YALWH belonged to bonding (family, friends, and neighbors), followed by bridging (informal groups), and linking (health professionals) social networks, respectively. Most YALWH, irrespective of gender, had close connections with their mothers or elder sisters. The commonest form of bridging networks was informal community groups that provided financial services, whereas the linking ones comprised health professionals’ directly involved in HIV patient care such as nurses, counselors, and their affiliates (expert clients or clinic based peer supporters), who occasionally acted as bonding networks. Structural barriers to ART adherence (eg, stigma) were the most cited, followed by medication- (eg, pill burden), and patient-related barriers (eg, non-disclosure of HIV status). Bonding networks were perceived to help overcome patient, medication, and structural barriers to ART adherence. Bridging networks overcame structural and medication-related barriers to ART adherence. Linking networks were perceived to help overcome some health systems and medication-related barriers to ART adherence. Conclusion Bonding social networks seem to play a prominent role in overcoming numerous barriers to ART adherence compared with bridging and linking social networks.
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Affiliation(s)
- Noble Ajuna
- Department of Nursing, Bishop Stuart University, Mbarara City, Southwestern Uganda
| | - Brian Tumusiime
- Department of Nursing, Bishop Stuart University, Mbarara City, Southwestern Uganda
| | - Joseph Amanya
- Department of Nursing, Bishop Stuart University, Mbarara City, Southwestern Uganda
| | - Sharon Awori
- Department of Nursing, Bishop Stuart University, Mbarara City, Southwestern Uganda
| | - Godfrey Z Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara City, Southwestern Uganda
| | - John Baptist Asiimwe
- Department of Nursing, Bishop Stuart University, Mbarara City, Southwestern Uganda
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Knettel BA, Wanda L, Amiri I, Myers J, Fernandez KM, Muiruri C, Watt MH, Mmbaga BT, Relf MV. Assessing the Influence of Community Health Worker Support on Early Antiretroviral Therapy Adherence, Anticipated Stigma, and Mental Health Among People Living with HIV in Tanzania. AIDS Patient Care STDS 2021; 35:308-317. [PMID: 34375138 PMCID: PMC8380803 DOI: 10.1089/apc.2021.0028] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
In many low- and middle-income countries, community health workers (CHWs) support multiple aspects of HIV care, including patient education and counseling, adherence support, and re-engaging patients lost to care. In Tanzania, the Community-Based HIV Services program is a nationwide cohort of CHWs supporting HIV care engagement. We enrolled a prospective cohort study of 80 people initiating HIV care at two Tanzanian clinics and conducted baseline and 3-month follow-up assessments to examine the potential influence of CHW support and other factors on patient early self-reported medication adherence, depression, anxiety, attitudes about medication, and HIV stigma. The vast majority of participants reported maintaining strong antiretroviral therapy (ART) adherence during the study and endorsed beliefs that ART is beneficial for them. However, there was high occurrence of likely depression and anxiety disorders in the study sample. Patient contact with CHWs at the clinic was unexpectedly low; fewer than two-thirds of participants were informed about the CHW program and fewer than one-third ever met with a CHW. Among participants who met with a CHW, there was mixed feedback about the helpfulness of the program, and contact with a CHW did not improve medication adherence at 3-month follow-up. Male participants, those with likely depression, and those who lived further from the clinic were significantly more likely to experience adherence challenges. The study findings indicate that CHWs are currently underutilized to provide patient support and may not be producing observable benefits to patients in this setting, representing a missed opportunity to address patient challenges, including depression and anxiety.
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Affiliation(s)
- Brandon A. Knettel
- Duke University School of Nursing, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Lisa Wanda
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Ismail Amiri
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - John Myers
- Duke University School of Nursing, Durham, North Carolina, USA
| | | | - Charles Muiruri
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Melissa H. Watt
- Department of Population Health Sciences, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Blandina T. Mmbaga
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Michael V. Relf
- Duke University School of Nursing, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
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Taverne B, Laborde-Balen G, Diaw K, Gueye M, Have NN, Etard JF, Sow K. Does universal health coverage reduce out-of-pocket expenditures for medical consultations for people living with HIV in Senegal? An exploratory cross-sectional study. BMJ Open 2021; 11:e046579. [PMID: 34233979 PMCID: PMC8264868 DOI: 10.1136/bmjopen-2020-046579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 06/22/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES In Senegal, a national health coverage system named Couverture Medicale Universelle (CMU) has been under development since 2013; its impact on out-of-pocket (OOP) expenses for people living with HIV (PLHIV) remains unknown. Our objective was to assess the impact of the national health coverage system on health expenses for PLHIV by measuring the OOP amount for a routine consultation for various categories of PLHIV, in Dakar and different regions in Senegal, viewed from the patients' perspective. DESIGN, SETTING AND PARTICIPANTS Cross-sectional survey in 2018 and 2019 using a face-to-face questionnaire with PLHIV: 344 adults followed up at Fann Regional Centre for research and training in clinical treatment in Dakar; 60 adult men who have sex with men (MSM) in 2 hospitals in Dakar and 7 facilities in the regions; and 130 children and adolescents (0-19 years) in 16 care facilities in the southern regions. We have calculated the total price of the consultation and associated prescriptions along with the patient's OOP medical and transportation contributions. The average amounts were compared using the Student's t-test. RESULTS All patients are on antiretroviral treatment with a median duration of 6 years, 5 years and 3 years for adults, MSM and children/adolescents, respectively. The percentage of people who have health coverage is 26%, 18% and 44% for adults, MSM and children. In practice, these systems are rarely used. The OOP amount (health expenses+transportation costs) for a routine consultation is €11 for adults and children, and €32.5 for MSM. CONCLUSION The number of PLHIV with coverage is low, and the system's effectiveness remains limited. Currently, this system has proved ineffective in implementing free healthcare, recommended by WHO since 2005.
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Affiliation(s)
- Bernard Taverne
- TransVIHMI, University of Montpellier, INSERM, Institut de Recherche pour le Développement, Montpellier, France
- Centre Régional de Recherche et de Formation à la prise en charge Clinique de Fann, Dakar, Senegal
| | - Gabrièle Laborde-Balen
- TransVIHMI, University of Montpellier, INSERM, Institut de Recherche pour le Développement, Montpellier, France
- Centre Régional de Recherche et de Formation à la prise en charge Clinique de Fann, Dakar, Senegal
| | | | - Madjiguene Gueye
- Centre Régional de Recherche et de Formation à la prise en charge Clinique de Fann, Dakar, Senegal
| | - Ndeye-Ngone Have
- Réseau National des Associations de Personnes Vivant Avec le VIH (RNP+), Dakar, Senegal
| | - Jean-Francois Etard
- TransVIHMI, University of Montpellier, INSERM, Institut de Recherche pour le Développement, Montpellier, France
| | - Khoudia Sow
- Centre Régional de Recherche et de Formation à la prise en charge Clinique de Fann, Dakar, Senegal
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Knowledge of Antiretroviral Treatment and Associated Factors in HIV-Infected Patients. Healthcare (Basel) 2021; 9:healthcare9040483. [PMID: 33923916 PMCID: PMC8073643 DOI: 10.3390/healthcare9040483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/06/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022] Open
Abstract
This study aimed to assess the knowledge of antiretroviral (ARV) treatment and the associated factors in HIV-infected patients in Vietnam. We conducted a cross-sectional descriptive study of 350 human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients being treated with ARV at outpatient clinics at Soc Trang, Vietnam, from June 2019 to December 2019. Using an interview questionnaire, patients who answered at least eight out of nine questions correctly, including some required questions, were considered to have a general knowledge of ARV treatment. Using multivariate logistic regression to identify factors associated with knowledge of ARV treatment, we found that 62% of HIV-infected patients had a general knowledge of ARV treatment, with a mean score of 8.2 (SD 1.4) out of 9 correct. A higher education level (p < 0.001); working away from home (p = 0.013); getting HIV transmitted by injecting drugs or from mother-to-child contact (p = 0.023); the presence of tension, anxiety, or stress (p = 0.005); self-reminding to take medication (p = 0.024); and a high self-evaluated adherence (p < 0.001) were found to be significantly associated with an adequate knowledge of ARV treatment. In conclusion, education programs for patients, as well as the quality of medical services and support, should be strengthened.
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Broderick K, Ponticiello M, Nabukalu D, Tushemereirwe P, Nuwagaba G, King R, Mwanga-Amumpaire J, Sundararajan R. Shortening "the Road" to Improve Engagement with HIV Testing Resources: A Qualitative Study Among Stakeholders in Rural Uganda. AIDS Patient Care STDS 2021; 35:56-62. [PMID: 33471578 PMCID: PMC7885900 DOI: 10.1089/apc.2020.0235] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In HIV-endemic areas, traditional healers are frequently used with, or instead of, biomedical resources for health care needs. Studies show healers are interested in and capable of supporting patients in the HIV care cascade. However, adults who receive care from healers have low engagement with HIV services. To achieve epidemic control, we must understand gaps between the needs of HIV-endemic communities and the potential for healers to improve HIV service uptake. This study's objective was to characterize stakeholder perspectives on barriers to HIV testing and approaches to mitigate barriers in a medically pluralistic, HIV-endemic region. This study was conducted in Mbarara District, a rural area of southwestern Uganda with high HIV prevalence. Participants included HIV clinical staff, traditional healers, and adults receiving care from healers. Fifty-six participants [N = 30 females (52%), median age 40 years (interquartile range, 32-51.5)] were recruited across three stakeholder groups for minimally structured interviews. Themes were identified using an inductive, grounded theory approach and linked together to create a framework explaining stakeholder perspectives on HIV testing. Stakeholders described the "road" to HIV testing as time-consuming, expensive, and stigmatizing. All agreed healers could mitigate barriers by delivering HIV testing at their practices. Collaborations between biomedical and traditional providers were considered essential to a successful healer-delivered HIV testing program. This work describes a novel approach to "shorten the road" to HIV testing, suggesting that traditional healer-delivered HIV testing holds promise to expand uptake of testing among communities with limited access to existing programs.
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Affiliation(s)
| | - Matthew Ponticiello
- Department of Global and Public Health Sciences, Cornell University, Ithaca, New York, USA
| | - Doreen Nabukalu
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Patricia Tushemereirwe
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Gabriel Nuwagaba
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Rachel King
- Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Juliet Mwanga-Amumpaire
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Radhika Sundararajan
- Center for Global Health, Weill Cornell Medicine, New York, New York, USA
- Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, USA
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Phiri K, McBride K, Siwale Z, Hubbard J, Bardon A, Moucheraud C, Haambokoma M, Pisa PT, Moyo C, Hoffman RM. Provider experiences with three- and six-month antiretroviral therapy dispensing for stable clients in Zambia. AIDS Care 2020; 33:541-547. [PMID: 32363910 DOI: 10.1080/09540121.2020.1755010] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Multi-month dispensing of antiretroviral therapy (ART) has been taken to scale in many settings in sub-Saharan Africa with the benefits of improved client satisfaction and decreased client costs. Six-month ART dispensing may further increase these benefits; however, data are lacking. Within a cluster-randomized trial of three- versus six-month dispensing in Malawi and Zambia, we performed a sub-study to explore Zambian provider experiences with multi-month dispensing. We conducted 18 in-depth interviews with clinical officers and nurses dispensing ART as part of INTERVAL in Zambia. Interview questions focused on provider perceptions of client acceptability, views on client sharing and selling of ART, and perceptions on provider workload and clinic efficiency, with a focus on differences between three- and six-month dispensing. Interviews were analyzed using inductive thematic analysis to identify key themes and patterns within the data. Providers perceived significant benefits of multi-month dispensing, with advantages of six-month over three-month dispensing related to a reduced burden on clients, and for reductions in their own workload and clinic congestion. Among nearly all providers, the six-month dispensing strategy was perceived as ideal. Further research is needed to quantify clinical outcomes of six-month dispensing and feasibility of scaling-up this intervention in resource-limited settings.Clinical Trial Number: NCT03101592.
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Affiliation(s)
- Khumbo Phiri
- Partners in Hope Medical Center, Lilongwe, Malawi
| | - Kaitlyn McBride
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Julie Hubbard
- Partners in Hope Medical Center, Lilongwe, Malawi.,Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ashley Bardon
- School of Public Health, University of Washington, Seattle, WA, USA
| | - Corrina Moucheraud
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | | | | | | | - Risa M Hoffman
- Partners in Hope Medical Center, Lilongwe, Malawi.,Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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