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Bergman AJ, McNabb KC, Mlandu K, Akumbom A, Flores DD. Identity management in the face of HIV and intersecting stigmas: A metasynthesis of qualitative reports from sub-Saharan Africa. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000706. [PMID: 36962951 PMCID: PMC10022386 DOI: 10.1371/journal.pgph.0000706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 12/06/2022] [Indexed: 02/04/2023]
Abstract
While stigma experienced by people living with HIV (PLWH) is well documented, intersectional stigma and additional stigmatized identities have not received similar attention. The purpose of this metasynthesis is to identify salient stigmatized intersections and their impact on health outcomes in PLWH in sub-Saharan Africa. Using Sandelowski and Barroso's metasynthesis method, we searched four databases for peer-reviewed qualitative literature. Included studies (1) explored personal experiences with intersecting stigmas, (2) included ≥1 element of infectious disease stigma, and (3) were conducted in sub-Saharan Africa. Our multinational team extracted, aggregated, interpreted, and synthesized the findings. From 454 screened abstracts, the 34 studies included in this metasynthesis reported perspectives of at least 1258 participants (282 men, 557 women, and 109 unspecified gender) and key informants. From these studies, gender and HIV was the most salient stigmatized intersection, with HIV testing avoidance and HIV-status denial seemingly more common among men to preserve traditional masculine identity. HIV did not threaten female identity in the same way with women more willing to test for HIV, but at the risk of abandonment and withdrawal of financial support. To guard against status loss, men and women used performative behaviors to highlight positive qualities or minimize perceived negative attributes. These identity management practices ultimately shaped health behaviors and outcomes. From this metasynthesis, the Stigma Identity Framework was devised for framing identity and stigma management, focusing on role expectation and fulfillment. This framework illustrates how PLWH create, minimize, or emphasize other identity traits to safeguard against status loss and discrimination. Providers must acknowledge how stigmatization disrupts PLWH's ability to fit into social schemas and tailor care to individuals' unique intersecting identities. Economic security and safety should be considered in women's HIV care, while highlighting antiretrovirals' role in preserving strength and virility may improve care engagement among men.
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Affiliation(s)
- Alanna J Bergman
- Center for Infectious Disease and Nursing Innovation, School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Katherine C McNabb
- Center for Infectious Disease and Nursing Innovation, School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Khaya Mlandu
- Izikhuba Unjani Clinic, Mngungundlovu, South Africa
| | - Alvine Akumbom
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America
| | - Dalmacio Dennis Flores
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States of America
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Furin J, Sotgiu G. Protecting those who serve: are we doing enough to prevent tuberculosis in healthcare workers? Eur Respir J 2019; 53:53/4/1900485. [DOI: 10.1183/13993003.00485-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/11/2019] [Indexed: 11/05/2022]
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Masquillier C, Wouters E, Sommerland N, Rau A, Engelbrecht M, Kigozi G, van Rensburg AJ. Fighting stigma, promoting care: a study on the use of occupationally-based HIV services in the Free State Province of South Africa. AIDS Care 2018; 30:16-23. [PMID: 29848050 DOI: 10.1080/09540121.2018.1468010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Fear of breaches in confidentiality and HIV-related stigma in the workplace have been shown to be primary concerns and potential barriers to uptake of HIV testing and treatment by health care workers (HCWs) at the Occupational Health Unit (OHU). In a context of human resource shortages, it is essential to investigate potential ways of reducing HIV-related stigma and promoting confidentially in the workplace. Using Structural Equation Modelling (SEM), baseline data of the "HIV and TB Stigma among Health Care Workers Study" (HaTSaH Study) for 818 respondents has been analysed to investigate (1) whether bottom-up stigma-reduction activities already occur; and (2) whether such grassroots actions can reduce the fear of breaches in confidentiality and HIV-related stigma - and thus indirectly stimulate the uptake of HIV services at the OHU. Results (aim 1) illustrate the occurrence of existing activities aiming to reduce HIV-related stigma, such as HCWs giving extra support to HIV positive co-workers and educating co-workers who stigmatise HIV. Furthermore, results of the SEM analysis (aim 2) show that the Fighting-stigma factor has a significant negative effect on HIV-related stigma and a significant positive effect on Confidentiality. Results show that the latent fighting-stigma factor has a significant positive total indirect effect on the use of HIV testing, CD4 cell count and HIV-treatment at the OHU. The findings reveal that the fear of breaches in confidentiality and HIV-related stigma can be potential barriers to the uptake of occupationally-based HIV services. However, results also show that a bottom-up climate of fighting HIV-related stigma can stimulate confidentiality in the workplace and diminish the negative effect of HIV-related stigma - resulting in an overall positive effect on the reported willingness to access occupationally-based HIV services.
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Affiliation(s)
- Caroline Masquillier
- a Department of Sociology and Centre for Longitudinal and Life Course Studies , University of Antwerp , Antwerp , Belgium
| | - Edwin Wouters
- a Department of Sociology and Centre for Longitudinal and Life Course Studies , University of Antwerp , Antwerp , Belgium.,b Centre for Health Systems Research and Development , University of the Free State , Bloemfontein , South Africa
| | - Nina Sommerland
- a Department of Sociology and Centre for Longitudinal and Life Course Studies , University of Antwerp , Antwerp , Belgium
| | - Asta Rau
- b Centre for Health Systems Research and Development , University of the Free State , Bloemfontein , South Africa
| | - Michelle Engelbrecht
- b Centre for Health Systems Research and Development , University of the Free State , Bloemfontein , South Africa
| | - Gladys Kigozi
- b Centre for Health Systems Research and Development , University of the Free State , Bloemfontein , South Africa
| | - Andre Janse van Rensburg
- b Centre for Health Systems Research and Development , University of the Free State , Bloemfontein , South Africa
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Harrowing JN, Edwards N, Richter S, Minnie K, Rae T. African and Caribbean Nurses' Decisions about HIV Testing: A Mixed Methods Study. AIDS Behav 2018; 22:545-559. [PMID: 28741133 DOI: 10.1007/s10461-017-1862-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Nurses in Jamaica, Kenya, South Africa, and Uganda are at risk for occupational exposure to HIV. Little is known about the experiences and policy supports related to nurses having themselves tested for the virus. This article reports a mixed-methods study about contextual influences on nurses' decision-making about HIV testing. Individual and focus group interviews, as well as a questionnaire on workplace polices and quality assurance and a human resource management assessment tool provided data. Fear of a positive diagnosis and stigma and lack of confidentiality along with gaps in the policy environment contributed to indecision about testing. There were significant differences in policy supports among countries. Institutional support must be addressed if improvements in HIV testing for health care workers are going to be effectively implemented. Future work is required to better understand how HRM policies intersect to create conditions of perceived vulnerability for HIV positive staff.
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Affiliation(s)
- Jean N Harrowing
- Faculty of Health Sciences, University of Lethbridge, 4401 University Drive West, Lethbridge, AB, T1K 3M4, Canada.
| | - Nancy Edwards
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Solina Richter
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Karin Minnie
- Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Tania Rae
- School of Nursing, University of the West Indies, Kingston, Jamaica
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Wouters E, Rau A, Engelbrecht M, Uebel K, Siegel J, Masquillier C, Kigozi G, Sommerland N, Yassi A. The Development and Piloting of Parallel Scales Measuring External and Internal HIV and Tuberculosis Stigma Among Healthcare Workers in the Free State Province, South Africa. Clin Infect Dis 2017; 62 Suppl 3:S244-54. [PMID: 27118854 DOI: 10.1093/cid/civ1185] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The dual burden of tuberculosis and human immunodeficiency virus (HIV) is severely impacting the South African healthcare workforce. However, the use of on-site occupational health services is hampered by stigma among the healthcare workforce. The success of stigma-reduction interventions is difficult to evaluate because of a dearth of appropriate scientific tools to measure stigma in this specific professional setting. METHODS The current pilot study aimed to develop and test a range of scales measuring different aspects of stigma-internal and external stigma toward tuberculosis as well as HIV-in a South African healthcare setting. The study employed data of a sample of 200 staff members of a large hospital in Bloemfontein, South Africa. RESULTS Confirmatory factor analysis produced 7 scales, displaying internal construct validity: (1) colleagues' external HIV stigma, (2) colleagues' actions against external HIV stigma, (3) respondent's external HIV stigma, (4) respondent's internal HIV stigma, (5) colleagues' external tuberculosis stigma, (6) respondent's external tuberculosis stigma, and (7) respondent's internal tuberculosis stigma. Subsequent analyses (reliability analysis, structural equation modeling) demonstrated that the scales displayed good psychometric properties in terms of reliability and external construct validity. CONCLUSIONS The study outcomes support the use of the developed scales as a valid and reliable means to measure levels of tuberculosis- and HIV-related stigma among the healthcare workforce in a resource-limited context. Future studies should build on these findings to fine-tune the instruments and apply them to larger study populations across a range of different resource-limited healthcare settings with high HIV and tuberculosis prevalence.
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Affiliation(s)
- Edwin Wouters
- Department of Sociology and Research Centre for Longitudinal and Life Course Studies, University of Antwerp, Belgium Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, South Africa
| | - Asta Rau
- Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, South Africa
| | - Michelle Engelbrecht
- Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, South Africa
| | - Kerry Uebel
- Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, South Africa
| | - Jacob Siegel
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Caroline Masquillier
- Department of Sociology and Research Centre for Longitudinal and Life Course Studies, University of Antwerp, Belgium
| | - Gladys Kigozi
- Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, South Africa
| | - Nina Sommerland
- Department of Sociology and Research Centre for Longitudinal and Life Course Studies, University of Antwerp, Belgium
| | - Annalee Yassi
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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Buregyeya E, Kasasa S, Mitchell EMH. Tuberculosis infection control knowledge and attitudes among health workers in Uganda: a cross-sectional study. BMC Infect Dis 2016; 16:416. [PMID: 27526850 PMCID: PMC4986352 DOI: 10.1186/s12879-016-1740-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 07/29/2016] [Indexed: 11/10/2022] Open
Abstract
Background The World Health Organization recommends TB infection control (TBIC) in health care facilities. In 2008, the Ministry of Health Uganda initiated efforts to implement TBIC by training of health care workers (HCWs). This study was carried out to assess knowledge and attitudes towards TBIC among HCWs. Methods We conducted a cross-sectional study among HCWs in health facilities in the districts of Mukono and Wakiso in Uganda, from October 2010 to February 2011. We assessed HCWs’ knowledge of basic standards of TB diagnosis, treatment and TBIC and attitudes towards TBIC measures. Results Twenty four percent of the participants answered correctly all the basic TB knowledge questions. Overall, 62 % of the HCWs were judged to have adequate basic TB knowledge. At multivariable analysis, non-clinical cadres, were more likely to have poor basic TB knowledge, [adjusted odds ratio (aOR) 0.43; 95 % confidence interval (CI) 0.27–0.68)]. Only 7 % of the respondents answered all the questions on TBIC correctly. Almost all the respondents (98 %; 529/541) knew that TB was transmitted through droplet nuclei, while only a third (34 %; 174/532) knew that masks do not protect the wearer from getting TB. Overall, 69 % (355/512) of the HCWs were judged to have adequate TBIC knowledge. At multivariable analysis, non-clinical cadres (aOR 0.61; 95 % CI 0.38–0.98) and having not attended TBIC training, (aOR 0.65; 95 % CI 0.42–0.99), were more likely to have poor TBIC knowledge. More than three quarters (77 %; 410/530) and 63 % (329/522) of the respondents had a high self-efficacy and perceived threat of acquiring TB at work, respectively. Having not attended a TBIC training was significantly associated with a low self-efficacy (aOR 0.52; 95 % CI 0.33–0.81) and low perceived threat of acquiring TB infection at work, (aOR 0.54; 95 % CI 0.36–0.81). Conclusions Our study finds moderate number of HCWs with correct knowledge and attitudes towards TBIC. Efforts should be put in place to train all HCWs in TBIC, with particular emphasis on the non-clinical staff due to their limited grasp of TBIC measures.
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Affiliation(s)
- Esther Buregyeya
- Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda.
| | - Simon Kasasa
- Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
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Godfrey C, Tauscher G, Hunsberger S, Austin M, Scott L, Schouten JT, Luetkemeyer AF, Benson C, Coombs R, Swindells S. A survey of tuberculosis infection control practices at the NIH/NIAID/DAIDS-supported clinical trial sites in low and middle income countries. BMC Infect Dis 2016; 16:269. [PMID: 27287374 PMCID: PMC4901412 DOI: 10.1186/s12879-016-1579-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 05/18/2016] [Indexed: 12/01/2022] Open
Abstract
Background Health care associated transmission of Mycobacterium tuberculosis (TB) is well described. A previous survey of infection control (IC) practices at clinical research sites in low and middle income countries (LMIC) funded by the National Institute of Allergy and Infectious Diseases (NIAID) conducting HIV research identified issues with respiratory IC practices. A guideline for TB IC based on international recommendations was developed and promulgated. This paper reports on adherence to the guideline at sites conducting or planning to conduct TB studies with the intention of supporting improvement. Methods A survey was developed that assessed IC activities in three domains: facility level measures, administrative control measures and environmental measures. An external site monitor visited each site in 2013–2014, to complete the audit. A central review committee evaluated the site-level survey and results were tabulated. Fisher’s exact test was performed to determine whether there were significant differences in practices at sites that had IC officers versus sites that did not have IC officers. Significance was assessed at p</=.05 Results Seven of thirty-three sites surveyed (22 %) had all the evaluated tuberculosis IC (TB IC) elements in place. Sixty-one percent of sites had an IC officer tasked with developing and maintaining TB IC standard operating procedures. Twenty-two (71 %) sites promptly identified and segregated individuals with TB symptoms. Thirty (93 %) sites had a separate waiting area for patients, and 26 (81 %) collected sputum within a specific well-ventilated area that was separate from the general waiting area. Sites with an IC officer were more likely to have standard operating procedures covering TB IC practices (p = 0.02) and monitor those policies (p = 0.02) and perform regular surveillance of healthcare workers (p = 0.02). The presence of an IC officer had a positive impact on performance in most of the TB IC domains surveyed including having adequate ventilation (p = 0.02) and a separate area for sputum collection (p = 0.02) Conclusions Specific and targeted support of TB IC activities in the clinical research environment is needed and is likely to have a positive and sustained impact on preventing the transmission of TB to both health care workers and vulnerable HIV-infected research participants. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1579-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Catherine Godfrey
- Division of AIDS, National Institute of Allergy and Infectious Diseases, 5601 Fisher's Lane Room 9E49, MSC 9830, 20892-9830, Bethesda, MD, USA.
| | - Gail Tauscher
- Division of AIDS, National Institute of Allergy and Infectious Diseases, 5601 Fisher's Lane Room 9E49, MSC 9830, 20892-9830, Bethesda, MD, USA
| | - Sally Hunsberger
- Division of AIDS, National Institute of Allergy and Infectious Diseases, 5601 Fisher's Lane Room 9E49, MSC 9830, 20892-9830, Bethesda, MD, USA
| | - Melissa Austin
- Office of HIV/AIDS Network Coordination, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lesley Scott
- Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand Johannesburg South Africa, Johannesburg, South Africa
| | - Jeffrey T Schouten
- Office of HIV/AIDS Network Coordination, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | - Robert Coombs
- Departments of Laboratory Medicine and Medicine, University of Washington, Seattle, WA, USA
| | - Susan Swindells
- Department of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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O’Hara NN, Roy L, O’Hara LM, Spiegel JM, Lynd LD, FitzGerald JM, Yassi A, Nophale LE, Marra CA. Healthcare Worker Preferences for Active Tuberculosis Case Finding Programs in South Africa: A Best-Worst Scaling Choice Experiment. PLoS One 2015. [PMID: 26197344 PMCID: PMC4511419 DOI: 10.1371/journal.pone.0133304] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective Healthcare workers (HCWs) in South Africa are at a high risk of developing active tuberculosis (TB) due to their occupational exposures. This study aimed to systematically quantify and compare the preferred attributes of an active TB case finding program for HCWs in South Africa. Methods A Best–Worst Scaling choice experiment estimated HCW’s preferences using a random-effects conditional logit model. Latent class analysis (LCA) was used to explore heterogeneity in preferences. Results “No cost”, “the assurance of confidentiality”, “no wait” and testing at the occupational health unit at one’s hospital were the most preferred attributes. LCA identified a four class model with consistent differences in preference strength. Sex, occupation, and the time since a previous TB test were statistically significant predictors of class membership. Conclusions The findings support the strengthening of occupational health units in South Africa to offer free and confidential active TB case finding programs for HCWs with minimal wait times. There is considerable variation in active TB case finding preferences amongst HCWs of different gender, occupation, and testing history. Attention to heterogeneity in preferences should optimize screening utilization of target HCW populations.
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Affiliation(s)
- Nathan N. O’Hara
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lilla Roy
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lyndsay M. O’Hara
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jerry M. Spiegel
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Larry D. Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - J. Mark FitzGerald
- Institute for Heart and Lung Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Annalee Yassi
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Letshego E. Nophale
- Department of Community Health, Faculty Of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Carlo A. Marra
- School of Pharmacy, Memorial University, St. John’s, Newfoundland, Canada
- * E-mail:
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Kwobah CM, Braitstein P, Koech JK, Simiyu G, Mwangi AW, Wools-Kaloustian K, Siika AM. Factors Associated with Late Engagement to HIV Care in Western Kenya: A Cross-Sectional Study. J Int Assoc Provid AIDS Care 2015; 15:505-511. [PMID: 25589304 DOI: 10.1177/2325957414567682] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Late presentation of patients contributes significantly to the high mortality reported in HIV -care and treatment programs in sub-Saharan Africa. METHODS A cross-sectional study was conducted to assess factors associated with late engagement to HIV care at the Academic Model Providing Access to Healthcare in western Kenya. Late engagement was defined as baseline CD4 ≤100 cells/mm3. RESULTS Of the 10 533 participants included in the analysis, 67% were female and mean age was 36.7 years. Overall, 23% of the participants presented late. Factors associated with late engagement included male gender (adjusted odds ratio [AOR]: 1.54, 95% confidence interval [CI]: 1.35-1.75), older age (AOR: 1.62, 95% CI: 1.02-2.56), and longer travel time to clinic (AOR: 1.18, 95% CI: 1.04-1.34). CONCLUSION Nearly one-quarter of HIV-infected patients in our setting present with advanced immune suppression at initial encounter. Being male, older age, and living further away from clinic are associated with late engagement to care.
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Affiliation(s)
- Charles Meja Kwobah
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya .,Department of Medicine, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Medicine, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,University of Toronto, Dalla Lana School of Public Health, Toronto, Canada
| | - Julius K Koech
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Gilbert Simiyu
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Ann W Mwangi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Behavioral Sciences, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Kara Wools-Kaloustian
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Abraham M Siika
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Medicine, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
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Khan R, Yassi A, Engelbrecht MC, Nophale L, van Rensburg AJ, Spiegel J. Barriers to HIV counseling and testing uptake by health workers in three public hospitals in Free State Province, South Africa. AIDS Care 2014; 27:198-205. [PMID: 25174842 DOI: 10.1080/09540121.2014.951308] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Recent WHO/ILO/UNAIDS guidelines recommend priority access to HIV services for health care workers (HCWs), in order to retain and support HCWs, especially those at risk of occupationally acquired tuberculosis (TB). The purpose of this study was to identify barriers to uptake of HIV counselling and testing (HCT) services for HCWs receiving HCT within occupational health units (OHUs). Questions were included within a larger occupational health survey of a 20% quota sample of HCWs from three public hospitals in Free State Province, South Africa. Of the 978 respondents, nearly 65% believed that their co-workers would not want to know their HIV status. Barriers to accessing HCT at the OHU included ambiguity over whether antiretroviral treatment was available at the OHU (only 51.1% knew), or whether TB treatment was available (55.5% knew). Nearly 40% of respondents perceived that stigma as a barrier. When controlling for age and race, the odds of perceiving HIV stigma in the workplace among patient-care health care workers (PCHWs) were 2.4 times that for non-PCHWs [95% confidence interval (CI): 1.80-3.15]. Of the 692 survey respondents who indicated a reason for not using HIV services at the OHU, 38.9% felt that confidentiality was the reason cited. Among PCHWs, the adjusted odds of expressing concern that confidentiality may not be maintained in the OHU were 2.4 times (95% CI: 1.8-3.2) that of non-PCHWs and were higher among Black [odds ratio (OR): 2.7, CI: 1.7-4.2] and Coloured HCWs (OR: 3.0, 95% CI: 1.6-5.6) as compared to White HCWs, suggesting that stigma and confidentiality concerns are still barriers to uptake of HCT. Campaigns to improve awareness of HCT and TB services offered in the OHUs, address stigma and ensure that the workforce is aware of the confidentiality provisions that are in place are warranted.
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Affiliation(s)
- Rabia Khan
- a School of Population and Public Health, Faculty of Medicine , University of British Columbia , Vancouver , BC , Canada
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Claassens MM, van Schalkwyk C, du Toit E, Roest E, Lombard CJ, Enarson DA, Beyers N, Borgdorff MW. Tuberculosis in healthcare workers and infection control measures at primary healthcare facilities in South Africa. PLoS One 2013; 8:e76272. [PMID: 24098461 PMCID: PMC3788748 DOI: 10.1371/journal.pone.0076272] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 08/22/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Challenges exist regarding TB infection control and TB in hospital-based healthcare workers in South Africa. However, few studies report on TB in non-hospital based healthcare workers such as primary or community healthcare workers. Our objectives were to investigate the implementation of TB infection control measures at primary healthcare facilities, the smear positive TB incidence rate amongst primary healthcare workers and the association between TB infection control measures and all types of TB in healthcare workers. METHODS One hundred and thirty three primary healthcare facilities were visited in five provinces of South Africa in 2009. At each facility, a TB infection control audit and facility questionnaire were completed. The number of healthcare workers who had had TB during the past three years was obtained. RESULTS The standardised incidence ratio of smear positive TB in primary healthcare workers indicated an incidence rate of more than double that of the general population. In a univariable logistic regression, the infection control audit score was significantly associated with reported cases of TB in healthcare workers (OR=1.04, 95%CI 1.01-1.08, p=0.02) as was the number of staff (OR=3.78, 95%CI 1.77-8.08). In the multivariable analysis, the number of staff remained significantly associated with TB in healthcare workers (OR=3.33, 95%CI 1.37-8.08). CONCLUSION The high rate of TB in healthcare workers suggests a substantial nosocomial transmission risk, but the infection control audit tool which was used did not perform adequately as a measure of this risk. Infection control measures should be monitored by validated tools developed and tested locally. Different strategies, such as routine surveillance systems, could be used to evaluate the burden of TB in healthcare workers in order to calculate TB incidence, monitor trends and implement interventions to decrease occupational TB.
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Affiliation(s)
- Mareli M. Claassens
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Parow, South Africa
- Department of Clinical Epidemiology, Biostatistics and Bio-informatics, University of Amsterdam, Amsterdam, The Netherlands
| | - Cari van Schalkwyk
- The South African Department of Science and Technology / National Research Foundation Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
| | - Elizabeth du Toit
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Parow, South Africa
| | - Eline Roest
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Parow, South Africa
| | - Carl J. Lombard
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Parow, South Africa
- Biostatistics Unit, Medical Research Council, Parow, South Africa
| | - Donald A. Enarson
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Parow, South Africa
- The International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Nulda Beyers
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Parow, South Africa
| | - Martien W. Borgdorff
- Department of Clinical Epidemiology, Biostatistics and Bio-informatics, University of Amsterdam, Amsterdam, The Netherlands
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Buregyeya E, Nuwaha F, Verver S, Criel B, Colebunders R, Wanyenze R, Kalyango JN, Katamba A, Mitchell EM. Implementation of tuberculosis infection control in health facilities in Mukono and Wakiso districts, Uganda. BMC Infect Dis 2013; 13:360. [PMID: 23915376 PMCID: PMC3735480 DOI: 10.1186/1471-2334-13-360] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 07/24/2013] [Indexed: 12/04/2022] Open
Abstract
Background Tuberculosis infection control (TBIC) is rarely implemented in the health facilities in resource limited settings. Understanding the reasons for low level of implementation is critical. The study aim was to assess TBIC practices and barriers to implementation in two districts in Uganda. Methods We conducted a cross-sectional study in 51 health facilities in districts of Mukono and Wakiso. The study included: a facility survey, observations of practices and eight focus group discussions with health workers. Results Quantitative: Only 16 facilities (31%) had a TBIC plan. Five facilities (10%) were screening patients for cough. Two facilities (4%) reported providing masks to patients with cough. Ventilation in the waiting areas was inadequate for TBIC in 43% (22/51) of the facilities. No facility possessed N95 particulate respirators. Qualitative: Barriers that hamper implementation of TBIC elicited included: under-staffing, lack of space for patient separation, lack of funds to purchase masks, and health workers not appreciating the importance of TBIC. Conclusion TBIC measures were not implemented in health facilities in the two Ugandan districts where the survey was done. Health system factors like lack of staff, space and funds are barriers to implement TBIC. Effective implementation of TBIC measures occurs when the fundamental health system building blocks -governance and stewardship, financing, infrastructure, procurement and supply chain management are in place and functioning appropriately.
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Affiliation(s)
- Esther Buregyeya
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
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