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Helova A, Onono M, Abuogi LL, Hampanda K, Owuor K, Odwar T, Krishna S, Odhiambo G, Odeny T, Turan JM. Experiences, perceptions and potential impact of community-based mentor mothers supporting pregnant and postpartum women with HIV in Kenya: a mixed-methods study. J Int AIDS Soc 2021; 24:e25843. [PMID: 34797955 PMCID: PMC8604379 DOI: 10.1002/jia2.25843] [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: 04/21/2021] [Accepted: 10/21/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Community‐based mentor mothers (cMMs) are women living with HIV who provide peer support to pregnant/postpartum women living with HIV (PWLWH) to enhance antiretroviral therapy (ART) adherence, retention in care and prevent perinatal transmission of HIV. The goal of this study was to explore the experiences, perceptions, mechanisms and health impact of cMMs on PWLWH in Kenya from the perspective of cMMs. Methods We conducted a prospective mixed‐methods study in southwestern Kenya in 2015–2018. In the qualitative phase, we completed in‐depth interviews with cMMs to explore their perceptions and experiences in supporting PWLWH. Transcripts were broad‐coded according to identified themes, then fine‐coded using an inductive approach. In the quantitative phase, we analysed medical record data from PWLWH who were randomized in the cMM intervention to examine the impact of cMM visits on optimal prevention of mother‐to‐child transmission (PMTCT). We used cluster‐adjusted generalized estimating equation models to examine relationships with a composite outcome (facility delivery, infant HIV testing, ART adherence and undetectable viral load at 6 weeks postpartum). Finally, qualitative and quantitative results were integrated. Results Convergence of findings from cMM interviews (n = 24) and PWLWH medical data (n = 589) revealed: (1) The cMM intervention was utilized and perceived as acceptable. PWLWH received, on average, 6.2 of 8 intended home visits through 6 weeks postpartum. (2) The cMMs reported serving as role models and confidantes, supporting PWLWH's acceptance of their HIV status, providing assurances about PMTCT and assisting with male partner disclosure and communication. cMMs also described benefits for themselves, including empowerment and increased income. (3) The cMM visits supported PWLWH's completion of PMTCT steps. Having ≥4 cMM home visits up to 6 weeks postpartum, as compared to <4 visits, was associated with higher likelihood of an optimal PMTCT composite outcome (adjusted relative risk 1.42, p = 0.044). Conclusions We found that peer support from cMMs during pregnancy through 6 weeks postpartum was associated with improved uptake of critical PMTCT services and health behaviours and was perceived as beneficial for cMMs themselves. CMM support of PWLWH may be valuable for other low‐resource settings to improve engagement with lifelong ART and HIV services among PWLWH.
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Affiliation(s)
- Anna Helova
- Department of Health Care Organization and Policy and Sparkman Center for Global Health, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Maricianah Onono
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lisa L Abuogi
- Department of Pediatrics, School of Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Karen Hampanda
- Department of Obstetrics and Gynecology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kevin Owuor
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.,Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tobias Odwar
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Sandhya Krishna
- Department of Health Care Organization and Policy and Sparkman Center for Global Health, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gladys Odhiambo
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Thomas Odeny
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.,Department of Medicine, University of Missouri, Kansas City, Missouri, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy and Sparkman Center for Global Health, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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2
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Chapman RR. Therapeutic Borderlands: Austerity, Maternal HIV Treatment, and the Elusive End of AIDS in Mozambique. Med Anthropol Q 2021; 35:226-245. [PMID: 33029848 PMCID: PMC11018325 DOI: 10.1111/maq.12613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 08/07/2020] [Accepted: 08/13/2020] [Indexed: 11/29/2022]
Abstract
"End of AIDS" requires ambitious testing, treatment, and adherence benchmarks, like UNAIDS' "90-90-90 by 2020." Mozambique's efforts to improve essential maternal/infant antiretroviral treatment (ART) exposes how austerity-related health system short-falls impede public HIV/AIDS service-delivery and hinder effective maternal ART and adherence. In therapeutic borderlands-where household impoverishment intersects with health-system impoverishment-HIV+ women and over-worked care-providers circumnavigate scarcity and stigma. Worrisome patterns of precarious use emerge-perinatal ART under-utilization, delayed initiation, intermittent adherence, and low retention. Ending HIV/AIDS requires ending austerity and reinvesting in a public sector health workforce to ensure universal health coverage as household and community safety nets.
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Masiano S, Machine E, Mphande M, Markham C, Tembo T, Chitani M, Mkandawire A, Mazenga A, Ahmed S, Kim M. Video-Based Intervention for Improving Maternal Retention and Adherence to HIV Treatment: Patient Perspectives and Experiences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041737. [PMID: 33579047 PMCID: PMC7916796 DOI: 10.3390/ijerph18041737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/24/2021] [Accepted: 01/30/2021] [Indexed: 11/24/2022]
Abstract
VITAL Start is a video-based intervention aimed to improve maternal retention in HIV care and adherence to antiretroviral therapy (ART) in Malawi. We explored the experiences of pregnant women living with HIV (PWLHIV) not yet on ART who received VITAL Start before ART initiation to assess the intervention’s acceptability, feasibility, fidelity of delivery, and perceived impact. Between February and September 2019, we conducted semi-structured interviews with a convenience sample of 34 PWLHIV within one month of receiving VITAL Start. The participants reported that VITAL Start was acceptable and feasible and had good fidelity of delivery. They also reported that the video had a positive impact on their lives, encouraging them to disclose their HIV status to their sexual partners who, in turn, supported them to adhere to ART. The participants suggested using a similar intervention to provide health-related education/counseling to people with long term conditions. Our findings suggest that video-based interventions may be an acceptable, feasible approach to optimizing ART retention and adherence amongst PWLHIV, and they can be delivered with high fidelity. Further exploration of the utility of low cost, scalable, video-based interventions to address health counseling gaps in sub-Saharan Africa is warranted.
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Affiliation(s)
- Steven Masiano
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
- Correspondence: (S.M.); (M.K.)
| | - Edwin Machine
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
| | - Mtisunge Mphande
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
| | - Christine Markham
- Center for Health Promotion and Preventive Research, Department of Health Promotion and Behavioral Sciences, The University of Texas, Houston, TX 77030, USA;
| | - Tapiwa Tembo
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
| | - Mike Chitani
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
| | - Angella Mkandawire
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
| | - Alick Mazenga
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
| | - Saeed Ahmed
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
- Section of Retrovirology and Global Health, Baylor College of Medicine, Houston, TX 77030, USA
| | - Maria Kim
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
- Section of Retrovirology and Global Health, Baylor College of Medicine, Houston, TX 77030, USA
- Correspondence: (S.M.); (M.K.)
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4
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Williams SM, Renjua J, Moshabela M, Wringe A. Understanding the influence of health systems on women's experiences of Option B+: A meta-ethnography of qualitative research from sub-Saharan Africa. Glob Public Health 2021; 16:167-185. [PMID: 33284727 PMCID: PMC7612946 DOI: 10.1080/17441692.2020.1851385] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 11/05/2020] [Indexed: 11/21/2022]
Abstract
We explored women's experiences of Option B+ in sub-Saharan African health facility settings through a meta-ethnography of 32 qualitative studies published between 2010 and 2019. First and second-order constructs were identified from the data and authors' interpretations respectively. Using a health systems lens, third-order constructs explored how the health systems shaped women's experiences of Option B+ and their subsequent engagement in care. Women's experiences of Option B+ services were influenced by their interactions with health workers, which were often reported to be inadequate and rushed, reflecting insufficient staffing or training to address pregnant women's needs. Women's experiences were also undermined by various manifestations of stigma which persisted in the absence of resources for social or mental health support, and were exacerbated by space constraints in health facilities that infringed on patient confidentiality. Sub-optimal service accessibility, drug stock-outs and inadequate tracing systems also shaped women's experiences of care. Strengthening health systems by improving health worker capacity to provide respectful and high-quality clinical and support services, improving supply chains and improving the privacy of consultation spaces would improve women's experiences of Option B+ services, thereby contributing to improved care retention. These lessons should be considered as universal test and treat programmes expand.
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Affiliation(s)
- Shannon M. Williams
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jenny Renjua
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical College, Moshi, Tanzania
| | - Mosa Moshabela
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Africa Health Research Institute, Durban, South Africa
| | - Alison Wringe
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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5
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Etoori D, Renju J, Reniers G, Ndhlovu V, Ndubane S, Makhubela P, Maritze M, Gomez-Olive FX, Wringe A. 'If the results are negative, they motivate us'. Experiences of early infant diagnosis of HIV and engagement in Option B. Glob Public Health 2020; 16:186-200. [PMID: 32673142 DOI: 10.1080/17441692.2020.1795220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Few studies have explored the relationship between early infant diagnosis (EID) of HIV and mothers' engagement in care under Option B+. We conducted in-depth interviews with 20 women who initiated antiretroviral therapy (ART) under Option B+ in rural South Africa to explore the interactions between EID and maternal care engagement. Drawing on practice theory, we identified themes relating to Option B+ care engagement and EID. Women's practice of engagement with HIV care shaped their decision-making around EID. Mothers who disengaged from care during pregnancy were less inclined to utilise EID as they lacked information about its availability and benefits. For some mothers, tensions between wanting to breastfeed and perceptions that it could facilitate transmission led to repeated utilisation of EID as reassurance that the child remained negative. Some mothers used their child's negative result as a proxy for their status, subsequently disengaging from care. For some participants, an HIV diagnosis of their infant and the subsequent double burden of treatment visits for themselves and their infant, contributed to their disengagement. Women's care-seeking practices for themselves and their infants work in a symbiotic ecosystem and should be viewed interdependently to tailor interventions to improve EID uptake and Option B+ care engagement.
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Affiliation(s)
- David Etoori
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jenny Renju
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Georges Reniers
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,MRC/WITS Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Violet Ndhlovu
- MRC/WITS Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sherly Ndubane
- MRC/WITS Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Princess Makhubela
- MRC/WITS Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Meriam Maritze
- MRC/WITS Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Francesc Xavier Gomez-Olive
- MRC/WITS Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alison Wringe
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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6
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Kim MH, Tembo TA, Mazenga A, Yu X, Myer L, Sabelli R, Flick R, Hartig M, Wetzel E, Simon K, Ahmed S, Nyirenda R, Kazembe PN, Mphande M, Mkandawire A, Chitani MJ, Markham C, Ciaranello A, Abrams EJ. The Video intervention to Inspire Treatment Adherence for Life (VITAL Start): protocol for a multisite randomized controlled trial of a brief video-based intervention to improve antiretroviral adherence and retention among HIV-infected pregnant women in Malawi. Trials 2020; 21:207. [PMID: 32075677 PMCID: PMC7031891 DOI: 10.1186/s13063-020-4131-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/01/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Improving maternal antiretroviral therapy (ART) retention and adherence is a critical challenge facing prevention of mother-to-child transmission (PMTCT) of HIV programs. There is an urgent need for evidence-based, cost-effective, and scalable interventions to improve maternal adherence and retention that can be feasibly implemented in overburdened health systems. Brief video-based interventions are a promising but underutilized approach to this crisis. We describe a trial protocol to evaluate the effectiveness and implementation of a standardized educational video-based intervention targeting HIV-infected pregnant women that seeks to optimize their ART retention and adherence by providing a VITAL Start (Video intervention to Inspire Treatment Adherence for Life) before committing to lifelong ART. METHODS This study is a multisite parallel group, randomized controlled trial assessing the effectiveness of a brief facility-based video intervention to optimize retention and adherence to ART among pregnant women living with HIV in Malawi. A total of 892 pregnant women living with HIV and not yet on ART will be randomized to standard-of-care pre-ART counseling or VITAL Start. The primary outcome is a composite of retention and adherence (viral load < 1000 copies/ml) 12 months after starting ART. Secondary outcomes include assessments of behavioral adherence (self-reported adherence, pharmacy refill, and tenofovir diphosphate concentration), psychosocial impact, and resource utilization. We will also examine the implementation of VITAL Start via surveys and qualitative interviews with patients, partners, and health care workers and conduct cost-effectiveness analyses. DISCUSSION This is a robust evaluation of an innovative facility-based video intervention for pregnant women living with HIV, with the potential to improve maternal and infant outcomes. TRIAL REGISTRATION ClinicalTrials.gov, NCT03654898. Registered on 31 August 2018.
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Affiliation(s)
- Maria H Kim
- Baylor College of Medicine International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA. .,Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.
| | - Tapiwa A Tembo
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Alick Mazenga
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Xiaoying Yu
- University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Rachael Sabelli
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Robert Flick
- Baylor College of Medicine International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA.,Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Miriam Hartig
- Baylor College of Medicine International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA.,Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Elizabeth Wetzel
- Baylor College of Medicine International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA.,Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Katie Simon
- Baylor College of Medicine International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA.,Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Saeed Ahmed
- Baylor College of Medicine International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA.,Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Rose Nyirenda
- HIV Unit, Malawi Ministry of Health, Lilongwe, Malawi
| | - Peter N Kazembe
- Baylor College of Medicine International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA.,Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Mtisunge Mphande
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Angella Mkandawire
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Mike J Chitani
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Christine Markham
- Health Promotion & Behavioral Sciences, The University of Texas School of Public Health, Houston, TX, USA
| | - Andrea Ciaranello
- Division of Infectious Diseases, Department of Medicine; Medical Practice Evaluation Center; both at Massachusetts General Hospital, Boston, MA, USA
| | - Elaine J Abrams
- ICAP at Columbia, Mailman School of Public Health and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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7
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Kim J, Floriano F, Castro GD, Manuel JL, Inguane C, Asbjornsdottir KH, Chale F, Zucule J, Sherr K, Gimbel S. Usability and Feasibility of an Innovative mLearning Approach for Nurses Providing Option B+ Services in Manica and Sofala Provinces, Mozambique. J Assoc Nurses AIDS Care 2020; 31:3-11. [PMID: 31834102 PMCID: PMC7060926 DOI: 10.1097/jnc.0000000000000154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The scaling of Option B+ services, whereby all pregnant women who test HIV positive are started on lifelong antiretroviral therapy upon diagnosis regardless of CD4 T-cell count, is ongoing in many high HIV burden, low-resource countries. We developed and evaluated a tablet-based mobile learning (mLearning) training approach to build Option B+ competencies in frontline nurses in central Mozambique. Its acceptability and impact on clinical skills were assessed in maternal child health nurses and managers at 20 intervention and 10 control clinics. Results show that skill and knowledge of nurses at intervention clinics improved threefold compared with control clinics (p = .04), nurse managers at intervention clinics demonstrated a 9- to 10-fold improvement, and nurses reported strong acceptance of this approach. "mLearning" is one viable modality to enhance nurses' clinical competencies in areas with limited health workforce and training budgets. This study's findings may guide future scaling and investments in commercially viable mLearning solutions.
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Affiliation(s)
- Jane Kim
- Jane Kim, BSN-RN, is a DNP-FNP student, School of Nursing, University of Washington, Seattle, Washington, USA. Florência Floriano, BSN, is a Research Nurse, Health Alliance International, Mozambique. Georgina De Castro, BSN, is a Research Nurse, Health Alliance International, Chimoio, Manica, Mozambique. João Luís Manuel, MPH, is an Education Specialist, Beira Operational Research Center, Mozambique. Celso Inguane, PhD, MPH, is a Postdoctoral Fellow, Department of Global Health, University of Washington, Seattle, Washington, USA. Kristjana H. Asbjornsdottir, PhD, MPH, is an Acting Assistant Professor, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Falume Chale, BS, is a Staff Researcher, Beira Operational Research Center, Mozambique. Justina Zucule, BSN, is a Research Nurse, Sofala Province Directorate of Health, Mozambique. Kenneth Sherr, PhD, MPH, is Director of Implementation Science & Mozambique Programs, Health Alliance International, Chimoio, Manica, Mozambique, and Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Sarah Gimbel, RN, PhD, MPH, is Co-Director, Center for Global Health Nursing, School of Nursing, University of Washington, Seattle, Washington, USA, and Adjunct Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA, and Senior Technical Advisor, Health Alliance International, Seattle, Washington, USA
| | - Florência Floriano
- Jane Kim, BSN-RN, is a DNP-FNP student, School of Nursing, University of Washington, Seattle, Washington, USA. Florência Floriano, BSN, is a Research Nurse, Health Alliance International, Mozambique. Georgina De Castro, BSN, is a Research Nurse, Health Alliance International, Chimoio, Manica, Mozambique. João Luís Manuel, MPH, is an Education Specialist, Beira Operational Research Center, Mozambique. Celso Inguane, PhD, MPH, is a Postdoctoral Fellow, Department of Global Health, University of Washington, Seattle, Washington, USA. Kristjana H. Asbjornsdottir, PhD, MPH, is an Acting Assistant Professor, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Falume Chale, BS, is a Staff Researcher, Beira Operational Research Center, Mozambique. Justina Zucule, BSN, is a Research Nurse, Sofala Province Directorate of Health, Mozambique. Kenneth Sherr, PhD, MPH, is Director of Implementation Science & Mozambique Programs, Health Alliance International, Chimoio, Manica, Mozambique, and Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Sarah Gimbel, RN, PhD, MPH, is Co-Director, Center for Global Health Nursing, School of Nursing, University of Washington, Seattle, Washington, USA, and Adjunct Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA, and Senior Technical Advisor, Health Alliance International, Seattle, Washington, USA
| | - Georgina De Castro
- Jane Kim, BSN-RN, is a DNP-FNP student, School of Nursing, University of Washington, Seattle, Washington, USA. Florência Floriano, BSN, is a Research Nurse, Health Alliance International, Mozambique. Georgina De Castro, BSN, is a Research Nurse, Health Alliance International, Chimoio, Manica, Mozambique. João Luís Manuel, MPH, is an Education Specialist, Beira Operational Research Center, Mozambique. Celso Inguane, PhD, MPH, is a Postdoctoral Fellow, Department of Global Health, University of Washington, Seattle, Washington, USA. Kristjana H. Asbjornsdottir, PhD, MPH, is an Acting Assistant Professor, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Falume Chale, BS, is a Staff Researcher, Beira Operational Research Center, Mozambique. Justina Zucule, BSN, is a Research Nurse, Sofala Province Directorate of Health, Mozambique. Kenneth Sherr, PhD, MPH, is Director of Implementation Science & Mozambique Programs, Health Alliance International, Chimoio, Manica, Mozambique, and Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Sarah Gimbel, RN, PhD, MPH, is Co-Director, Center for Global Health Nursing, School of Nursing, University of Washington, Seattle, Washington, USA, and Adjunct Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA, and Senior Technical Advisor, Health Alliance International, Seattle, Washington, USA
| | - João Luís Manuel
- Jane Kim, BSN-RN, is a DNP-FNP student, School of Nursing, University of Washington, Seattle, Washington, USA. Florência Floriano, BSN, is a Research Nurse, Health Alliance International, Mozambique. Georgina De Castro, BSN, is a Research Nurse, Health Alliance International, Chimoio, Manica, Mozambique. João Luís Manuel, MPH, is an Education Specialist, Beira Operational Research Center, Mozambique. Celso Inguane, PhD, MPH, is a Postdoctoral Fellow, Department of Global Health, University of Washington, Seattle, Washington, USA. Kristjana H. Asbjornsdottir, PhD, MPH, is an Acting Assistant Professor, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Falume Chale, BS, is a Staff Researcher, Beira Operational Research Center, Mozambique. Justina Zucule, BSN, is a Research Nurse, Sofala Province Directorate of Health, Mozambique. Kenneth Sherr, PhD, MPH, is Director of Implementation Science & Mozambique Programs, Health Alliance International, Chimoio, Manica, Mozambique, and Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Sarah Gimbel, RN, PhD, MPH, is Co-Director, Center for Global Health Nursing, School of Nursing, University of Washington, Seattle, Washington, USA, and Adjunct Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA, and Senior Technical Advisor, Health Alliance International, Seattle, Washington, USA
| | - Celso Inguane
- Jane Kim, BSN-RN, is a DNP-FNP student, School of Nursing, University of Washington, Seattle, Washington, USA. Florência Floriano, BSN, is a Research Nurse, Health Alliance International, Mozambique. Georgina De Castro, BSN, is a Research Nurse, Health Alliance International, Chimoio, Manica, Mozambique. João Luís Manuel, MPH, is an Education Specialist, Beira Operational Research Center, Mozambique. Celso Inguane, PhD, MPH, is a Postdoctoral Fellow, Department of Global Health, University of Washington, Seattle, Washington, USA. Kristjana H. Asbjornsdottir, PhD, MPH, is an Acting Assistant Professor, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Falume Chale, BS, is a Staff Researcher, Beira Operational Research Center, Mozambique. Justina Zucule, BSN, is a Research Nurse, Sofala Province Directorate of Health, Mozambique. Kenneth Sherr, PhD, MPH, is Director of Implementation Science & Mozambique Programs, Health Alliance International, Chimoio, Manica, Mozambique, and Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Sarah Gimbel, RN, PhD, MPH, is Co-Director, Center for Global Health Nursing, School of Nursing, University of Washington, Seattle, Washington, USA, and Adjunct Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA, and Senior Technical Advisor, Health Alliance International, Seattle, Washington, USA
| | - Kristjana H. Asbjornsdottir
- Jane Kim, BSN-RN, is a DNP-FNP student, School of Nursing, University of Washington, Seattle, Washington, USA. Florência Floriano, BSN, is a Research Nurse, Health Alliance International, Mozambique. Georgina De Castro, BSN, is a Research Nurse, Health Alliance International, Chimoio, Manica, Mozambique. João Luís Manuel, MPH, is an Education Specialist, Beira Operational Research Center, Mozambique. Celso Inguane, PhD, MPH, is a Postdoctoral Fellow, Department of Global Health, University of Washington, Seattle, Washington, USA. Kristjana H. Asbjornsdottir, PhD, MPH, is an Acting Assistant Professor, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Falume Chale, BS, is a Staff Researcher, Beira Operational Research Center, Mozambique. Justina Zucule, BSN, is a Research Nurse, Sofala Province Directorate of Health, Mozambique. Kenneth Sherr, PhD, MPH, is Director of Implementation Science & Mozambique Programs, Health Alliance International, Chimoio, Manica, Mozambique, and Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Sarah Gimbel, RN, PhD, MPH, is Co-Director, Center for Global Health Nursing, School of Nursing, University of Washington, Seattle, Washington, USA, and Adjunct Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA, and Senior Technical Advisor, Health Alliance International, Seattle, Washington, USA
| | - Falume Chale
- Jane Kim, BSN-RN, is a DNP-FNP student, School of Nursing, University of Washington, Seattle, Washington, USA. Florência Floriano, BSN, is a Research Nurse, Health Alliance International, Mozambique. Georgina De Castro, BSN, is a Research Nurse, Health Alliance International, Chimoio, Manica, Mozambique. João Luís Manuel, MPH, is an Education Specialist, Beira Operational Research Center, Mozambique. Celso Inguane, PhD, MPH, is a Postdoctoral Fellow, Department of Global Health, University of Washington, Seattle, Washington, USA. Kristjana H. Asbjornsdottir, PhD, MPH, is an Acting Assistant Professor, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Falume Chale, BS, is a Staff Researcher, Beira Operational Research Center, Mozambique. Justina Zucule, BSN, is a Research Nurse, Sofala Province Directorate of Health, Mozambique. Kenneth Sherr, PhD, MPH, is Director of Implementation Science & Mozambique Programs, Health Alliance International, Chimoio, Manica, Mozambique, and Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Sarah Gimbel, RN, PhD, MPH, is Co-Director, Center for Global Health Nursing, School of Nursing, University of Washington, Seattle, Washington, USA, and Adjunct Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA, and Senior Technical Advisor, Health Alliance International, Seattle, Washington, USA
| | - Justina Zucule
- Jane Kim, BSN-RN, is a DNP-FNP student, School of Nursing, University of Washington, Seattle, Washington, USA. Florência Floriano, BSN, is a Research Nurse, Health Alliance International, Mozambique. Georgina De Castro, BSN, is a Research Nurse, Health Alliance International, Chimoio, Manica, Mozambique. João Luís Manuel, MPH, is an Education Specialist, Beira Operational Research Center, Mozambique. Celso Inguane, PhD, MPH, is a Postdoctoral Fellow, Department of Global Health, University of Washington, Seattle, Washington, USA. Kristjana H. Asbjornsdottir, PhD, MPH, is an Acting Assistant Professor, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Falume Chale, BS, is a Staff Researcher, Beira Operational Research Center, Mozambique. Justina Zucule, BSN, is a Research Nurse, Sofala Province Directorate of Health, Mozambique. Kenneth Sherr, PhD, MPH, is Director of Implementation Science & Mozambique Programs, Health Alliance International, Chimoio, Manica, Mozambique, and Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Sarah Gimbel, RN, PhD, MPH, is Co-Director, Center for Global Health Nursing, School of Nursing, University of Washington, Seattle, Washington, USA, and Adjunct Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA, and Senior Technical Advisor, Health Alliance International, Seattle, Washington, USA
| | - Kenneth Sherr
- Jane Kim, BSN-RN, is a DNP-FNP student, School of Nursing, University of Washington, Seattle, Washington, USA. Florência Floriano, BSN, is a Research Nurse, Health Alliance International, Mozambique. Georgina De Castro, BSN, is a Research Nurse, Health Alliance International, Chimoio, Manica, Mozambique. João Luís Manuel, MPH, is an Education Specialist, Beira Operational Research Center, Mozambique. Celso Inguane, PhD, MPH, is a Postdoctoral Fellow, Department of Global Health, University of Washington, Seattle, Washington, USA. Kristjana H. Asbjornsdottir, PhD, MPH, is an Acting Assistant Professor, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Falume Chale, BS, is a Staff Researcher, Beira Operational Research Center, Mozambique. Justina Zucule, BSN, is a Research Nurse, Sofala Province Directorate of Health, Mozambique. Kenneth Sherr, PhD, MPH, is Director of Implementation Science & Mozambique Programs, Health Alliance International, Chimoio, Manica, Mozambique, and Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Sarah Gimbel, RN, PhD, MPH, is Co-Director, Center for Global Health Nursing, School of Nursing, University of Washington, Seattle, Washington, USA, and Adjunct Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA, and Senior Technical Advisor, Health Alliance International, Seattle, Washington, USA
| | - Sarah Gimbel
- Jane Kim, BSN-RN, is a DNP-FNP student, School of Nursing, University of Washington, Seattle, Washington, USA. Florência Floriano, BSN, is a Research Nurse, Health Alliance International, Mozambique. Georgina De Castro, BSN, is a Research Nurse, Health Alliance International, Chimoio, Manica, Mozambique. João Luís Manuel, MPH, is an Education Specialist, Beira Operational Research Center, Mozambique. Celso Inguane, PhD, MPH, is a Postdoctoral Fellow, Department of Global Health, University of Washington, Seattle, Washington, USA. Kristjana H. Asbjornsdottir, PhD, MPH, is an Acting Assistant Professor, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Falume Chale, BS, is a Staff Researcher, Beira Operational Research Center, Mozambique. Justina Zucule, BSN, is a Research Nurse, Sofala Province Directorate of Health, Mozambique. Kenneth Sherr, PhD, MPH, is Director of Implementation Science & Mozambique Programs, Health Alliance International, Chimoio, Manica, Mozambique, and Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA. Sarah Gimbel, RN, PhD, MPH, is Co-Director, Center for Global Health Nursing, School of Nursing, University of Washington, Seattle, Washington, USA, and Adjunct Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA, and Senior Technical Advisor, Health Alliance International, Seattle, Washington, USA
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8
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Abstract
In many African countries, hundreds of health-related NGOs are fed by a chaotic tangle of donor funding streams. The case of Mozambique illustrates how this NGO model impedes Universal Health Coverage. In the 1990s, NGOs multiplied across post-war Mozambique: the country’s structural adjustment program constrained public and foreign aid expenditures on the public health system, while donors favored private contractors and NGOs. In the 2000s, funding for HIV/AIDS and other vertical aid from many donors increased dramatically. In 2004, the United States introduced PEPFAR in Mozambique at nearly 500 million USD per year, roughly equivalent to the entire budget of the Ministry of Health. To be sure, PEPFAR funding has helped thousands access antiretroviral treatment, but over 90% of resources flow “off-budget” to NGO “implementing partners,” with little left for the public health system. After a decade of this major donor funding to NGOs, public sector health system coverage had barely changed. In 2014, the workforce/ population ratio was still among the five worst in the world at 71/10000; the health facility/per capita ratio worsened since 2009 to only 1 per 16,795. Achieving UHC will require rejection of austerity constraints on public sector health systems, and rechanneling of aid to public systems building rather than to NGOs.
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Affiliation(s)
- James Pfeiffer
- Department of Global Health, Department of Anthropology, University of Washington, Box 357965, Seattle, WA, 98195-7965, USA.
| | - Rachel R Chapman
- Department of Anthropology, University of Washington, Box 353100, Seattle, WA, 98195-3100, USA
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9
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Ahoua L, Tiendrebeogo T, Arikawa S, Lahuerta M, Aly D, Journot V, Abrams EJ, Becquet R, Dabis F. PMTCT care cascade and factors associated with attrition in the first four years after Option B+ implementation in Mozambique. Trop Med Int Health 2019; 25:222-235. [PMID: 31667997 DOI: 10.1111/tmi.13324] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of the prevention of mother-to-child transmission (PMTCT) Option B+ programme in two provinces with high human immunodeficiency virus (HIV) burden in Mozambique over the first four years of programme implementation. METHODS We assessed the PMTCT cascade in antenatal care (ANC) from July 2013 to December 2017 using facility-level data and performed a retrospective cohort analysis with patient-level data. We compared the 12-month antiretroviral therapy (ART) retention rates between women with HIV infection who initiated ART under Option B+ ('B+ pregnant') and those who initiated ART for their own health ('own health'). RESULTS A total of 916 280 pregnant women enrolled in ANC. The proportion of women with a documented HIV status increased from 93% in 2013 to 96% in 2017. The proportion of those tested HIV-positive decreased from 8% to 6% while that of those HIV-positive on ART increased from 42% to 95%. Of the 44 377 HIV-positive women included in the analysis, 35% were lost to care. 'B+ pregnant' women initiating ART in 2015 were less likely to have no follow-up (NFU) compared with 'own health' women starting ART during the same period (adjusted odds ratio: 0.77, 95% confidence interval [CI]: 0.64-0.94, P = 0.01). There was no statistical difference between the two groups during the other years in which ART was initiated. Of those returning for care after their first visit (N = 39 801), the 'B+ pregnant' women showed a higher risk of non-retention than the other group (adjusted hazard ratio: 1.14, 95% CI: 1.03-1.25) when ART was initiated in 2013. The risk decreased during the subsequent years, with no difference observed between the groups. CONCLUSION PMTCT Option B+ programme scale-up has yielded positive results, including the maintenance of high HIV testing and ART initiation rates in ANC. Challenges still remain, however, in improving immediate engagement in care and long-term retention. Seeking alternative service delivery models to support existing health systems and prevent defaulters is required to achieve the UNAIDS 95-95-95 targets for PMTCT in Mozambique.
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Affiliation(s)
- Laurence Ahoua
- INSERM U1219 - Bordeaux Population Health, Institute for Public Health, Epidemiology, and Development, Bordeaux University, Bordeaux, France.,Mailman School of Public Health, ICAP at Columbia University, Maputo, Mozambique
| | - Thierry Tiendrebeogo
- INSERM U1219 - Bordeaux Population Health, Institute for Public Health, Epidemiology, and Development, Bordeaux University, Bordeaux, France
| | - Shino Arikawa
- INSERM U1219 - Bordeaux Population Health, Institute for Public Health, Epidemiology, and Development, Bordeaux University, Bordeaux, France
| | - Maria Lahuerta
- Mailman School of Public Health, ICAP at Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Dario Aly
- Mailman School of Public Health, ICAP at Columbia University, Maputo, Mozambique
| | - Valerie Journot
- Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France
| | - Elaine J Abrams
- Mailman School of Public Health, ICAP at Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.,Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Renaud Becquet
- INSERM U1219 - Bordeaux Population Health, Institute for Public Health, Epidemiology, and Development, Bordeaux University, Bordeaux, France
| | - Francois Dabis
- INSERM U1219 - Bordeaux Population Health, Institute for Public Health, Epidemiology, and Development, Bordeaux University, Bordeaux, France
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10
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Kim MH, Ahmed S, Tembo T, Sabelli R, Flick R, Yu X, Mazenga A, Le Blond H, Simon K, Hartig M, Wetzel E, Nyirenda R, Kazembe PN, Mphande M, Mkandawire A, Chitani MJ, Abrams EJ. VITAL Start: Video-Based Intervention to Inspire Treatment Adherence for Life-Pilot of a Novel Video-Based Approach to HIV Counseling for Pregnant Women Living with HIV. AIDS Behav 2019; 23:3140-3151. [PMID: 31410618 PMCID: PMC6803103 DOI: 10.1007/s10461-019-02634-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We developed and piloted a video-based intervention targeting HIV-positive pregnant women to optimize antiretroviral therapy (ART) retention and adherence by providing a VITAL Start (Video-intervention to Inspire Treatment Adherence for Life) before ART. VITAL Start (VS) was grounded in behavior-determinant models and developed through an iterative multi-stakeholder process. Of 306 pregnant women eligible for ART, 160 were randomized to standard of care (SOC), 146 to VS and followed for one-month. Of those assigned to VS, 100% completed video-viewing; 96.5% reported they would recommend VS. Of 11 health workers interviewed, 82% preferred VS over SOC; 91% found VS more time-efficient. Compared to SOC, VS group had greater change in HIV/ART knowledge (p < 0.01), trend towards being more likely to start ART (p = 0.07), and better self-reported adherence (p = 0.02). There were no significant group differences in 1-month retention and pharmacy pill count. VITAL Start was highly acceptable, feasible, with promising benefits to ART adherence.
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Affiliation(s)
- Maria H Kim
- Baylor College of Medicine International Paediatric AIDS Initiative, Texas Children's Hospital, Houston, USA.
- Baylor College of Medicine - Abbott Fund Children's Clinical Centre of Excellence, Private bag B-397, Lilongwe 3, Malawi.
| | - Saeed Ahmed
- Baylor College of Medicine International Paediatric AIDS Initiative, Texas Children's Hospital, Houston, USA
- Baylor College of Medicine - Abbott Fund Children's Clinical Centre of Excellence, Private bag B-397, Lilongwe 3, Malawi
| | - Tapiwa Tembo
- Baylor College of Medicine - Abbott Fund Children's Clinical Centre of Excellence, Private bag B-397, Lilongwe 3, Malawi
| | - Rachael Sabelli
- Baylor College of Medicine - Abbott Fund Children's Clinical Centre of Excellence, Private bag B-397, Lilongwe 3, Malawi
| | - Robert Flick
- Baylor College of Medicine International Paediatric AIDS Initiative, Texas Children's Hospital, Houston, USA
- Baylor College of Medicine - Abbott Fund Children's Clinical Centre of Excellence, Private bag B-397, Lilongwe 3, Malawi
| | - Xiaoying Yu
- University of Texas Medical Branch at Galveston, Galveston, USA
| | - Alick Mazenga
- Baylor College of Medicine - Abbott Fund Children's Clinical Centre of Excellence, Private bag B-397, Lilongwe 3, Malawi
| | | | - Katie Simon
- Baylor College of Medicine International Paediatric AIDS Initiative, Texas Children's Hospital, Houston, USA
- Baylor College of Medicine - Abbott Fund Children's Clinical Centre of Excellence, Private bag B-397, Lilongwe 3, Malawi
| | - Miriam Hartig
- Baylor College of Medicine International Paediatric AIDS Initiative, Texas Children's Hospital, Houston, USA
- Baylor College of Medicine - Abbott Fund Children's Clinical Centre of Excellence, Private bag B-397, Lilongwe 3, Malawi
| | - Elizabeth Wetzel
- Baylor College of Medicine International Paediatric AIDS Initiative, Texas Children's Hospital, Houston, USA
- Baylor College of Medicine - Abbott Fund Children's Clinical Centre of Excellence, Private bag B-397, Lilongwe 3, Malawi
| | - Rose Nyirenda
- HIV Unit, Malawi Ministry of Health, Lilongwe, Malawi
| | - Peter N Kazembe
- Baylor College of Medicine International Paediatric AIDS Initiative, Texas Children's Hospital, Houston, USA
- Baylor College of Medicine - Abbott Fund Children's Clinical Centre of Excellence, Private bag B-397, Lilongwe 3, Malawi
| | - Mtisunge Mphande
- Baylor College of Medicine - Abbott Fund Children's Clinical Centre of Excellence, Private bag B-397, Lilongwe 3, Malawi
| | - Angella Mkandawire
- Baylor College of Medicine - Abbott Fund Children's Clinical Centre of Excellence, Private bag B-397, Lilongwe 3, Malawi
| | - Mike J Chitani
- Baylor College of Medicine - Abbott Fund Children's Clinical Centre of Excellence, Private bag B-397, Lilongwe 3, Malawi
| | - Elaine J Abrams
- ICAP at Columbia, Mailman School of Public Health and Vagelos College of Physicians & Surgeons, Columbia University, New York, USA
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11
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Myrtil MP, Puttkammer N, Gloyd S, Robinson J, Yuhas K, Domercant JW, Honoré JG, Francois K. ART Attrition across Health Facilities Implementing Option B+ in Haiti. J Int Assoc Provid AIDS Care 2019; 17:2325958218774037. [PMID: 29781378 PMCID: PMC6748512 DOI: 10.1177/2325958218774037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Describing factors related to high attrition is important in order to improve the implementation of the Option B+ strategy in Haiti. Methods: We conducted a retrospective cohort study to describe the variability of antiretroviral therapy (ART) retention across health facilities among pregnant and lactating women and assess for differences in ART retention between Option B+ clients and other ART patients. Results: There were 1989 Option B+ clients who initiated ART in 45 health facilities. The percentage of attrition varied from 9% to 81% across the facilities. The largest health facilities had 38% higher risk of attrition (relative risk [RR]: 1.38, 95% confidence interval [CI]: 1.08-1.77, P = .009). Private institutions had 18% less risk of attrition (RR: 0.82, 95% CI: 0.70-0.96, P = .020). Health facilities located in the West department and the South region had lower risk of attrition. Conclusion: Being on treatment in a large or public health facility or a facility located in the North region was a significant risk factor associated with high attrition among Option B+ clients. The implementation of the Option B+ strategy must be reevaluated in order to effectively eliminate mother-to-child HIV transmission.
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Affiliation(s)
| | - Nancy Puttkammer
- 1 Department of Global Health, University of Washington, Seattle, WA, USA.,2 International Training and Education Center for Health (I-TECH), Seattle, WA, USA
| | - Stephen Gloyd
- 1 Department of Global Health, University of Washington, Seattle, WA, USA.,3 Health Alliance International (HAI), Seattle, WA, USA
| | - Julia Robinson
- 1 Department of Global Health, University of Washington, Seattle, WA, USA.,3 Health Alliance International (HAI), Seattle, WA, USA
| | - Krista Yuhas
- 4 University of Washington Center for AIDS Research, Seattle, WA, USA
| | | | - Jean Guy Honoré
- 6 International Training and Education Center for Health (I-TECH), Port au Prince, Haiti
| | - Kesner Francois
- 7 Ministry of Health of the Government of Haiti, Port au Prince, Haiti
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12
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Wanga I, Helova A, Abuogi LL, Bukusi EA, Nalwa W, Akama E, Odeny TA, Turan JM, Onono M. Acceptability of community-based mentor mothers to support HIV-positive pregnant women on antiretroviral treatment in western Kenya: a qualitative study. BMC Pregnancy Childbirth 2019; 19:288. [PMID: 31409297 PMCID: PMC6693232 DOI: 10.1186/s12884-019-2419-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 07/19/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Option B+ is a comprehensive antiretroviral treatment (ART) designed for HIV-infected pregnant/ postpartum women. However, barriers to implementing Option B+ and establishing long-term ART adherence while facilitating retention in prevention of mother to child transmission of HIV (PMTCT) services remain. Community-based mentor mothers (cMMs) who can provide home-based support for PMTCT services may address some of the barriers to successful adoption and retention in Option B+. Thus, we evaluated the acceptability of using cMMs as home-based support for PMTCT services. METHODS Gender-matched in-depth interviews were conducted between September-November 2014 for HIV-infected pregnant/postpartum women and their male partners living in southwestern Kenya (n = 40); additionally, we conducted four focus groups involving 30 health workers (n = 70) within four health facilities. Audio-recordings were transcribed, translated, and then coded using a thematic analytical approach in which data were deductively and inductively coded with support from prior literature, identified themes within the interview guides, and emerging themes from the transcripts utilizing Dedoose software. RESULTS Overall, the study results suggest high acceptability of cMMs among individual participants and health workers. Stigma reduction, improvement of utilization of health care services, as well as ART adherence were most frequently discussed potential benefits of cMMs. Participants pictured a cMM as someone acting as a role model and confidant, and who was over 30 years old. Many respondents raised concerns about breaches of confidentiality and inadvertent disclosure. Respondent suggestions to overcome these issues included the cMM working in different communities than where she lives and attending home-visits with no identifying clothing as an HIV-related health worker. CONCLUSIONS The home-based cMM approach may be a beneficial and acceptable strategy for promoting ART adherence and retention within PMTCT services for pregnant/postpartum women living with HIV. Considering the risks of inadvertent disclosure of HIV-infected status and related negative consequences for pregnant/postpartum women living with HIV, similar cMM program designs may benefit from recognizing and addressing these risks. TRIAL REGISTRATION The MOTIVATE! study was registered on July 7, 2015 at the ClinicalTrials.gov ( NCT02491177 ).
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Affiliation(s)
- Iris Wanga
- Centre for Microbiology Research, Kenya Medical Research Institute, P.O. Box 19464 - 00202, Nairobi, Kenya
| | - Anna Helova
- Department of Health Care Policy and Organization, School of Public Health, University of Alabama at Birmingham, 517 RPHB 1665 University Blvd, Birmingham, AL 35294 USA
| | - Lisa L. Abuogi
- Department of Pediatrics, University of Colorado Denver, 13199 East Montview Blvd, Suite 310 Mail Stop A090, Aurora, CO 80045 USA
| | - Elizabeth A. Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, P.O. Box 19464 - 00202, Nairobi, Kenya
| | - Wafula Nalwa
- Maseno University School of Medicine, Box 3365-40100, Kisumu, Kenya
| | - Eliud Akama
- Centre for Microbiology Research, Kenya Medical Research Institute, P.O. Box 19464 - 00202, Nairobi, Kenya
| | - Thomas A. Odeny
- Centre for Microbiology Research, Kenya Medical Research Institute, P.O. Box 19464 - 00202, Nairobi, Kenya
| | - Janet M. Turan
- Department of Health Care Policy and Organization, School of Public Health, University of Alabama at Birmingham, 517 RPHB 1665 University Blvd, Birmingham, AL 35294 USA
| | - Maricianah Onono
- Centre for Microbiology Research, Kenya Medical Research Institute, P.O. Box 19464 - 00202, Nairobi, Kenya
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13
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Gong E, Dula J, Alberto C, de Albuquerque A, Steenland M, Fernandes Q, Cuco RM, Sequeira S, Chicumbe S, Gudo ES, McConnell M. Client experiences with antenatal care waiting times in southern Mozambique. BMC Health Serv Res 2019; 19:538. [PMID: 31370854 PMCID: PMC6670125 DOI: 10.1186/s12913-019-4369-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/24/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Antenatal care (ANC) provides a range of critical health services during pregnancy that can improve maternal and neonatal health outcomes. In Mozambique, only half of women receive four or more ANC visits, which are provided for free at public health centers by maternal and child health (MCH) nurses. Waiting time has been shown to contribute to negative client experiences, which may be a driver of low maternity care utilization. A recent pilot study of a program to schedule ANC visits demonstrated that scheduling care reduces waiting time and results in higher rates of complete ANC. This study aims to explore client experiences with waiting time for ANC in standard practice and care and after the introduction of appointment scheduling. METHODS This study uses a series of qualitative interviews to unpack client experiences with ANC waiting time with and without scheduled care, in order to better understand the impact of waiting time on client experiences. Thirty-eight interviews were collected in May to June 2017 at three pilot study clinics in southern Mozambique, with a focus on two paired intervention and comparison facilities sharing similar facility characteristics. Data were analyzed using inductive thematic analysis methods using NVivo software. RESULTS Clients described strong motivations to seek ANC, pointing to the need to address convenience of care, and highlighted direct and indirect costs of seeking care that were exacerbated by long waiting times. Direct costs include time and transport costs of going to the clinic, while indirect costs include being unable to fulfill household and work obligations. Other barriers to complete ANC utilization of four or more visits include transport costs, negative provider experiences, and delayed ANC initiation, which limit the potential number of clinic contacts. CONCLUSIONS Findings demonstrate that the scheduling intervention improves the client experience of seeking care by allowing women to both seek ANC and fulfill other productive obligations. Innovation in healthcare delivery should consider adapting models that minimize waiting times.
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Affiliation(s)
- Estelle Gong
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA USA
| | - Janeth Dula
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Carla Alberto
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | | | - Maria Steenland
- Population Studies and Training Center, Brown University, Providence, RI USA
| | - Quinhas Fernandes
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique
| | - Rosa Marlene Cuco
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique
| | - Sandra Sequeira
- Department of International Development, London School of Economics, London, UK
| | - Sérgio Chicumbe
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Eduardo Samo Gudo
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Margaret McConnell
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA USA
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14
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Vulnerable at Each Step in the PMTCT Care Cascade: High Loss to Follow Up During Pregnancy and the Postpartum Period in Tanzania. AIDS Behav 2019; 23:1824-1832. [PMID: 30327997 DOI: 10.1007/s10461-018-2298-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In 2013, Tanzania adopted the World Health Organization's Option B+ guidelines for prevention of mother-to-child transmission of HIV (PMTCT), whereby all HIV-infected pregnant women initiate lifelong antiretroviral therapy. This study examined retention in PMTCT across critical junctures in the care continuum. This was a retrospective study of patient-level data for a cohort of women enrolled in PMTCT during the first year of Option B+ in Tanzania. Retention in care was described across three periods: (1) the first month of antenatal care (ANC), (2) pregnancy, and (3) the postpartum period. Logistic regression was used to identify factors associated with loss to follow up (LTFU) during the first month of ANC. Survival analyses were used to identify factors associated with LTFU during pregnancy and the postpartum periods. 650 participants were included in the cohort; 262 (40.3%) were newly diagnosed with HIV. Two years after delivery, 383/650 (58.7%) were LTFU. Of the 383 LTFU, 73 (19.1%) were lost during the first month of ANC, 44 (11.5%) during pregnancy, and 266 (69.5%) after delivery. Being newly diagnosed with HIV predicted higher LTFU during the first month of ANC (aOR 1.76; 95% CI 1.06-2.94) and faster time to LTFU during the postpartum period (adjusted relative time, 0.68; 95% CI 0.51-0.89). High LTFU occurred across the PMTCT continuum, including immediately after enrollment into ANC and the postpartum period. Ongoing research is needed to encourage treatment uptake and sustained engagement after delivery.
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Kawakyu N, Nduati R, Munguambe K, Coutinho J, Mburu N, DeCastro G, Inguane C, Zunt A, Abburi N, Sherr K, Gimbel S. Development and Implementation of a Mobile Phone-Based Prevention of Mother-To-Child Transmission of HIV Cascade Analysis Tool: Usability and Feasibility Testing in Kenya and Mozambique. JMIR Mhealth Uhealth 2019; 7:e13963. [PMID: 31094351 PMCID: PMC6535976 DOI: 10.2196/13963] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/20/2019] [Accepted: 04/23/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Prevention of mother-to-child HIV transmission (PMTCT) care cascade failures drive pediatric HIV infections in sub-Saharan Africa. As nurses' clinical and management role in PMTCT expand, decision-support tools for nurses are needed to facilitate identification of cascade inefficiencies and solutions. The mobile phone-based PMTCT cascade analysis tool (mPCAT) provides health facility staff a quick summary of the number of patients and percentage drop-off at each step of the PMCTC care cascade, as well as how many women-infant pairs would be retained if a step was optimized. OBJECTIVE The objective of this study was to understand and improve the mPCAT's core usability factors and assess the health workers' experience with using the mPCAT. METHODS Overall, 2 rounds of usability testing were conducted with health workers from 4 clinics and leading experts in maternal and child health in Kenya and Mozambique using videotaped think aloud assessment techniques. Semistructured group interviews gauged the understanding of mPCAT's core usability factors, based on the Nielsen Usability Framework, followed by development of cognitive demand tables describing the needed mPCAT updates. Post adaptation, feasibility was assessed in 3 high volume clinics over 12 weeks. Participants completed a 5-point Likert questionnaire designed to measure ease of use, convenience of integration into work, and future intention to use the mPCAT. Focus group discussions with nurse participants at each facility and in-depth interviews with nurse managers were also conducted to assess the acceptability, use, and recommendations for adaptations of the mPCAT. RESULTS Usability testing with software engineers enabled real-time feedback to build a tool following empathic design principles. The revised mPCAT had improved navigation and simplified data entry interface, with only 1 data entry field per page. Improvements to the results page included a data visualization feature and the ability to share results through WhatsApp. Coding was simplified to enable future revisions by nontechnical staff-critical for context-specific adaptations for scale-up. Health care workers and facility managers found the tool easy to use (mean=4.3), used the tool very often (mean=4.1), and definitely intended to continue to use the tool (mean=4.8). Ease of use was the most common theme identified, with emphasis on how the tool readily informed system improvement decision making. CONCLUSIONS The mPCAT was well accepted by frontline health workers and facility managers. The collaborative process between software developer and user led to the development of a more user-friendly, context-specific tool that could be easily integrated into routine clinical practice and workflow. The mPCAT gave frontline health workers and facility managers an immediate, direct, and tangible way to use their clinical documentation and routinely reported data for decision making for their own clinical practice and facility-level improvements.
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Affiliation(s)
- Nami Kawakyu
- Center for Global Health Nursing, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Ruth Nduati
- Network of AIDS Researchers in East and Southern Africa, Nairobi, Kenya
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Khátia Munguambe
- University of Eduardo Mondlane, Maputo, Mozambique
- Manhiça Health Research Centre, Manhiça, Mozambique
| | - Joana Coutinho
- Health Alliance International, Beira / Chimoio, Mozambique
| | - Nancy Mburu
- Network of AIDS Researchers in East and Southern Africa, Nairobi, Kenya
| | | | - Celso Inguane
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Andrew Zunt
- Paul G Allen School of Computer Science and Engineering, University of Washington, Seattle, WA, United States
| | - Neil Abburi
- Paul G Allen School of Computer Science and Engineering, University of Washington, Seattle, WA, United States
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, WA, United States
- Health Alliance International, Seattle, WA, United States
| | - Sarah Gimbel
- Center for Global Health Nursing, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Health Alliance International, Seattle, WA, United States
- Department of Family and Child Nursing, University of Washington, Seattle, WA, United States
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Phillips TK, Myer L. Shifting to the long view: engagement of pregnant and postpartum women living with HIV in lifelong antiretroviral therapy services. Expert Rev Anti Infect Ther 2019; 17:349-361. [PMID: 30978126 DOI: 10.1080/14787210.2019.1607296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: The advent of policies promoting lifelong antiretroviral therapy (ART) for all pregnant and postpartum women living with HIV has shifted focus from short-term prevention of mother-to-child transmission (PMTCT) to lifelong engagement in ART services. However, disengagement from care threatens the long-term treatment and prevention benefits of lifelong ART. Areas covered: A framework for considering the unique aspects of ART for pregnant and postpartum women is presented along with a review of the literature on maternal engagement in care in sub-Saharan Africa and a discussion of potential interventions to sustain engagement in lifelong ART. Expert opinion: Engaging women and mothers in ART services for life is critical for maternal health, PMTCT, and prevention of sexual transmission. Evidence-based interventions exist to support engagement in care but most focus on periods of mother-to-child transmission risk. In the long term, life transitions and health-care transfers are inevitable. Thus, interventions that can reach beyond a single facility or provide a bridge between health services should be prioritized. Multicomponent interventions will also be essential to address the numerous intersecting barriers to sustained engagement in ART services.
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Affiliation(s)
- Tamsin K Phillips
- a Division of Epidemiology & Biostatistics and Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine , University of Cape Town , Cape Town , South Africa
| | - Landon Myer
- a Division of Epidemiology & Biostatistics and Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine , University of Cape Town , Cape Town , South Africa
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Retention in HIV Care During Pregnancy and the Postpartum Period in the Option B+ Era: Systematic Review and Meta-Analysis of Studies in Africa. J Acquir Immune Defic Syndr 2019; 77:427-438. [PMID: 29287029 DOI: 10.1097/qai.0000000000001616] [Citation(s) in RCA: 156] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Under Option B+ guidelines for prevention of mother-to-child transmission of HIV, pregnant and breastfeeding women initiate antiretroviral therapy for lifelong use. The objectives of this study were: (1) to synthesize data on retention in care over time in option B+ programs in Africa, and (2) to identify factors associated with retention in care. METHODS PubMed, EMBASE, and African Index Medicus were systematically searched from January 2012 to June 2017. Pooled estimates of the proportion of women retained were generated and factors associated with retention were analyzed thematically. RESULTS Thirty-five articles were included in the final review; 22 reported retention rates (n = 60,890) and 25 reported factors associated with retention. Pooled estimates of retention were 72.9% (95% confidence interval: 66.4% to 78.9%) at 6 months for studies reporting <12 months of follow-up and 76.4% (95% confidence interval: 69.0% to 83.1%) at 12 months for studies reporting ≥12 months of follow-up. Data on undocumented clinic transfers were largely absent. Risk factors for poor retention included younger age, initiating antiretroviral therapy on the same day as diagnosis, initiating during pregnancy versus breastfeeding, and initiating late in the pregnancy. Retention was compromised by stigma, fear of disclosure, and lack of social support. CONCLUSIONS Retention rates in prevention of mother-to-child transmission under option B+ were below those of the general adult population, necessitating interventions targeting the complex circumstances of women initiating care under option B+. Improved and standardized procedures to track and report retention are needed to accurately represent care engagement and capture undocumented transfers within the health system.
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Kristunas CA, Hemming K, Eborall H, Eldridge S, Gray LJ. The current use of feasibility studies in the assessment of feasibility for stepped-wedge cluster randomised trials: a systematic review. BMC Med Res Methodol 2019; 19:12. [PMID: 30630416 PMCID: PMC6327386 DOI: 10.1186/s12874-019-0658-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 01/02/2019] [Indexed: 11/12/2022] Open
Abstract
Background Stepped-wedge cluster randomised trials (SW-CRTs) are a pragmatic trial design, providing an unprecedented opportunity to increase the robustness of evidence underpinning implementation and quality improvement interventions. Given the complexity of the SW-CRT, the likelihood of trials not delivering on their objectives will be mitigated if a feasibility study precedes the definitive trial. It is not currently known if feasibility studies are being conducted for SW-CRTs nor what the objectives of these studies are. Methods Searches were conducted of several databases to identify published feasibility studies which were designed to inform a future SW-CRT. For each eligible study, data were extracted on the characteristics of and rationale for the feasibility study; the process for determining progression to the main trial; how the feasibility study informed the main trial; and whether the main trial went ahead. A narrative synthesis and descriptive analysis are presented. Results Eleven feasibility studies were identified, which included eight completed study reports and three protocols. Three studies used a stepped-wedge design and these were the only studies to be randomised. Studies were predominantly of a mixed-methods design. Only one study assessed specific features related to the feasibility of using a SW-CRT and one investigated the time taken to complete the study procedures. The other studies were mostly assessing the feasibility and acceptability of the intervention. Conclusion Published feasibility studies for SW-CRTs are scarce and those that are being reported do not investigate issues specific to the complexities of the trial design. When conducting feasibility studies in advance of a definitive SW-CRT, researchers should consider assessing the feasibility of study procedures, particularly those specific to the SW-CRT design, and ensure that the findings are published for the benefit of other researchers. Electronic supplementary material The online version of this article (10.1186/s12874-019-0658-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Helen Eborall
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
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Watt MH, Cichowitz C, Kisigo G, Minja L, Knettel BA, Knippler ET, Ngocho J, Manavalan P, Mmbaga BT. Predictors of postpartum HIV care engagement for women enrolled in prevention of mother-to-child transmission (PMTCT) programs in Tanzania. AIDS Care 2018; 31:687-698. [PMID: 30466304 DOI: 10.1080/09540121.2018.1550248] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Prevention of mother-to-child transmission of HIV (PMTCT) is a foundational component of a comprehensive HIV treatment program. In addition to preventing vertical transmission to children, PMTCT is an important catch-point for universal test-and-treat strategies that can reduce community viral load and slow the epidemic. However, systematic reviews suggest that care engagement in PMTCT programs is sub-optimal. This study enrolled a cohort of 200 women initiating PMTCT in Kilimanjaro, Tanzania, and followed them to assess HIV care engagement and associated factors. Six months after delivery, 42/200 (21%) of participants were identified as having poor care engagement, defined as HIV RNA >200 copies/mL or, if viral load was unavailable, being lost-to-follow-up in the clinical records or self-reporting being out of care. In a multivariable risk factor analysis, younger women were more likely to have poor postpartum care engagement; with each year of age, women were 7% less likely to have poor care engagement (aRR: 0.93; 95% CI: 0.89, 0.98). Additionally, women who had told at least one person about their HIV status were 47% less likely to have poor care engagement (aRR: .53; 95% CI: 0.29, 0.97). Among women who entered antenatal care with an established HIV diagnosis, those who were pregnant for the first time had increased risk of poor care engagement (aRR 4.16; 95% CI 1.53, 11.28). The findings suggest that care engagement remains a concern in PMTCT programs, and must be addressed to realize the goals of PMTCT. Comprehensive counseling on HIV disclosure, along with community-based stigma reduction programs to provide a supportive environment for people living with HIV, are crucial to address barriers to care engagement and support long-term treatment. Women presenting to antenatal care with an established HIV status require support for care engagement during the crucial period surrounding childbirth, particularly those pregnant for the first time.
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Affiliation(s)
- Melissa H Watt
- a Duke Global Health Institute , Duke University , Durham , NC , USA
| | - Cody Cichowitz
- a Duke Global Health Institute , Duke University , Durham , NC , USA.,b School of Medicine, Johns Hopkins University , Baltimore , MD , USA
| | - Godfrey Kisigo
- a Duke Global Health Institute , Duke University , Durham , NC , USA.,c Kilimanjaro Clinical Research Institute , Moshi , Tanzania
| | - Linda Minja
- c Kilimanjaro Clinical Research Institute , Moshi , Tanzania
| | - Brandon A Knettel
- a Duke Global Health Institute , Duke University , Durham , NC , USA
| | | | - James Ngocho
- d Kilimanjaro Christian Medical Centre , Moshi , Tanzania.,e Kilimanjaro Christian Medical University College , Moshi , Tanzania
| | - Preeti Manavalan
- a Duke Global Health Institute , Duke University , Durham , NC , USA
| | - Blandina T Mmbaga
- a Duke Global Health Institute , Duke University , Durham , NC , USA.,c Kilimanjaro Clinical Research Institute , Moshi , Tanzania.,d Kilimanjaro Christian Medical Centre , Moshi , Tanzania.,e Kilimanjaro Christian Medical University College , Moshi , Tanzania
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Hoffmann CJ, Milovanovic M, Kinghorn A, Kim HY, Motlhaoleng K, Martinson NA, Variava E. Value stream mapping to characterize value and waste associated with accessing HIV care in South Africa. PLoS One 2018; 13:e0201032. [PMID: 30040836 PMCID: PMC6057670 DOI: 10.1371/journal.pone.0201032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 07/06/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Inefficient clinic-level delivery of HIV services is a barrier to linkage and engagement in care. We used value stream mapping to quantify time spent on each component of a clinic visit while receiving care following a hospital admission in South Africa. METHODS We described time for each clinic service ("process time") and time spent waiting for that service ("lead time"). We also determined time and patient costs associated with travel to the clinic and expenditures during the clinic visits for 15 clinic visits in South Africa. Participants were selected consecutively based on timing of scheduled clinic visit from a cohort of HIV-positive patients recently discharged from inpatient hospital care. During the mapping we asked the participants to assess challenges faced at the clinic visit. We subsequently conducted in depth interviews and included themes from the care experience in this analysis. RESULTS The 15 clinic visits occurred at five clinics; four primary care and one hospital-based specialty clinic. Nine (64%) of the participants were women, the median age was 44 years (IQR: 32-49), three of the participants had one or more clinic visit in the prior 14 days, all but one participant was on antiretroviral therapy (ART) at the time of the clinic visit (ART was stopped following the hospital visit for that participant). The median time since hospital discharge was 131 days (interquartile range; IQR: 121-183) for the observed visits. The median travel time to and from the clinic to a place of residence was 60 minutes. The median time spent at the clinic was 3.5 hours (IQR: 2.5-5.3) of which 2.9 hours was lead time and 25 minutes was process time (registration, vital signs, clinician assessment, laboratory, and check-out). The median patient cost for transport and food while at the clinic was ZAR43/USD2.8 (median monthly household income in the district was ZAR2450/USD157). Participants highlighted long queues, repeat clinic visits, and multiple queues during the visit (median of 5 queues) as challenges. CONCLUSIONS Accessing HIV care in South Africa is time consuming, complicated by multiple queues and frequent visits. A more patient-centered approach to care may decrease the burden of receiving care and improve outcomes.
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Affiliation(s)
- Christopher J. Hoffmann
- Johns Hopkins University School of Medicine, Baltimore, United States of America
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States of America
- * E-mail:
| | - Minja Milovanovic
- Perinatal HIV Research Unit, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Anthony Kinghorn
- Perinatal HIV Research Unit, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Hae-Young Kim
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States of America
| | - Katlego Motlhaoleng
- Perinatal HIV Research Unit, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Neil A. Martinson
- Perinatal HIV Research Unit, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Ebrahim Variava
- Department of Internal Medicine, Klerksdorp Tshepong Hospital Complex and the University of the Witwatersrand, Klerksdorp, South Africa
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Omonaiye O, Kusljic S, Nicholson P, Manias E. Medication adherence in pregnant women with human immunodeficiency virus receiving antiretroviral therapy in sub-Saharan Africa: a systematic review. BMC Public Health 2018; 18:805. [PMID: 29945601 PMCID: PMC6020364 DOI: 10.1186/s12889-018-5651-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of antiretroviral therapy (ART) is a core strategy proposed by the World Health Organization in preventing mother to child transmission (MTCT) of HIV. This systematic review aimed to examine the enablers and barriers of medication adherence among HIV positive pregnant women in sub-Saharan Africa. METHODS We used the following keywords: HIV AND (Pregnancy OR Pregnant*) AND (PMTCT OR "PMTCT Cascade" OR "Vertical Transmission" OR "Mother-to-Child") AND (Prevent OR Prevention) AND (HAART OR "Antiretroviral Therapy" OR "Triple Therapy") AND (Retention OR Concordance OR Adherence OR Compliance) to conduct electronic searches in the following databases: MEDLINE Complete (1916-Dec 2017), Embase (1947-Dec 2017), Global Health (1910-Dec 2017) and CINAHL Complete (1937-Dec 2017). Of the four databases searched, 401 studies were identified with 44 meeting the inclusion criteria. Seven studies were added after searching reference lists of included articles, resulting in 51 articles in total. RESULTS The review demonstrated that stigma, cost of transportation, food deprivation and a woman's disclosure or non-disclosure of her HIV status to a partner, family and the community, could limit or define the extent of her adherence to prescribed antiretroviral drugs during pregnancy. Furthermore, the review indicated that knowledge of HIV status, either before or during pregnancy, was significantly associated with medication adherence. Women who knew their HIV status before pregnancy demonstrated good adherence while women who found out their HIV infection status during pregnancy were linked with non-adherence to ART. CONCLUSION This review revealed several barriers and enablers of adherence among pregnant women taking ART in sub-Saharan Africa. Major barriers included the fear of HIV infection status disclosure to partners and family members, stigma and discrimination. A major enabler of adherence in women taking ART was women's knowledge of their HIV status prior to becoming pregnant. Enhanced effort is needed to facilitate women's knowledge of their HIV status before pregnancy to enable disease acceptance and management, and to support pregnant women and her partner and family in dealing with fear, stigma and discrimination about HIV.
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Affiliation(s)
- Olumuyiwa Omonaiye
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood Campus, Melbourne, VIC, 3125, Australia.
| | - Snezana Kusljic
- Department of Nursing, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Pat Nicholson
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood Campus, Melbourne, VIC, 3125, Australia
| | - Elizabeth Manias
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood Campus, Melbourne, VIC, 3125, Australia
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Retention in HIV Care During Pregnancy and the Postpartum Period in the Option B+ Era: Systematic Review and Meta-Analysis of Studies in Africa. JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES (1999) 2018. [PMID: 29287029 DOI: 10.1097/qai.000000000001616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Under Option B+ guidelines for prevention of mother-to-child transmission of HIV, pregnant and breastfeeding women initiate antiretroviral therapy for lifelong use. The objectives of this study were: (1) to synthesize data on retention in care over time in option B+ programs in Africa, and (2) to identify factors associated with retention in care. METHODS PubMed, EMBASE, and African Index Medicus were systematically searched from January 2012 to June 2017. Pooled estimates of the proportion of women retained were generated and factors associated with retention were analyzed thematically. RESULTS Thirty-five articles were included in the final review; 22 reported retention rates (n = 60,890) and 25 reported factors associated with retention. Pooled estimates of retention were 72.9% (95% confidence interval: 66.4% to 78.9%) at 6 months for studies reporting <12 months of follow-up and 76.4% (95% confidence interval: 69.0% to 83.1%) at 12 months for studies reporting ≥12 months of follow-up. Data on undocumented clinic transfers were largely absent. Risk factors for poor retention included younger age, initiating antiretroviral therapy on the same day as diagnosis, initiating during pregnancy versus breastfeeding, and initiating late in the pregnancy. Retention was compromised by stigma, fear of disclosure, and lack of social support. CONCLUSIONS Retention rates in prevention of mother-to-child transmission under option B+ were below those of the general adult population, necessitating interventions targeting the complex circumstances of women initiating care under option B+. Improved and standardized procedures to track and report retention are needed to accurately represent care engagement and capture undocumented transfers within the health system.
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McLean E, Renju J, Wamoyi J, Bukenya D, Ddaaki W, Church K, Zaba B, Wringe A. 'I wanted to safeguard the baby': a qualitative study to understand the experiences of Option B+ for pregnant women and the potential implications for 'test-and-treat' in four sub-Saharan African settings. Sex Transm Infect 2017; 93:sextrans-2016-052972. [PMID: 28736391 PMCID: PMC5739848 DOI: 10.1136/sextrans-2016-052972] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 03/24/2017] [Accepted: 04/03/2017] [Indexed: 11/04/2022] Open
Abstract
Objective To explore what influences on engagement with Option B+ in four sub-Saharan African settings. Methods In-depth interviews were conducted in 2015, with 22 HIV-positive women who had been pregnant since Option B+ was available, and 15 healthcare workers (HCWs) involved in HIV service delivery. Participants were purposely selected from four health and demographic surveillance sites in Malawi, Tanzania and Uganda. A thematic content analysis was conducted to investigate what influenced engagement with Option B+. Results Feeling ‘ready’ was key to pregnant women accepting antiretroviral treatment (ART) on the same day as diagnosis at antenatal clinic; this was influenced by previous knowledge of HIV-positive status, interactions with HCWs and relationship with their partners. The desire to protect their unborn infant was the main issue that motivated women to initiate treatment, temporarily over-riding barriers to starting ART. Many HCWs recognised that pressurising women into starting ART may lead them to stop treatment following delivery. However, their own responsibility to protect the infant sometimes drove HCWs to use strong persuasive techniques to initiate pregnant women onto ART as early as possible, occasionally causing women to disengage. Conclusions Protecting the baby superseded feelings of unpreparedness for lifelong ART and may explain poor retention observed in Option B+ programmes. Women may benefit from more time to accept their status, and counselling on the long-term value of ART beyond the pregnancy and breastfeeding period. Strategies to promote readiness for same-day initiation of lifelong treatment are urgently needed, and may provide important lessons for universal test-and-treat implementation.
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Affiliation(s)
- Estelle McLean
- Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jenny Renju
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Joyce Wamoyi
- National Institute for Medical Research, Mwanza, Tanzania
| | - Dominic Bukenya
- Medical Research Council/Uganda Virus Research Institute Research Unit on AIDS, Entebbe, Uganda
| | | | - Kathryn Church
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Basia Zaba
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Alison Wringe
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Stepped-Wedge Cluster Randomized Controlled Trial to Promote Option B+ Retention in Central Mozambique. J Acquir Immune Defic Syndr 2017; 76:273-280. [PMID: 28777263 DOI: 10.1097/qai.0000000000001515] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND This randomized trial studied performance of Option B+ in Mozambique and evaluated an enhanced retention package in public clinics. SETTING The study was conducted at 6 clinics in Manica and Sofala Provinces in central Mozambique. METHODS Seven hundred sixty-one pregnant women tested HIV+, immediately initiated antiretroviral (ARV) therapy, and were followed to track retention at 6 clinics from May 2014 to May 2015. Clinics were randomly allocated within a stepped-wedge fashion to intervention and control periods. The intervention included (1) workflow modifications and (2) active patient tracking. Retention was defined as percentage of patients returning for 30-, 60-, and 90-day medication refills within 25-35 days of previous refills. RESULTS During control periods, 52.3% of women returned for 30-day refills vs. 70.8% in intervention periods [odds ratio (OR): 1.80; 95% confidence interval (CI): 1.05 to 3.08]. At 60 days, 46.1% control vs. 57.9% intervention were retained (OR: 1.82; CI: 1.06 to 3.11), and at 90 days, 38.3% control vs. 41.0% intervention (OR: 1.04; CI: 0.60 to 1.82). In prespecified subanalyses, birth before pickups was strongly associated with failure-women giving birth before ARV pickup were 33.3 times (CI: 4.4 to 250.3), 7.5 times (CI: 3.6 to 15.9), and 3.7 times (CI: 2.2 to 6.0) as likely to not return for ARV pickups at 30, 60, and 90 days, respectively. CONCLUSIONS The intervention was effective at 30 and 60 days, but not at 90 days. Combined 90-day retention (40%) and adherence (22.5%) were low. Efforts to improve retention are particularly important for women giving birth before ARV refills.
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A group randomized trial using an appointment system to improve adherence to ART at reproductive and child health clinics implementing Option B+ in Tanzania. PLoS One 2017; 12:e0184591. [PMID: 28957381 PMCID: PMC5619716 DOI: 10.1371/journal.pone.0184591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/18/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION In October 2013, Tanzania adopted Option B+ under which HIV-positive pregnant women are initiated on antiretroviral therapy in reproductive and child health clinics at diagnosis. Studies have shown that adherence and retention to antiretroviral treatment can be problematic. METHODS We implemented a group randomized controlled trial in 24 reproductive and child health clinics in eight districts in Mbeya region. The trial tested the impact of implementing paper-based appointment tracking and community outreach systems on the rate of missed appointments and number of days covered by dispensed antiretroviral medications among women previously established on antiretroviral therapy. We used interrupted time series analysis to assess study outcomes. Clinic staff and patients in intervention clinics were aware of the intervention because of change in clinic procedures; data collectors knew the study group assignment. RESULTS Three months pre-intervention, we identified 1924 and 1226 patients established on antiretroviral therapy for six months or more in intervention and control clinics, respectively, of whom 83.4% and 86.9% had one or more post-intervention visits. The unadjusted rate of missed visits declined from 36.5% to 34.4% in intervention clinics and increased from 38.9% to 45.5% in control clinics following the intervention. Interrupted time series analyses demonstrated a net decrease of 13.7% (95% CI [-15.4,-12.1]) for missed visits at six months post-intervention. Similar differential changes were observed for visits missed by 3, 7, 15, or 60 days. CONCLUSION Appointment-tracking and community outreach significantly improved appointment-keeping for women on antiretroviral therapy. The facility staff controlled their workload better, identified missing patients rapidly, and worked with existing community organizations. There is now enough evidence to scale up this approach to all antiretroviral therapy and Option B+ reproductive and child health clinics in Tanzania as well as to evaluate the intervention in medical clinics that treat other chronic health conditions. TRIAL REGISTRATION Registry for International Development Impact Evaluations ID-55310280d8757.
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Naburi H, Mujinja P, Kilewo C, Orsini N, Bärnighausen T, Manji K, Biberfeld G, Sando D, Geldsetzer P, Chalamila G, Ekström AM. Job satisfaction and turnover intentions among health care staff providing services for prevention of mother-to-child transmission of HIV in Dar es Salaam, Tanzania. HUMAN RESOURCES FOR HEALTH 2017; 15:61. [PMID: 28874156 PMCID: PMC5585985 DOI: 10.1186/s12960-017-0235-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 08/25/2017] [Indexed: 05/31/2023]
Abstract
BACKGROUND Option B+ for the prevention of mother-to-child transmission (PMTCT) of HIV (i.e., lifelong antiretroviral treatment for all pregnant and breastfeeding mothers living with HIV) was initiated in Tanzania in 2013. While there is evidence that this policy has benefits for the health of the mother and the child, Option B+ may also increase the workload for health care providers in resource-constrained settings, possibly leading to job dissatisfaction and unwanted workforce turnover. METHODS From March to April 2014, a questionnaire asking about job satisfaction and turnover intentions was administered to all nurses at 36 public-sector health facilities offering antenatal and PMTCT services in Dar es Salaam, Tanzania. Multivariable logistic regression models were used to identify factors associated with job dissatisfaction and intention to quit one's job. RESULTS Slightly over half (54%, 114/213) of the providers were dissatisfied with their current job, and 35% (74/213) intended to leave their job. Most of the providers were dissatisfied with low salaries and high workload, but satisfied with workplace harmony and being able to follow their moral values. The odds of reporting to be globally dissatisfied with one's job were high if the provider was dissatisfied with salary (adjusted odds ratio (aOR) 5.6, 95% CI 1.2-26.8), availability of protective gear (aOR 4.0, 95% CI 1.5-10.6), job description (aOR 4.3, 95% CI 1.2-14.7), and working hours (aOR 3.2, 95% CI 1.3-7.6). Perceiving clients to prefer PMTCT Option B+ reduced job dissatisfaction (aOR 0.2, 95% CI 0.1-0.8). The following factors were associated with providers' intention to leave their current job: job stability dissatisfaction (aOR 3.7, 95% CI 1.3-10.5), not being recognized by one's superior (aOR 3.6, 95% CI 1.7-7.6), and poor feedback on the overall unit performance (aOR 2.7, 95% CI 1.3-5.8). CONCLUSION Job dissatisfaction and turnover intentions are comparatively high among nurses in Dar es Salaam's public-sector maternal care facilities. Providing reasonable salaries and working hours, clearer job descriptions, appropriate safety measures, job stability, and improved supervision and feedback will be key to retaining satisfied PMTCT providers and thus to sustain successful implementation of Option B+ in Tanzania.
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Affiliation(s)
- Helga Naburi
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
| | - Phares Mujinja
- School of Public Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Charles Kilewo
- Departments of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Nicola Orsini
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Till Bärnighausen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Africa Health Research Institute (AHRI), Mtubatuba, South Africa
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Karim Manji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Gunnel Biberfeld
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - David Sando
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Management and Development for Health (MDH) Organisation, Dar es Salaam, Tanzania
| | - Pascal Geldsetzer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Guerino Chalamila
- Management and Development for Health (MDH) Organisation, Dar es Salaam, Tanzania
| | - Anna Mia Ekström
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Huddinge, Stockholm, Sweden
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Gugsa S, Potter K, Tweya H, Phiri S, Sande O, Sikwese P, Chikonda J, O’Malley G. Exploring factors associated with ART adherence and retention in care under Option B+ strategy in Malawi: A qualitative study. PLoS One 2017. [PMID: 28636669 PMCID: PMC5479573 DOI: 10.1371/journal.pone.0179838] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Although several studies have documented challenges related to inadequate adherence to antiretroviral therapy (ART) and high loss to follow-up (LTFU) among Option B+ women, there is limited understanding of why these challenges occur and how to address them. This qualitative study examines women's experiences with ART adherence and retention in care. Between July and October 2015, in-depth interviews were conducted with 39 pregnant and lactating women who initiated ART at Bwaila Hospital in Lilongwe, Malawi. Study participants included 14 in care and 25 out of care women, according to facility records. Data were analyzed using an inductive, open-coding approach to thematic analysis. Ten of the respondents (7 out of care, 3 in-care) had stopped and re-started treatment before the interview date. One of the most important factors influencing adherence and retention was the strength of women's support systems. In contrast to women in-care, most out-of-care women lacked emotional and financial support from male partners, received minimal counseling from providers at initiation, lacked designated guardians to assist with medication refills or clinic appointments, and were highly mobile. Mobility led to difficulties in accessing treatment in new settings. The most common reasons women re-started treatment following interruptions were due to providers' counseling and encouragement and the mother's desire to be healthy. Improved counseling at initiation, active follow-up counseling, women's economic empowerment interventions, promotion of peer counseling schemes and meaningful engagement of male partners can help in addressing the identified barriers and promoting sustained retention of Option B+ women.
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Affiliation(s)
- Salem Gugsa
- Lighthouse Trust, Lilongwe, Malawi
- International Training and Education Center for Health (I-TECH), University of Washington Department of Global Health, Seattle, Washington, United States of America
- * E-mail:
| | - Katy Potter
- International Training and Education Center for Health (I-TECH), University of Washington Department of Global Health, Seattle, Washington, United States of America
| | - Hannock Tweya
- Lighthouse Trust, Lilongwe, Malawi
- The International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Sam Phiri
- Lighthouse Trust, Lilongwe, Malawi
- University of North Carolina, School of Medicine, Department of Medicine, Chapel Hill, North Carolina, United States of America
- University of Malawi, College of Medicine, School of Public Health and Family Medicine, Department of Public Health, Lilongwe, Malawi
| | | | | | - Janet Chikonda
- Ministry of Health, District Health Office, Lilongwe, Malawi
| | - Gabrielle O’Malley
- International Training and Education Center for Health (I-TECH), University of Washington Department of Global Health, Seattle, Washington, United States of America
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Wagenaar BH, Gimbel S, Hoek R, Pfeiffer J, Michel C, Cuembelo F, Quembo T, Afonso P, Gloyd S, Lambdin BH, Micek MA, Porthé V, Sherr K. Wait and consult times for primary healthcare services in central Mozambique: a time-motion study. Glob Health Action 2016; 9:31980. [PMID: 27580822 PMCID: PMC5007246 DOI: 10.3402/gha.v9.31980] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/19/2016] [Accepted: 08/06/2016] [Indexed: 11/17/2022] Open
Abstract
Background We describe wait and consult times across public-sector clinics and identify health facility determinants of wait and consult times. Design We observed 8,102 patient arrivals and departures from clinical service areas across 12 public-sector clinics in Sofala and Manica Provinces between January and April 2011. Negative binomial generalized estimating equations were used to model associated health facility factors. Results Mean wait times (in minutes) were: 26.1 for reception; 43.5 for outpatient consults; 58.8 for antenatal visits; 16.2 for well-child visits; 8.0 for pharmacy; and 15.6 for laboratory. Mean consultation times (in minutes) were: 5.3 for outpatient consults; 9.4 for antenatal visits; and 2.3 for well-child visits. Over 70% (884/1,248) of patients arrived at the clinic to begin queuing for general reception prior to 10:30 am. Facilities with more institutional births had significantly longer wait times for general reception, antenatal visits, and well-child visits. Clinics in rural areas had especially shorter wait times for well-child visits. Outpatient consultations were significantly longer at the smallest health facilities, followed by rural hospitals, tertiary/quaternary facilities, compared with Type 1 rural health centers. Discussion The average outpatient consult in Central Mozambique lasts 5 min, following over 40 min of waiting, not including time to register at most clinics. Wait times for first antenatal visits are even longer at almost 1 h. Urgent investments in public-sector human resources for health alongside innovative operational research are needed to increase consult times, decrease wait times, and improve health system responsiveness.
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Affiliation(s)
- Bradley H Wagenaar
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA.,Health Alliance International, Seattle, WA, USA;
| | - Sarah Gimbel
- Health Alliance International, Seattle, WA, USA.,Department of Family Child Nursing, University of Washington, Seattle, WA, USA
| | - Roxanne Hoek
- Health Alliance International, Beira, Mozambique.,Beira Operations Research Center, Ministry of Health, Beira, Mozambique
| | - James Pfeiffer
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA.,Health Alliance International, Seattle, WA, USA
| | - Cathy Michel
- Health Alliance International, Beira, Mozambique
| | - Fatima Cuembelo
- Community Health Department, School of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Titos Quembo
- Health Alliance International, Beira, Mozambique.,Beira Operations Research Center, Ministry of Health, Beira, Mozambique
| | - Pires Afonso
- Health Alliance International, Beira, Mozambique.,Beira Operations Research Center, Ministry of Health, Beira, Mozambique
| | - Stephen Gloyd
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA.,Health Alliance International, Seattle, WA, USA
| | - Barrot H Lambdin
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA.,Pangea Global AIDS, Oakland, CA, USA
| | - Mark A Micek
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA.,Health Alliance International, Seattle, WA, USA
| | - Victoria Porthé
- Health Alliance International, Beira, Mozambique.,Beira Operations Research Center, Ministry of Health, Beira, Mozambique
| | - Kenneth Sherr
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA.,Health Alliance International, Seattle, WA, USA
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