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Masrie A, Shawel S, Tamire A, Mandefro M, Gebru T, Seboka Ergiba M, Getachew M. Implementation Evaluation of HIV/AIDS Voluntary Counseling and Testing (VCT) Service at Public Health Facilities of Akaki Kality Sub-City, Addis Ababa, Ethiopia. HIV AIDS (Auckl) 2023; 15:503-518. [PMID: 37691691 PMCID: PMC10488598 DOI: 10.2147/hiv.s422516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/26/2023] [Indexed: 09/12/2023] Open
Abstract
Background Voluntary Counseling and Testing (VCT) is widely acknowledged globally as an effective method for preventing and treating HIV/AIDS. It allows people to understand their HIV status, make informed choices about getting tested for it, evaluate their personal risk of contracting HIV, and create plans to reduce that risk. The study aimed to evaluate the process of VCT services in public health facilities of Akaki Kality sub-city, Addis Ababa, Ethiopia. Methods and Materials A case study evaluation design with a mixed method was employed from May 12 to June 12, 2021. A total of 244 clients were interviewed during the study period. Furthermore, 12 direct observations, a review of documents from the past six months to the study period, and 12 key informant interviews were conducted. Quantitative data were entered into Epi data 4.6 and exported to SPSS version 25 for analysis. Univariate analysis was done and presented in tables and texts. Qualitative data were transcribed, translated, coded, and analyzed using thematic analysis. The overall service implementation process was measured on the basis of pre-determined judgmental criteria. Results The overall level of VCT service implementation was 83.84%, to which the availability of resources (84.8%), compliance of service providers with the national guidelines (85.38%), and client satisfaction (76.93%) contributed. One facility had stock-outs of test kits in the last three months, and all VCT counseling and testing rooms lacked audio-visual privacy. Supportive supervision, the use of IEC materials during counseling, linking all HIV-positive clients to treatment and care services, and sending complete reports were practiced in a way that needs some improvement. Conclusion Overall, the service implementation was deemed satisfactory, but further action is required to improve resource availability, ensure provider compliance with national guidelines, and enhance the status of the service. In addition, the Woreda Health Office and Addis Abeba Health Bureau should regularly supervise and provide feedback.
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Affiliation(s)
- Awoke Masrie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Samrawit Shawel
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Aklilu Tamire
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Miheret Mandefro
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tilaye Gebru
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Meskerem Seboka Ergiba
- Department of Health Policy and Management, Public Health Faculty, Institute of Health Jimma University, Jimma, Oromia, Ethiopia
| | - Muluneh Getachew
- Department of Health Policy and Management, Public Health Faculty, Institute of Health Jimma University, Jimma, Oromia, Ethiopia
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Adepoju VA, Imoyera W, Onoja AJ. Preferences for oral- vs blood-based human immunodeficiency virus self-testing: A scoping review of the literature. World J Methodol 2023; 13:142-152. [PMID: 37456972 PMCID: PMC10348079 DOI: 10.5662/wjm.v13.i3.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/22/2023] [Accepted: 05/24/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND The evidence on preferences for oral- vs blood-based human immunodeficiency virus self-testing (HIVST) has been heterogenous and inconclusive. In addition, most evaluations have relied on hypothetical or stated use cases using discreet choice experiments rather than actual preferences among experienced users, which are more objective and critical for the understanding of product uptake. Direct head-to-head comparison of consumer preferences for oral- versus blood-based HIVST is lacking.
AIM To examine the existing literature on preferences for oral- vs blood-based HIVST, determine the factors that impact these preferences, and assess the potential implications for HIVST programs.
METHODS Databases such as PubMed, Medline, Google Scholar, and Web of Science were searched for articles published between January 2011 to October 2022. Articles must address preferences for oral- vs blood-based HIVST. The study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist to ensure the quality of the study.
RESULTS The initial search revealed 2424 records, of which 8 studies were finally included in the scoping review. Pooled preference for blood-based HIVST was 48.8% (9%-78.6%), whereas pooled preference for oral HIVST was 59.8% (34.2%-91%) across all studies. However, for male-specific studies, the preference for blood-based HIVST (58%-65.6%) was higher than that for oral (34.2%-41%). The four studies that reported a higher preference for blood-based HIVST were in men. Participants considered blood-based HIVST to be more accurate and rapid, while those with a higher preference for oral HIVST did so because these were considered non-invasive and easy to use.
CONCLUSION Consistently in the literature, men preferred blood-based HIVST over oral HIVST due to higher risk perception and desire for a test that provides higher accuracy coupled with rapidity, autonomy, privacy, and confidentiality, whereas those with a higher preference for oral HIVST did so because these were considered non-invasive and easy to use. Misinformation and distrust need to be addressed through promotional messaging to maximize the diversity of this new biomedical technology.
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Affiliation(s)
- Victor Abiola Adepoju
- Department of HIV and Infectious Diseases, Jhpiego Nigeria, an affiliate of John Hopkins University, Abuja 900901, Federal Capital Territory, Nigeria
| | - Winifred Imoyera
- Department of HIV and Infectious Diseases, Jhpiego Nigeria, an affiliate of John Hopkins University, Abuja 900901, Federal Capital Territory, Nigeria
| | - Ali Johnson Onoja
- Research, African Health Project, Abuja 900901, Federal Capital Territory, Nigeria
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Aba Abraham S, Clow SE. HIV counselling and testing experiences of expectant mothers in the prevention of vertical transmission programme: implications for policy and service delivery. Ther Adv Infect Dis 2022; 9:20499361221078424. [PMID: 35198199 PMCID: PMC8859687 DOI: 10.1177/20499361221078424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/19/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: This study explored the HIV counselling and testing (HCT) experiences of women who were diagnosed positive in the current pregnancy in a district hospital within the Sekondi-Takoradi Metropolis in Ghana following the implementation of the ‘opt out’ testing policy. Methods: Adopting a qualitative explorative descriptive design, 12 mothers were sampled purposively and in-depth interviews were conducted. Thematic analysis using Colaizzi’s approach was applied to unearth the experiences of the participants. Results: Three key themes emerged: The Pre-test Counselling Experience; The Test; and After Talk: Post-test Counselling. Provider-initiated testing was offered to all the participants at antenatal booking. Most counsellors were silent about the ‘opt-out’ option of testing while pretest counselling focused on preventing vertical transmission and not on the health of the woman. Attitudes towards pretest counselling was mainly indifference or anxiety which affected the women’s initial acceptance of a positive result. All the women took a confirmatory test after the initial positive results which aided them in accepting their diagnosis. Of the women who tested, all received post-test counselling that focused on enrolling on antiretroviral therapy (ART). Conclusion: Attitudes towards pretest counselling impacts the mothers’ reaction to a positive test result. HIV counselling that does not solicit voluntary testing may be effective in increasing testing but may affect uptake of treatment. It is recommended that midwives providing HCT be trained periodically to enhance service delivery while focus on women-centred care and improving women’s agency in the prevention of vertical transmission services should be the paramount.
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Affiliation(s)
- Susanna Aba Abraham
- Department of Adult Health, School of Nursing and Midwifery, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
- Division of Nursing and Midwifery, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, 7925, South Africa
| | - Sheila E. Clow
- Division of Nursing and Midwifery, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Luwanda LB, Vyas S, Songo J, Chimukuche RS, McLean E, Hassan F, Schouten E, Todd J, Geubbels E, Wringe A, Renju J. Assessing the implementation of facility-based HIV testing policies in Malawi, South Africa and Tanzania from 2013–2018: Findings from SHAPE-UTT study. Glob Public Health 2020; 16:241-255. [DOI: 10.1080/17441692.2020.1763420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Seema Vyas
- Department of Population Studies, London School of Hygiene and Tropical Medicine, London, UK
| | - John Songo
- Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi
| | | | - Estelle McLean
- Department of Population Studies, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Jim Todd
- Department of Population Studies, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Alison Wringe
- Department of Population Studies, London School of Hygiene and Tropical Medicine, London, UK
| | - Jenny Renju
- Department of Population Studies, London School of Hygiene and Tropical Medicine, London, UK
- Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Deribew A, Biadgilign S, Berhanu D, Defar A, Deribe K, Tekle E, Asheber K, Dejene T. Capacity of health facilities for diagnosis and treatment of HIV/AIDS in Ethiopia. BMC Health Serv Res 2018; 18:535. [PMID: 29996821 PMCID: PMC6042210 DOI: 10.1186/s12913-018-3347-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 07/02/2018] [Indexed: 11/29/2022] Open
Abstract
Background There are dearth of literature on the capacity of the health system to diagnose and treat HIV/AIDS in Ethiopia. In this study we evaluated the capacity of health facilities for HIV/AIDS care, its spatial distribution and variations by regions and zones in Ethiopia. Methods We analyzed the Service Provision Assessment plus (SPA+) survey data that were collected in 2014 in all regions of Ethiopia. We assessed structural, process and overall capacity of the health system based on the Donabedian quality of care model. We included 5 structural and 8 process indicators and overall capacity score was constructed by taking the average of all indicators. Multiple linear regression was done using STATA 14 to assess the association of the location and types of health facilities with overall capacity score. Maps displaying the average capacity score at Zonal level were produced using ArcGIS Desktop v10.3 (Environmental Systems Research Institute Inc., Redlands CA, USA). Results A total of 873 health facilities were included in the analysis. Less than 5% of the private facilities provided antiretroviral therapy (ART); had national ART guideline, baseline CD4 count or viral load and tuberculosis screening mechanisms. Nearly one-third of the health centers (34.9%) provided ART. Public hospitals have better capacity score (77.1%) than health centers (45.9%) and private health facilities (24.8%). The overall capacity score for urban facilities (57.1%) was higher than that of the rural (38.2%) health facilities (β = 15.4, 95% CI: 11.7, 19.2). Health centers (β = − 21.4, 95% CI: -25.4, − 17.4) and private health facilities (β = − 50.9, 95% CI: -54.8, − 47.1) had lower overall capacity score than hospitals. Facilities in Somali (β = − 13.8, 95% CI: -20.6, − 7.0) and SNNPR (β = − 5.0, 95% CI: -9.8, − 0.1) regions had lower overall capacity score than facilities in the Oromia region. Zones located in emerging regions such as Gambella and Benishangul Gumz and in remote areas of Oromia and SNNPR had lower capacity score in terms of process indicators. Conclusions There is a significant geographical heterogeneity on the capacity of health facilities for HIV/AIDS care and treatment in Ethiopia. Targeted capacity improvement initiatives are recommended with focus on health centers and private health facilities, and emerging Regions and the rural and remote areas.
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Affiliation(s)
- Amare Deribew
- St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia. .,Nutrition International, Addis Ababa, Ethiopia.
| | - Sibhatu Biadgilign
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, USA
| | - Della Berhanu
- London School of Hygiene and Tropical Medicine, London, UK.,Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Atkure Defar
- Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Kebede Deribe
- Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton & Sussex Medical School, Falmer, Brighton, UK.,Collage of Health Sciences, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ephrem Tekle
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Tariku Dejene
- Center for Population Studies, Addis Ababa University, Addis Ababa, Ethiopia
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Boeke CE, Nabitaka V, Rowan A, Guerra K, Kabbale A, Asire B, Magongo E, Nawaggi P, Mulema V, Mirembe B, Bigira V, Musoke A, Katureebe C. Assessing linkage to and retention in care among HIV patients in Uganda and identifying opportunities for health systems strengthening: a descriptive study. BMC Infect Dis 2018; 18:138. [PMID: 29566666 PMCID: PMC5865302 DOI: 10.1186/s12879-018-3042-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 03/12/2018] [Indexed: 12/31/2022] Open
Abstract
Background While antiretroviral therapy (ART) availability for HIV patients has increased dramatically in Uganda, patient linkage to and retention in care remains a challenge. We assessed patterns of engagement in care in 20 Ugandan health facilities with low retention based on national reporting. Methods We assessed patient linkage to care (defined as registering for pre-ART or ART care at the facility within 1 month of HIV diagnosis) and 6-month retention in care (having a visit 3-6 months after ART initiation) and associations with patient−/facility-level factors using multivariate logistic regression. Results Among 928 newly HIV-diagnosed patients, only 53.0% linked to care within 1 month. Of these, 83.7% linked within 1 week. Among 678 newly initiated ART patients, 14.5% never returned for a follow-up visit at the facility. Retention was 71.7% according to our primary definition but much lower if stricter definitions were used. Most patients were already falling behind appointment schedules at their first ART follow-up (median: 28 days post-initiation vs. recommended 14 days). 27.3% of newly-initiated patients had follow-up appointments scheduled 45+ days apart rather than monthly per national guidelines. Linkage and retention were not strongly correlated with each other within facilities (rs = 0.06; p = 0.82). Females, adolescents, and patients in rural settings tended to have lower linkage and retention in multivariable-adjusted models. Conclusions Linkage support may be most critical immediately after testing positive, as patients are less likely to link over time. More information is needed on reasons for appointment schedules by clinicians and implications on retention. Trial registration This study was registered in the Pan African Clinical Trial Registry database (#PACTR201611001756166). Electronic supplementary material The online version of this article (10.1186/s12879-018-3042-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Caroline E Boeke
- Clinton Health Access Initiative (CHAI), Boston, USA. .,, 383 Dorchester Road, Suite 400, Boston, Massachusetts, 02127, USA.
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7
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Wringe A, Moshabela M, Nyamukapa C, Bukenya D, Ondenge K, Ddaaki W, Wamoyi J, Seeley J, Church K, Zaba B, Hosegood V, Bonnington O, Skovdal M, Renju J. HIV testing experiences and their implications for patient engagement with HIV care and treatment on the eve of 'test and treat': findings from a multicountry qualitative study. Sex Transm Infect 2017; 93:e052969. [PMID: 28736389 PMCID: PMC5739849 DOI: 10.1136/sextrans-2016-052969] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/15/2017] [Accepted: 05/20/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE In view of expanding 'test and treat' initiatives, we sought to elicit how the experience of HIV testing influenced subsequent engagement in HIV care among people diagnosed with HIV. METHODS As part of a multisite qualitative study, we conducted in-depth interviews in Uganda, South Africa, Tanzania, Kenya, Malawi and Zimbabwe with 5-10 health workers and 28-59 people living with HIV, per country. Topic guides covered patient and provider experiences of HIV testing and treatment services. Themes were derived through deductive and inductive coding. RESULTS Various practices and techniques were employed by health workers to increase HIV testing uptake in line with national policies, some of which affected patients' subsequent engagement with HIV services. Provider-initiated testing was generally appreciated, but rarely considered voluntary, with instances of coercion and testing without consent, which could lead to disengagement from care.Conflicting rationalities for HIV testing between health workers and their clients caused tensions that undermined engagement in HIV care among people living with HIV. Although many health workers helped clients to accept their diagnosis and engage in care, some delivered static, morally charged messages regarding sexual behaviours and expectations of clinic use which discouraged future care seeking. Repeat testing was commonly reported, reflecting patients' doubts over the accuracy of prior results and beliefs that antiretroviral therapy may cure HIV. Repeat testing provided an opportunity to develop familiarity with clinical procedures, address concerns about HIV services and build trust with health workers. CONCLUSION The principles of consent and confidentiality that should underlie HIV testing and counselling practices may be modified or omitted by health workers to achieve perceived public health benefits and policy expectations. While such actions can increase HIV testing rates, they may also jeopardise efforts to connect people diagnosed with HIV to long-term care, and undermine the potential of test and treat interventions.
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Affiliation(s)
- Alison Wringe
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mosa Moshabela
- University of KwaZulu Natal, Durban, South Africa
- African Health Research Institute, KwaZulu-Natal, South Africa
| | | | - Dominic Bukenya
- Medical Research Council/Uganda Virus Research Institute Research Unit on AIDS, Entebbe, Uganda
| | - Ken Ondenge
- Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Joyce Wamoyi
- National Institute for Medical Research, Mwanza, Tanzania
| | - Janet Seeley
- African Health Research Institute, KwaZulu-Natal, South Africa
- Medical Research Council/Uganda Virus Research Institute Research Unit on AIDS, Entebbe, Uganda
- Department of Global Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Kathryn Church
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Basia Zaba
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Victoria Hosegood
- African Health Research Institute, KwaZulu-Natal, South Africa
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK
| | - Oliver Bonnington
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Morten Skovdal
- University of Copenhagen, Copenhagen, Denmark
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Jenny Renju
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi
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MacCarthy S, Hoffmann M, Nunn A, da Silva LAV, Dourado I. Barriers to HIV testing, linkage to care, and treatment adherence: a cross-sectional study from a large urban center of Brazil. Rev Panam Salud Publica 2016; 40:418-426. [PMID: 28718490 PMCID: PMC9897025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 09/29/2016] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Early, continued engagement with the HIV treatment continuum can help achieve viral suppression, though few studies have explored how risk factors for delays differ across the continuum. The objective of this study was to identify predictors of delayed diagnosis, delayed linkage to care, and nonadherence to treatment in the city of Salvador, Bahia, Brazil. METHODS Data were collected during 2010 in a cross-sectional study with a sample (n = 1 970) of HIV-infected individuals enrolled in care. Multiple logistic regression analyses identified sociodemographic variables, behaviors, and measures of health service quality that were associated with delayed diagnosis, delayed linkage to care, and treatment nonadherence. RESULTS For delayed diagnosis, male gender (adjusted odds ratio (AOR), 3.02; 95% confidence interval (CI), 2.0-4.6); age 45 years and older (AOR, 1.67; 95% CI, 1.1-2.5); and provider-initiated testing (AOR, 3.00; 95% CI, 2.1-4.4) increased odds, while drug use (AOR, 0.29; 95% CI, 0.2-0.5) and receiving results in a private space (AOR, 0.37; 95% CI, 0.2-0.8) decreased odds. For delayed linkage to care, unemployment (AOR, 1.42; 95% CI, 1.07-1.9) and difficulty understanding or speaking with a health care worker (AOR, 1.61; 95% CI, 1.2-2.1) increased odds, while posttest counseling (AOR, 0.49; 95% CI, 0.3-0.7) decreased odds. For nonadherence, experiencing verbal or physical discrimination related to HIV (AOR, 1.94; 95% CI, 1.3-3.0) and feeling mistreated or not properly attended to at HIV care (AOR, 1.60; 95% CI, 1.0-2.5) increased odds, while posttest counseling (AOR, 0.34; 95% CI, 0.2-0.6) decreased odds. CONCLUSIONS More attention is needed on how policies, programs, and research can provide tailored support across the treatment continuum.
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Affiliation(s)
- Sarah MacCarthy
- RAND Corporation, Santa Monica, California, United States of America
| | - Michael Hoffmann
- Brown University, Providence, Rhode Island, United States of America
| | - Amy Nunn
- Brown University, Providence, Rhode Island, United States of America
| | | | - Ines Dourado
- Instituto de Saúde Coletiva/Universidade Federal da Bahia, Salvador, Bahia, Brazil
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Rachlis B, Naanyu V, Wachira J, Genberg B, Koech B, Kamene R, Akinyi J, Braitstein P. Community Perceptions of Community Health Workers (CHWs) and Their Roles in Management for HIV, Tuberculosis and Hypertension in Western Kenya. PLoS One 2016; 11:e0149412. [PMID: 26901854 PMCID: PMC4764025 DOI: 10.1371/journal.pone.0149412] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 02/01/2016] [Indexed: 11/19/2022] Open
Abstract
Given shortages of health care providers and a rise in the number of people living with both communicable and non-communicable diseases, Community Health Workers (CHWs) are increasingly incorporated into health care programs. We sought to explore community perceptions of CHWs including perceptions of their roles in chronic disease management as part of the Academic Model Providing Access to Healthcare Program (AMPATH) in western Kenya. In depth interviews and focus group discussions were conducted between July 2012 and August 2013. Study participants were purposively sampled from three AMPATH sites: Chulaimbo, Teso and Turbo, and included patients within the AMPATH program receiving HIV, tuberculosis (TB), and hypertension (HTN) care, as well as caregivers of children with HIV, community leaders, and health care workers. Participants were asked to describe their perceptions of AMPATH CHWs, including identifying the various roles they play in engagement in care for chronic diseases including HIV, TB and HTN. Data was coded and various themes were identified. We organized the concepts and themes generated using the Andersen-Newman Framework of Health Services Utilization and considering CHWs as a potential enabling resource. A total of 207 participants including 110 individuals living with HIV (n = 50), TB (n = 39), or HTN (n = 21); 24 caregivers; 10 community leaders; and 34 healthcare providers participated. Participants identified several roles for CHWs including promoting primary care, encouraging testing, providing education and facilitating engagement in care. While various facilitating aspects of CHWs were uncovered, several barriers of CHW care were raised, including issues with training and confidentiality. Suggested resources to help CHWs improve their services were also described. Our findings suggest that CHWs can act as catalysts and role models by empowering members of their communities with increased knowledge and support.
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Affiliation(s)
- Beth Rachlis
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario, Canada
- The Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | - Violet Naanyu
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Juddy Wachira
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Becky Genberg
- Department of Health Services, Policy and Practice, Brown University, Providence, Rhode Island, United States
| | - Beatrice Koech
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Regina Kamene
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Jackie Akinyi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
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Osborn M, Obermeyer CM. Understanding client satisfaction with HIV testing and counseling services: a mixed-methods study in four African countries. AIDS Care 2016; 28:689-94. [PMID: 26872848 DOI: 10.1080/09540121.2016.1140889] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This paper uses mixed methods to provide comparative evidence across four African countries and identify those aspects of the testing experience that are the most important components of clients' satisfaction with services. We analyze data from three sources: a survey of clients at health facilities that included closed-ended questions about specific services and interactions around testing; responses to open-ended questions about testing experiences that were part of the same survey; and semi-structured interviews with a subsample of respondents who described their experience of testing and being diagnosed with HIV. High levels of reported satisfaction are found in both the survey and interview. The critical factors contributing to client satisfaction included: the three C's of testing-counseling, consent, and confidentiality, client-provider interactions, convenience of location, "good services", and reliable test results.
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Affiliation(s)
- Michelle Osborn
- a Department of Anthropology , Union College , Schenectady , NY , USA
| | - Carla Makhlouf Obermeyer
- b Department of Epidemiology and Population Health , American University of Beirut , Beirut , Lebanon
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Barbosa TLDA, Gomes LMX, Holzmann APF, Paula AMBD, Haikal DSA. Aconselhamento em doenças sexualmente transmissíveis na atenção primária: percepção e prática profissional. ACTA PAUL ENFERM 2015. [DOI: 10.1590/1982-0194201500089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Compreender percepção dos profissionais sobre a prática do aconselhamento em doenças sexualmente transmissíveis/HIV na atenção primária. Métodos Estudo qualitativo realizado com enfermeiros e médicos que atuam na atenção primária de saúde. A coleta de dados ocorreu mediante a técnica grupo focal, ancorada no Reporting Pesquisa Qualitativa - COREQ. A análise dos dados foi submetida aos passos da Fenomenologia Social, Alfred Schütz, evidenciando-se as categorias do estudo. Resultados Os profissionais realizam o aconselhamento de forma reduzida baseada na orientação para prevenção de doenças. Essa prática está inserida no planejamento familiar e atividades escolares. O acesso do usuário com doença sexualmente transmissível é marcado por procura mínima. No acolhimento, apontou-se a priorização do atendimento dos casos. Constataram-se sensação de despreparo e insegurança na comunicação do resultado de exames, dificuldades para o aconselhamento na visita domiciliar, manutenção do sigilo e da privacidade de informações dos usuários. Conclusão Os profissionais percebem o aconselhamento como uma prática relevante, porém acompanhada de limitações e barreiras na realização.
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