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Baldé A, Lièvre L, Maiga AI, Diallo F, Maiga IA, Costagliola D, Abgrall S. Re-engagement in care of people living with HIV lost to follow-up after initiation of antiretroviral therapy in Mali: Who returns to care? PLoS One 2020; 15:e0238687. [PMID: 32911516 PMCID: PMC7482938 DOI: 10.1371/journal.pone.0238687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 08/21/2020] [Indexed: 01/26/2023] Open
Abstract
Objectives We assessed cumulative incidence rates of and factors associated with re-engagement in HIV care for PLHIV lost to follow-up in Mali. Methods HIV-1-infected individuals lost to follow-up before 31/12/2013, ≥ 18 years old, who started ART from 2006 to 2012 at one of 16 care centres were considered. Loss to follow-up (LTFU) was defined as an interruption of ≥ 6 months during follow-up. The re-engagement in care in PLHIV lost to follow-up before 31/12/2013 was defined as having at least one clinical visit after LTFU. The cumulative incidence rates of re-engagement in care was estimated by Kaplan-Meier and its predictive factors were assessed using Cox models. Socio-demographic characteristics, clinical and immune status, period, region, centre expertise level, and distance from home at the start of ART plus a combined variable of duration of ART until LTFU and 12-month change in CD4 count were assessed. Multiple imputation was used to deal with missing data. Results We included 3,650 PLHIV lost to follow-up before December 2013, starting ART in nine outpatient clinics and seven hospitals (5+2 in Bamako and 4+5 in other regions): 35% male, median (IQR) age 35 (29–43), and duration of ART until LTFU 11 months (5–22). Among these PLHIV, 1,975 (54%) were definitively LTFU and 1,675 (46%) subsequently returned to care. The cumulative incidence rates of re-engagement in care rose from 39.0% at one year to 47.0% at three years after LTFU. Predictors of re-engagement in care were starting ART with WHO stage 1–2 and CD4 counts ≥ 200 cells/μL, being treated for ≥ 12 months with CD4 count gain ≥ 50 cells/μL, or being followed in Bamako. People followed at regional hospitals or outpatient clinics ≥ 5 km away, or being treated for ≥ 12 months with CD4 count gain < 50 cells/μL were less likely to return to care. Conclusions Starting ART with a higher CD4 count, better gain in CD4 count, and being followed either in Bamako or close to home in the regions were associated with re-engagement in care.
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Affiliation(s)
- Aliou Baldé
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, IPLESP, Paris, France
- * E-mail:
| | - Laurence Lièvre
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, IPLESP, Paris, France
| | - Almoustapha Issiaka Maiga
- Unité d'épidémiologie moléculaire de la résistance du VIH aux ARV du Centre de Recherche et de Formation sur le VIH/SIDA et la tuberculose (SEREFO), Université des Sciences, des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali
| | - Fodié Diallo
- Association de Recherche, de Communication, d’Accompagnement à Domicile des Personnes Vivant avec le VIH (ARCAD-SIDA), Bamako, Mali
| | - Issouf Alassane Maiga
- Ensemble pour une Solidarité Thérapeutique Hospitalière en Réseau (ESTHER)/Expertise France, Bamako, Mali
| | - Dominique Costagliola
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, IPLESP, Paris, France
| | - Sophie Abgrall
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, IPLESP, Paris, France
- AP-HP, Hôpital Antoine Béclère, Service de Médecine Interne, Clamart, INSERM, Université Paris Sud, Université Paris Saclay, France
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Iemmi V. Sustainable development for global mental health: a typology and systematic evidence mapping of external actors in low-income and middle-income countries. BMJ Glob Health 2019; 4:e001826. [PMID: 31908860 PMCID: PMC6936513 DOI: 10.1136/bmjgh-2019-001826] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 11/01/2019] [Accepted: 11/10/2019] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Mental disorders account for a substantial burden of disease and costs in low-income and middle-income countries (LMICs), but attract few resources. With LMIC governments often under economic pressure, an understanding of the external funding landscape is urgently needed. This study develops a new typology of external actors in global health adapted for the sustainable development goals (SDGs) era and uses it to systematically map available evidence on external actors in global mental health. METHODS The new typology was developed in line with conceptualisation in the literature and the SDGs to include 11 types of external actors for health in LMICs. Five databases (EconLit, Embase, Global Health, MEDLINE, PsycINFO) were searched for manuscripts published in peer-reviewed journals in English, French, Italian, Portuguese or Spanish between 1 January 2000 and 31 July 2018 and reporting information on external actors for mental disorders in LMICs. Records were screened by abstract, then full-text against inclusion criteria. Data were extracted and synthesised using narrative analysis. RESULTS 79 studies were included in the final review. Five were quantitative studies analysing the resource flow of development assistance for mental health globally over the last two decades. The remainder were qualitative studies providing a description of external actors: the majority of them were published in the last decade, focused on Africa, and on public sector (bilateral and multilateral governmental organisations) and third sector organisations (non-governmental organisations). Evidence was particularly scarce for for-profit organisations and individual households. CONCLUSION This study reveals opportunities for unlocking additional funding for global mental health in the SDG-era from an ecosystem of external actors, and highlights the need to coordinate efforts and to use sustainable, ethical approaches to disbursements. Further research is needed to understand all external actors and the allocation of their contributions in different settings.
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Affiliation(s)
- Valentina Iemmi
- Department of Social Policy, London School of Economics and Political Science, London, UK
- Department of Health Policy, London School of Economics and Political Science, London, UK
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Fiori KP, Belli HM, Lauria ME, Hirschhorn LR, Schechter J, Hansman E, Rajshekhar N, Katin V, Gbeleou S, Grunitsky-Bekele M, Pitche VP. Implementing an integrated community based health systems strengthening approach to improve HIV survival in Northern Togo. AIDS Care 2019; 32:705-713. [PMID: 31170827 DOI: 10.1080/09540121.2019.1626342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To disseminate lessons learned from the implementation experience of a public-private sector partnership, we describe a comprehensive HIV/AIDS program including 5-year survival outcomes for individuals who initiated antiretroviral therapy (ART) treatment in Togo from 2010 to 2015. A retrospective case study analysis was conducted from a cohort of patients receiving ART at an HIV/AIDS care clinic in Kara Region, Togo. Kaplan-Meier curves with Log rank tests were used to compare estimated survival curves by demographic and clinical characteristics. Associations were described between survival probability and age, gender, World Health Organization (WHO) disease stage, and timing of ART initiation. Cox proportional hazard model was used to determine predictors of mortality. After approximately five-years since ART initiation (1780 days), there were 114 deaths, with a survival probability of 75.3% (95% CI: 70.3-80.6%). Participants with advanced WHO disease stage were more likely at risk of death relative to patients categorized as WHO Stage 1, with Stage 4 approximately 9 times more likely (aHR 9.22, 95% CI 4.29-19.84). Our study suggests that delivering comprehensive HIV care through a private-public partnership may serve as a model to expand and improve HIV/AIDS care as well as high quality primary care.
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Affiliation(s)
- Kevin P Fiori
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.,Community Health Systems Lab, Integrate Health/Santé Intégrée, Kara, Togo and New York, NY, USA
| | - Hayley M Belli
- New York University School of Medicine, New York, NY, USA
| | - Molly E Lauria
- Community Health Systems Lab, Integrate Health/Santé Intégrée, Kara, Togo and New York, NY, USA
| | - Lisa R Hirschhorn
- Community Health Systems Lab, Integrate Health/Santé Intégrée, Kara, Togo and New York, NY, USA.,Northwestern University Feinberg School of Medicine, Chicago, USA
| | | | - Emily Hansman
- Integrate Health/Santé Intégrée, Kara, Togo and New York, NY, USA
| | | | - Venance Katin
- Integrate Health/Santé Intégrée, Kara, Togo and New York, NY, USA.,Service de dermatologie et IST, Centre Hospitalier Universitaire (CHU) Kara, Kara, Togo
| | - Sesso Gbeleou
- Integrate Health/Santé Intégrée, Kara, Togo and New York, NY, USA
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Chabrol F, Albert L, Ridde V. 40 years after Alma-Ata, is building new hospitals in low-income and lower-middle-income countries beneficial? BMJ Glob Health 2019; 3:e001293. [PMID: 31168419 PMCID: PMC6518371 DOI: 10.1136/bmjgh-2018-001293] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/22/2019] [Accepted: 02/25/2019] [Indexed: 11/08/2022] Open
Abstract
Public hospitals in low-income and lower-middle-income countries face acute material and financial constraints, and there is a trend towards building new hospitals to contend with growing population health needs. Three cases of new hospital construction are used to explore issues in relation to their funding, maintenance and sustainability. While hospitals are recognised as a key component of healthcare systems, their role, organisation, funding and other aspects have been largely neglected in health policies and debates since the Alma Ata Declaration. Building new hospitals is politically more attractive for both national decision-makers and donors because they symbolise progress, better services and nation-building. To avoid the ‘white elephant’ syndrome, the deepening of within-country socioeconomic and geographical inequalities (especially urban–rural), and the exacerbation of hospital-centrism, there is an urgent need to investigate in greater depth how these hospitals are integrated into health systems and to discuss their long-term economic, social and environmental sustainability.
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Affiliation(s)
- Fanny Chabrol
- Centre Population et Développement (CEPED), French Institute for Research on Sustainable Development (IRD) and Université de Paris, INSERM SAGESUD, Paris, France
| | - Lucien Albert
- École de santé publique, Université de Montréal, Montréal, Québec, Canada
| | - Valéry Ridde
- Centre Population et Développement (CEPED), French Institute for Research on Sustainable Development (IRD) and Université de Paris, INSERM SAGESUD, Paris, France
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Baldé A, Lièvre L, Maiga AI, Diallo F, Maiga IA, Costagliola D, Abgrall S. Risk factors for loss to follow-up, transfer or death among people living with HIV on their first antiretroviral therapy regimen in Mali. HIV Med 2018; 20:47-53. [PMID: 30270487 DOI: 10.1111/hiv.12668] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Risk factors for loss to follow-up (LTFU) were assessed for people living with HIV (PLHIV) at various reference out-patient clinics (expertise level II) and hospitals (expertise level III) in Mali. METHODS HIV-1-positive adults starting antiretroviral therapy (ART) in 2006-2013 were eligible for inclusion. Risk factors for LTFU, defined as no visit in the 6 months preceding the last database update, were assessed with the Cox model, taking into account the competing risks of transfer and death. Potential risk factors at the start of ART were demographic and socioeconomic variables, World Health Organization (WHO) stage, CD4 count, period of ART initiation, type of ART, region of care, expertise level and distance from home. RESULTS We included 9821 PLHIV, 33% of whom were male, starting ART at nine out-patient clinics and seven hospitals [five and two in the capital Bamako and four and five in the 'regions' (i.e. districts outside the capital), respectively] with a median (interquartile range) CD4 count of 153 (56-270) cells/μL. Five-year cumulative incidences of LTFU, transfer and death were 35.2, 9.7 and 6.7%, respectively. People followed at Bamako hospitals > 5 km from home, at regional hospitals or at regional out-patient clinics < 5 km from home were at higher risk of LTFU than people followed at Bamako out-patient clinics, whereas people followed at regional out-patient clinics 5-50 km away from home were at lower risk for LTFU. Deaths were less frequent at hospitals, whether in Bamako or in the regions, than at Bamako out-patient clinics, and more frequent at regional out-patient clinics. CONCLUSIONS Expertise level and distance to care were associated with LTFU. Stigmatization may play a role for PLHIV living close to the centres in the regions.
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Affiliation(s)
- A Baldé
- Pierre Louis Institute of Epidemiology and Public Health IPLESP, Sorbonne Université, INSERM, Paris, France
| | - L Lièvre
- Pierre Louis Institute of Epidemiology and Public Health IPLESP, Sorbonne Université, INSERM, Paris, France
| | - A I Maiga
- Unité d'épidémiologie moléculaire de la résistance du VIH aux ARV du Centre de Recherche et de Formation sur le VIH/Sida et la tuberculose (SEREFO), Université des Sciences des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali
| | - F Diallo
- Association de Recherche, de Communication d'Accompagnement à Domicile des personnes vivant avec le VIH (ARCAD-Sida), Bamako, Mali
| | - I A Maiga
- Département santé, Ensemble pour une Solidarité Thérapeutique Hospitalière en Réseau (ESTHER)/Expertise France, Bamako, Mali
| | - D Costagliola
- Pierre Louis Institute of Epidemiology and Public Health IPLESP, Sorbonne Université, INSERM, Paris, France
| | - S Abgrall
- Pierre Louis Institute of Epidemiology and Public Health IPLESP, Sorbonne Université, INSERM, Paris, France.,Service de Médecine Interne, AP-HP, Hôpital Antoine Béclère, INSERM, Université Paris Sud, Université Paris Saclay, Clamart, France
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Neuhann F, Barteit S. Lessons learnt from the MAGNET Malawian-German Hospital Partnership: the German perspective on contributions to patient care and capacity development. Global Health 2017; 13:50. [PMID: 28747207 PMCID: PMC5530525 DOI: 10.1186/s12992-017-0270-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 06/22/2017] [Indexed: 11/30/2022] Open
Abstract
Background Malawi is a low-income country with one of the highest HIV prevalence rates worldwide (Kendig et al., Trop Med Health 41:163–170, 2013). The health system depends largely on external funding. Official German development aid has supported health care in Malawi for many years (German Embassy Lilongwe, The German Development Cooperation in Malawi), including placing medical doctors in various departments of the Kamuzu Central Hospital (KCH) in Lilongwe. In 2008, a hospital partnership called MAGNET (Malawi German Networking for Capacity Building in Treatment, Training and Research at KCH) evolved as part of the German ESTHER network. The partnership was abruptly terminated in 2015. Methods We reviewed 35 partnership documents and conducted an online survey of partnership stakeholders to retrospectively assess the hospital partnership based on the Capacity WORKS model of the German Corporation for International Cooperation (GIZ). This model evaluates systems’ management and implementation to understand and support the functioning of cooperation within societies. Based on this model, we considered the five success factors for cooperation management: (1) strategy, (2) cooperation, (3) steering, (4) processes, and (5) learning and innovation. In an online survey, we used an adapted version of the partnership evaluation tool by the Centers for Disease Control and Prevention (CDC). Results From 2008 to 2015, the MAGNET partnership contributed to capacity building and improved patient care in the KCH Medical Department through clinical care, technical support, teaching and trainings, and operations research based on mutually agreed upon objectives. The MAGNET partnership was implemented in three phases during which there were changes in leadership in the Medical Department and the hospital, contractual policies, funder priorities and the competing influences of other actors. Communication and follow up among partners worked best during phases when a German doctor was onsite. The partnership was judged as a positive driver for change and support within the Medical Department, but eventually failed to implement self-sustainable, robust processes within the partnership to cope with multiple changes and challenges. Conclusion The MAGNET partnership made a considerable contribution to patient care, continuous medical education and operations research at KCH, despite its abrupt termination. Changes in the institutional infrastructure, donor policy and interpersonal relations contributed to the loss of shared expectations and the end of the project. Institutional-hospital partnerships, like MAGNET, can make a valuable contribution to health care provision and hence a wider health agenda, provided there is a flexible, mutually agreed upon strategy, personal commitment, continuous communication and robust processes. However, partnership projects remain vulnerable to the influences of external actors and structures. Ministries of Health and donor agencies should appreciate the particular strength of hospital partnerships.
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Affiliation(s)
- Florian Neuhann
- University Hospital Heidelberg, Institute of Public Health, Heidelberg, Germany
| | - Sandra Barteit
- University Hospital Heidelberg, Institute of Public Health, Heidelberg, Germany.
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Tambo E, Chengho CF, Ugwu CE, Wurie I, Jonhson JK, Ngogang JY. Rebuilding transformation strategies in post-Ebola epidemics in Africa. Infect Dis Poverty 2017; 6:71. [PMID: 28486978 PMCID: PMC5424336 DOI: 10.1186/s40249-017-0278-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 03/06/2017] [Indexed: 11/10/2022] Open
Abstract
Rebuilding transformation strategies in post-Ebola epidemics in West Africa requires long-term surveillance and strengthening health system preparedness to disease outbreak. This paper assesses reconstruction efforts from socio-cultural, economic and ecological transformation response approaches and strategies in improving sustainable survivors and affected communities livelihood and wellbeing. A comprehensive approach is required in the recovery and rebuilding processes. Investing in rebuilding transformation requires fostering evidence-based and effective engaging new investors partnership strengthening, financing community-based programmes ownership, novel socio-economic innovations strategies and tools against the evolving and future Ebola epidemics. Thus, there should be improved community partnership, health and economic rebuilding programmes to address mistrust and care underutilization, poverty and care access inequity at all levels. Implementing effective post-Ebola national 'One Health' approach coupled with climate change mitigation and adaptations strategies is urgent public health needs aiming at improving the quality healthcare access, delivery trust and uptake in anticipation of EVD immunization program, productivity and emerging economy.
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Affiliation(s)
- Ernest Tambo
- Higher Institute of Health Sciences, Université des Montagnes, Bangangte, Cameroon
- Africa Disease Intelligence and Surveillance, Communication and Response (Africa DISCoR) Institute, Yaoundé, Cameroon
| | - Chryseis F. Chengho
- Department of Health and Life Sciences, University of Coventry, Coventry, Leicester, UK
| | - Chidiebere E. Ugwu
- Faculty of Basic Medical Sciences, Department of Human Biochemistry, NnamdiAzikiwe University Awka, Nnewi Campus, Awka, Nigeria
| | - Isatta Wurie
- Department of Chemical Pathology, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | | | - Jeanne Y. Ngogang
- Higher Institute of Health Sciences, Université des Montagnes, Bangangte, Cameroon
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