1
|
Thakkar A, Valente T, Andesia J, Njuguna B, Miheso J, Mercer T, Mugo R, Mwangi A, Mwangi E, Pastakia SD, Pathak S, Pillsbury MKM, Kamano J, Naanyu V, Williams M, Vedanthan R, Akwanalo C, Bloomfield GS. Network characteristics of a referral system for patients with hypertension in Western Kenya: results from the Strengthening Referral Networks for Management of Hypertension Across the Health System (STRENGTHS) study. BMC Health Serv Res 2022; 22:315. [PMID: 35255913 PMCID: PMC8903732 DOI: 10.1186/s12913-022-07699-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 02/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Health system approaches to improve hypertension control require an effective referral network. A national referral strategy exists in Kenya; however, a number of barriers to referral completion persist. This paper is a baseline assessment of a hypertension referral network for a cluster-randomized trial to improve hypertension control and reduce cardiovascular disease risk. METHODS We used sociometric network analysis to understand the relationships between providers within a network of nine geographic clusters in western Kenya, including primary, secondary, and tertiary care facilities. We conducted a survey which asked providers to nominate individuals and facilities to which they refer patients with controlled and uncontrolled hypertension. Degree centrality measures were used to identify providers in prominent positions, while mixed-effect regression models were used to determine provider characteristics related to the likelihood of receiving referrals. We calculated core-periphery correlation scores (CP) for each cluster (ideal CP score = 1.0). RESULTS We surveyed 152 providers (physicians, nurses, medical officers, and clinical officers), range 10-36 per cluster. Median number of hypertensive patients seen per month was 40 (range 1-600). While 97% of providers reported referring patients up to a more specialized health facility, only 55% reported referring down to lower level facilities. Individuals were more likely to receive a referral if they had higher level of training, worked at a higher level facility, were male, or had more job experience. CP scores for provider networks range from 0.335 to 0.693, while the CP scores for the facility networks range from 0.707 to 0.949. CONCLUSIONS This analysis highlights several points of weakness in this referral network including cluster variability, poor provider linkages, and the lack of down referrals. Facility networks were stronger than provider networks. These shortcomings represent opportunities to focus interventions to improve referral networks for hypertension. TRIAL REGISTRATION Trial Registered on ClinicalTrials.gov NCT03543787 , June 1, 2018.
Collapse
Affiliation(s)
- Aarti Thakkar
- grid.26009.3d0000 0004 1936 7961Duke University School of Medicine, 300 West Morgan Street, Durham, NC 27701 USA
| | - Thomas Valente
- grid.42505.360000 0001 2156 6853University of Southern California, Los Angeles, CA USA
| | - Josephine Andesia
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Juliet Miheso
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Tim Mercer
- grid.89336.370000 0004 1936 9924The University of Texas at Austin Dell Medical School, Austin, TX USA
| | - Richard Mugo
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Ann Mwangi
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya ,grid.79730.3a0000 0001 0495 4256College of Health Sciences, Moi University, Eldoret, Kenya
| | - Eunice Mwangi
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Sonak D. Pastakia
- grid.169077.e0000 0004 1937 2197College of Pharmacy, Purdue University, West Lafayette, IN USA
| | - Shravani Pathak
- grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mt. Sinai, New York, NY USA
| | - Mc Kinsey M. Pillsbury
- grid.266102.10000 0001 2297 6811University of California San Francisco School of Medicine, San Francisco, CA USA
| | - Jemima Kamano
- Moi Teaching and Referral Hospital, Eldoret, Kenya ,grid.79730.3a0000 0001 0495 4256College of Health Sciences, Moi University, Eldoret, Kenya
| | - Violet Naanyu
- grid.79730.3a0000 0001 0495 4256College of Health Sciences, Moi University, Eldoret, Kenya
| | - Makeda Williams
- grid.279885.90000 0001 2293 4638National Heart, Lung and Blood Institute, Bethesda, MD USA
| | - Rajesh Vedanthan
- grid.240324.30000 0001 2109 4251New York University, Grossman School of Medicine, New York, NY USA
| | | | - Gerald S. Bloomfield
- grid.26009.3d0000 0004 1936 7961Duke University School of Medicine, 300 West Morgan Street, Durham, NC 27701 USA
| |
Collapse
|
2
|
Torlesse H, Ruducha J, Mann C, Murira Z. Assessment of regional networks on nutrition in South Asia: a multi-methods study. BMC Public Health 2022; 22:174. [PMID: 35078437 PMCID: PMC8790857 DOI: 10.1186/s12889-022-12585-3] [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: 07/07/2021] [Accepted: 01/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many national and international organizations are working to improve maternal and child nutrition in countries with high malnutrition prevalence and burdens. While there has been progress in strengthening multi-organizational networks on nutrition at country and global levels, the regional level has received much less attention. We conducted a study to 1) determine the existing relationships and levels of engagement between international organizations working to improve nutrition at the regional level or in at least two countries in South Asia; and 2) examine the experiences and perspectives of international organizations on regional-level communication, coordination or collaboration on nutrition in South Asia. METHODS A mixed methods approach involving organizational network analysis (ONA) and semi-structured interviews was used to develop an understanding of the existing network and relationships between international organizations working on nutrition in South Asia. ONA data from 43 international organizations was analysed using a social network analysis software (UCINET) to systematically quantify and visualize the patterns of relationships between organizations. RESULTS We found a high degree of connectivity between most of the international organizations in South Asia, but there were gaps between the many organizations that knew each other and the work they did together regionally on nutrition. Most organizations worked together only 'rarely' or 'sometimes' on nutrition at the regional level and high-intensity (collaborative) working relationships were uncommon. Organizations of the same type tended to cluster together, and a small number of UN agencies and multilateral organizations were central brokers in the nutrition working relationships. Perceived constraints to the nutrition working relationships included organizations' agenda and mandate, threats to visibility and branding, human and financial resources, history, trust and power relations with other organizations, absence of a regional network for cooperation, and donor expectations. There was high demand to remedy this situation and to put network mechanisms in place to strengthen communication, coordination and collaboration on nutrition. CONCLUSIONS Opportunities are being missed for organizations to work together on nutrition at the regional level in South Asia. The effectiveness of regional nutrition networks in influencing policy or programme decisions and resources for nutrition at country level should be explored.
Collapse
Affiliation(s)
- Harriet Torlesse
- UNICEF Regional Office for South Asia, Leknath Marg, Kathmandu, 44600, Nepal
| | - Jenny Ruducha
- Braintree Global Health, 4322 West Point Place, Vancouver, BC, V6R 4M9, Canada.
| | - Carlyn Mann
- Braintree Global Health, 4322 West Point Place, Vancouver, BC, V6R 4M9, Canada
| | - Zivai Murira
- UNICEF Regional Office for South Asia, Leknath Marg, Kathmandu, 44600, Nepal
| |
Collapse
|
3
|
Simpson VL, Hass ZJ, Panchal J, McGowan B. Understanding the Development, Evaluation, and Sustainability of Community Health Networks Using Social Network Analysis: A Scoping Review. Am J Health Promot 2021; 36:318-327. [PMID: 34865522 DOI: 10.1177/08901171211045984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Identify the scope of the literature which reports use of social network analysis to inform, support, or evaluate health promotion-focused community network/partnership development. DATA SOURCE A comprehensive search (not date-limited) of PubMed, CINAHL, Web of Science Core Collection, PsycInfo, and the Cochrane Library Database for Systematic Reviews. INCLUSION AND EXCLUSION CRITERIA Criteria for inclusion included published in the English language and used social network analysis to inform, support, or evaluate development of community networks/partnerships aiding health promotion efforts. Studies were excluded if they did not use social network analysis or were not focused upon health promotion. DATA EXTRACTION Three of the four authors extracted data using a summary chart to document information regarding study aims, target issue/population, methods, and key outcomes of the social network analysis. DATA SYNTHESIS The extracted data were qualitatively analyzed by 3 authors to categorize key social network analysis outcomes into categories. RESULTS Ninety-seven studies representing 9 geographical regions were included, with the majority (69) published after 2010. Key outcomes included the effectiveness of social network analysis to identify network characteristics, track network change over time, compare similar networks across locations, and correlate network attributes with outcomes. CONCLUSION Findings support the utility of social network analysis to inform, support, and evaluate development of sustainable health promotion-focused networks/partnerships.
Collapse
Affiliation(s)
| | - Zachary Joseph Hass
- Regenstrief Center for Healthcare Engineering Core Faculty, Schools of Nursing and Industrial Engineering, 311308Purdue University, West Lafayette, IN, USA
| | - Jitesh Panchal
- School of Mechanical Engineering, 311308Purdue University, West Lafayette, IN, USA
| | - Bethany McGowan
- Libraries and School of Information Studies, 311308Purdue University, West Lafayette, IN, USA
| |
Collapse
|
4
|
Glandon D, Paina L, Hoe C. Reflections on benefits and challenges of longitudinal organisational network analysis as a tool for health systems research and practice. BMJ Glob Health 2021; 6:bmjgh-2021-005849. [PMID: 34385160 PMCID: PMC8362700 DOI: 10.1136/bmjgh-2021-005849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/25/2021] [Indexed: 11/05/2022] Open
Abstract
As health systems practitioners and researchers increasingly turn towards systems thinking approaches and work on building interorganisational networks, they have demonstrated increasing interest in network analysis for investigating relationships and interactions between system actors, both at the individual and organisational levels. Despite the potential of network-based approaches to improve health system efficiency, effectiveness and responsiveness, both the theoretical and practical guidance on designing and evaluating network-building strategies is underdeveloped within the field. While there are multiple tools and resources to help users collect, manage and analyse network data, there is much less guidance on the practical applications of this information. One apparent gap is the limited application of longitudinal organisational network analysis, in which data are collected from the same organisational actors repeatedly over multiple time points. This yields insights into the dynamic nature of networks, including how the network structure and interactions change over time. Given that networks are rarely static, the addition of the time dimension has the potential to substantially enhance the analytical value of network analysis and contribute to more nuanced guidance for interested practitioners and policymakers. In this article, the authors draw on their experiences in conducting longitudinal network analysis of interorganisational relationships in the USA and India to comment on the opportunities and challenges of the methodology within the field of health systems research. We also provide suggestions as to how some of these challenges may be addressed or mitigated.
Collapse
Affiliation(s)
- Douglas Glandon
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ligia Paina
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Connie Hoe
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
5
|
Mukamuyango J, Ingabire R, Parker R, Nyombayire J, Abaasa A, Asiki G, Easter SR, Wall KM, Nyirazinyoye L, Tichacek A, Kaslow N, Price MA, Allen S, Karita E. Uptake of long acting reversible contraception following integrated couples HIV and fertility goal-based family planning counselling in Catholic and non-Catholic, urban and rural government health centers in Kigali, Rwanda. Reprod Health 2020; 17:126. [PMID: 32807177 PMCID: PMC7433361 DOI: 10.1186/s12978-020-00981-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND When integrated with couples' voluntary HIV counselling and testing (CVCT), family planning including long acting reversible contraceptives (LARC) addresses prongs one and two of prevention of mother-to-child transmission (PMTCT). METHODS In this observational study, we enrolled equal numbers of HIV concordant and discordant couples in four rural and four urban clinics, with two Catholic and two non-Catholic clinics in each area. Eligible couples were fertile, not already using a LARC method, and wished to limit or delay fertility for at least 2 years. We provided CVCT and fertility goal-based family planning counselling with the offer of LARC and conducted multivariate analysis of clinic, couple, and individual predictors of LARC uptake. RESULTS Of 1290 couples enrolled, 960 (74%) selected LARC: Jadelle 5-year implant (37%), Implanon 3-year implant (26%), or copper intrauterine device (IUD) (11%). Uptake was higher in non-Catholic clinics (85% vs. 63% in Catholic clinics, p < 0.0001), in urban clinics (82% vs. 67% in rural clinics, p < 0.0001), and in HIV concordant couples (79% vs. 70% of discordant couples, p = .0005). Religion of the couple was unrelated to clinic religious affiliation, and uptake was highest among Catholics (80%) and lowest among Protestants (70%) who were predominantly Pentecostal. In multivariable analysis, urban location and non-Catholic clinic affiliation, Catholic religion of woman or couple, younger age of men, lower educational level of both partners, non-use of condoms or injectable contraception at enrollment, prior discussion of LARC by the couple, and women not having concerns about negative side effects of implant were associated with LARC uptake. CONCLUSIONS Fertility goal-based LARC recommendations combined with couples' HIV counselling and testing resulted in a high uptake of LARC methods, even among discordant couples using condoms for HIV prevention, in Catholic clinics, and in rural populations. This model successfully integrates prevention of HIV and unplanned pregnancy.
Collapse
Affiliation(s)
| | - Rosine Ingabire
- Projet San Francisco, Rwanda Zambia HIV Research Group, Kigali, Rwanda
| | - Rachel Parker
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Julien Nyombayire
- Projet San Francisco, Rwanda Zambia HIV Research Group, Kigali, Rwanda
| | - Andrew Abaasa
- London School of Hygiene & Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
- Medical Research Council, Uganda Vaccine Research Institute & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Gershim Asiki
- Medical Research Council, Uganda Vaccine Research Institute & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Sarah Rae Easter
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristin M Wall
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Nadine Kaslow
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, GA, USA
| | - Matt A Price
- International AIDS Vaccine Initiative, New York, NY, USA
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
| | - Etienne Karita
- Projet San Francisco, Rwanda Zambia HIV Research Group, Kigali, Rwanda
| |
Collapse
|
6
|
Sabot K, Blanchet K, Berhanu D, Spicer N, Schellenberg J. Professional advice for primary healthcare workers in Ethiopia: a social network analysis. BMC Health Serv Res 2020; 20:551. [PMID: 32552727 PMCID: PMC7302001 DOI: 10.1186/s12913-020-05367-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In an era of increasingly competitive funding, governments and donors will be looking for creative ways to extend and maximise resources. One such means can include building upon professional advice networks to more efficiently introduce, scale up, or change programmes and healthcare provider practices. This cross-sectional, mixed-methods, observational study compared professional advice networks of healthcare workers in eight primary healthcare units across four regions of Ethiopia. Primary healthcare units include a health centre and typically five satellite health posts. METHODS One hundred sixty staff at eight primary healthcare units were interviewed using a structured tool. Quantitative data captured the frequency of healthcare worker advice seeking and giving on providing antenatal, childbirth, postnatal and newborn care. Network and actor-level metrics were calculated including density (ratio of ties between actors to all possible ties), centrality (number of ties incident to an actor), distance (average number of steps between actors) and size (number of actors within the network). Following quantitative network analyses, 20 qualitative interviews were conducted with network study participants from four primary healthcare units. Qualitative interviews aimed to interpret and explain network properties observed. Data were entered, analysed or visualised using Excel 6.0, UCINET 6.0, Netdraw, Adobe InDesign and MaxQDA10 software packages. RESULTS The following average network level metrics were observed: density .26 (SD.11), degree centrality .45 (SD.08), distance 1.94 (SD.26), number of ties 95.63 (SD 35.46), size of network 20.25 (SD 3.65). Advice networks for antenatal or maternity care were more utilised than advice networks for post-natal or newborn care. Advice networks were typically limited to primary healthcare unit staff, but not necessarily to supervisors. In seeking advice, a colleague's level of training and knowledge were valued over experience. Advice exchange primarily took place in person or over the phone rather than over email or online fora. There were few barriers to seeking advice. CONCLUSION Informal, inter-and intra-cadre advice networks existed. Fellow primary healthcare unit staff were preferred, particularly midwives, but networks were not limited to the primary healthcare unit. Additional research is needed to associate network properties with outcomes and pilot network interventions with central actors.
Collapse
Affiliation(s)
- Kate Sabot
- The Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK. .,Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Karl Blanchet
- Department of Global Health, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Della Berhanu
- The Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.,Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Neil Spicer
- Department of Global Health, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Joanna Schellenberg
- The Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.,Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| |
Collapse
|
7
|
Agala CB, Fried BJ, Thomas JC, Reynolds HW, Lich KH, Whetten K, Zimmer C, Morrissey JP. Reliability, validity and measurement invariance of the Simplified Medication Adherence Questionnaire (SMAQ) among HIV-positive women in Ethiopia: a quasi-experimental study. BMC Public Health 2020; 20:567. [PMID: 32345253 PMCID: PMC7189687 DOI: 10.1186/s12889-020-08585-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 03/25/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Adherence to antiretroviral therapy is critical to the achievement of the third target of the UNAIDS Fast-Track Initiative goals of 2020-2030. Reliable, valid and accurate measurement of adherence are important for correct assessment of adherence and in predicting the efficacy of ART. The Simplified Medication Adherence Questionnaire is a six-item scale which assesses the perception of persons living with HIV about their adherence to ART. Despite recent widespread use, its measurement properties have yet to be carefully documented beyond the original study in Spain. The objective of this paper was to conduct internal consistency reliability, concurrent validity and measurement invariance tests for the SMAQ. METHODS HIV-positive women who were receiving ART services from 51 service providers in two sub-cities of Addis Ababa, Ethiopia completed the SMAQ in a HIV treatment referral network study between 2011 and 2012. Two cross-sections of 402 and 524 female patients of reproductive age, respectively, from the two sub-cities were randomly selected and interviewed at baseline and follow-up. We used Cronbach's coefficient alpha (α) to assess internal consistency reliability, Pearson product-moment correlation (r) to assess concurrent validity and multiple-group confirmatory factor analysis to analyze factorial structure and measurement invariance of the SMAQ. RESULTS All participants were female with a mean age of 33; median: 34 years; range 18-45 years. Cronbach's alphas for the six items of the SMAQ were 0.66, 0.68, 0.75 and 0.75 for T1 control, T1 intervention, T2 control, and T2 intervention groups, respectively. Pearson correlation coefficients were 0.78, 0.49, 0.52, 0.48, 0.76 and 0.80 for items 1 to 6, respectively, between T1 compared to T2. We found invariance for factor loadings, observed item intercepts and factor variances, also known as strong measurement invariance, when we compared latent adherence levels between and across patient-groups. CONCLUSIONS Our results show that the six-item SMAQ scale has adequate reliability and validity indices for this sample, in addition to being invariant across comparison groups. The findings of this study strengthen the evidence in support of the increasing use of SMAQ by interventionists and researchers to examine, pool and compare adherence scores across groups and time periods.
Collapse
Affiliation(s)
- Chris B. Agala
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina United States of America
| | - Bruce J. Fried
- Health Policy & Management, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina United States of America
| | - James C. Thomas
- MEASURE Evaluation and Epidemiology Department, University of North Carolina, Chapel Hill, North Carolina United States of America
| | - Heidi W. Reynolds
- MEASURE Evaluation, University of North Carolina, Chapel Hill, North Carolina United States of America
| | - Kristen Hassmiller Lich
- Health Policy & Management, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina United States of America
| | - Kathryn Whetten
- Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina United States of America
| | - Catherine Zimmer
- Odum Institute for Research in Social Science, University of North Carolina, Chapel Hill, North Carolina United States of America
| | - Joseph P. Morrissey
- Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina United States of America
| |
Collapse
|
8
|
Improving Referrals for HIV Care Through Organizational Network Analysis. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 25:E36-E44. [PMID: 30180118 DOI: 10.1097/phh.0000000000000839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT The link between testing for HIV and obtaining antiretroviral therapy (ART) is central to the HIV/AIDS control strategies of UNAIDS (the "90-90-90" goals) and the International Association of Providers of AIDS Care ("Test and Start"). To ensure that 90% of those diagnosed with HIV/AIDS begin ART and 90% of those on ART achieve viral suppression, service providers not providing all services need to refer patients to other organizations. SETTING Homa Bay, Kenya. OBJECTIVE Homa Bay county's HIV/AIDS prevalence is one of the country's highest. We identified the organizations providing some aspect of HIV/AIDS care and investigated ways in which they work together, or do not, to cover the comprehensive needs of those they serve. DESIGN AND PARTICIPANTS We identified 56 organizations and interviewed a representative from each about his or her organization's services and its connections with the other 55, with particular interest in referrals from sites that test for HIV but do not treat infections to sites that do treat infections. MAIN OUTCOME MEASURE Referral connections. RESULTS Referral connections among the 56 in the past 30 days were relatively rare, averaging fewer than 2; 13 organizations made no referrals at all. Notably, 5 facilities that test for HIV did not refer their clients to an ART provider. We found 2 distinct clusters of connected organizations: one in Homa Bay Township and the other in Rangwe subcounty. When we convened the organizations and presented our results to them, they expressed interest in establishing better connections and referrals. CONCLUSIONS Homa Bay has an opportunity to improve care for people with HIV/AIDS, in particular ensuring that those testing positive receive treatment, simply by making better use of the services already available. This can be achieved by informing each organization of the services provided by each of the others and by bringing the organizations together to plan and monitor the services' coordination. These steps could be implemented separately in each of the 2 organizational clusters.
Collapse
|
9
|
Agala CB, Thomas JC, Fried BJ, Lich KH, Morrissey J, Zimmer C, Whetten K, Reynolds HW. Organizational network strengthening effects on antiretroviral therapy initiation and adherence. Transl Behav Med 2018; 8:585-597. [PMID: 30016523 DOI: 10.1093/tbm/ibx058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The WHO recommends antiretroviral therapy (ART) initiation immediately after HIV diagnosis. When HIV services are fragmented and poorly coordinated, initiation of ART can be delayed. MEASURE Evaluation conducted an organizational network intervention in Addis Ababa, Ethiopia, which increased referral network density and client satisfaction in the intervention versus control networks. The objective of our study was to extend the parent study by assessing effects of network density on the speed of ART initiation and adherence to ART. Measures of client-time since HIV diagnosis, use of ART, satisfaction with HIV-related services, and adherence were obtained from cross-sectional interviews with female service recipients with HIV/AIDS at baseline (T1, 402) and at 18-month follow-up (T2, 524) and compared between network sites. We used weighted least squares estimation with probit regression techniques in a structural equation modeling framework for analyses. On average at follow-up, clients in the intervention network were more likely to have quicker ART initiation, and were initiated on ART 15 days faster than clients in the control network. Moreover, quicker ART initiation was associated with higher adherence. A unit increase in speed of ART initiation was associated with 0.5 points increase in latent adherence score in the intervention group (p < .05). Satisfaction with care positively predicted adherence to ART. Network density had no direct effect on ART adherence. This quasi-experiment demonstrated that increased referral network density, through improved HIV client referrals, can enhance speed of ART initiation, resulting in improved adherence.
Collapse
Affiliation(s)
- Chris Bernard Agala
- MEASURE Evaluation, Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - James C Thomas
- MEASURE Evaluation, Carolina Population Center and Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Bruce J Fried
- Department of Health Policy & Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Kristen Hassmiller Lich
- Department of Health Policy & Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Joseph Morrissey
- North Carolina Rural Health Research and Policy Analysis Center, Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
| | - Catherine Zimmer
- Odum Institute for Research in Social Science, University of North Carolina, Chapel Hill, NC, USA
| | - Kathryn Whetten
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Heidi W Reynolds
- MEASURE Evaluation, Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
10
|
Bintabara D, Nakamura K, Seino K. Determinants of facility readiness for integration of family planning with HIV testing and counseling services: evidence from the Tanzania service provision assessment survey, 2014-2015. BMC Health Serv Res 2017; 17:844. [PMID: 29273033 PMCID: PMC5741912 DOI: 10.1186/s12913-017-2809-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 12/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Global policy reports, national frameworks, and programmatic tools and guidance emphasize the integration of family planning and HIV testing and counseling services to ensure universal access to reproductive health care and HIV prevention. However, the status of integration between these two services in Tanzanian health facilities is unclear. This study examined determinants of facility readiness for integration of family planning with HIV testing and counseling services in Tanzania. METHODS Data from the 2014-2015 Tanzania Service Provision Assessment Survey were analyzed. Facilities were considered ready for integration of family planning with HIV testing and counseling services if they scored ≥ 50% on both family planning and HIV testing and counseling service readiness indices as identified by the World Health Organization. All analyses were adjusted for clustering effects, and estimates were weighted to correct for non-responses and disproportionate sampling. Descriptive, bivariate, and multivariate logistic regression analyses were performed. RESULTS A total of 1188 health facilities were included in the study. Of all of the health facilities, 915 (77%) reported offering both family planning and HIV testing and counseling services, while only 536 (45%) were considered ready to integrate these two services. Significant determinants of facility readiness for integrating these two services were being government owned [AOR = 3.2; 95%CI, 1.9-5.6], having routine management meetings [AOR = 1.9; 95%CI, 1.1-3.3], availability of guidelines [AOR = 3.8; 95%CI, 2.4-5.8], in-service training of staff [AOR = 2.6; 95%CI, 1.3-5.2], and availability of laboratories for HIV testing [AOR = 17.1; 95%CI, 8.2-35.6]. CONCLUSION The proportion of facility readiness for the integration of family planning with HIV testing and counseling in Tanzania is unsatisfactory. The Ministry of Health should distribute and ensure constant availability of guidelines, availability of rapid diagnostic tests for HIV testing, and the provision of refresher training to health providers, as these were among the determinants of facility readiness.
Collapse
Affiliation(s)
- Deogratius Bintabara
- Department of Global Health Entrepreneurship, Division of Public Health, Graduate School of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.,Department of Public Health, College of Health Sciences, The University of Dodoma, P.O Box 259, Dodoma, Tanzania
| | - Keiko Nakamura
- Department of Global Health Entrepreneurship, Division of Public Health, Graduate School of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Kaoruko Seino
- Department of Global Health Entrepreneurship, Division of Public Health, Graduate School of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| |
Collapse
|
11
|
Rutaremwa G, Kabagenyi A. Utilization of integrated HIV and sexual and reproductive health services among women in Uganda. BMC Health Serv Res 2016; 16:494. [PMID: 27645152 PMCID: PMC5029044 DOI: 10.1186/s12913-016-1761-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 09/15/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND While the rationale for integration of HIV and sexual and reproductive health (HIV and SRH) services is strong, there is paucity of information on which population groups most utilize these services. Such studies would inform policy and programs on integration of services. The overall objective of this assessment is to provide information to researchers, planners and policy makers on the best practices for integrated services in order to maximize feasibility of scaling up. Specifically, this research paper identifies demographic and socioeconomic factors that are most related to utilization of integrated services in Uganda. METHODS This manuscript uses data from a sample of 9,691 women interviewed during the Uganda AIDS Indicator Survey (UAIS) of 2011. The selection criteria of the study respondents for this paper included women of reproductive age 15 - 49 years. The dependent variable is whether the respondent utilized integrated HIV and SRH services during pregnancy and delivery of the last child, while independent variables include; region of residence, age-group of woman, marital status, rural-urban residence, wealth indicator and educational level attainment. In the main analysis, a binary logistic regression model was fitted to the data. RESULTS Log-odds of utilizing integrated services were significantly higher among those women with a primary education (OR = 1.2, 95 % CI = 1.0-1.4, p < 0.05) compared to those with no education. Women from the Central part of Uganda were more likely to utilize integrated HIV and SRH services (OR = 1.3, 95 % CI = 1.0-1.7, p < 0.05), further the log-odds of utilizing integrated HIV and SRH services were significantly higher among women residing in Northern region (OR = 1.6, 95 % CI = 1.2-2.2, p < 0.01). The odds of utilization of integrated HIV and SRH services were higher for currently married women (OR = 6.6, 95 % CI = 5.5-8.0, p < 0.01) and the formerly married (OR = 3.4, 95 % CI = 2.7-4.2, p < 0.01), compared to the never married group. The odds of utilizing integrated HIV and SRH services were higher for younger women of ages less than 35 years compared to older women aged 40 - 49 years. CONCLUSIONS Utilization of integrated HIV and SRH services in Uganda is influenced greatly by demographic and socioeconomic characteristics. This study contributes to the current debate as it shows the on how best ways to improve HIV and SRH service delivery to the people.
Collapse
Affiliation(s)
- Gideon Rutaremwa
- United Nations Economic Commission for Africa (ECA), Social Development Policy Division, P.O.Box 3001, Addis Ababa, Ethiopia
| | - Allen Kabagenyi
- Center for Population and Applied Statistics (CPAS) and Department of Population Studies, Makerere University, Kampala, Uganda
| |
Collapse
|
12
|
Kruk ME, Riley PL, Palma AM, Adhikari S, Ahoua L, Arnaldo C, Belo DF, Brusamento S, Cumba LIG, Dziuban EJ, El-Sadr WM, Gutema Y, Habtamu Z, Heller T, Kidanu A, Langa J, Mahagaja E, McCarthy CF, Melaku Z, Shodell D, Tsiouris F, Young PR, Rabkin M. How Can the Health System Retain Women in HIV Treatment for a Lifetime? A Discrete Choice Experiment in Ethiopia and Mozambique. PLoS One 2016; 11:e0160764. [PMID: 27551785 PMCID: PMC4994936 DOI: 10.1371/journal.pone.0160764] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 07/25/2016] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Option B+, an approach that involves provision of antiretroviral therapy (ART) to all HIV-infected pregnant women for life, is the preferred strategy for prevention of mother to child transmission of HIV. Lifelong retention in care is essential to its success. We conducted a discrete choice experiment in Ethiopia and Mozambique to identify health system characteristics preferred by HIV-infected women to promote continuity of care. METHODS Women living with HIV and receiving care at hospitals in Oromia Region, Ethiopia and Zambézia Province, Mozambique were shown nine choice cards and asked to select one of two hypothetical health facilities, each with six varying characteristics related to the delivery of HIV services for long term treatment. Mixed logit models were used to estimate the influence of six health service attributes on choice of clinics. RESULTS 2,033 women participated in the study (response rate 97.8% in Ethiopia and 94.7% in Mozambique). Among the various attributes of structure and content of lifelong ART services, the most important attributes identified in both countries were respectful provider attitude and ability to obtain non-HIV health services during HIV-related visits. Availability of counseling support services was also a driver of choice. Facility type, i.e., hospital versus health center, was substantially less important. CONCLUSIONS Efforts to enhance retention in HIV care and treatment for pregnant women should focus on promoting respectful care by providers and integrating access to non-HIV health services in the same visit, as well as continuing to strengthen counseling.
Collapse
Affiliation(s)
- Margaret E. Kruk
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Patricia L. Riley
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Anton M. Palma
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Sweta Adhikari
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Laurence Ahoua
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Carlos Arnaldo
- Center for Population and Health Research, Maputo, Mozambique
| | | | - Serena Brusamento
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | | | - Eric J. Dziuban
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Wafaa M. El-Sadr
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Yoseph Gutema
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Zelalem Habtamu
- Oromio Regional Health Bureau, Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | - Thomas Heller
- Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | | | - Judite Langa
- Centers for Disease Control and Prevention, Maputo, Mozambique
| | | | - Carey F. McCarthy
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Zenebe Melaku
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Daniel Shodell
- Centers for Disease Control and Prevention, Maputo, Mozambique
| | - Fatima Tsiouris
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Paul R. Young
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Miriam Rabkin
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| |
Collapse
|
13
|
Thomas JC, Reynolds HW, Alterescu X, Bevc C, Tsegaye A. Improving referrals and integrating family planning and HIV services through organizational network strengthening. Health Policy Plan 2015; 31:302-8. [PMID: 26135363 DOI: 10.1093/heapol/czv058] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The service needs of people with human immunodeficiency virus (HIV) in low-income settings are wide-ranging. Service provision in a community is often disjointed among a variety of providers. We sought to reduce unmet patient needs by increasing referral coordination for HIV and family planning, measured as network density, with an organizational network approach. METHODS We conducted organizational network analysis on two networks in sub-cities of Addis Ababa, Ethiopia. There were 25 organizations in one sub-city network and 26 in the other. In one of them we sought to increase referrals through three network strengthening meetings. We then conducted the network analysis again in both sub-cities to measure any changes since baseline. We also quantitatively measured reported client service needs in both sub-cities before and after the intervention with two cross-sectional samples of face-to-face interviews with clients (459 at baseline and 587 at follow-up). RESULTS In the sub-city with the intervention, the number of referral connections between organizations, measured as network density, increased 55%. In the control community, the density decreased over the same period. Reported unmet client service needs declined more consistently across services in the intervention community. DISCUSSION This quasi experiment demonstrated that (1) an organizational network analysis can inform an intervention, (2) a modest network strengthening intervention can enhance client referrals in the network, (3) improvement in client referrals was accompanied by a decrease in atient-reported unmet needs and (4) a series of network analyses can be a useful evaluation tool.
Collapse
Affiliation(s)
- James C Thomas
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA MEASURE Evaluation, Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - Heidi W Reynolds
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | | | - Christine Bevc
- North Carolina Institute for Public Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA and
| | | |
Collapse
|
14
|
Exploring the use of social network analysis to measure communication between disease programme and district managers at sub-national level in South Africa. Soc Sci Med 2015; 135:1-14. [PMID: 25931377 DOI: 10.1016/j.socscimed.2015.04.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
With increasing interest in maximising synergies between disease control programmes (DCP) and general health services (GHS), methods are needed to measure interactions between DCP and GHS actors. In South Africa, administrative integration reforms make GHS managers at decentralised level (district managers) responsible for the oversight of DCP operations within districts, with DCP managers (programme managers) providing specialist support. The reforms necessitate interdependence, but these actors work together ineffectively. Communication is crucial for joint working, but no research to assess communication between these actors has been done. This study explores the use of social network analysis (SNA) to measure the extent to which programme and district managers in South Africa communicate, using HIV monitoring and evaluation (M&E) as an exemplar. Data were collected from fifty one managers in two provinces during 2010-2011, to measure: a) one-on-one task-related communication - talking about the collation (verification, reporting) and use of HIV data for monitoring HIV interventions; and b) group communication through co-participating in management committees where HIV data are used for monitoring HIV interventions in districts. SNA measures were computed to describe actor centrality, network density (cohesion), and communication within and between respective manager groups. Block modelling was applied to identify management committees that connect respective manager groups. Results show HIV programme managers located at higher level communicated largely amongst themselves as a group (homophily), seldom talked to the district managers to whom they are supposed to provide specialist HIV M&E support, and rarely participated with them in management committees. This research demonstrates the utility of SNA as a tool for measuring the extent of communication between DCP and GHS actors at sub-national level. Actions are needed to bridge observed communication gaps in order to promote collaborative monitoring of HIV programme interventions within districts.
Collapse
|