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Naanyu V, Koros H, Goodrich S, Siika A, Toroitich-Ruto C, Bateganya M, Wools-Kaloustian K. Post-intervention perceptions on the antiretroviral therapy community group model in Trans Nzoia County, Kenya. Pan Afr Med J 2024; 47:113. [PMID: 38828427 PMCID: PMC11143075 DOI: 10.11604/pamj.2024.47.113.41843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/19/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction the increasing number of people receiving antiretroviral therapy (ART) in sub-Saharan Africa has stressed already overburdened health systems. A care model utilizing community-based peer-groups (ART Co-ops) facilitated by community health workers (CHW) was implemented (2016-2018) to address these challenges. In 2018, a post-intervention study assessed perceptions of the intervention. Methods forty participants were engaged in focus group discussions consisting of ART Co-op clients, study staff, and health care providers from Kitale HIV clinic. Data were analyzed thematically for content on the intervention, challenges, and recommendations for improvement. Results all participants liked the intervention. However, some reported traveling long distances to attend ART Co-op meetings and experiencing stigma with ART Co-ops participation. The ART Co-op inclusion criteria were considered appropriate; however, additional outreach to deliberately include spouses living with HIV, the disabled, the poor, and HIV pregnant women was recommended. Participants liked CHW-directed quarterly group meetings which included ART distribution, adherence review, and illness identification. The inability of the CHW to provide full clinical care, inconvenient meeting venues, poor timekeeping, and non-attendance behaviors were noted as issues. Participants indicated that program continuation, regular CHW training, rotating meetings at group members´ homes, training ART Co-ops leaders to assume CHW tasks, use of pill diaries to check adherence, nutritional support, and economically empowering members through income generation projects would be beneficial. Conclusion the intervention was viewed positively by both clinic staff and clients. They identified specific challenges and generated actionable key considerations to improve access and acceptability of the community-based model of care.
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Affiliation(s)
- Violet Naanyu
- Department of Sociology Psychology and Anthropology, School of Arts and Social Sciences, Moi University, Eldoret, Kenya
- AMPATH Qualitative Research Core, Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Hillary Koros
- AMPATH Qualitative Research Core, Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Suzanne Goodrich
- Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Abraham Siika
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Cathy Toroitich-Ruto
- Division of Global HIV and TB (DGHT), Centers for Global Health (CGH), US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | | | - Kara Wools-Kaloustian
- Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
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Inguane C, Gimbel S, Soi C, Tavede E, Murgorgo F, Isidoro X, Sidat Y, Nassiaca R, Coutinho J, Cruz M, Agostinho M, Amaral F, Dinis A, Ábsjörnsdóttir K, Crocker J, Manaca N, Ramiro I, Pfeiffer J, de Fátima Cuembelo M, Sherr K. Assessing drivers of implementing "Scaling-up the Systems Analysis and Improvement Approach" for Prevention of Mother-to-Child HIV Transmission in Mozambique (SAIA-SCALE) over implementation waves. Implement Sci Commun 2023; 4:84. [PMID: 37488632 PMCID: PMC10364357 DOI: 10.1186/s43058-023-00422-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 04/01/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND The Systems Analysis and Improvement Approach (SAIA) is an evidence-based package of systems engineering tools originally designed to improve patient flow through the prevention of Mother-to-Child transmission of HIV (PMTCT) cascade. SAIA is a potentially scalable model for maximizing the benefits of universal antiretroviral therapy (ART) for mothers and their babies. SAIA-SCALE was a stepped wedge trial implemented in Manica Province, Mozambique, to evaluate SAIA's effectiveness when led by district health managers, rather than by study nurses. We present the results of a qualitative assessment of implementation determinants of the SAIA-SCALE strategy during two intensive and one maintenance phases. METHODS We used an extended case study design that embedded the Consolidated Framework for Implementation Research (CFIR) to guide data collection, analysis, and interpretation. From March 2019 to April 2020, we conducted in-depth individual interviews (IDIs) and focus group discussions (FGDs) with district managers, health facility maternal and child health (MCH) managers, and frontline nurses at 21 health facilities and seven districts of Manica Province (Chimoio, Báruè, Gondola, Macate, Manica, Sussundenga, and Vanduzi). RESULTS We included 85 participants: 50 through IDIs and 35 from three FGDs. Most study participants were women (98%), frontline nurses (49.4%), and MCH health facility managers (32.5%). An identified facilitator of successful intervention implementation (regardless of intervention phase) was related to SAIA's compatibility with organizational structures, processes, and priorities of Mozambique's health system at the district and health facility levels. Identified barriers to successful implementation included (a) inadequate health facility and road infrastructure preventing mothers from accessing MCH/PMTCT services at study health facilities and preventing nurses from dedicating time to improving service provision, and (b) challenges in managing intervention funds. CONCLUSIONS The SAIA-SCALE qualitative evaluation suggests that the scalability of SAIA for PMTCT is enhanced by its fit within organizational structures, processes, and priorities at the primary level of healthcare delivery and health system management in Mozambique. Barriers to implementation that impact the scalability of SAIA include district-level financial management capabilities and lack of infrastructure at the health facility level. SAIA cannot be successfully scaled up to adequately address PMTCT needs without leveraging central-level resources and priorities. TRIAL REGISTRATION ClinicalTrials.gov, NCT03425136 . Registered on 02/06/2018.
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Affiliation(s)
- Celso Inguane
- Department of Global Health, University of Washington, Seattle, WA, USA.
- Hans Rosling Center for Population Health, 700D.4, University of Washington, Box 351620, 3980 15Th Ave. NE, Seattle, WA, 98105, USA.
- Cooperativa de Ideias e Pesquisa em Saúde - CO-IDEAS, Maputo City, Mozambique.
| | - Sarah Gimbel
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Child, Family and Population Health Nursing, University of Washington, Seattle, WA, USA
| | - Caroline Soi
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | | | | | - Yaesh Sidat
- Manica Province Health Directorate, Chimoio, Mozambique
| | | | - Joana Coutinho
- Comité Para a Saúde de Moçambique, Maputo City, Mozambique
| | - Maria Cruz
- Comité Para a Saúde de Moçambique, Maputo City, Mozambique
| | - Mery Agostinho
- Comité Para a Saúde de Moçambique, Maputo City, Mozambique
| | | | - Aneth Dinis
- Department of Global Health, University of Washington, Seattle, WA, USA
- National Department of Public Health, Ministry of Health, Maputo City, Mozambique
| | - Kristjana Ábsjörnsdóttir
- Center for Public Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Jonny Crocker
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Nélia Manaca
- Health Alliance International, Beira, Mozambique
| | - Isaias Ramiro
- Comité Para a Saúde de Moçambique, Maputo City, Mozambique
| | - James Pfeiffer
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Anthropology, University of Washington, Seattle, WA, USA
| | - Maria de Fátima Cuembelo
- Department of Community Health, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo City, Mozambique
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Industrial & Systems Engineering, University of Washington, Seattle, WA, USA
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3
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Knettel BA, Muhirwa A, Wanda L, Amiri I, Muiruri C, Fernandez KM, Watt MH, Mmbaga BT, Relf MV. Patient perspectives on the helpfulness of a community health worker program for HIV care engagement in Tanzania. AIDS Care 2023; 35:1014-1021. [PMID: 34702095 PMCID: PMC9038954 DOI: 10.1080/09540121.2021.1995840] [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: 12/02/2020] [Accepted: 10/14/2021] [Indexed: 10/20/2022]
Abstract
Task-shifting is a valuable approach for redistributing clinical tasks to nonprofessional health workers and relieving human resource shortages. The Community-Based HIV Services (CBHS) program is a national cohort of volunteer community health workers (CHWs) who support HIV care engagement at clinics in Tanzania. We recruited 23 patients initiating HIV care at two clinics to understand their experiences with the CBHS program. Participants completed qualitative interviews by telephone discussing the perceived helpfulness of the program, their level of connection with CHWs, and suggestions for improvement. Data were analyzed through an inductive, team-based qualitative approach. Most participants found the program to be helpful and described close, positive connections. CHWs offered education, emotional support to accept one's diagnosis and cope with stigma, and encouragement to remain engaged in HIV care. However, several participants described minimal, shallow contact with CHWs, and felt the program did not benefit their HIV care. Participants recommended increasing CHW efforts to engage people living with HIV (PLWH) in the broader community, and addressing socioeconomic barriers to care engagement. When contacts are consistent, the CBHS program is a strong resource for PLWH. To maximize the potential of the program, administrators should enhance oversight and extend new training opportunities for CHWs.
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Affiliation(s)
- Brandon A. Knettel
- Duke University School of Nursing, Durham, NC
- Duke Global Health Institute, Duke University, Durham, NC
| | | | - Lisa Wanda
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Ismail Amiri
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Charles Muiruri
- Department of Population Health Sciences, Duke University, Durham, NC
| | - Kimberly M. Fernandez
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Melissa H. Watt
- Duke Global Health Institute, Duke University, Durham, NC
- Department of Population Health Sciences, The University of Utah School of Medicine
| | - Blandina T. Mmbaga
- Duke Global Health Institute, Duke University, Durham, NC
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University, Moshi, Tanzania
| | - Michael V. Relf
- Duke University School of Nursing, Durham, NC
- Duke Global Health Institute, Duke University, Durham, NC
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Camellia A, Swandari P, Rahma G, Merati TP, Bakta IM, Duarsa DP. A Peer-support Mini-counseling Model to Improve Treatment in HIV-positive Pregnant Women in Kupang City, East Nusa Tenggara, Indonesia. J Prev Med Public Health 2023; 56:238-247. [PMID: 37287201 PMCID: PMC10248100 DOI: 10.3961/jpmph.22.516] [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: 12/12/2022] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVES Low adherence to antiretroviral (ARV) therapy in pregnant women with human immunodeficiency virus (HIV) increases the risk of virus transmission from mother to newborn. Increasing mothers' knowledge and motivation to access treatment has been identified as a critical factor in prevention. Therefore, this research aimed to explore barriers and enablers in accessing HIV care and treatment services. METHODS This research was the first phase of a mixed-method analysis conducted in Kupang, a remote city in East Nusa Tenggara Province, Indonesia. Samples were taken by purposive sampling of 17 people interviewed, consisting of 6 mothers with HIV, 5 peer facilitators, and 6 health workers. Data were collected through semi-structured interviews, focus group discussions, observations, and document review. Inductive thematic analysis was also performed. The existing data were grouped into several themes, then relationships and linkages were drawn from each group of informants. RESULTS Barriers to accessing care and treatment were lack of knowledge about the benefits of ARV; stigma from within and the surrounding environment; difficulty in accessing services due to distance, time, and cost; completeness of administration; drugs' side effects; and the quality of health workers and HIV services. CONCLUSIONS There was a need for a structured and integrated model of peer support to improve ARV uptake and treatment in pregnant women with HIV. This research identified needs including mini-counseling sessions designed to address psychosocial barriers as an integrated approach to support antenatal care that can effectively assist HIV-positive pregnant women in improving treatment adherence.
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Affiliation(s)
- Artha Camellia
- Department of Health, UNICEF Indonesia, Jakarta, Indonesia
| | - Plamularsih Swandari
- Department of Research and Community Centre, AIDS Research Center, Atmajaya University, Jakarta, Indonesia
| | - Gusni Rahma
- Department of Public Health, STIKes Alifah Padang, Padang, Indonesia
| | - Tuti Parwati Merati
- Department of Internal Medicine, Faculty of Medicine, Udayana University, Denpasar, Indonesia
| | - I Made Bakta
- Department of Internal Medicine, Faculty of Medicine, Udayana University, Denpasar, Indonesia
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Prasad R, Jaiswal A, Prasad R, Wanjari MB, Sharma DR. The Vital Role of Public Health Nurses in Perinatal HIV Prevention and Elimination. Cureus 2023; 15:e38704. [PMID: 37292570 PMCID: PMC10246483 DOI: 10.7759/cureus.38704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 06/10/2023] Open
Abstract
Perinatal HIV transmission remains a significant public health challenge, with an estimated 160,000 children newly infected with HIV each year. Public health nurses play a critical role in the prevention and elimination of perinatal HIV transmission through targeted interventions such as identification of pregnant women with HIV, referral and linkage to care, provision of antiretroviral therapy, and follow-up and retention in care for both mothers and infants. However, significant barriers to successful implementation exist, including stigma and discrimination, limited access to healthcare services, socioeconomic factors, and limited resources. Addressing these barriers will require a multifaceted approach that includes policy changes, community engagement, and targeted support and resources for affected families. In this review article, we provide an overview of the epidemiology of perinatal HIV transmission, current strategies for prevention and elimination, and the vital role of public health nurses in these efforts. We will also discuss the barriers to the successful implementation of public health nurse interventions and the future directions for research and practice in this field. Ultimately, the goal of perinatal HIV prevention and elimination can only be achieved through a sustained and collaborative effort across multiple sectors and stakeholders, with public health nurses playing a crucial role in this effort.
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Affiliation(s)
- Rajnandini Prasad
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Arpita Jaiswal
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, wardha, IND
| | - Roshan Prasad
- Department of Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mayur B Wanjari
- Department of Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Dr Ranjana Sharma
- Department of Medical Surgical Nursing, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Khumalo GE, Lutge E, Mashamba-Thompson TP. Exploring how outreach team leaders perceive community health workers' experiences of providing HIV services in KwaZulu-Natal, South Africa. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2022; 21:239-250. [PMID: 36102053 DOI: 10.2989/16085906.2022.2060841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 03/22/2022] [Accepted: 03/29/2022] [Indexed: 06/15/2023]
Abstract
Objectives: In 2018, the KwaZulu-Natal Department of Health launched the ward-based primary health care outreach teams policy framework which sought to expand the community health worker (CHW) programme's provision of longitudinal patient support, including human immunodeficiency virus (HIV) services in communities. This study sought to explore the perceptions of outreach team leaders who supervise CHWs on their experiences of providing HIV services in the province.Study design: This was a qualitative, phenomenology study.Methods: Convenience sampling was done to select one outreach team leader from each of the 11 KwaZulu-Natal health districts to be interviewed using an interview guide. Thematic analysis, guided by the Ritchie and Spencer framework analysis, was used to analyse the data.Results: The challenges faced by CHWs in delivering HIV services were: the absence of individuals when CHWs visited their homes, self-HIV stigma, rejection of CHWs' HIV services due to traditional beliefs, CHW shortages, lack of other resources, low levels of CWH education and a lack of training. On the other hand, the provision of HIV services was fascilitated by: supportive supervision, training, having cell phones and having a positive attitude towards providing HIV services by CHWs that were HIV-positive.Conclusion: The CHWs in KwaZulu-Natal face more challenges than enablers in the provision of HIV services. The delegation of HIV services to CHWs should be aligned with their holistic empowerment by eliminating barriers to the provision of HIV services.
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Affiliation(s)
- Gugulethu E Khumalo
- Public Health Medicine, School of Nursing & Public Health, University of KwaZulu-Natal, Durban, South Africa
- Health Research & Knowledge Management Unit, KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa
| | - Elizabeth Lutge
- Public Health Medicine, School of Nursing & Public Health, University of KwaZulu-Natal, Durban, South Africa
- Health Research & Knowledge Management Unit, KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa
| | - Tivani P Mashamba-Thompson
- Public Health Medicine, School of Nursing & Public Health, University of KwaZulu-Natal, Durban, South Africa
- Faculty of Health Sciences, University of Pretoria, Prinshof Campus, Pretoria, South Africa
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7
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Okal JO, Sarna A, Lango D, Matheka J, Owuor D, Kinywa EA, Kalibala S. Client Experiences in a Mobile-Phone Counseling Intervention for Enhancing Access to Prevention of Mother To-Child Transmission (PMTCT) Services in Kenya. Front Glob Womens Health 2022; 3:785194. [PMID: 35720809 PMCID: PMC9204057 DOI: 10.3389/fgwh.2022.785194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 04/12/2022] [Indexed: 11/25/2022] Open
Abstract
Background The prevention of mother-to-child transmission (PMTCT) is considered one of the most successful HIV prevention strategies in detecting and reducing HIV acquisition in utero or at birth. It is anticipated that with the increasing growth of digital technologies mobile phones can be utilized to enhance PMTCT services by improving provider-client interactions, expanding access to counseling services, and assisting in counteracting social and structural barriers to uptake of PMTCT services. Understanding the subjective experiences of women accessing PMTCT services in different settings has the potential to inform the development and promotion of such methods. This paper explores the perspectives of HIV-positive pregnant women attending maternal and neonatal clinic services in Kisumu, Kenya. Methods Data are reported from in-depth interviews with women, following a longitudinal study investigating the impact of a structured, counselor-delivered, mobile phone counseling intervention to promote retention in care and adherence to ARV prophylaxis/treatment, for HIV-positive pregnant women. Thematic content analysis was conducted. Results Discussions indicated that mobile-phone counseling provided useful health-related information, enhanced agency, and assisted mothers access critical PMTCT services across the cascade of care. Similarly, mobile-phone counseling offered personalized one-to-one contact with trained health providers including facilitating discussion of personal issues that likely affect access to services. Findings also identified barriers to the uptake of services, including a lack of partner support, poor health, poverty, facility-related factors, and provider attitudes. Discussion Overall, findings show that mobile-phone counseling is feasible, acceptable, and can enhance access to PMTCT services by overcoming some of the individual and facility-level barriers. Although mobile-phone counseling has not been routinized in most health facilities, future work is needed to assess whether mobile-phone counseling can be scaled-up to aid in the effective use of HIV and PMTCT services, as well as improving other related outcomes for mother and child dyad.
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Affiliation(s)
- Jerry Okoth Okal
- Population Council, Nairobi, Kenya
- *Correspondence: Jerry Okoth Okal
| | | | | | | | | | | | - Sam Kalibala
- Population Council, Washington, DC, United States
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Doat AR, Amoah RM, Konlan KD, Konlan KD, Abdulai JA, Kukeba MW, Mohammed I, Saah JA. Factors associated with pregnancy uptake decisions among seropositive
HIV
people receiving antiretroviral therapy in
sub‐Saharan
Africa: A systematic review. Nurs Open 2022; 9:2239-2249. [PMID: 35643950 PMCID: PMC9374407 DOI: 10.1002/nop2.1251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/08/2022] [Indexed: 12/02/2022] Open
Abstract
Aim This study determined the factors associated with pregnancy uptake decision among seropositive HIV people receiving antiretroviral therapy in sub‐Saharan Africa. Design Systematic review. Methods The population, intervention, comparison and outcomes framework was adopted to search for literature after a scoping review using the preferred reporting items for systematic reviews and meta‐analyses guidelines adopted in searching, and screening articles from four databases (PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, and Google scholar) to find 12 articles suitable for this study. Results Motivators of pregnancy uptake among HIV‐positive women include desire to have children, knowledge about PMTCT, cultural duty for married women to have children, and household income. Demotivating factors included the modern method of contraception and burden associated with pregnancy. Conclusion There is a need to improve on services that reduce conception‐related risks especially for women who choose to conceive and to incorporate fertility‐related counselling into HIV treatment services.
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Affiliation(s)
- Abdul Razak Doat
- Department of Paediatric Nursing, School of Nursing and Midwifery CK Tedam University of Technology and Applied Sciences Navrongo Ghana
| | - Roberta Mensima Amoah
- Maternal and Child Health Unit, University Health Services University for Development Studies Tamale Ghana
| | - Kennedy Diema Konlan
- Department of Public Health Nursing, School of Nursing and Midwifery University of Health and Allied Sciences Ho Ghana
| | - Kennedy Dodam Konlan
- Department of Adult Health, School of Nursing and Midwifery University of Ghana Accra Ghana
| | | | - Margaret W. Kukeba
- School of Nursing and Midwifery CK Tedam University of Technology and Applied Sciences Navrongo Ghana
| | - Iddrisu Mohammed
- Department of Social and Behavioral Change, School of Public Health University for Development Studies Tamale Ghana
| | - Joel Afram Saah
- Department of Social and Behavioral Change, School of Public Health University for Development Studies Tamale Ghana
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Knettel BA, Fernandez KM, Wanda L, Amiri I, Cassiello-Robbins C, Watt MH, Mmbaga BT, Relf MV. The Role of Community Health Workers in HIV Care Engagement: A Qualitative Study of Stakeholder Perspectives in Tanzania. J Assoc Nurses AIDS Care 2021; 32:682-692. [PMID: 33908407 PMCID: PMC8548405 DOI: 10.1097/jnc.0000000000000267] [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: 10/21/2022]
Abstract
ABSTRACT Suboptimal retention in HIV care is a major driver of the global epidemic, including in sub-Saharan Africa. In Tanzania, the national Community-Based HIV Services program integrates volunteer community health workers (CHWs) to support patient care engagement and reduce the burden placed on HIV clinic nurses; however, few studies have assessed the value of CHWs supporting HIV care. Qualitative interviews were conducted with 48 administrators, nurses, CHWs, and patients to explore strengths and limitations of the Community-Based HIV Services program. Stakeholders believed CHWs are uniquely positioned to establish trust and provide patient support. Patients who had frequent contact with CHWs described them as valued sources of education and encouragement, but fewer than half of the patients interviewed had ever met with a CHW. Clinic nurses described feeling disconnected from CHWs, and stakeholders highlighted the need for financial, logistical, and educational support to rejuvenate the program and effectively address care engagement challenges.
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Affiliation(s)
- Brandon A. Knettel
- Duke University School of Nursing and Duke Global Health Institute, Durham, North Carolina, USA
| | | | - Lisa Wanda
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Ismail Amiri
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Clair Cassiello-Robbins
- Center for Misophonia and Emotion Regulation, Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA
| | - Melissa H. Watt
- University of Utah, Department of Population Health Sciences, Salt Lake City, Utah, USA
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical Centre, Director of Research and Consultancy at Kilimanjaro Christian Medical University College, Director of the Kilimanjaro Clinical Research Institute, and Adjunct Associate Professor at Duke Global Health Institute
| | - Michael V. Relf
- JANAC and the Associate Dean for Global and Community Health Affairs, Duke University School of Nursing and Associate Professor, Duke Global Health Institute, Durham, North Carolina, USA
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Khumalo GE, Lutge EE, Naidoo P, Mashamba-Thompson TP. Barriers and facilitators of rendering HIV services by community health workers in sub-Saharan Africa: a meta-synthesis. Fam Med Community Health 2021; 9:fmch-2021-000958. [PMID: 34561220 PMCID: PMC8475151 DOI: 10.1136/fmch-2021-000958] [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] [Indexed: 01/01/2023] Open
Abstract
Objectives To synthesise qualitative studies that address the barriers to and facilitators of providing HIV services by community health workers (CHWs) in sub-Saharan Africa (SSA). Design This meta-synthesis was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We included studies that were published between 2009 and 2019. The Ritchie and Spencer framework and the Supporting the Use of Research Evidence framework were used for thematic analysis and framework analysis, respectively. The Qualitative Assessment and Review Instrument was used to assess the quality of selected studies. Eligibility criteria Qualitative studies published between 2009 and 2019, that included CHWs linked directly or indirectly to the Ministry of Health and providing HIV services in the communities. Information sources An extensive search was conducted on the following databases: EBSCOhost- (ERIC; Health Source-Nursing/Academic Edition; MEDLINE Full Text), Google Scholar and PubMed. Results Barriers to rendering of HIV services by CHWs were community HIV stigma; lack of CHW respect, CHWs’ poor education and training; poor stakeholders’ involvement; poor access to the communities; shortage of CHWs; unsatisfactory incentives; lack of CHW support and supervision, lack of equipment and supplies and social barriers due to culture, language and political structures. The altruistic behaviour of CHWs and the availability of job facilitated the provision of HIV services. Conclusion The delivery of HIV services by CHWs in SSA is faced by more lingering barriers than facilitators. Planners and policymakers can minimise the barriers by investing in both CHW and community training regarding HIV services. Furthermore, sufficient funding should be allocated to the programme to ensure its efficiency. PROSPERO registration number CRD42020160012.
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Affiliation(s)
- Gugulethu Eve Khumalo
- Nursing and Public Health, University of KwaZulu-Natal College of Health Sciences, Durban, KwaZulu-Natal, South Africa .,Health Research and Knowledge Management Unit, KwaZulu-Natal Department of Health, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Elizabeth E Lutge
- Nursing and Public Health, University of KwaZulu-Natal College of Health Sciences, Durban, KwaZulu-Natal, South Africa.,Health Research and Knowledge Management Unit, KwaZulu-Natal Department of Health, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Praba Naidoo
- Library, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, KwaZulu-Natal, South Africa
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Odiachi A, Al-Mujtaba M, Torbunde N, Erekaha S, Afe AJ, Adejuyigbe E, Galadanci HS, Jasper TL, Cornelius LJ, Sam-Agudu NA. Acceptability of mentor mother peer support for women living with HIV in North-Central Nigeria: a qualitative study. BMC Pregnancy Childbirth 2021; 21:545. [PMID: 34364384 PMCID: PMC8349095 DOI: 10.1186/s12884-021-04002-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 07/13/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Mentor mothers provide psychosocial and other support to pregnant and post-partum women living with HIV (WLHIV), which has been shown to enhance maternal-infant outcomes in the prevention of mother-to-child transmission of HIV (PMTCT). Our objective was to assess the acceptability of mentor mothers as a PMTCT intervention, and to explore opinions on mentor mother program composition and delivery among stakeholders in North-Central Nigeria. METHODS We conducted nine focus group discussions and 31 in-depth interviews with 118 participants, including WLHIV, pregnant women, male partners, health workers, traditional birth attendants, community leaders, PMTCT program implementers, and policymakers. Participants were purposively recruited from health facilities and surrounding communities in the Federal Capital Territory and Nasarawa State. Transcripts were manually analysed using a Grounded Theory approach, where theory was derived from the data collected. RESULTS Most participants were female (n = 78, 67%), and married (n = 110, 94%). All participant groups found mentor mothers acceptable as women providing care to pregnant and postpartum women, and as WLHIV supporting other WLHIV. Mentor mothers were uniquely relatable as role models for WLHIV because they were women, living with HIV, and had achieved an HIV-negative status for their HIV-exposed infants. Mentor mothers were recognized as playing major roles in maternal health education, HIV treatment initiation, adherence, and retention, HIV prevention for male partners and infants, and couple HIV disclosure. Most WLHIV preferred to receive mentor mothers' services at health facilities rather than at home, due to concerns about HIV-related stigma and discrimination through association with mentor mothers. Key mentor mother needs were identified as training, remuneration, and validation as lay health workers. CONCLUSIONS Mentor mothers are an acceptable PMTCT intervention among stakeholders in North-Central Nigeria. However, stigma and discrimination for both mentor mothers and their clients remain a critical challenge, and mentor mother needs such as training, pay, and a sustainably supported niche in health systems require focused attention. TRIAL REGISTRATION Clinicaltrials.gov registration number ( NCT01936753 ), registered on September 3, 2013 (retrospectively registered).
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Affiliation(s)
| | - Maryam Al-Mujtaba
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Present address: Duke University School of Nursing, Durham, USA
| | - Nguavese Torbunde
- Pediatric and Adolescent HIV Unit, Prevention, Care and Treatment Department, Institute of Human Virology Nigeria, Abuja, Nigeria
- Present address: Elizabeth Glaser Pediatric AIDS Foundation, Abuja, Nigeria
| | - Salome Erekaha
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Present address: Society for Family Health, Abuja, Nigeria
| | - Abayomi J Afe
- Department of Community Medicine, Equitable Health Access Initiative, Lagos, Nigeria
| | - Ebun Adejuyigbe
- Department of Pediatrics, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Hadiza S Galadanci
- Africa Center of Excellence for Population Health and Policy, Bayero University, Kano, Nigeria
| | - Tongdiyen L Jasper
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Continuous Quality Improvement Unit, Learning and Development Department, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Llewellyn J Cornelius
- School of Social Work and College of Public Health, University of Georgia Athens, Athens, GA, USA
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria.
- Pediatric and Adolescent HIV Unit, Prevention, Care and Treatment Department, Institute of Human Virology Nigeria, Abuja, Nigeria.
- Institute of Human Virology and Department of Pediatrics, University of Maryland School of Medicine, Baltimore, USA.
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Project ACCLAIM: Intervention Effect on Community Knowledge, Attitudes and Beliefs of Maternal and Child Health and HIV/AIDS in Eswatini, Uganda and Zimbabwe. AIDS Behav 2021; 25:2400-2409. [PMID: 33661426 PMCID: PMC8222038 DOI: 10.1007/s10461-021-03202-2] [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] [Accepted: 02/14/2021] [Indexed: 11/21/2022]
Abstract
The ACCLAIM Study aimed to assess the effect of a package of community interventions on the demand for, uptake of, and retention of HIV-positive pregnant/postpartum women in maternal and child health (MCH) and prevention of mother-to-child HIV transmission (PMTCT) services. The study occurred from 2013 to 2015 in Eswatini, Uganda, and Zimbabwe. The three interventions were: (1) a social learning and action component for community leaders, (2) community days, and (3) peer discussion groups. Household cross-sectional surveys on community members’ MCH and PMTCT knowledge, attitudes, and beliefs were analyzed pre- and post-intervention, using MCH, HIV stigma, and gender-equitable men (GEM) indicators. We used t-tests to measure the significance of mean pre- vs. post-intervention score changes stratified by gender within each intervention arm and generalized linear models to compare mean score changes of the cumulative intervention arms with the community leaders-only intervention. Response rates were over 85% for both surveys for men and women, with a total of 3337 pre-intervention and 3162 post-intervention responses. The combined package of three interventions demonstrated a significantly greater increase in MCH scores for both women (diff = 1.34, p ≤ 0.001) and men (diff = 2.03, p < 0.001). The arms that included interventions for both community leader engagement and community days (arms 2 and 3)led to a greater increase in mean GEM scores compared to the community leader engagement intervention alone (arm 1), for both women (diff = 1.32, p = 0.002) and men (diff = 1.37, p = 0.004). Our findings suggest that a package of community interventions may be most effective in increasing community MCH/HIV knowledge and improving gender-equitable norms.
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Memiah P, Tlale J, Shimabale M, Nzyoka S, Komba P, Sebeza J, Tina A, Makokha V. Continuous quality improvement (CQI) Institutionalization to reach 95:95:95 HIV targets: a multicountry experience from the Global South. BMC Health Serv Res 2021; 21:711. [PMID: 34284785 PMCID: PMC8293523 DOI: 10.1186/s12913-021-06731-7] [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: 11/05/2020] [Accepted: 07/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Scaling up continuous quality improvement (CQI) processes could be key in achieving the 95:95:95 cascade and global HIV targets. This paper describes the experiences and outcomes related to implementing CQI processes to help reach these targets, with particular focus on clinical and programmatic settings in 6 countries from the global south. METHODS The HIV program at the University of Maryland, Baltimore (UMB) implemented an adapted CQI model in Kenya, Tanzania, Botswana, Zambia, Nigeria and Rwanda that included the following steps: (1) analysing the problem to identify goals and objectives for improvement; (2) developing individual changes or 'change packages', (3) developing a monitoring system to measure improvements; and (4) implementing and measuring changes through continuous 'plan-do-study-act' (PDSA) cycles. We describe country-level experiences related to implementing this adaptive design, a collaborative learning and scale-up/sustainability model that addresses the 95:95:95 global HIV targets via a CQI learning network, and mechanisms for fostering communication and the sharing of ideas and results; we describe trends both before and after model implementation. RESULTS Our selected country-level experiences based on implementing our CQI approach resulted in an increased partner testing acceptance rate from 21.7 to 48.2 % in Rwanda, which resulted in an increase in the HIV testing yield from 2.1 to 6.3 %. In Botswana, the overall linkage to treatment improved from 63 to 94 %, while in Kenya, the viral load testing uptake among paediatric and adolescent patients improved from 65 to 96 %, and the viral load suppression improved from 53 to 88 %. CONCLUSIONS Adopting CQI processes is a useful approach for accelerating progress towards the attainment of the global 95:95:95 HIV targets. This paper also highlights the value of institutionalizing CQI processes and building the capacity of Ministry of Health (MoH) personnel in sub-Saharan Africa for the effective quality improvement of HIV programs and subsequent sustainability efforts.
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Affiliation(s)
- Peter Memiah
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Room N345, MD, 21201, Baltimore, USA.
| | - Josephine Tlale
- Institute of Human Virology, Center for International Health, Education, and Biosecurity (CIHEB), University of Maryland School of Medicine in Botswana, Gaborone, Botswana
| | - Mope Shimabale
- Institute of Human Virology, Center for International Health, Education, and Biosecurity (CIHEB), University of Maryland School of Medicine in Zambia, Lusaka, Zambia
| | - Sarah Nzyoka
- Institute of Human Virology, Center for International Health, Education, and Biosecurity (CIHEB), University of Maryland School of Medicine in Kenya, Baltimore, Kenya
| | - Patience Komba
- Institute of Human Virology, Center for International Health, Education, and Biosecurity (CIHEB), University of Maryland School of Medicine in Tanzania, Baltimore, Tanzania
| | - Jackson Sebeza
- Institute of Human Virology, Center for International Health, Education, and Biosecurity (CIHEB), University of Maryland School of Medicine in Rwanda, Kigali, Rwanda
| | - Adesina Tina
- Institute of Human Virology, Center for International Health, Education, and Biosecurity (CIHEB), University of Maryland School of Medicine in Nigeria, Abuja, Nigeria
| | - Violet Makokha
- Institute of Human Virology, Center for International Health, Education, and Biosecurity (CIHEB), University of Maryland School of Medicine in Kenya, Baltimore, Kenya
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Digolo L, Ajema C, Kiruki M, Mireku M, Kotut R, Undie CC. The use of case advocates to manage child survivors of sexual violence in public health facilities in Kenya: A qualitative study exploring the perceptions of child survivors, care givers and health care providers. CHILD ABUSE & NEGLECT 2021; 116:104376. [PMID: 31959494 DOI: 10.1016/j.chiabu.2020.104376] [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] [Received: 08/12/2018] [Revised: 12/28/2019] [Accepted: 01/13/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND The uptake of and retention in health services by child survivors of violence (CSV) is a growing challenge, especially in sub-Saharan Africa. While lay health workers have been used in several settings to improve access to health services, there is limited literature on the use of such workers to support services for CSV. OBJECTIVE To explore the acceptability of using trained lay health workers (case advocates) to provide basic information and escort CSV to various referral points within two public health facilities in Kenya. PARTICIPANTS The following participants were enrolled after giving their consent: CSV 14-18 years of age presenting for services along with their caregivers during the study; caregivers above age 18; and healthcare providers (HCPs) providing services for sexual violence at the two study sites. METHODS In-depth interviews (14 with CSV and 27 with caregivers) and four focus group discussions (with 30 HCPs) were conducted. Data were transcribed in MSWord and analysed using a grounded theory analytical approach. RESULTS Caregivers and CSV reported that the case advocates were useful in fast-tracking access to services, easing CSV movement through health facilities and helping CSV communicate their issues. HCPs reported improved timeliness and completeness of services due to the involvement of the case advocates. CONCLUSION The use of case advocates to support CSV is acceptable to children, caregivers and HCPs. Task-sharing between case advocates and HCPs has the potential to improve the uptake of the various services offered to CSV, especially in resource-limited settings.
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Affiliation(s)
- Lina Digolo
- LVCT Health, Department of Research and Strategic Information, P.O. Box 19835-00202, KNH, Nairobi, Kenya.
| | - Carolyne Ajema
- LVCT Health, Department of Research and Strategic Information, P.O. Box 19835-00202, KNH, Nairobi, Kenya.
| | - Millicent Kiruki
- LVCT Health, Department of Research and Strategic Information, P.O. Box 19835-00202, KNH, Nairobi, Kenya.
| | - Maryline Mireku
- LVCT Health, Department of Research and Strategic Information, P.O. Box 19835-00202, KNH, Nairobi, Kenya.
| | - Ronald Kotut
- LVCT Health, Department of Research and Strategic Information, P.O. Box 19835-00202, KNH, Nairobi, Kenya.
| | - Chi-Chi Undie
- Population Council, P.O. Box 17643-00500, Nairobi, Kenya.
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Chagomerana MB, Edwards JK, Zalla LC, Carbone NB, Banda GT, Mofolo IA, Hosseinipour MC, Herce ME. Timing of HIV testing among pregnant and breastfeeding women and risk of mother-to-child HIV transmission in Malawi: a sampling-based cohort study. J Int AIDS Soc 2021; 24:e25687. [PMID: 33749155 PMCID: PMC7982503 DOI: 10.1002/jia2.25687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 02/02/2021] [Accepted: 02/17/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Pregnant women living with HIV can achieve viral suppression and prevent HIV mother-to-child transmission (MTCT) with timely HIV testing and early ART initiation and maintenance. Although it is recommended that pregnant women undergo HIV testing early in antenatal care in Malawi, many women test positive during breastfeeding because they did not have their HIV status ascertained during pregnancy, or they tested negative during pregnancy but seroconverted postpartum. We sought to estimate the association between the timing of last positive HIV test (during pregnancy vs. breastfeeding) and outcomes of maternal viral suppression and MTCT in Malawi's PMTCT programme. METHODS We conducted a two-stage cohort study among mother-infant pairs in 30 randomly selected high-volume health facilities across five nationally representative districts of Malawi between 1 July 2016 and 30 June 2017. Log-binomial regression was used to estimate prevalence ratios (PR) and risk ratios (RR) for associations between timing of last positive HIV test (i.e. breastfeeding vs. pregnancy) and maternal viral suppression and MTCT, controlling for confounding using inverse probability weighting. RESULTS Of 822 mother-infant pairs who had available information on the timing of the last positive HIV test, 102 mothers (12.4%) had their last positive test during breastfeeding. Women who lived one to two hours (PR = 2.15; 95% CI: 1.29 to 3.58) or >2 hours (PR = 2.36; 95% CI: 1.37 to 4.10) travel time to the nearest health facility were more likely to have had their last positive HIV test during breastfeeding compared to women living <1 hour travel time to the nearest health facility. The risk of unsuppressed VL did not differ between women who had their last positive HIV test during breastfeeding versus pregnancy (adjusted RR [aRR] = 0.87; 95% CI: 0.48 to 1.57). MTCT risk was higher among women who had their last positive HIV test during breastfeeding compared to women who had it during pregnancy (aRR = 6.57; 95% CI: 3.37 to 12.81). CONCLUSIONS MTCT in Malawi occurred disproportionately among women with a last positive HIV test during breastfeeding. Testing delayed until the postpartum period may lead to higher MTCT. To optimize maternal and child health outcomes, PMTCT programmes should focus on early ART initiation and providing targeted testing, prevention, treatment and support to breastfeeding women.
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Affiliation(s)
- Maganizo B Chagomerana
- University of North Carolina Project/Malawi, Lilongwe, Malawi
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Jessie K Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lauren C Zalla
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Godfrey T Banda
- University of North Carolina Project/Malawi, Lilongwe, Malawi
| | - Innocent A Mofolo
- University of North Carolina Project/Malawi, Lilongwe, Malawi
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Mina C Hosseinipour
- University of North Carolina Project/Malawi, Lilongwe, Malawi
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Michael E Herce
- University of North Carolina Project/Malawi, Lilongwe, Malawi
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Mubiana-Mbewe M, Bosomprah S, Kadota JL, Koyuncu A, Kusanathan T, Mweebo K, Musokotwane K, Mulenga PL, Chi BH, Vinikoor MJ. Effect of Enhanced Adherence Package on Early ART Uptake Among HIV-Positive Pregnant Women in Zambia: An Individual Randomized Controlled Trial. AIDS Behav 2021; 25:992-1000. [PMID: 33033996 PMCID: PMC10580733 DOI: 10.1007/s10461-020-03060-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2020] [Indexed: 10/23/2022]
Abstract
We evaluated the effect of an option B-plus Enhanced Adherence Package (BEAP), on early ART uptake in a randomized controlled trial. HIV-positive, ART naïve pregnant women in Lusaka, Zambia, were randomized to receive BEAP (phone calls/home visits, additional counseling, male partner engagement and missed-visit follow-up) versus standard of care (SOC). The primary outcome was initiating and remaining on ART at 30 days. Analysis was by intention to treat (ITT) using logistic regression. Additional per protocol analysis was done. We enrolled 454 women; 229 randomized to BEAP and 225 to SOC. Within 30 days of eligibility, 445 (98.2%) initiated ART. In ITT analysis, 82.5% BEAP versus 80.4% SOC participants reached primary outcome (crude relative risk [RR] 1.03; 95% confidence interval [CI] 0.91-1.16; Wald test statistic = 0.44; p-value = 0.66). In per protocol analysis, (92 participants (40.2%) excluded), 91.9% BEAP versus 80.4% SOC participants reached primary outcome (crude RR 1.14; 95% CI 1.02-1.29; Wald test statistic = 2.23; p-value = 0.03). Early ART initiation in pregnancy was nearly universal but there was early drop out suggesting need for additional adherence support.This trial was registered at ClinicalTrials.gov (trials number NCT02459678) on May 14, 2015.
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Affiliation(s)
- Mwangelwa Mubiana-Mbewe
- Centre for Infectious Disease Research in Zambia, Plot 34620 Off Alick Nkhata Road, P.O. Box 34681, Lusaka, Zambia.
| | - Samuel Bosomprah
- Centre for Infectious Disease Research in Zambia, Plot 34620 Off Alick Nkhata Road, P.O. Box 34681, Lusaka, Zambia
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | - Jillian L Kadota
- Centre for Infectious Disease Research in Zambia, Plot 34620 Off Alick Nkhata Road, P.O. Box 34681, Lusaka, Zambia
- Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, USA
| | - Aybüke Koyuncu
- Centre for Infectious Disease Research in Zambia, Plot 34620 Off Alick Nkhata Road, P.O. Box 34681, Lusaka, Zambia
| | | | - Keith Mweebo
- Prevention, Care and Treatment Branch, U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Kebby Musokotwane
- Prevention, Care and Treatment Branch, U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
| | | | - Benjamin H Chi
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - Michael J Vinikoor
- Centre for Infectious Disease Research in Zambia, Plot 34620 Off Alick Nkhata Road, P.O. Box 34681, Lusaka, Zambia
- Department of Medicine, University of Alabama at Birmingham, Birmingham, USA
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Munishi OM, McCormack V, Mchome B, Mangi G, Zullig LL, Bartlett J, Mapunda O, Nyindo P, Namwai T, Muiruri C, Kimaro F, Karia F, Mmbaga BT. Awareness of Cancer Risk Factors and Its Signs and Symptoms in Northern Tanzania: a Cross-Sectional Survey in the General Population and in People Living with HIV. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:696-704. [PMID: 30915669 PMCID: PMC7363667 DOI: 10.1007/s13187-019-01513-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
An important component of cancer control programs for the growing burden in sub-Saharan Africa is a population's awareness of risk factors. Studies thereof have focused on single rather than multiple cancers and carcinogens. During March and April 2015, we undertook a survey to assess awareness of multiple cancer risk factors and symptoms in the Kilimanjaro Region, North Tanzania. General population (n = 620) and attendees at HIV care-and-treatment clinics (CTCs) were included (n = 207). Participants' mean age was 43.8 (interquartile range 30-52) years; 58% were female. Awareness of cancer risk was highest for tobacco (90%) and alcoholic spirits (67%), but tended to be lower for infections (41% for HIV (42.2% and 41.4% for CTC and community group, respectively) and 16% for HPV (16.0% and 16.6% for CTC and community group, respectively)), while that of moldy maize and peanuts was 35% for both. Awareness of specific cancer signs and symptoms ranged between 70% and 90%. Awareness of alcohol and tobacco was higher in men than women (odds ratio = 1.82 (1.38, 2.40) and 3.96 (2.14, 7.31), respectively). In relation to cancer treatment, 70% preferred modern medicine and 10% preferred traditional medicine alone. Sixty percent was not aware of any local cancer early detection services. Only 20% had ever been examined for cancer, and of those screened, CTC group was 1.5 times more likely to screen than community participants. Awareness did not differ by age or HIV status. There are good levels of cancer risk factor awareness for certain lifestyle-related carcinogens in Tanzania; however, increased awareness is needed especially for infections and cancer warning symptom both in the general and HIV-positive population, as well as some myths to be dispelled.
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Affiliation(s)
- Oresto Michael Munishi
- School of Social Sciences, Tampere University, Tampere, Finland.
- Kilimanjaro Christian Medical Center (KCMC), Moshi, Kilimanjaro, Tanzania.
- Kilimanjaro Clinical Research Institute (KCRI), P.O. Box 2236, Moshi, Kilimanjaro, Tanzania.
| | | | - Bariki Mchome
- Kilimanjaro Christian Medical Center (KCMC), Moshi, Kilimanjaro, Tanzania
- Kilimanjaro Christian Medical College (KCMUCo), Moshi, Kilimanjaro, Tanzania
| | | | | | - John Bartlett
- Kilimanjaro Christian Medical Center (KCMC), Moshi, Kilimanjaro, Tanzania
- Kilimanjaro Christian Medical College (KCMUCo), Moshi, Kilimanjaro, Tanzania
- Duke University Medical Center, Durham, NC, USA
| | - Oscar Mapunda
- Kilimanjaro Christian Medical College (KCMUCo), Moshi, Kilimanjaro, Tanzania
| | - Pilli Nyindo
- Kilimanjaro Christian Medical Center (KCMC), Moshi, Kilimanjaro, Tanzania
| | - Theresia Namwai
- Kilimanjaro Christian Medical Center (KCMC), Moshi, Kilimanjaro, Tanzania
| | | | - Frank Kimaro
- Kilimanjaro Christian Medical Center (KCMC), Moshi, Kilimanjaro, Tanzania
| | - Francis Karia
- Kilimanjaro Christian Medical Center (KCMC), Moshi, Kilimanjaro, Tanzania
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical Center (KCMC), Moshi, Kilimanjaro, Tanzania
- Kilimanjaro Clinical Research Institute (KCRI), P.O. Box 2236, Moshi, Kilimanjaro, Tanzania
- Kilimanjaro Christian Medical College (KCMUCo), Moshi, Kilimanjaro, Tanzania
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Odendaal WA, Anstey Watkins J, Leon N, Goudge J, Griffiths F, Tomlinson M, Daniels K. Health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis. Cochrane Database Syst Rev 2020; 3:CD011942. [PMID: 32216074 PMCID: PMC7098082 DOI: 10.1002/14651858.cd011942.pub2] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Mobile health (mHealth), refers to healthcare practices supported by mobile devices, such as mobile phones and tablets. Within primary care, health workers often use mobile devices to register clients, track their health, and make decisions about care, as well as to communicate with clients and other health workers. An understanding of how health workers relate to, and experience mHealth, can help in its implementation. OBJECTIVES To synthesise qualitative research evidence on health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services, and to develop hypotheses about why some technologies are more effective than others. SEARCH METHODS We searched MEDLINE, Embase, CINAHL, Science Citation Index and Social Sciences Citation Index in January 2018. We searched Global Health in December 2015. We screened the reference lists of included studies and key references and searched seven sources for grey literature (16 February to 5 March 2018). We re-ran the search strategies in February 2020. We screened these records and any studies that we identified as potentially relevant are awaiting classification. SELECTION CRITERIA We included studies that used qualitative data collection and analysis methods. We included studies of mHealth programmes that were part of primary healthcare services. These services could be implemented in public or private primary healthcare facilities, community and workplace, or the homes of clients. We included all categories of health workers, as well as those persons who supported the delivery and management of the mHealth programmes. We excluded participants identified as technical staff who developed and maintained the mHealth technology, without otherwise being involved in the programme delivery. We included studies conducted in any country. DATA COLLECTION AND ANALYSIS We assessed abstracts, titles and full-text papers according to the inclusion criteria. We found 53 studies that met the inclusion criteria and sampled 43 of these for our analysis. For the 43 sampled studies, we extracted information, such as country, health worker category, and the mHealth technology. We used a thematic analysis process. We used GRADE-CERQual to assess our confidence in the findings. MAIN RESULTS Most of the 43 included sample studies were from low- or middle-income countries. In many of the studies, the mobile devices had decision support software loaded onto them, which showed the steps the health workers had to follow when they provided health care. Other uses included in-person and/or text message communication, and recording clients' health information. Almost half of the studies looked at health workers' use of mobile devices for mother, child, and newborn health. We have moderate or high confidence in the following findings. mHealth changed how health workers worked with each other: health workers appreciated being more connected to colleagues, and thought that this improved co-ordination and quality of care. However, some described problems when senior colleagues did not respond or responded in anger. Some preferred face-to-face connection with colleagues. Some believed that mHealth improved their reporting, while others compared it to "big brother watching". mHealth changed how health workers delivered care: health workers appreciated how mHealth let them take on new tasks, work flexibly, and reach clients in difficult-to-reach areas. They appreciated mHealth when it improved feedback, speed and workflow, but not when it was slow or time consuming. Some health workers found decision support software useful; others thought it threatened their clinical skills. Most health workers saw mHealth as better than paper, but some preferred paper. Some health workers saw mHealth as creating more work. mHealth led to new forms of engagement and relationships with clients and communities: health workers felt that communicating with clients by mobile phone improved care and their relationships with clients, but felt that some clients needed face-to-face contact. Health workers were aware of the importance of protecting confidential client information when using mobile devices. Some health workers did not mind being contacted by clients outside working hours, while others wanted boundaries. Health workers described how some community members trusted health workers that used mHealth while others were sceptical. Health workers pointed to problems when clients needed to own their own phones. Health workers' use and perceptions of mHealth could be influenced by factors tied to costs, the health worker, the technology, the health system and society, poor network access, and poor access to electricity: some health workers did not mind covering extra costs. Others complained that phone credit was not delivered on time. Health workers who were accustomed to using mobile phones were sometimes more positive towards mHealth. Others with less experience, were sometimes embarrassed about making mistakes in front of clients or worried about job security. Health workers wanted training, technical support, user-friendly devices, and systems that were integrated into existing electronic health systems. The main challenges health workers experienced were poor network connections, access to electricity, and the cost of recharging phones. Other problems included damaged phones. Factors outside the health system also influenced how health workers experienced mHealth, including language, gender, and poverty issues. Health workers felt that their commitment to clients helped them cope with these challenges. AUTHORS' CONCLUSIONS Our findings propose a nuanced view about mHealth programmes. The complexities of healthcare delivery and human interactions defy simplistic conclusions on how health workers will perceive and experience their use of mHealth. Perceptions reflect the interplay between the technology, contexts, and human attributes. Detailed descriptions of the programme, implementation processes and contexts, alongside effectiveness studies, will help to unravel this interplay to formulate hypotheses regarding the effectiveness of mHealth.
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Affiliation(s)
- Willem A Odendaal
- South African Medical Research CouncilHealth Systems Research UnitCape TownWestern CapeSouth Africa
- Stellenbosch UniversityDepartment of PsychiatryCape TownSouth Africa
| | | | - Natalie Leon
- South African Medical Research CouncilHealth Systems Research UnitCape TownWestern CapeSouth Africa
- Brown UniversitySchool of Public HealthProvidenceRhode IslandUSA
| | - Jane Goudge
- University of the WitwatersrandCentre for Health Policy, School of Public Health, Faculty of Health SciencesJohannesburgSouth Africa
| | - Frances Griffiths
- University of WarwickWarwick Medical SchoolCoventryUK
- University of the WitwatersrandCentre for Health Policy, School of Public Health, Faculty of Health SciencesJohannesburgSouth Africa
| | - Mark Tomlinson
- Stellenbosch UniversityInstitute for Life Course Health Research, Department of Global HealthCape TownSouth Africa
- Queens UniversitySchool of Nursing and MidwiferyBelfastUK
| | - Karen Daniels
- South African Medical Research CouncilHealth Systems Research UnitCape TownWestern CapeSouth Africa
- University of Cape TownHealth Policy and Systems Division, School of Public Health and Family MedicineCape TownWestern CapeSouth Africa7925
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Using mHealth to improve health care delivery in India: A qualitative examination of the perspectives of community health workers and beneficiaries. PLoS One 2020; 15:e0227451. [PMID: 31940326 PMCID: PMC6961923 DOI: 10.1371/journal.pone.0227451] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 12/18/2019] [Indexed: 11/19/2022] Open
Abstract
Background mHealth technologies are proliferating globally to address quality and timeliness of health care delivery by Community Health Workers (CHWs). This study aimed to examine CHW and beneficiaries’ perceptions of a new mHealth intervention (Common Application Software [CAS] for CHWs in India. The objectives of the study were to seek perspectives of CHWs and beneficiaries on the uptake of CAS, changes in CHW-beneficiary interactions since the introduction of CAS and potential barriers faced by CHWs in use of CAS. Further, important contextual factors related to CHW-beneficiary interface and dynamics that may have a bearing on CAS have been described. Methods A qualitative study was conducted in two states of India (Bihar and Madhya Pradesh) from March-April 2018 with CHWs (n = 32) and beneficiaries (n = 55). All interviews were conducted and recorded in Hindi, transcribed and translated into English, and coded and thematically analysed using Dedoose. Findings The mHealth intervention was acceptable to the CHWs who felt that CAS improved their status in the communities where they worked. Beneficiaries’ views were a mix of positive and negative perceptions. The divergent views between CHWs and beneficiaries surrounding the use and impact of CAS highlight an underlying mistrust, socio-cultural barriers in engagement, and technological barriers in implementation. All these contextual factors can influence the perception and uptake of CAS. Conclusions mHealth interventions targeting CHWs and beneficiaries have the potential to improve performance of CHWs, reduce barriers to information and potentially change the behaviors of beneficiaries. While technology is an enabler for CHWs to improve their service delivery, it does not necessarily help overcome social and cultural barriers that impede CHW-beneficiary interactions to bring about improvements in knowledge and health behaviors. Future interventions for CHWs including mHealth interventions should examine contextual factors along with the acceptability, accessibility, and usability by beneficiaries and community members.
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Igumbor JO, Ouma J, Otwombe K, Musenge E, Anyanwu FC, Basera T, Mbule M, Scheepers E, Schmitz K. Effect of a Mentor Mother Programme on retention of mother-baby pairs in HIV care: A secondary analysis of programme data in Uganda. PLoS One 2019; 14:e0223332. [PMID: 31609974 PMCID: PMC6791554 DOI: 10.1371/journal.pone.0223332] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 09/18/2019] [Indexed: 12/20/2022] Open
Abstract
Background Community healthcare workers (CHWs) play an important role in promoting HIV-care retention. Notwithstanding inconsistencies in the outcomes of CHW programmes, these programmes are known to have a positive effect on retention of mother-baby pairs in HIV-care in sub-Saharan Africa. Aim The aim of this analysis was to assess the effect of mothers2mothers (m2m) Ugandan Mentor Mother (MM) programme on the retention of mother-baby pairs in HIV-care. Methods We conducted a secondary analysis of data obtained from the m2m Uganda MM programme in nine East Central districts. The primary data was generated through a quasi-experimental study of women attending prevention of mother to child transmission of HIV (PMTCT) clinics in Uganda between January 2011 and March 2014; where those who were enrolled at PMTCT sites with the MM intervention (n = 1161) were compared with those who received standard PMCTCT services without the MM intervention (n = 1143). Frequencies and descriptive statistics were calculated for categorical and continuous measures respectively. Risk factors for retention in care were determined by clustered generalised estimating equations and reported as adjusted odds ratios (AOR) with 95% confidence intervals (95% CI). Results Retention in the PMTCT cascade was significantly higher for mother-baby pairs in the intervention arm compared to those in the control arm across all measured time points (96.7% vs 65.8% at 6 weeks after birth, p<0.001; 81.5% vs 42% at 6 weeks after cessation of breastfeeding, p<0.001; and 71.2% vs 20.6% at 18 months after birth, p<0.001). Relative to the control group, women in the intervention group were less likely to be lost to follow up following treatment initiation (AOR 0.05, 95% CI: 0.02, 0.15). There was no difference in the proportion of the retained mother-baby pairs who received prescribed PMTCT interventions at different time points but a significantly higher number of mother-baby pairs in the intervention arm were retained at different time points. Conclusion HIV positive mothers and their HIV exposed children in the mothers2mothers Ugandan Mentor Mother programme had higher retention in HIV care at every step along the PMTCT cascade. We therefore recommend adoption of this peer-to-peer model in sub-Saharan Africa to complement retention in care strategies and health system interventions especially among priority and key populations.
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Affiliation(s)
- Jude Ofuzinim Igumbor
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Joseph Ouma
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kennedy Otwombe
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Eustasius Musenge
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Felix Chima Anyanwu
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tariro Basera
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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