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Trickey A, Johnson LF, Fung F, Bonifacio R, Iwuji C, Biraro S, Bosomprah S, Chirimuta L, Euvrard J, Fatti G, Fox MP, Von Groote P, Gumulira J, Howard G, Jennings L, Kiragga A, Muula G, Tanser F, Wagener T, Low A, Vickerman P. Associations of inter-annual rainfall decreases with subsequent HIV outcomes for persons with HIV on antiretroviral therapy in Southern Africa: a collaborative analysis of cohort studies. BMC Infect Dis 2023; 23:889. [PMID: 38114912 PMCID: PMC10731689 DOI: 10.1186/s12879-023-08902-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/13/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Periods of droughts can lead to decreased food security, and altered behaviours, potentially affecting outcomes on antiretroviral therapy (ART) among persons with HIV (PWH). We investigated whether decreased rainfall is associated with adverse outcomes among PWH on ART in Southern Africa. METHODS Data were combined from 11 clinical cohorts of PWH in Lesotho, Malawi, Mozambique, South Africa, Zambia, and Zimbabwe, participating in the International epidemiology Databases to Evaluate AIDS Southern Africa (IeDEA-SA) collaboration. Adult PWH who had started ART prior to 01/06/2016 and were in follow-up in the year prior to 01/06/2016 were included. Two-year rainfall from June 2014 to May 2016 at the location of each HIV centre was summed and ranked against historical 2-year rainfall amounts (1981-2016) to give an empirical relative percentile rainfall estimate. The IeDEA-SA and rainfall data were combined using each HIV centre's latitude/longitude. In individual-level analyses, multivariable Cox or generalized estimating equation regression models (GEEs) assessed associations between decreased rainfall versus historical levels and four separate outcomes (mortality, CD4 counts < 200 cells/mm3, viral loads > 400 copies/mL, and > 12-month gaps in follow-up) in the two years following the rainfall period. GEEs were used to investigate the association between relative rainfall and monthly numbers of unique visitors per HIV centre. RESULTS Among 270,708 PWH across 386 HIV centres (67% female, median age 39 [IQR: 32-46]), lower rainfall than usual was associated with higher mortality (adjusted Hazard Ratio: 1.18 [95%CI: 1.07-1.32] per 10 percentile rainfall rank decrease) and unsuppressed viral loads (adjusted Odds Ratio: 1.05 [1.01-1.09]). Levels of rainfall were not strongly associated with CD4 counts < 200 cell/mm3 or > 12-month gaps in care. HIV centres in areas with less rainfall than usual had lower numbers of PWH visiting them (adjusted Rate Ratio: 0.80 [0.66-0.98] per 10 percentile rainfall rank decrease). CONCLUSIONS Decreased rainfall could negatively impact on HIV treatment behaviours and outcomes. Further research is needed to explore the reasons for these effects. Interventions to mitigate the health impact of severe weather events are required.
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Affiliation(s)
- Adam Trickey
- Population Health Sciences, University of Bristol, Bristol, UK.
| | - Leigh F Johnson
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Fai Fung
- Department of Civil Engineering, University of Bristol, Bristol, UK
- UK Meteorological Office, Exeter, UK
| | - Rogerio Bonifacio
- Climate and Earth Observation Unit, Research Assessment and Monitoring Division, World Food Programme HQ, Rome, Italy
| | - Collins Iwuji
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Department of Global Health Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Samuel Biraro
- ICAP at Columbia University, Nakasero, Kampala, Uganda
| | - Samuel Bosomprah
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | | | - Jonathan Euvrard
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Geoffrey Fatti
- Kheth'Impilo AIDS Free Living, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Matthew P Fox
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health and Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Per Von Groote
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Guy Howard
- Department of Civil Engineering and Cabot Institute of the Environment, University of Bristol, Bristol, UK
| | - Lauren Jennings
- Desmond Tutu Health Foundation, Institute of Infectious Diseases and Molecular Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Agnes Kiragga
- Research Division, African Population and Health Research Center, Nairobi, Kenya
| | - Guy Muula
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Frank Tanser
- Centre for Epidemic Response and Innovation, School of Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Thorsten Wagener
- Institute of Environmental Science and Geography, University of Potsdam, Potsdam, Germany
| | - Andrea Low
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, Bristol, UK
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Al Imam MH, Jahan I, Das MC, Bashar SMK, Khan A, Muhit M, Power R, Akbar D, Badawi N, Khandaker G. SUpporting People in extreme POverty with Rehabilitation and Therapy (SUPPORT CP): a trial among families of children with cerebral palsy in Bangladesh. Dev Med Child Neurol 2022; 65:773-782. [PMID: 36335570 DOI: 10.1111/dmcn.15445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/08/2022]
Abstract
AIM To test the efficacy of an integrated microfinance/livelihood and community-based rehabilitation (IMCBR) programme in improving health-related quality of life (HRQoL) and motor function of children with cerebral palsy (CP) and gain in social capital to their ultra-poor families in rural Bangladesh. METHOD This was an open-label cluster randomized control trial. Children with CP aged 5 years or under were randomly allocated to three arms; Arm A: IMCBR; Arm B: community-based rehabilitation (CBR); and Arm C: care-as-usual. The CBR was modified with phone follow-up followed by home-based CBR at 2.5 months post-enrolment because of the COVID-19 pandemic. Intention-to-treat analysis was performed. RESULTS Twenty-four clusters constituting 251 children-primary caregivers' dyads were assigned to three arms (Arm A = 80; Arm B = 82; Arm C = 89). Between baseline and endline, the percentage mean change in the physical functioning domain of HRQoL was highest in Arm A (30.0%) with a significant mean difference between Arm A and Arm B (p = 0.015). Improvement in the mean social capital score was significantly higher in Arm A compared to Arm C (p < 0.001). INTERPRETATION The findings suggest that IMCBR could improve the HRQoL of children with CP and the social capital of their ultra-poor families. Long-term follow-up of the trial participants and future exploration of such interventions are essential. The integrated livelihood and CBR programme holds potential to improve health and well-being of children with CP and their ultra-poor families.
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Affiliation(s)
- Mahmudul Hassan Al Imam
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh.,School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia.,Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Israt Jahan
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh.,School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Manik Chandra Das
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
| | - Sk Md Kamrul Bashar
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
| | - Arifuzzaman Khan
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh.,Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia.,School of Public Health, The University of Queensland, Brisbane, Australia
| | - Mohammad Muhit
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
| | - Rosalie Power
- Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh.,Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Delwar Akbar
- School of Business and Law, Central Queensland University, Rockhampton, Queensland, Australia
| | - Nadia Badawi
- Grace Centre for Newborn Intensive Care, Sydney Children's Hospital Network, The University of Sydney, Sydney, Australia.,Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, Australia
| | - Gulam Khandaker
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia.,Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia.,Grace Centre for Newborn Intensive Care, Sydney Children's Hospital Network, The University of Sydney, Sydney, Australia
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Al Imam MH, Jahan I, Muhit M, Das MC, Power R, Khan A, Akbar D, Badawi N, Khandaker G. Supporting Ultra Poor People with Rehabilitation and Therapy among families of children with Cerebral Palsy in rural Bangladesh (SUPPORT CP): Protocol of a randomised controlled trial. PLoS One 2021; 16:e0261148. [PMID: 34972100 PMCID: PMC8719685 DOI: 10.1371/journal.pone.0261148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/07/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Poverty is a key contributor to delayed diagnosis and limited access to early intervention and rehabilitation for children with cerebral palsy (CP) in rural Bangladesh. 97% of families of children with CP live below the poverty line in Bangladesh. Therefore, in low-and middle-income countries (LMICs), efforts to improve outcomes for children with CP (including health-related quality of life, motor function, communication, and nutritional attainments) should also include measures to improve family economic and social capital. We propose a randomised controlled trial (RCT) to evaluate the effectiveness of an integrated microfinance/livelihood and community-based rehabilitation (IMCBR) program for ultra-poor families of children with CP in rural Bangladesh. MATERIAL AND METHODS This will be a cluster RCT comparing three arms: (a) integrated microfinance/livelihood and community-based rehabilitation (IMCBR); (b) community-based rehabilitation (CBR) alone; and (c) care-as-usual (i.e. no intervention). Seven clusters will be recruited within each arm. Each cluster will consist of 10 child-caregiver dyads totalling 21 clusters with 210 dyads. Parents recruited in the IMCBR arm will take part in a microfinance/livelihood program and Parent Training Module (PTM), their children with CP will take part in a Goal Directed Training (GDT) program. The programs will be facilitated by specially trained Community Rehabilitation Officers. The CBR arm includes the same PTM and GDT interventions excluding the microfinance/livelihood program. The care-as-usual arm will be provided with information about early intervention and rehabilitation. The assessors will be blinded to group allocation. The duration of the intervention will be 12 months; outcomes will be measured at baseline, 6 months, 12 months, and 18 months. CONCLUSION This will be the first RCT of an integrated microfinance/livelihood and CBR program for children with CP in LMIC settings. Evidence from the study could transform approaches to improving wellbeing of children with CP and their ultra-poor families.
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Affiliation(s)
- Mahmudul Hassan Al Imam
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Israt Jahan
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Mohammad Muhit
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Manik Chandra Das
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Rosalie Power
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
- Translational Health Research Institute (THRI), Western Sydney University, Campbelltown, New South Wales, Australia
| | - Arifuzzaman Khan
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Delwar Akbar
- School of Business and Law, Central Queensland University, Rockhampton, Queensland, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
- Grace Centre for Newborn Intensive Care, Sydney Children’s Hospital Network, Westmead, New South Wales, Australia
| | - Gulam Khandaker
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia
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Kiekens A, Mosha IH, Zlatić L, Bwire GM, Mangara A, Dierckx de Casterlé B, Decouttere C, Vandaele N, Sangeda RZ, Swalehe O, Cottone P, Surian A, Killewo J, Vandamme AM. Factors Associated with HIV Drug Resistance in Dar es Salaam, Tanzania: Analysis of a Complex Adaptive System. Pathogens 2021; 10:1535. [PMID: 34959490 PMCID: PMC8707982 DOI: 10.3390/pathogens10121535] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/12/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022] Open
Abstract
HIV drug resistance (HIVDR) is a complex problem with multiple interconnected and context dependent causes. Although the factors influencing HIVDR are known and well-studied, HIVDR remains a threat to the effectiveness of antiretroviral therapy. To understand the complexity of HIVDR, a comprehensive, systems approach is needed. Therefore, a local systems map was developed integrating all reported factors influencing HIVDR in the Dar es Salaam Urban Cohort Study area in Tanzania. The map was designed based on semi-structured interviews and workshops with people living with HIV and local actors who encounter people living with HIV during their daily activities. We visualized the feedback loops driving HIVDR, compared the local map with a systems map for Sub-Saharan Africa, previously constructed from interviews with international HIVDR experts, and suggest potential interventions to prevent HIVDR. We found several interconnected balancing and reinforcing feedback loops related to poverty, stigmatization, status disclosure, self-esteem, knowledge about HIVDR and healthcare system workload, among others, and identified three potential leverage points. Insights from this local systems map were complementary to the insights from the Sub-Saharan systems map showing that both viewpoints are needed to fully understand the system. This study provides a strong baseline for quantitative modelling, and for the identification of context-dependent, complexity-informed leverage points.
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Affiliation(s)
- Anneleen Kiekens
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Institute for the Future, KU Leuven, 3000 Leuven, Belgium; (L.Z.); (G.M.B.); (A.-M.V.)
| | - Idda H. Mosha
- Department of Behavioural Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam 65015, Tanzania;
| | - Lara Zlatić
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Institute for the Future, KU Leuven, 3000 Leuven, Belgium; (L.Z.); (G.M.B.); (A.-M.V.)
- FISPPA Department, Università degli Studi di Padova, 35139 Padova, Italy; (P.C.); (A.S.)
| | - George M. Bwire
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Institute for the Future, KU Leuven, 3000 Leuven, Belgium; (L.Z.); (G.M.B.); (A.-M.V.)
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam 65013, Tanzania;
| | - Ally Mangara
- Dar es Salaam Urban Cohort Study, Dar es Salaam 65013, Tanzania;
| | - Bernadette Dierckx de Casterlé
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, 3000 Leuven, Belgium;
| | - Catherine Decouttere
- Faculty of Economics and Business, Access to Medicine Research Center, KU Leuven, 3000 Leuven, Belgium; (C.D.); (N.V.)
| | - Nico Vandaele
- Faculty of Economics and Business, Access to Medicine Research Center, KU Leuven, 3000 Leuven, Belgium; (C.D.); (N.V.)
| | - Raphael Z. Sangeda
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam 65013, Tanzania;
| | - Omary Swalehe
- Department of Business Studies, School of Business, Mzumbe University, Dar es Salaam 20266, Tanzania;
| | - Paolo Cottone
- FISPPA Department, Università degli Studi di Padova, 35139 Padova, Italy; (P.C.); (A.S.)
| | - Alessio Surian
- FISPPA Department, Università degli Studi di Padova, 35139 Padova, Italy; (P.C.); (A.S.)
| | - Japhet Killewo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam 65001, Tanzania;
| | - Anne-Mieke Vandamme
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Institute for the Future, KU Leuven, 3000 Leuven, Belgium; (L.Z.); (G.M.B.); (A.-M.V.)
- Center for Global Health and Tropical Medicine, Unidade de Microbiologia, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 1349-008 Lisbon, Portugal
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Genberg BL, Wilson-Barthes MG, Omodi V, Hogan JW, Steingrimsson J, Wachira J, Pastakia S, Tran DN, Kiragu ZW, Ruhl LJ, Rosenberg M, Kimaiyo S, Galárraga O. Microfinance, retention in care, and mortality among patients enrolled in HIV care in East Africa. AIDS 2021; 35:1997-2005. [PMID: 34115646 PMCID: PMC8963387 DOI: 10.1097/qad.0000000000002987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To measure associations between participation in community-based microfinance groups, retention in HIV care, and death among people with HIV (PWH) in low-resource settings. DESIGN AND METHODS We prospectively analyzed data from 3609 patients enrolled in an HIV care program in western Kenya. HIV patients who were eligible and chose to participate in a Group Integrated Savings for Health Empowerment (GISHE) microfinance group were matched 1 : 2 on age, sex, year of enrollment in HIV care, and location of initial HIV clinic visit to patients not participating in GISHE. Follow-up data were abstracted from medical records from January 2018 through February 2020. Logistic regression analysis examined associations between GISHE participation and two outcomes: retention in HIV care (i.e. >1 HIV care visit attended within 6 months prior to the end of follow-up) and death. Socioeconomic factors associated with HIV outcomes were included in adjusted models. RESULTS The study population was majority women (78.3%) with a median age of 37.4 years. Microfinance group participants were more likely to be retained in care relative to HIV patients not participating in a microfinance group [adjusted odds ratio (aOR) = 1.31, 95% confidence interval (CI) 1.01-1.71; P = 0.046]. Participation in group microfinance was associated with a reduced odds of death during the follow-up period (aOR = 0.57, 95% CI 0.28-1.09; P = 0.105). CONCLUSION Participation in group-based microfinance appears to be associated with better HIV treatment outcomes. A randomized trial is needed to assess whether microfinance groups can improve clinical and socioeconomic outcomes among PWH in similar settings.
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Affiliation(s)
- Becky L. Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Marta G. Wilson-Barthes
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Victor Omodi
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Joseph W. Hogan
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Jon Steingrimsson
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Juddy Wachira
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Department of Behavioral Science, Moi University College of Health Sciences, School of Medicine, Eldoret, Kenya
| | - Sonak Pastakia
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Purdue University College of Pharmacy, Center for Health Equity and Innovation, Indianapolis, Indiana
| | - Dan N. Tran
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, Pennsylvania
| | - Zana W. Kiragu
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Laura J. Ruhl
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Department of Medicine, Indiana University School of Medicine, Indianapolis
| | - Molly Rosenberg
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, Indiana
| | | | - Omar Galárraga
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
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Thorpe J, Viney K, Hensing G, Lönnroth K. Income security during periods of ill health: a scoping review of policies, practice and coverage in low-income and middle-income countries. BMJ Glob Health 2020; 5:e002425. [PMID: 32540963 PMCID: PMC7299014 DOI: 10.1136/bmjgh-2020-002425] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 01/20/2023] Open
Abstract
The COVID-19 pandemic is a reminder that insufficient income security in periods of ill health leads to economic hardship for individuals and hampers disease control efforts as people struggle to stay home when sick or advised to observe quarantine. Evidence on income security during periods of ill health is growing but has not previously been reviewed as a full body of work concerning low-income and middle-income countries (LMICs). We performed a scoping review to map the range, features, coverage, protective effects and equity of policies that aim to provide income security for adults whose ill health prevents them from participating in gainful work. A total of 134 studies were included, providing data from 95% of LMICs. However, data across the majority of these countries were severely limited. Collectively the included studies demonstrate that coverage of contributory income-security schemes is low, especially for informal and low-income workers. Meanwhile, non-contributory schemes targeting low-income groups are often not explicitly designed to provide income support in periods of ill health, they can be difficult to access and rarely provide sufficient income support to cover the needs of eligible recipients. While identifying an urgent need for more research on illness-related income security in LMICs, this review concludes that scaling up and diversifying the range of income security interventions is crucial for improving coverage and equity. To achieve these outcomes, illness-related income protection must receive greater recognition in health policy and health financing circles, expanding our understanding of financial hardship beyond direct medical costs.
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Affiliation(s)
- Jennifer Thorpe
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Kerri Viney
- National Centre for Epidemiology and Population Health, Australian National University Research Division of Biomedical Science and Biochemistry, Canberra, Australian Capital Territory, Australia
| | - Gunnel Hensing
- Department of Public Health and Community Medicine, University of Gothenburg, Goteborg, Sweden
| | - Knut Lönnroth
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
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Islam R, Ahmad R, Ghailan K, Hoque KE. An Islamic Microfinance Approach to Scaling up the Economic Life of Vulnerable People with HIV/AIDS in the Muslim Society. JOURNAL OF RELIGION AND HEALTH 2020; 59:1327-1343. [PMID: 31134517 DOI: 10.1007/s10943-019-00832-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
People with HIV/AIDS (PLWHA) commonly pose problems to their family as well as to society because of their vulnerable health and economic conditions. Contrarily, PLWHA encounter social discrimination and adverse realities while finding it difficult to continue in their jobs. These complex phenomena interact to push them into a low economic status. A microfinance program can hopefully assist poor patients to cope with the negative economic consequences of this disease. But the conventional market-oriented microfinance institutions show reluctance to serve this group of people due to the possibilities of having credit risk. In this paper, we propose an alternative microfinancing technique that can provide a better economic life of the PLWHA while absorbing the credit risks. A comprehensive model is designed using specific Islamic financial instruments in conjugation with household economic portfolio theory. Critical realism method was adopted to construct this model. We concluded that the application of Islamic microfinance can enhance income of HIV patients while reducing the productivity-loss. This model can be useful to the microfinance practitioners and policymakers for addressing a different market segment, diversifying products, and formulating policy.
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Affiliation(s)
- Reazul Islam
- Asia-Europe Institute, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Rubi Ahmad
- Faculty of Business and Accountancy, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Khalid Ghailan
- Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia
| | - Kazi Enamul Hoque
- Faculty of Education, University of Malaya, 50603, Kuala Lumpur, Malaysia
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Walcott M, Kempf MC, Merlin JS, Nunn A, Turan JM. Perceived Value of Microenterprise for Low-Income Women Living with HIV in Alabama. AIDS Behav 2019; 23:276-286. [PMID: 31586283 DOI: 10.1007/s10461-019-02656-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We characterized the potential benefits and risks of participating in a microenterprise program targeting low-income women living with HIV (WLWH) in Alabama; and described potential mechanisms through which microenterprise programs could influence sexual risk behaviors and engagement in HIV care. Fourteen stakeholders and 46 WLWH (89% African American) participated in the qualitative study. Data were collected using in-depth interviews (stakeholders) and focus group discussions (WLWH). NVivo qualitative software was used for the management and analysis of the data. The data revealed four main mechanisms through which microenterprise programs could potentially improve health outcomes: (1) social support and encouragement from other women, (2) improvement in self-esteem, (3) creating structure in the women's lives, and (4) financial strengthening. Potential risks included unwanted disclosure of HV status, stigma and loss of insurance benefits. Microenterprise programs have the potential to be acceptable and may contribute to improved health and social outcomes among low-income WLWH in Alabama.
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Affiliation(s)
- Melonie Walcott
- Department of Public Health, Hartwick College, 1 Hartwick Dr., Oneonta, NY, 13820, USA.
| | - Mirjam-Colette Kempf
- School of Nursing, Public Health and Medicine, University of Alabama at Birmingham, 1701 University Boulevard, Birmingham, AL, 35294-1210, USA
| | - Jessica S Merlin
- Divisions of General Internal Medicine and Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Amy Nunn
- Brown University and the Rhode Island Public Health Institute, Brown University, Providence, RI, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35294, USA
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