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Potential roles of pharmacists in HIV/AIDS care delivery in Nepal: A qualitative study. PLoS One 2023; 18:e0280160. [PMID: 36608028 PMCID: PMC9821491 DOI: 10.1371/journal.pone.0280160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 12/21/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Nepal is facing escalating infection rates of HIV/AIDS, a major global public health threat. Continuum of services is an identified strategic component of Joint United Nations Programme on HIV/AIDS (UNAIDS) commitment to end this public health crisis by 2030 and achieve the Sustainable Development Goal 6 (SDG 6). Pharmacists are integral members of the continuum of care in HIV/AIDS but the idea is novel to Nepal. Realizing need to explore and identify potential roles of pharmacists in HIV/AIDS care delivery, this study aimed to gain an insight into the views of stakeholders on the roles of pharmacists in this arena. METHODS A qualitative approach was used where 14 key informants were interviewed using a semi-structured interview protocol. Participants were selected through a sequence of purposive sampling and snowball sampling technique. The interviews were conducted, transcribed verbatim and analyzed using thematic analysis. RESULTS Potential roles of pharmacists reside in adherence monitoring, pharmacovigilance, provincial and district level ART centers. Pharmacists and other stakeholders held divergent views on the pharmacist's role in dispensing and counseling antiretroviral medications. Barriers to the pharmacists' involvement were lack of workforce, advocacy and government support, frailty of professional organizations, self-limited scope, policy constraints, structural limitations, biasedness, and societal unawareness. Pharmacists themselves and organizations such as National Government Organizations (NGOs) and International Government Organizations (INGOs) were identified as the facilitators. CONCLUSION Stakeholders are willing to expand role of pharmacists in HIV/AIDS care in Nepal. Nevertheless, some crucial impediments exist. Primarily, an aggressive and assertive advocacy is needed from pharmacists themselves and their professional organizations to establish their roles in HIV/AIDS care delivery. Additionally, unearthing potential of pharmacists as contributors in HIV/AIDS care delivery or any other chronic disease management equally demands a strong support from the government officials as well as the other health care professionals.
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Wong A, Hung KKC, Mabhala M, Tenney JW, Graham CA. Filling the Gaps in the Pharmacy Workforce in Post-Conflict Areas: Experience from Four Countries in Sub-Saharan Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158132. [PMID: 34360423 PMCID: PMC8346012 DOI: 10.3390/ijerph18158132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/21/2021] [Accepted: 07/28/2021] [Indexed: 11/23/2022]
Abstract
Background: While the pharmacy workforce is the third largest professional healthcare group worldwide, the pharmacy workforce landscape remains unclear in post-conflict areas in sub-Saharan Africa. Method: Key informants were selected for semi-structured interviews due to their role in providing pharmacy services in the selected country: the Central African Republic (CAR), the Democratic Republic of Congo (DRC), Ethiopia, and South Sudan. Transcripts from the interviews were anonymized, coded, and analyzed. Results: Nine participants were recruited (CAR: 2; DRC: 2; Ethiopia: 2; South Sudan: 3), and all except two were pharmacists. Conflict-specific challenges in pharmacy service delivery were identified as the following: unpredictable health needs and/or mismatched pharmaceutical supply, transport difficulties due to insecure roads, and shortage of pharmacy workforce due to brain drain or interrupted schooling. Barriers to health workforce retention and growth were identified to be brain drain as a result of suboptimal living and working conditions or remuneration, the perception of an unsafe work environment, and a career pathway or commitment duration that does not fit the diaspora or expatriate staff. Conclusion: To tackle the barriers of pharmacy health workforce retention and growth, policy solutions will be required and efforts that can bring about long-term improvement should be prioritized. This is essential to achieve universal health coverage and the targets of the sustainable development goals for conflict affected areas, as well as to “leave no one behind”.
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Affiliation(s)
- Anabelle Wong
- The Institute of Public Health, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany;
- Max Planck Institute for Infection Biology, 10117 Berlin, Germany
| | - Kevin K. C. Hung
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China;
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong, China
- Correspondence:
| | - Mzwandile Mabhala
- Department of Public Health and Wellbeing, University of Chester, Chester CH1 4BJ, UK;
| | - Justin W. Tenney
- School of Pharmacy, West Coast University, Los Angeles, CA 92617-3040, USA;
| | - Colin A. Graham
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China;
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong, China
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Sianturi EI, Latifah E, Pane M, Perwitasari DA, Satibi, Kristina SA, Hastuti EB, Pavlovich J, Taxis K. Knowledge, empathy, and willingness to counsel patients with HIV among Indonesian pharmacists: a national survey of stigma. AIDS Care 2021; 34:21-28. [PMID: 33565323 DOI: 10.1080/09540121.2021.1883506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study aimed to assess the level of HIV treatment knowledge, empathy, and HIV stigma of pharmacy students and pharmacists working with patients as well as potential factors associated with stigma. This survey included 250 hospital pharmacists within 33 provinces and 1013 final-year pharmacy students from Java, the most populated island in Indonesia. The data were collected via Qualtrics® and distributed by WhatsApp. The mean age of the participants was (Mean ± SD) 24.68 ± 5.30 years, and 80.0% were female. The mean knowledge score of students and pharmacists were 14.14 ± 2.01 and 15.39 ± 1.87, respectively, out of the maximum score of 21. The mean empathy score of students and pharmacists was 72.06 ± 5.39 and 77.40 ± 1.35, respectively out of the maximum score of 105. The mean stigma score of students and pharmacists was 21.02 ± 4.65 and 20.66 ± 4.41, respectively, out of a maximum score of 48. Regression analysis showed that knowledge, empathy, and willingness to counsel patients were negatively associated with stigma. Working with patients was positively associated with stigma. A multi-level intervention including education may reduce stigma and strengthen the role of pharmacists in caring for patients.
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Affiliation(s)
- E I Sianturi
- PharmacoTherapy, -Epidemiology and -Economics (PTEE), Department of Pharmacy, University of Groningen, Groningen, Netherlands.,Faculty of Mathematics and Natural Sciences, University of Cenderawasih, Papua, Indonesia
| | - E Latifah
- Department of Pharmacy, Faculty of Health Science, Universitas Muhammadiyah Magelang, Magelang, Indonesia.,Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - M Pane
- National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia.,Indonesia Epidemiological Association Perhimpunan Ahli Epidemiologi Indonesia (PAEI), Jakarta, Indonesia.,Public Health Post-Graduate Program, University of Sari Mutiara Indonesia, Medan, Indonesia
| | - D A Perwitasari
- Faculty of Pharmacy, University of Ahmad Dahlan, Yogyakarta, Indonesia
| | - Satibi
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - S A Kristina
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - E B Hastuti
- Directorate General of Diseases Control, Ministry of Health Republic of Indonesia, Indonesia
| | - J Pavlovich
- PharmacoTherapy, -Epidemiology and -Economics (PTEE), Department of Pharmacy, University of Groningen, Groningen, Netherlands
| | - K Taxis
- PharmacoTherapy, -Epidemiology and -Economics (PTEE), Department of Pharmacy, University of Groningen, Groningen, Netherlands
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Mbuagbaw L, Hajizadeh A, Wang A, Mertz D, Lawson DO, Smieja M, Benoit AC, Alvarez E, Puchalski Ritchie L, Rachlis B, Logie C, Husbands W, Margolese S, Zani B, Thabane L. Overview of systematic reviews on strategies to improve treatment initiation, adherence to antiretroviral therapy and retention in care for people living with HIV: part 1. BMJ Open 2020; 10:e034793. [PMID: 32967868 PMCID: PMC7513605 DOI: 10.1136/bmjopen-2019-034793] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 07/01/2020] [Accepted: 08/07/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES We sought to map the evidence and identify interventions that increase initiation of antiretroviral therapy, adherence to antiretroviral therapy and retention in care for people living with HIV at high risk for poor engagement in care. METHODS We conducted an overview of systematic reviews and sought for evidence on vulnerable populations (men who have sex with men (MSM), African, Caribbean and Black (ACB) people, sex workers (SWs), people who inject drugs (PWID) and indigenous people). We searched PubMed, Excerpta Medica dataBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science and the Cochrane Library in November 2018. We screened, extracted data and assessed methodological quality in duplicate and present a narrative synthesis. RESULTS We identified 2420 records of which only 98 systematic reviews were eligible. Overall, 65/98 (66.3%) were at low risk of bias. Systematic reviews focused on ACB (66/98; 67.3%), MSM (32/98; 32.7%), PWID (6/98; 6.1%), SWs and prisoners (both 4/98; 4.1%). Interventions were: mixed (37/98; 37.8%), digital (22/98; 22.4%), behavioural or educational (9/98; 9.2%), peer or community based (8/98; 8.2%), health system (7/98; 7.1%), medication modification (6/98; 6.1%), economic (4/98; 4.1%), pharmacy based (3/98; 3.1%) or task-shifting (2/98; 2.0%). Most of the reviews concluded that the interventions effective (69/98; 70.4%), 17.3% (17/98) were neutral or were indeterminate 12.2% (12/98). Knowledge gaps were the types of participants included in primary studies (vulnerable populations not included), poor research quality of primary studies and poorly tailored interventions (not designed for vulnerable populations). Digital, mixed and peer/community-based interventions were reported to be effective across the continuum of care. CONCLUSIONS Interventions along the care cascade are mostly focused on adherence and do not sufficiently address all vulnerable populations.
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Affiliation(s)
- Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
- Centre for the Develoment of Best Practices in Health, Yaounde Central Hospital, Yaounde, Cameroon
| | - Anisa Hajizadeh
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Annie Wang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Dominik Mertz
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Daeria O Lawson
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Division of Rheumatology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Marek Smieja
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anita C Benoit
- Women's College Research Institute, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - Lisa Puchalski Ritchie
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Beth Rachlis
- Division of Clinical Public Health, Dalla Lana School of Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Carmen Logie
- Women's College Research Institute, Toronto, Ontario, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | | | - Shari Margolese
- Canadian HIV Trials Network Community Advisory Committee, Vancouver, British Columbia, Canada
| | - Babalwa Zani
- Knowledge Translation Unit, University of Cape Town Lung Institute, Rondebosch, Western Cape, South Africa
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
- Pediatrics and Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Centre for Evaluation of Medicine, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
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Supportive interventions to improve retention on ART in people with HIV in low- and middle-income countries: A systematic review. PLoS One 2018; 13:e0208814. [PMID: 30550574 PMCID: PMC6294385 DOI: 10.1371/journal.pone.0208814] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 11/24/2018] [Indexed: 01/01/2023] Open
Abstract
Objectives To determine whether supportive interventions can increase retention in care for patients on antiretroviral therapy (ART) in low- and middle-income countries (LMIC). Design Systematic review and meta-analysis. Methods We used Cochrane Collaboration methods. We included randomised controlled trials (RCT) and observational studies with comparators conducted in LMIC. Our principal outcomes were retention, mortality and the combined outcome of lost-to-follow-up (LTFU) or death. Results We identified seven studies (published in nine articles); six of the studies were from Sub-Saharan Africa. We found four types of interventions: 1) directly observed therapy plus extra support (“DOT-plus”), 2) community-based adherence support, 3) adherence clubs and 4) extra care for patients with low CD4 count. One RCT of a community-based intervention showed significantly improved retention at 12 months (RR 1.14, 95% CI 1.02 to 1.27), and three observational studies found significantly improved retention for paediatric patients followed for 12 to 36 months (RR 1.07, 95 CI 1.03 to 1.11), and for adult patients at 12 (RR 1.38, 95% CI 1.13 to 1.70) and 60 months (RR 1.07, 95% CI 1.07 to 1.08). One observational study of adherence clubs showed significantly reduced LTFU or mortality (RR 0.20, 95% CI 0.12 to 0.33). A cluster RCT of an extra-care intervention for high-risk patients also showed a significant increase in retention (RR 1.06, 95% CI 1.01 to 1.10), and an observational study of extra nursing care found a significant decrease in LTFU or mortality (RR 0.76, 95% CI 0.66 to 0.87). Conclusions Supportive interventions are associated with increased ART programme retention, but evidence quality is generally low to moderate. The data from this review suggest that programmes addressing psychosocial needs can significantly help retain patients in care.
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Wu H, Liang Y, Jiang X, Wei X, Liu Y, Liu W, Guo Y, Tang W. Meta-analysis of intravoxel incoherent motion magnetic resonance imaging in differentiating focal lesions of the liver. Medicine (Baltimore) 2018; 97:e12071. [PMID: 30142864 PMCID: PMC6112959 DOI: 10.1097/md.0000000000012071] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Accurate detection and characterization of focal liver lesions, including differentiation between malignant and benign lesions, are particularly important. The objective of this meta-analysis was to evaluate the parameters of intravoxel incoherent motion (IVIM), including apparent diffusion coefficient (ADC), pure molecular diffusion coefficient (D), perfusion-related diffusion coefficient (D*), and perfusion fraction (f) in differentiating focal liver lesions. METHODS IVIM method employed for focal liver lesion and the quality assessment of diagnostic studies were evaluated. Standardized mean differences and 95% confidence intervals were calculated. The heterogeneity was quantified with the I statistic. RESULTS The difference between groups was analyzed according to the I values from 6 different studies using fixed effects or random effects models. Significant differences in ADC (P < .001) and D (P < .001) were observed between benign and malignant lesions. Moreover, significant differences in ADC (P < .001), D (P < .001), and f (P = .01) were found between hemangioma and hepatocellular carcinoma (HCC). In addition, no significant difference was observed between the metastases and HCC. CONCLUSIONS D and ADC values were useful for the differentiation between benignity and malignancy; higher values of ADC, D, and f were observed in hemangioma compared to HCC. Nevertheless, IVIM did not result as the optimal approach for differentiation between the metastases and HCC.
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Affiliation(s)
- Hongzhen Wu
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong
- Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yingying Liang
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong
| | - Xinqing Jiang
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong
- Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xinhua Wei
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong
| | - Yu Liu
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong
| | - Weifeng Liu
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong
| | - Yuan Guo
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong
| | - Wenjie Tang
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong
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