An assessment of HIV patient's adherence to treatment and need for pharmaceutical care in Jordan

HIV- related knowledge, attitude, practices, and stigma among healthcare providers caring for HIV in Jordan: Identification of several organizational challenges

Background

There is a paucity of data on Healthcare Providers (HCPs) caring for people living with HIV in Jordan.

Objective

We aimed to understand HCPs' knowledge, attitude, stigma, and practices, to assess the gaps in HIV care in Jordan.

Methods

We conducted recorded in-depth interviews with all five HCPs working at the only HIV Service Center in Jordan, using semi-structured questions in 2021. Content analysis was performed.

Results

Several organizational challenges were identified. Only one had received HIV training. All were uncertain of updated recommendations with little knowledge of international guidelines, vertical transmission, contraception, sexually transmitted infections (STIs), non-communicable diseases (NCDs), and prophylaxis. Four HCPs perform counseling, focusing on easing anxieties, risk modification, and the importance of treatment adherence. However, their counseling on contraception, risk of transmission, STIs, and NCDs is inadequate, and they have little-to-no experience with prophylaxis. Most had a positive attitude towards people living with HIV, especially HCPs working at the center the longest, encouraging marriage and reproduction. Most do not approve of mandatory testing, or of breaching patient confidentiality. They repetitively described risky behavior as 'immoral behavior', empathizing more with patients who caught HIV through blood transfusion or birth, and demonstrating embedded stigmatized beliefs. They reported people living with HIV experience anticipated stigma and stigma by their general community including by other HCPs.

Conclusion

This is the first study on HCPs caring for people living with HIV in Jordan. It highlights the suboptimal knowledge, practices, and stigma which improve with greater participatory exposure to HIV care. HCPs had an overall positive attitude, more evident in HCPs working at the clinic the longest.

Scoping review of sexual and reproductive healthcare for men in the MENA (Middle East and North Africa) region: a handful of paradoxes?

Background

No study appraised the knowledge gaps and factors impacting men’s sexual and reproductive health (SRH) in MENA (Middle East and North Africa). The current scoping review undertook this task.

Methods

We searched PubMed and Web of Science (WoS) electronic databases for original articles on men’s SRH published from MENA. Data was extracted from the selected articles and mapped out employing the WHO framework for operationalising SRH. Analyses and data synthesis identified the factors impacting on men’s experiences of and access to SRH.

Results

A total of 98 articles met the inclusion criteria and were included in the analysis. The majority of studies focused on HIV and other sexually transmissible infections (67%); followed by comprehensive education and information (10%); contraception counselling/provision (9%); sexual function and psychosexual counselling (5%); fertility care (8%); and gender-based violence prevention, support/care (1%). There were no studies on antenatal/intrapartum/postnatal care and on safe abortion care (0% for both). Conceptually, there was lack of knowledge of the different domains of men’s SRH, with negative attitudes, and many misconceptions; as well as a deficiency of health system policies, strategies and interventions for SRH.

Conclusion

Men’s SRH is not sufficiently prioritized. We observed five ‘paradoxes’: strong focus on HIV/AIDS, when MENA has low prevalence of HIV; weak focus on both fertility and sexual dysfunctions, despite their high prevalence in MENA; no publications on men’s involvement in sexual gender-based violence, despite its frequency across MENA; no studies of men’s involvement in antenatal/intrapartum/postnatal care, despite the international literature valuing such involvement; and, many studies identifying lack of SRH knowledge, but no publications on policies and strategies addressing such shortcoming. These ‘mismatches’ suggest the necessity for efforts to enhance the education of the general population and healthcare workers, as well as improvements across MENA health systems, with future research examining their effects on men’s SRH.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14716-2.

Meaning in life, goals, and adherence to antiretroviral treatment in people living with HIV

Patients living with HIV who do not adhere to antiretroviral treatment (ART) have a high viral load, increasing the risk of developing AIDS, as well as new treatment-resistant strains. There are several psychological factors that must be studied to understand the reasons for non-adherence to ART. We studied whether the goals reported by patients with HIV, as well as their sense of meaning in life, influence ART adherence in a sample of adult patients attending HIV outpatient care in Mexico. Participants completed the Antiretroviral Treatment Adherence Assessment Questionnaire, the Dimensional Scale of Meaning in Life and were asked to write both short-term and long-term goals. The most frequent goals reported were those categorized as "personal development," followed by "being healthy." Participants with the highest adherence had more short-term "personal development" goals. Moreover, they showed the lowest levels of existential vacuum (lack of meaning in life). These variables predicted treatment adherence. We conclude that the design of programs to improve ART adherence should promote the establishment of personal development goals and offer tools that allow having a sense of meaning in life to reduce AIDS-related complications.

A nationwide exploratory survey assessing perception, practice, and barriers toward pharmaceutical care provision among hospital pharmacists in Nepal

Pharmaceutical care (PC) services reduce medication errors, improve the use of medicines, and optimize the cost of treatment. It can detect medication-related problems and improve patient medication adherence. However, PC services are not commonly provided in hospital pharmacies in Nepal. Therefore, the present study was done to determine the situation of PC in hospital pharmacies and explore the perception, practice, and barriers (and their determinants) encountered by hospital pharmacists while providing PC. A descriptive online cross-sectional study was conducted from 25th March to 25th October 2021 among pharmacists with a bachelor’s degree and above working in hospital pharmacies using non-probability quota sampling. The questionnaire in English addressed perception and practice regarding PC, and barriers encountered and were validated by experts and pre-tested among 23 pharmacists. Descriptive statistics were used to describe the data. Kendall’s correlation was used to explore the correlations among various perception and practice constructs. The scores were also compared among subgroups of respondents using the Mann–Whitney test for subgroups with two categories and Kruskal–Wallis test for greater than two categories. A total of 144 pharmacists participated in the study. Majority of the participants were male, between 22 and 31 years of age, and had work experience between 10 and 20 years. Over 50% had received no training in PC. The perception scores were higher among those with more work experience and the practice scores among those who had received PC training. Participants agreed that there were significant barriers to providing PC, including lack of support from other professionals, lack of demand from patients, absence of guidelines, inadequate training, lack of skills in communication, lack of compensation, problems with access to the patient medical record, lack of remuneration, and problems with accessing objective medicine information sources. A correlation was noted between certain perceptions and practice-related constructs. Hospital pharmacists who participated had a positive perception and practice providing PC. However, PC was not commonly practised in hospital pharmacies. Significant barriers were identified in providing PC. Further studies, especially in the eastern and western provinces, are required. Similar studies may be considered in community pharmacies.