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Topp SM, Abimbola S, Joshi R, Negin J. How to assess and prepare health systems in low- and middle-income countries for integration of services-a systematic review. Health Policy Plan 2018; 33:298-312. [PMID: 29272396 PMCID: PMC5886169 DOI: 10.1093/heapol/czx169] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2017] [Indexed: 12/26/2022] Open
Abstract
Despite growing support for integration of frontline services, a lack of information about the pre-conditions necessary to integrate such services hampers the ability of policy makers and implementers to assess how feasible or worthwhile integration may be, especially in low- and middle-income countries (LMICs). We adopted a modified systematic review with aspects of realist review, including quantitative and qualitative studies that incorporated assessment of health system preparedness for and capacity to implement integrated services. We searched Medline via Ovid, Web of Science and the Cochrane library using terms adapted from Dudley and Garner’s systematic review on integration in LMICs. From an initial list of 10 550 articles, 206 were selected for full-text review by two reviewers who independently reviewed articles and inductively extracted and synthesized themes related to health system preparedness. We identified five ‘context’ related categories and four health system ‘capability’ themes. The contextual enabling and constraining factors for frontline service integration were: (1) the organizational framework of frontline services, (2) health care worker preparedness, (3) community and client preparedness, (4) upstream logistics and (5) policy and governance issues. The intersecting health system capabilities identified were the need for: (1) sufficiently functional frontline health services, (2) sufficiently trained and motivated health care workers, (3) availability of technical tools and equipment suitable to facilitate integrated frontline services and (4) appropriately devolved authority and decision-making processes to enable frontline managers and staff to adapt integration to local circumstances. Moving beyond claims that integration is defined differently by different programs and thus unsuitable for comparison, this review demonstrates that synthesis is possible. It presents a common set of contextual factors and health system capabilities necessary for successful service integration which may be considered indicators of preparedness and could form the basis for an ‘integration preparedness tool’.
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Affiliation(s)
- Stephanie M Topp
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4812, Australia.,Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Seye Abimbola
- Sydney School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Rohina Joshi
- The George Institute, University of New South Wales, NSW 2042, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Joel Negin
- Sydney School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
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Auchynnikava A. Do HIV prevention interventions in Asia lead to increase in condom utilization?: A meta-analysis study. Int J Health Plann Manage 2018; 34:232-240. [PMID: 30091479 DOI: 10.1002/hpm.2621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 07/13/2018] [Indexed: 11/07/2022] Open
Abstract
This meta-analytic review synthesizes the findings of published independent studies that assessed the effectiveness of HIV prevention interventions in promoting condom usage in Asia. We focused on 20 studies that used randomized control studies to establish whether HIV prevention interventions lead to increased condom utilization. As compared with the average control group client, we found that 68% of the clients who participated in an intervention group increased their condom usage. The effectiveness of HIV prevention intervention is not related to country and rural-urban contexts, to male-female samples, to the type of outcome measured, or the timing of the latest follow-up assessment. The implications of these findings are that policy-makers, health administrators, and international donors should view behavioral HIV prevention interventions as an effective approach through which to increase condom usage in order to reduce the HIV infection rate in Asia.
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Ma F, Lv F, Xu P, Zhang D, Meng S, Ju L, Jiang H, Ma L, Sun J, Wu Z. Task shifting of HIV/AIDS case management to Community Health Service Centers in urban China: a qualitative policy analysis. BMC Health Serv Res 2015; 15:253. [PMID: 26135395 PMCID: PMC4487980 DOI: 10.1186/s12913-015-0924-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 06/12/2015] [Indexed: 11/15/2022] Open
Abstract
Background The growing number of people living with HIV/AIDS (PLWHA) in China points to an increased need for case management services of HIV/AIDS. This study sought to explore the challenges and enablers in shifting the HIV/AIDS case management services from Centers for Disease Control and Prevention (CDCs) to Community Health Service Centers (CHSCs) in urban China. Methods A qualitative method based on the Health Policy Triangle (HPT) framework was employed to gain in-depth insights into four elements of the task shifting strategy. This included a review on published literature and health policy documents, 15 focus group discussions (FGDs) and 30 in-depth interviews (IDIs) with four types of key actors from three cities in China. A total of 78 studies and 17 policy files at the national, municipal and local levels were obtained and reviewed comprehensively. Three semi-structured interview guides were used to explore key actors’ views on shifting the HIV/AIDS case management services to CHSCs. Results It is necessary and feasible for CHSCs to engage in case management services for PLWHA in local communities. The increasing number of PLWHA and shortage of qualified health professionals in CDCs made shifting case management services downwards to CHSCs an urgent agenda. CHSCs’ wide distribution, technical capacity, accessibility and current practice enabled them to carry out case management services for PLWHA. However our findings indicated several challenges in this task shifting process. Those challenges included lack of specific policy and stable financial support for CHSCs, inadequate manpower, relatively low capacity for health service delivery, lack of coordination among sectors, PLWHA’s fear for discrimination and privacy disclosure in local communities, which may compromise the effectiveness and sustainability of those services. Conclusions Shifting the HIV/AIDS case management services from CDCs to CHSCs is a new approach to cope with the rising number of PLWHA in China, but it should be implemented alongside with other efforts and resources such as increasing public funding, planned team building, professional training, coordination with other sectors and education on privacy protection as well as non-discrimination to make this approach more effective and sustainable. Policy makers need to ensure both political feasibility and resources accessibility to facilitate this shifting process.
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Affiliation(s)
- Fuchang Ma
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Fan Lv
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Peng Xu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Dapeng Zhang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Sining Meng
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Lahong Ju
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Huihui Jiang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Liping Ma
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Jiangping Sun
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China.
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Li H(H, Holroyd E, Li X, Lau J. A qualitative analysis of barriers to accessing HIV/AIDS-related services among newly diagnosed HIV-positive men who have sex with men in China. Int J STD AIDS 2014; 26:13-9. [DOI: 10.1177/0956462414528309] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Summary In China, specific HIV/AIDS-related services have been in place since 2004. However, utilisation of these services remains limited among people living with HIV. We explored barriers to accessing HIV/AIDS-related services from the perspective of newly diagnosed HIV-positive men who have sex with men. We conducted repeated in-depth interviews with 31 newly diagnosed HIV-positive men who have sex with men, using the socio-ecological framework and thematic content analysis. Multiple barriers for utilisation of HIV/AIDS-related services were identified, including perceptions of subjective health and poor quality of services, mental and emotional health problems, lack of trust and understanding of the services on offer, low economic status, lack of insurance, and high medical fees, being refused access to services, and restrictive attendance policies. The findings provide information on potential multi-level obstacles preventing newly diagnosed HIV-positive men who have sex with men to use services that they need. It is recommended that policy makers should create a trustful and non-discriminating environment and services integrating physical and mental healthcare.
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Affiliation(s)
- Haochu (Howard) Li
- Pediatric Prevention Research Center, Wayne State University, Detroit, MI, USA
| | - Eleanor Holroyd
- School of Health Sciences, RMIT University, Australia and Centre for Women’s Health, Gender & Society, the University of Melbourne, Melbourne, VIC, Australia
| | - Xiaoming Li
- Pediatric Prevention Research Center, Wayne State University, Detroit, MI, USA
| | - Joseph Lau
- Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong SAR, China
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Xiao Z, Noar SM, Zeng L. Systematic review of HIV prevention interventions in China: a health communication perspective. Int J Public Health 2013; 59:123-42. [PMID: 23604051 DOI: 10.1007/s00038-013-0467-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 02/12/2013] [Accepted: 04/09/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES To examine whether communication strategies and principles have been utilized in the HIV prevention intervention programs conducted in China. METHODS Comprehensive literature searches were conducted using PsycINFO, Medline, and Academic Search Complete with combinations of a number of keywords. Studies were included if they (1) were conducted in China and published prior to October 2011; (2) tested interventions promoting HIV/sexual risk reduction; and (3) reported empirical outcome evaluations on HIV knowledge, condom use and other condom-related variables. Data on 11 dimensions were extracted and analyzed, including formative research, theory, message targeting, messenger and channels, process evaluation, evaluation design, outcome measures. RESULTS The majority of the 45 intervention studies were not theory-based, did not report conducting formative research or process evaluation, used pretest-posttest control group designs, combined nonmedia channels, printed and visual materials, and employed HIV knowledge and condom use as outcome measures. CONCLUSIONS Many HIV prevention interventions in China have been successful in reducing HIV risk-related outcomes. This literature has its weaknesses; however, the current review illuminates gaps in the literature and points to important future directions for research.
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Affiliation(s)
- Zhiwen Xiao
- Valenti School of Communication, University of Houston, 101 Communication Bldg, Houston, TX, 77204-3002, USA,
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Xiao Z, Li X, Mehrotra P. HIV/sexual risk reduction interventions in China: a meta-analysis. AIDS Patient Care STDS 2012; 26:597-613. [PMID: 22989271 DOI: 10.1089/apc.2012.0151] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The current study was a meta-analysis of the efficacy of educational, psychosocial or behavioral interventions that were conducted in China to promote HIV/sexual risk reduction. A total of 26 intervention studies qualified for the meta-analysis. Outcome variables for which effect sizes were calculated included condom use with different types of sexual partners, HIV/AIDS knowledge, condom use knowledge, intentions of condom use, condom use self-efficacy, and others. Mean weighted effect sizes were calculated for each outcome measure across reviewed studies; effect size for each outcome measure was weighted by their inverse variance; fixed effects and random effects meta-analytic procedures were used. The Q statistic was used to examine whether the effect sizes were homogeneous in nature and moderating analysis (i.e., the Q(b) statistic) was used to compare the effect sizes of intervention studies that were different in a number of categorical variables. The reviewed interventions were successful in improving HIV knowledge (d=0.706), condom use knowledge (d=0.620), attitudes toward people living with HIV/AIDS (PLWHA; d=0.625) and in increasing condom use with regular partners (d=0.477), condom use with casual partners (d=0.444), general condom use (d=0.408), and condom use self-efficacy (d=0.584) among target audiences. In addition, moderating analyses on three most examined variables, including HIV knowledge, condom use, and attitudes toward PLWHA, demonstrated that interventions that reported the conduction of formative research and process evaluation, that were peer-led, and that included only one follow-up were more likely to report a positive impact on condom use behavior among target audiences (p<0.001), HIV knowledge (p<0.001), or attitudes toward PLWHA (p<0.001).
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Affiliation(s)
- Zhiwen Xiao
- Valenti School of Communication, University of Houston, Houston, Texas
| | - Xiaoming Li
- School of Medicine, Wayne State University, Detroit, Michigan
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