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Goldstein D, Kiplagat J, Taderera C, Whitehouse ER, Chimbetete C, Kimaiyo S, Urasa S, Paddick SM, Godfrey C. Person-centred care for older adults living with HIV in sub-Saharan Africa. Lancet HIV 2024:S2352-3018(24)00123-1. [PMID: 38996592 DOI: 10.1016/s2352-3018(24)00123-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/29/2024] [Accepted: 05/02/2024] [Indexed: 07/14/2024]
Abstract
More than a fifth of people living with HIV in the US President's Emergency Plan for AIDS Relief-supported programmes are older individuals, defined as aged 50 years and older, yet optimal person-centred models of care for older adults with HIV in sub-Saharan Africa, including screening and treatment for geriatric syndromes and common comorbidities associated with ageing, remain undefined. This Position Paper explores the disproportionate burden of comorbidities and geriatric syndromes faced by older adults with HIV, with a special focus on women. We seek to motivate global interest in improving quality of life for older people with HIV by presenting available research and identifying research gaps for common geriatric syndromes, including frailty and cognitive decline, and multimorbidity among older people with HIV in sub-Saharan Africa. We share two successful models of holistic care for older people with HIV that are ongoing in Zimbabwe and Kenya. Lastly, we provide policy, research, and implementation considerations to best serve this growing population.
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Affiliation(s)
- Deborah Goldstein
- Office of HIV/AIDS, US Agency for International Development, Washington, DC, USA.
| | - Jepchirchir Kiplagat
- Moi University, College of Health Sciences, Eldoret, Kenya; USAID AMPATH Uzima, Eldoret, Kenya
| | | | | | | | - Sylvester Kimaiyo
- Moi University, College of Health Sciences, Eldoret, Kenya; USAID AMPATH Uzima, Eldoret, Kenya
| | - Sarah Urasa
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Stella-Maria Paddick
- Translational and Clinical Medicine Research Institute, Newcastle University, Newcastle, UK
| | - Catherine Godfrey
- Global Health Security and Diplomacy Bureau, Department of State, Washington, DC, USA
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Lyons M, Harper GW, Jadwin-Cakmak L, Beyer A, Graham SM. Listening to the Voices of Gay and Bisexual Men and Other Men Who Have Sex with Men in Kenya: Recommendations for Improved HIV Prevention Programming. THE UNDERGRADUATE JOURNAL OF PUBLIC HEALTH AT THE UNIVERSITY OF MICHIGAN 2024; 7:84-96. [PMID: 37398631 PMCID: PMC10310496 DOI: 10.3998/ujph.3949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Young gay and bisexual men and other men who have sex with men (GBMSM) are a key population at high risk for new human immunodeficiency virus (HIV) infections in Kenya; thus, increased efforts are necessary to reduce their health risks. This qualitative study describes recommendations offered by young GBMSM in Kenya regarding the development and delivery of culturally appropriate HIV prevention services. Both young GBMSM Community Members and Peer Educators recommend that future HIV prevention efforts enhance economic empowerment, provide mental health and substance use services, and incorporate arts-based health promotion strategies. In addition, participants recommended that public health professionals increase the ease of access to HIV prevention services for GBMSM and that researchers disseminate findings from HIV prevention research back to the community.
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Kasongo B, Mukalay A, Molima C, Makali SL, Chiribagula C, Mparanyi G, Karemere H, Bisimwa G, Macq J. Community perceptions of a biopsychosocial model of integrated care in the health center: the case of 4 health districts in South Kivu, Democratic Republic of Congo. BMC Health Serv Res 2023; 23:1431. [PMID: 38110919 PMCID: PMC10726631 DOI: 10.1186/s12913-023-10455-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 12/07/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Biopsychosocial care is one of the approaches recommended in the health system by the WHO. Although efforts are being made on the provider side to implement it and integrate it into the health system, the community dynamic also remains to be taken into account for its support. The objective of this study is to understand the community's perceptions of the concept of integrated health care management according to the biopsychosocial approach (BPS) at the Health Center of a Health District and its evaluation in its implementation. METHODS This cross-sectional study was done in six Health Areas belonging to four Health Districts in South Kivu, DRC. We conducted 15 semi-directive individual interviews with 9 respondents selected by convenience, including 6 members of the Development Committees of the Health Areas, with whom we conducted 12 interviews and 3 patients met in the health centers. The adapted Normalization MeAsure Development (NoMAD) tool, derived from the Theory of the Normalization Process of Complex Interventions, allowed us to collect data from November 2017 to February 2018, and then from November 2018 to February 2019. After data extraction and synthesis, we conducted a thematic analysis using the NoMAD tool to build a thematic framework. Six themes were grouped into three categories. RESULTS Initially, community reports that the BPS approach of integrated care in the Health Centre is understood differently by providers; but then, through collective coordination and integrated leadership within the health care team, the approach becomes clearer. The community encouraged some practices identified as catalysts to help the approach, notably the development of financial autonomy and mutual support, to the detriment of those identified as barriers. According to the community, the BPS model has further strengthened the performance of health workers and should be expanded and sustained. CONCLUSIONS The results of our study show the importance of community dynamics in the care of biopsychosocial situations by providers. The barriers and catalysts to the mechanism, both community-based and professional, identified in our study should be considered in the process of integrating the biopsychosocial model of person-centered health care.
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Affiliation(s)
- Bertin Kasongo
- Ecole Régionale de Santé Publique (ERSP), Catholic University of Bukavu, Bukavu, Democratic Republic of Congo.
- School of Public Health (ESP), University of Lubumbashi, Lubumbashi, Democratic Republic of Congo.
| | - Abdon Mukalay
- School of Public Health (ESP), University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Christian Molima
- Ecole Régionale de Santé Publique (ERSP), Catholic University of Bukavu, Bukavu, Democratic Republic of Congo
| | - Samuel Lwamushi Makali
- Ecole Régionale de Santé Publique (ERSP), Catholic University of Bukavu, Bukavu, Democratic Republic of Congo
| | - Christian Chiribagula
- Ecole Régionale de Santé Publique (ERSP), Catholic University of Bukavu, Bukavu, Democratic Republic of Congo
| | - Gérard Mparanyi
- Faculty of Pharmaceutical Sciences and Public Health, Official University of Bukavu, Bukavu, Democratic Republic of Congo
| | - Hermès Karemere
- Ecole Régionale de Santé Publique (ERSP), Catholic University of Bukavu, Bukavu, Democratic Republic of Congo
| | - Ghislain Bisimwa
- Ecole Régionale de Santé Publique (ERSP), Catholic University of Bukavu, Bukavu, Democratic Republic of Congo
| | - Jean Macq
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium
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Kafu C, Wachira J, Omodi V, Said J, Pastakia SD, Tran DN, Onyango JA, Aburi D, Wilson-Barthes M, Galárraga O, Genberg BL. Integrating community-based HIV and non-communicable disease care with microfinance groups: a feasibility study in Western Kenya. Pilot Feasibility Stud 2022; 8:266. [PMID: 36578093 PMCID: PMC9795156 DOI: 10.1186/s40814-022-01218-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 11/29/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The Harambee study is a cluster randomized trial in Western Kenya that tests the effect, mechanisms, and cost-effectiveness of integrating community-based HIV and non-communicable disease care within microfinance groups on chronic disease treatment outcomes. This paper documents the stages of our feasibility study conducted in preparation for the Harambee trial, which include (1) characterizing the target population and gauging recruitment capacity, (2) determining community acceptability of the integrated intervention and study procedures, and (3) identifying key implementation considerations prior to study start. METHODS Feasibility research took place between November 2019 and February 2020 in Western Kenya. Mixed methods data collection included surveys administered to 115 leaders of 105 community-based microfinance groups, 7 in-person meetings and two workshops with stakeholders from multiple sectors of the health system, and ascertainment of field notes and geographic coordinates for group meeting locations and HIV healthcare facilities. Quantitative survey data were analyzed using STATA IC/13. Longitude and latitude coordinates were mapped to county boundaries using Esri ArcMap. Qualitative data obtained from stakeholder meetings and field notes were analyzed thematically. RESULTS Of the 105 surveyed microfinance groups, 77 met eligibility criteria. Eligible groups had been in existence from 6 months to 18 years and had an average of 22 members. The majority (64%) of groups had at least one member who owned a smartphone. The definition of "active" membership and model of saving and lending differed across groups. Stakeholders perceived the community-based intervention and trial procedures to be acceptable given the minimal risks to participants and the potential to improve HIV treatment outcomes while facilitating care integration. Potential challenges identified by stakeholders included possible conflicts between the trial and existing community-based interventions, fear of group disintegration prior to trial end, clinicians' inability to draw blood for viral load testing in the community, and deviations from standard care protocols. CONCLUSIONS This study revealed that it was feasible to recruit the number of microfinance groups necessary to ensure that our clinical trial was sufficient powered. Elicitation of stakeholder feedback confirmed that the planned intervention was largely acceptable and was critical to identifying challenges prior to implementation. TRIAL REGISTRATION The original trial was prospectively registered with ClinicalTrials.gov (NCT04417127) on 4 June 2020.
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Affiliation(s)
- Catherine Kafu
- Academic Model Providing Access to Healthcare, P.O. Box 4606-30100, Eldoret, Kenya. .,School of Literature, Language and Media, Department of Media Studies, University of Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2000, South Africa.
| | - Juddy Wachira
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare, P.O. Box 4606-30100, Eldoret, Kenya ,grid.79730.3a0000 0001 0495 4256School of Medicine, Department of Behavioral Science, Moi University College of Health Sciences, P.O. Box 4606-30100, Eldoret, Kenya
| | - Victor Omodi
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare, P.O. Box 4606-30100, Eldoret, Kenya
| | - Jamil Said
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare, P.O. Box 4606-30100, Eldoret, Kenya ,grid.79730.3a0000 0001 0495 4256School of Medicine, Department of Human Anatomy, Moi University College of Health Sciences, P.O. Box 4606-30100, Eldoret, Kenya
| | - Sonak D. Pastakia
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare, P.O. Box 4606-30100, Eldoret, Kenya ,grid.169077.e0000 0004 1937 2197Center for Health Equity and Innovation, Purdue University College of Pharmacy, 640 Eskenazi Ave, Indianapolis, IN 46202 USA
| | - Dan N. Tran
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare, P.O. Box 4606-30100, Eldoret, Kenya ,grid.264727.20000 0001 2248 3398Department of Pharmacy Practice, Temple University School of Pharmacy, 3307 N Broad St, Philadelphia, PA 19140 USA
| | - Jael Adongo Onyango
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare, P.O. Box 4606-30100, Eldoret, Kenya
| | - Dan Aburi
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare, P.O. Box 4606-30100, Eldoret, Kenya
| | - Marta Wilson-Barthes
- grid.40263.330000 0004 1936 9094Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912 USA
| | - Omar Galárraga
- grid.40263.330000 0004 1936 9094Department of Health Services, Policy and Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912 USA
| | - Becky Lynn Genberg
- grid.21107.350000 0001 2171 9311Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
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