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Senkoro E, Mbabazi P, Banturaki G, Naikoba S, Castelnuovo B. The impact of geriatric syndromes on quality of life among older people living with HIV in Kampala, Uganda. Front Public Health 2024; 12:1306151. [PMID: 38322125 PMCID: PMC10845335 DOI: 10.3389/fpubh.2024.1306151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/03/2024] [Indexed: 02/08/2024] Open
Abstract
Objective Older people living with HIV (OPWH) often have lower quality of life (QoL) compared to general population. Measuring their QoL is an important step in HIV care to ensure they have long healthy lives. This study aimed to evaluate the quality of life and its associated factors among people living with HIV aged 60 years and above in Uganda. Methods We used a cross-sectional analysis of older people living with HIV (OPWH) enrolled in a prospective cohort from December 2020 - December 2021. Quality of life was assessed using the World Health Organisation QoL OLD instrument (WHOQOL-OLD). Linear regression model was used to determine associated factors. Results Of the 500 participants enrolled, 51.2% were men and their median age was 64 years (IQR: 62 - 68). WHOQOL-OLD mean score (SD) was 90.1 (8.3) out of 120. Factors that increased overall QoL were (Coefficient [95% Confidence Interval]): being male 2.35 (1.21 - 3.73), having an income of ≥$1 1.30 (-0.16 - 2.76) and paradoxically having more than 2 non-communicable diseases 0.69 (-0.76 - 2.14) in the past, present and future domain of QoL. Those that decreased QoL in the overall and various domains included: an increasing number of geriatric syndromes, depression, pre-frailty, frailty, malnutrition, and low physical function. Conclusion Our findings suggest that financial stability contributed to good QoL while geriatric syndromes decreased QoL for OPWH. Integrating the screening and management of geriatric syndromes into HIV care has the potential to improve the overall QoL of OPWH.
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Affiliation(s)
- Elizabeth Senkoro
- Mark Wainberg Fellowship Program, International AIDS Society (IAS), Geneva, Switzerland
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- Chronic Disease Clinic, Ifakara Health Institute, Ifakara, Tanzania
| | - Phoebe Mbabazi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Grace Banturaki
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Suzan Naikoba
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Barbara Castelnuovo
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
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Odeny BM, Njoroge A, Gloyd S, Hughes JP, Wagenaar BH, Odhiambo J, Nyagah LM, Manya A, Oghera OW, Puttkammer N. Development of novel composite data quality scores to evaluate facility-level data quality in electronic data in Kenya: a nationwide retrospective cohort study. BMC Health Serv Res 2023; 23:1139. [PMID: 37872540 PMCID: PMC10594801 DOI: 10.1186/s12913-023-10133-2] [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: 08/07/2022] [Accepted: 10/10/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND In this evaluation, we aim to strengthen Routine Health Information Systems (RHIS) through the digitization of data quality assessment (DQA) processes. We leverage electronic data from the Kenya Health Information System (KHIS) which is based on the District Health Information System version 2 (DHIS2) to perform DQAs at scale. We provide a systematic guide to developing composite data quality scores and use these scores to assess data quality in Kenya. METHODS We evaluated 187 HIV care facilities with electronic medical records across Kenya. Using quarterly, longitudinal KHIS data from January 2011 to June 2018 (total N = 30 quarters), we extracted indicators encompassing general HIV services including services to prevent mother-to-child transmission (PMTCT). We assessed the accuracy (the extent to which data were correct and free of error) of these data using three data-driven composite scores: 1) completeness score; 2) consistency score; and 3) discrepancy score. Completeness refers to the presence of the appropriate amount of data. Consistency refers to uniformity of data across multiple indicators. Discrepancy (measured on a Z-scale) refers to the degree of alignment (or lack thereof) of data with rules that defined the possible valid values for the data. RESULTS A total of 5,610 unique facility-quarters were extracted from KHIS. The mean completeness score was 61.1% [standard deviation (SD) = 27%]. The mean consistency score was 80% (SD = 16.4%). The mean discrepancy score was 0.07 (SD = 0.22). A strong and positive correlation was identified between the consistency score and discrepancy score (correlation coefficient = 0.77), whereas the correlation of either score with the completeness score was low with a correlation coefficient of -0.12 (with consistency score) and -0.36 (with discrepancy score). General HIV indicators were more complete, but less consistent, and less plausible than PMTCT indicators. CONCLUSION We observed a lack of correlation between the completeness score and the other two scores. As such, for a holistic DQA, completeness assessment should be paired with the measurement of either consistency or discrepancy to reflect distinct dimensions of data quality. Given the complexity of the discrepancy score, we recommend the simpler consistency score, since they were highly correlated. Routine use of composite scores on KHIS data could enhance efficiencies in DQA at scale as digitization of health information expands and could be applied to other health sectors beyondHIV clinics.
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Affiliation(s)
- Beryne M Odeny
- Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA.
| | - Anne Njoroge
- International Training and Education Center for Health (I-TECH), Seattle, WA, USA
| | - Steve Gloyd
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Bradley H Wagenaar
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | | | | | | | | | - Nancy Puttkammer
- International Training and Education Center for Health (I-TECH), Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
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Abore KW, Debiso AT, Birhanu BE, Bua BZ, Negeri KG. Health professionals' readiness to implement electronic medical recording system and associated factors in public general hospitals of Sidama region, Ethiopia. PLoS One 2022; 17:e0276371. [PMID: 36256669 PMCID: PMC9578591 DOI: 10.1371/journal.pone.0276371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Electronic medical recording system is one of the information technologies that has a proven benefit to improve the quality of health service. Readiness assessment is one of the recommended steps to be taken prior to implementing electronic medical recording system to reduce the probability of failure. OBJECTIVE To determine the level of health professional readiness to implement Electronic medical recording system and associated factors in public general hospitals of Sidama region, 2022. METHODOLOGY A cross-sectional study design complemented with qualitative study was employed at three public general hospitals in Sidama region on a sample of 306 participants. A pretested self-administered questionnaire was used to collect quantitative data and in-depth interview was used for the qualitative study. Bivariate and multivariate Binary logistics regression was performed to determine predictors of readiness at α = 0.05, using an odds ratio and 95% confidence interval. Thematic analysis was done for qualitative data collected through in-depth interview. RESULT The overall readiness for health professionals was 36.5%. Of the study participants, 201 (73.4%) were computer literate, 176(64.23%) had good knowledge, and 204 (74.45%) had favorable attitude towards EMR. Only 31 participants had previous training (11.3%), while 64 (23%) had previous experience. EMR knowledge (AOR = 3.332; 95%CI: (1.662, 6.682)) and attitude towards electronic medical recording (AOR = 2.432; 95%CI: (1.146, 5.159)) were statistically significant predictors of readiness to implement electronic medical recording. Qualitative analysis has revealed lack of training, ease of use concerns, information security concerns, and perceived inadequacy of infrastructures including internet connectivity and electricity as common barriers for health professional readiness to implement EMR. CONCLUSION Health professionals' readiness in this study was low. Capacity building efforts to increase the awareness and skills of health professionals should be done before implementing the system.
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Affiliation(s)
| | - Alemu Tamiso Debiso
- School of Public health, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Betelhem Eshetu Birhanu
- School of Public health, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Bezahegn Zerihun Bua
- Health system strengthening project, College of health science, Hawassa University, Hawassa, Ethiopia
| | - Keneni Gutema Negeri
- School of Public health, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
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Lee S, Lee YJ, Kim S, Choi W, Jeong Y, Rhim NJ, Seo I, Kim SY. Perceptions on Data Quality, Use, and Management Following the Adoption of Tablet-Based Electronic Health Records: Results from a Pre-Post Survey with District Health Officers in Ghana. J Multidiscip Healthc 2022; 15:1457-1468. [PMID: 35855755 PMCID: PMC9288181 DOI: 10.2147/jmdh.s368704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/01/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose An electronic health record (EHR) system known as the e-Tracker was introduced in community health facilities in Ghana and numerous advantages were expected for clinical staff, as evidenced by previous literature. However, little is known about public health officials’ views, specifically in low-resource settings. This study aimed to investigate the perceptions of district health officers on data quality, use, and management following the adoption of tablet-based electronic health records in Ghana. Methods A pre- and post-survey was conducted in two regions of Ghana that adopted the e-Tracker for the entire districts during the early stages of the national rollout. Sociodemographic information, internet connection environment, and perceptions on data quality, use, and management were measured. McNemar’s test and Wilcoxon Signed-Rank test were performed to identify changes in perceptions. Chi-square test and Mann–Whitney U-test were used to find any statistical differences in demographic characteristics between the two regions. Results Twenty-four out of 25 districts in Volta and 24 out of 26 districts in Eastern regions participated in both pre- and post-surveys, with a total of 73 participants. In terms of efficiency in data management, the district health officers reported reduced time commitment in data validation and aggregation. Within less than a year, however, no statistically significant improvement was found in data quality and the use of electronic data for relevant tasks. Conclusion A new EHR system in low-resource settings can rapidly improve efficiency in data management from the public health officials’ perspectives. Further impact evaluation is warranted to assess the long-term effect of the EHR system.
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Affiliation(s)
- Seohyun Lee
- Department of Global Public Administration, Yonsei University Mirae Campus, Wonju, Republic of Korea
| | - Young-Ji Lee
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - SeYeon Kim
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Wonil Choi
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Yoojin Jeong
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | | | | | - Sun-Young Kim
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea.,Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
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Ngusie HS, Kassie SY, Chereka AA, Enyew EB. Healthcare providers' readiness for electronic health record adoption: a cross-sectional study during pre-implementation phase. BMC Health Serv Res 2022; 22:282. [PMID: 35232436 PMCID: PMC8889777 DOI: 10.1186/s12913-022-07688-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/25/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The adoption of an electronic health record (EHR) in the healthcare system has the potential to make healthcare service delivery effective and efficient by providing accurate, up-to-date, and complete information. Despite its great importance, the adoptions of EHR in low-income country settings, like Ethiopia, were lagging and increasingly failed. Assessing the readiness of stakeholders before the actual adoption of EHR is considered the prominent solution to tackle the problem. However, little is known about healthcare providers' EHR readiness in this study setting. Accordingly, this research was conducted aiming at examining healthcare providers' readiness for EHR adoption and associated factors in southwestern Ethiopia. METHODS An institutional-based cross-sectional study was conducted from September 1 to October 30, 2021. A total of 423 healthcare providers working in public hospitals were selected using a simple random sampling technique. Multivariable logistic regression was fitted to identify determinant factors of overall healthcare providers' readiness after the other covariates were controlled. RESULT In this study, the overall good readiness level of EHR adoption was 52.8% (n = 204) [95% CI of 47.9% to 56.6%]. Age, computer literacy, computer access at health facilities, attitude towards EHRs, awareness about EHRs, perceived benefit, and perceived technology self-efficacy were significantly associated with the overall health care providers' readiness for the adoption of EHR using a cut point of P-value less than 0.05. CONCLUSION Around half of the respondents had a good level of overall healthcare providers' readiness for the adoption of EHR which was considered inadequate. This finding implied that a huge effort is required to improve readiness before the actual implementation of EHRs. The finding implied that younger-aged groups were more ready for such technology which in turn implied; the older one needs more concern. Enhancing computer literacy, confidence building to raise self-efficacy of such technology, addressing the issue of computer availability at health facilities, building a positive attitude, awareness campaign of EHR, and recognizing the usefulness of such systems were the necessary measures to improve EHR readiness in this setting. Additionally, further studies are recommended to encompass all types of EHR readiness such as organizational readiness, technology readiness, societal readiness, and so on. Additionally, exploring the healthcare provider opinion with qualitative study and extending the proposed study to other implementation settings are recommended to be addressed by future works.
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Affiliation(s)
- Habtamu Setegn Ngusie
- Department of Health Informatics, College of Health Sciences, Mettu University, P.O.Box:318, Mettu, Ethiopia
| | - Sisay Yitayih Kassie
- Department of Health Informatics, College of Health Sciences, Mettu University, P.O.Box:318, Mettu, Ethiopia
| | - Alex Ayenew Chereka
- Department of Health Informatics, College of Health Sciences, Mettu University, P.O.Box:318, Mettu, Ethiopia
| | - Ermias Bekele Enyew
- Department of Health Informatics, College of Health Sciences, Mettu University, P.O.Box:318, Mettu, Ethiopia
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Abstract
Identifying evidence-based interventions that can optimize the re-engagement into care of people living with HIV is necessary to achieve and sustain HIV epidemic control. We conducted a systematic review of interventions for re-engagement into HIV care to examine the accumulated evidence and to identify similarities and differences across studies. Between January and March 2020, we searched MEDLINE, Embase, CINAHL, and PsycINFO databases for publications from 1996 to 2020. We screened 765 references and selected 125 publications for full-text review. For the nine included studies, the intervention centered on (1) integration of clinic and HIV surveillance data; (2) additional or different levels of support provided by healthcare workers; or (3) multi-component intervention. Irrespective of the interventions, mixed results were found for re-engagement into care or ART re-initiation. None of the studies led to an improvement in viral suppression. Re-engagement in HIV care is critical for longitudinal HIV and national program success. Standardizing definitions for out-of-care and re-engagement would facilitate the comparison of interventions. Rigorous study designs to assess strategies to enhance HIV re-engagement are warranted.
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Irungu EM, Odoyo J, Wamoni E, Bukusi EA, Mugo NR, Ngure K, Morton JF, Mugwanya KK, Baeten JM, O'Malley G. Process evaluation of PrEP implementation in Kenya: adaptation of practices and contextual modifications in public HIV care clinics. J Int AIDS Soc 2021; 24:e25799. [PMID: 34496148 PMCID: PMC8425783 DOI: 10.1002/jia2.25799] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION In Africa, oral pre-exposure prophylaxis (PrEP) is largely provided via over-burdened public HIV care clinics. Successfully incorporating PrEP services into these clinics may require adaptations to practices outlined in national implementation guidelines and modifications to routine existing service delivery. We aimed to describe adaptations made by public HIV clinics in Kenya to integrate PrEP delivery into existing services. METHODS The Partners Scale-Up Project aimed to catalyse integration of PrEP in 25 public HIV care clinics. Between May and December 2018, we conducted qualitative interviews with health providers and documented clinic observations in technical assistance (TA) reports to understand the process of PrEP service integration. We analysed 36 health provider interview transcripts and 25 TA reports to identify clinic-level adaptations to activities outlined in Kenyan Ministry of Health PrEP guidelines and modifications made to existing service delivery practices to successfully incorporate PrEP services. Identified adaptations were reported using the expanded framework for reporting adaptations and modifications (FRAME). RESULTS All clinics (n = 25) performed HIV testing, HIV risk assessment, PrEP education and adherence counselling as stipulated in the guidelines. Most clinics initiated clients on PrEP without creatinine testing if otherwise healthy. While monthly refill appointments are recommended, a majority of clinics issued PrEP users two to three months of pills at a time. Clinics also implemented practices that had not been specified in the guidelines including incorporating PrEP-related topics into routine health talks, calling clients with missed PrEP appointments, discussing PrEP service delivery in regular staff meetings, 'fast-tracking' PrEP clients and dispensing PrEP in clinic rooms rather than at clinic-based pharmacies. PrEP initiation numbers were highest among clinics that did not require creatinine testing, conducted peer on-the-job PrEP training and those that discussed PrEP delivery in their routine meetings. Above-average continuation was observed among clinics that discussed PrEP in their routine meetings, dispensed PrEP in clinic rooms and offered PrEP at nonregular hours. CONCLUSIONS Health providers in public HIV care clinics instituted practices and made innovative adaptations to PrEP delivery to reduce barriers for clients and staff. Encouraging clinic level adaptations to national implementation guidelines will facilitate scale-up of PrEP delivery.
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Affiliation(s)
- Elizabeth M. Irungu
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Centre for Clinical ResearchKenya Medical Research InstituteNairobiKenya
| | - Josephine Odoyo
- Centre for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
| | - Elizabeth Wamoni
- Centre for Clinical ResearchKenya Medical Research InstituteNairobiKenya
| | - Elizabeth A. Bukusi
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Department of Obstetrics and GynecologyUniversity of WashingtonSeattleWashingtonUSA
- Centre for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
| | - Nelly R. Mugo
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Centre for Clinical ResearchKenya Medical Research InstituteNairobiKenya
| | - Kenneth Ngure
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- School of Public HealthJomo Kenyatta University of Agriculture and TechnologyNairobiKenya
| | | | | | - Jared M. Baeten
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
- Gilead SciencesFoster CityCAUSA
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Drevin G, Albutt K, Baluku M, Tuhumwiire C, Deng H, Musinguzi N, Modest V, Ngonzi J, Ttendo S, Firth P. Outcome Measurement at a Ugandan Referral Hospital: Validation of the Mbarara Surgical Services Quality Assurance Database. World J Surg 2021; 44:2550-2556. [PMID: 32333160 DOI: 10.1007/s00268-020-05537-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Five billion people lack access to surgery. Accurate and complete data have been identified as essential to the global scale-up of perioperative care. This study retrospectively validates the Mbarara Surgical Services Quality Assurance Database (SQUAD), an electronic outcomes database at a Ugandan secondary referral hospital. METHODS SQUAD data were compared to paper records from August 2013 to January 2017. To assess data entry accuracy, two researchers independently extracted 24 patient variables from 170 charts. To assess completeness of patient capture, SQUAD entries were compared to a sample of charts returned to the Medical Records Department, and to a sample of entries in ward and operating room logbooks. Two-tailed binomial proportions with 95% CI were calculated from the comparative results of patient observations, against a predefined accuracy of 0.85-0.95. RESULTS Agreement between completed validation observations from charts and SQUAD data was 91.5% (n = 3734/4080 data points). Binomial tests indicated that 15 variables had higher than 95% accuracy. A total 19 of 24 variables had ≥ 85% accuracy. The completeness of SQUAD patient capture was 98.2% (n = 167/170) of charts returned to the Medical Records Department, 97.5% (n = 198/203) of operating logbook entries, and 100% (n = 111/111) of ward logbook entries, respectively. CONCLUSION SQUAD closely reflects the primary surgical and anaesthetic data at a Ugandan secondary hospital. Data accuracy of key variables and completeness of population capture were comparable to those of databases in high-income countries and outperformed those of other low- and middle-income countries.
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Affiliation(s)
- Gustaf Drevin
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Department for Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Katherine Albutt
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Department of General Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Moris Baluku
- Department of Anaesthesia and Critical Care, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Caleb Tuhumwiire
- Department of Surgery, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Hao Deng
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Nicholas Musinguzi
- Harvard-Mbarara University of Science and Technology Collaborative, Mbarara, Uganda
| | - Vicki Modest
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Joseph Ngonzi
- Department of Obstetrics and Gynaecology, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Stephen Ttendo
- Department of Anaesthesia and Critical Care, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Paul Firth
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA.
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Mwaka ES, Munabi IG, Castelnuovo B, Kaimal A, Kasozi W, Kambugu A, Musoke P, Katabira E. Low bone mass in people living with HIV on long-term anti-retroviral therapy: A single center study in Uganda. PLoS One 2021; 16:e0246389. [PMID: 33544754 PMCID: PMC7864439 DOI: 10.1371/journal.pone.0246389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/15/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND This study set out to determine the prevalence of low bone mass following long-term exposure to antiretroviral therapy in Ugandan people living with HIV. METHODS A cross-sectional study was conducted among 199 people living with HIV that had been on anti-retroviral therapy for at least 10 years. All participants had dual X-ray absorptiometry to determine their bone mineral density. The data collected included antiretroviral drug history and behavioral risk data Descriptive statistics were used to summarize the data. Inferential statistics were analyzed using multilevel binomial longitudinal Markov chain Monte Carlo mixed multivariate regression modelling using the rstanarm package. RESULTS One hundred ninety nine adults were enrolled with equal representation of males and females. The mean age was 39.5 (SD 8.5) years. Mean durations on anti-retroviral treatment was 12.1 (SD 1.44) years, CD4 cell count was 563.9 cells/mm3. 178 (89.5%) had viral suppression with <50 viral copies/ml. There were 4 (2.0%) and 36 (18%) participants with low bone mass of the hip and lumbar spine respectively. Each unit increase in body mass index was associated with a significant reduction in the odds for low bone mineral density of the hip and lumbar spine. The duration on and exposure to the various antiretroviral medications had no significant effect on the participant's odds for developing low bone mass. All the coefficients of the variables in a multivariable model for either hip or lumbar spine bone mass were not significant. CONCLUSION These results provide additional evidence that patients on long term ART achieve bone mass stabilization. Maintaining adequate body weight is important in maintaining good bone health in people on antiretroviral therapy.
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Affiliation(s)
- Erisa Sabakaki Mwaka
- School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ian Guyton Munabi
- School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Barbara Castelnuovo
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Arvind Kaimal
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - William Kasozi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Andrew Kambugu
- School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Philippa Musoke
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Elly Katabira
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Comparison of different cardiovascular risk tools used in HIV patient cohorts in sub-Saharan Africa; do we need to include laboratory tests? PLoS One 2021; 16:e0243552. [PMID: 33507945 PMCID: PMC7842918 DOI: 10.1371/journal.pone.0243552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 11/23/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Cardiovascular disease (CVD) is the leading cause of death globally, representing 31% of all global deaths. HIV and long term anti-retroviral therapy (ART) are risk factors for development of CVD in populations of people living with HIV (PLHIV). CVD risk assessment tools are currently being applied to SSA populations, but there are questions about accuracy as well as implementation challenges of these tools in lower resource setting populations. We aimed to assess the level of agreement between the various cardiovascular screening tools (Data collection on Adverse effects of anti-HIV Drugs (D:A:D), Framingham risk score, WHO risk score and The Atherosclerotic Cardiovascular Disease Score) when applied to an HIV ART experienced population in Sub-Saharan Africa. Methods This study was undertaken in an Anti-Retroviral Long Term (ALT) Cohort of 1000 PLHIV in care who have been on ART for at least 10 years in urban Uganda. A systematic review was undertaken to find the most frequently used screening tools from SSA PLHIV populations; these were applied to the ALT cohort. Levels of agreement between the resulting scores (those including lipids and non-lipids based, as well as HIV-specific and non-HIV specific) as applied to our cohort were compared. Prevalence Bias Adjusted Kappa was used to evaluate agreement between tools. Results Overall, PLHIV in ALT cohort had a median score of 1.1–1.4% risk of a CVD event over 5 years and 1.7–2.5% risk of a CVD event over 10 years. There was no statistical difference in the risk scores obtained for this population when comparing the different tools, including comparisons of those with lipids and non-lipids, and HIV specific vs non-HIV specific. Conclusion The various tools yielded similar results, but those not including lipids are more feasible to apply in our setting. Long-term cohorts of PLHIV in SSA should in future provide longitudinal data to evaluate existing CVD risk prediction tools for these populations. Inclusion of HIV and ART history factors to existing scoring systems may improve accuracy without adding the expense and technical difficulty of lipid testing.
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Lorenzo-Redondo R, Ozer EA, Achenbach CJ, D'Aquila RT, Hultquist JF. Molecular epidemiology in the HIV and SARS-CoV-2 pandemics. Curr Opin HIV AIDS 2021; 16:11-24. [PMID: 33186230 PMCID: PMC7723008 DOI: 10.1097/coh.0000000000000660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW The aim of this review was to compare and contrast the application of molecular epidemiology approaches for the improved management and understanding of the HIV versus SARS-CoV-2 epidemics. RECENT FINDINGS Molecular biology approaches, including PCR and whole genome sequencing (WGS), have become powerful tools for epidemiological investigation. PCR approaches form the basis for many high-sensitivity diagnostic tests and can supplement traditional contact tracing and surveillance strategies to define risk networks and transmission patterns. WGS approaches can further define the causative agents of disease, trace the origins of the pathogen, and clarify routes of transmission. When coupled with clinical datasets, such as electronic medical record data, these approaches can investigate co-correlates of disease and pathogenesis. In the ongoing HIV epidemic, these approaches have been effectively deployed to identify treatment gaps, transmission clusters and risk factors, though significant barriers to rapid or real-time implementation remain critical to overcome. Likewise, these approaches have been successful in addressing some questions of SARS-CoV-2 transmission and pathogenesis, but the nature and rapid spread of the virus have posed additional challenges. SUMMARY Overall, molecular epidemiology approaches offer unique advantages and challenges that complement traditional epidemiological tools for the improved understanding and management of epidemics.
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Affiliation(s)
- Ramon Lorenzo-Redondo
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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An Introduction to Clinical Registries: Types, Uptake and Future Directions. SYSTEMS MEDICINE 2021. [DOI: 10.1016/b978-0-12-801238-3.11666-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Afolaranmi TO, Hassan ZI, Dawar BL, Wilson BD, Zakari AI, Bello KK, Ofakunrin AOD, Ogbeyi GO. Knowledge of electronic medical records system among frontline health care workers in Jos University teaching hospital, Plateau State Nigeria. ACTA ACUST UNITED AC 2020; 8:3837-3843. [PMID: 34109251 PMCID: PMC8186285 DOI: 10.18203/2320-6012.ijrms20204867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Electronic Medical Records system (EMRs) in any healthcare system has the potential to transform healthcare in terms of saving costs, reducing medical errors, improving service quality, increasing patients’ safety, decision-making, saving time, data confidentiality, and sharing medical. Evidence on the current state of EMR system in Nigeria health system particularly its knowledge among health professionals is limited. Hence, this study was conducted to assess the level of knowledge EMRs among frontline health care workers in a tertiary health institution in Jos, Plateau State. Methods: This was a cross-sectional study conducted between April and August 2019 among 228 frontline health care workers in Jos University Teaching Hospital using quantitative method of data collection. SPSS version 20 was used for data analysis and a p-value of ≤ 0.05 considered statistically significant. Results: The mean age of the respondents in this study was 35±8 years with 93 (40.8%) being 36 years and above. The overall level of knowledge of EMRs was adjudged to be good among 163 (71.5%) of the participants. Category (pharmacists) of the respondents was found to influence good knowledge of EMRs (OR=1.37; 95% CI=1.007–1.865; p=0.045). Conclusions: This study has demonstrated a relatively high level of good knowledge of EMRs with variation existing along the categories of health care workers bringing to light the existence of a good knowledge base in the light of future EMRs implementation.
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Affiliation(s)
- Tolulope O Afolaranmi
- Department of Community Medicine, University of Jos and Jos University Teaching Hospital, Jos Plateau State Nigeria
| | - Zuwaira I Hassan
- Department of Community Medicine, Abubakar Tafawa Balewa University, Bauchi, Bauchi State Nigeria
| | - Bulus L Dawar
- College of Health Sciences, University of Jos, Jos Plateau State Nigeria
| | - Bamkat D Wilson
- College of Health Sciences, University of Jos, Jos Plateau State Nigeria
| | | | - Kayode K Bello
- Department of Community Medicine, University of Jos and Jos University Teaching Hospital, Jos Plateau State Nigeria
| | - Akinyemi O D Ofakunrin
- Department of Community Medicine, Jos University Teaching Hospital, Jos Plateau State Nigeria
| | - Gabriel O Ogbeyi
- Department of Epidemiology and Community Health, College of Health Sciences, Benue State University Makurdi, Nigeria
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The Potential Teratogenicity Alert for Women Conceiving on Dolutegravir-Based Regimens: An Assessment of Risk Communication by an Urban HIV Clinic in Uganda and Choices made by Women. Drug Saf 2020; 43:1133-1140. [DOI: 10.1007/s40264-020-00974-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Muddu M, Tusubira AK, Nakirya B, Nalwoga R, Semitala FC, Akiteng AR, Schwartz JI, Ssinabulya I. Exploring barriers and facilitators to integrated hypertension-HIV management in Ugandan HIV clinics using the Consolidated Framework for Implementation Research (CFIR). Implement Sci Commun 2020; 1:45. [PMID: 32885202 PMCID: PMC7427847 DOI: 10.1186/s43058-020-00033-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 04/15/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Persons living with HIV (PLHIV) receiving antiretroviral therapy have increased risk of cardiovascular disease (CVD). Integration of services for hypertension (HTN), the primary CVD risk factor, into HIV clinics is recommended in Uganda. Our prior work demonstrated multiple gaps in implementation of integrated HTN care along the HIV treatment cascade. In this study, we sought to explore barriers to and facilitators of integrating HTN screening and treatment into HIV clinics in Eastern Uganda. METHODS We conducted a qualitative study at three HIV clinics with low, intermediate, and high HTN care cascade performance, which we classified based on our prior work. Guided by the Consolidated Framework for Implementation Research (CFIR), we conducted semi-structured interviews and focus group discussions with health services managers, healthcare providers, and hypertensive PLHIV (n = 83). Interviews were transcribed verbatim. Three qualitative researchers used the deductive (CFIR-driven) method to develop relevant codes and themes. Ratings were performed to determine valence and strengths of each CFIR construct regarding influencing HTN/HIV integration. RESULTS Barriers to HTN/HIV integration arose from six CFIR constructs: organizational incentives and rewards, available resources, access to knowledge and information, knowledge and beliefs about the intervention, self-efficacy, and planning. The barriers include lack of functional BP machines, inadequate supply of anti-hypertensive medicines, additional workload to providers for HTN services, PLHIV's inadequate knowledge about HTN care, sub-optimal knowledge, skills and self-efficacy of healthcare providers to screen and treat HTN, and inadequate planning for integrated HTN/HIV services.Relative advantage of offering HTN and HIV services in a one-stop centre, simplicity (non-complex nature) of HTN/HIV integrated care, adaptability, and compatibility of HTN care with existing HIV services are the facilitators for HTN/HIV integration. The remaining CFIR constructs were non-significant regarding influencing HTN/HIV integration. CONCLUSION Using the CFIR, we have shown that while there are modifiable barriers to HTN/HIV integration, HTN/HIV integration is of interest to patients, healthcare providers, and managers. Improving access to HTN care among PLHIV will require overcoming barriers and capitalizing on facilitators using a health system strengthening approach. These findings are a springboard for designing contextually appropriate interventions for HTN/HIV integration in low- and middle-income countries.
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Affiliation(s)
- Martin Muddu
- grid.11194.3c0000 0004 0620 0548Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda ,Uganda Initiative for Integrated Management of Non-Communicable Diseases (UINCD), Kampala, Uganda ,grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), P.O. Box 7587, Kampala, Uganda
| | - Andrew K. Tusubira
- Uganda Initiative for Integrated Management of Non-Communicable Diseases (UINCD), Kampala, Uganda
| | - Brenda Nakirya
- Uganda Initiative for Integrated Management of Non-Communicable Diseases (UINCD), Kampala, Uganda
| | - Rita Nalwoga
- Uganda Initiative for Integrated Management of Non-Communicable Diseases (UINCD), Kampala, Uganda
| | - Fred C. Semitala
- grid.11194.3c0000 0004 0620 0548Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda ,grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), P.O. Box 7587, Kampala, Uganda
| | - Ann R. Akiteng
- Uganda Initiative for Integrated Management of Non-Communicable Diseases (UINCD), Kampala, Uganda
| | - Jeremy I. Schwartz
- Uganda Initiative for Integrated Management of Non-Communicable Diseases (UINCD), Kampala, Uganda ,grid.47100.320000000419368710Section of General Internal Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06511 USA
| | - Isaac Ssinabulya
- grid.11194.3c0000 0004 0620 0548Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda ,Uganda Initiative for Integrated Management of Non-Communicable Diseases (UINCD), Kampala, Uganda ,grid.416252.60000 0000 9634 2734Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
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Virological Outcome of Patients With HIV Drug Resistance Attending an Urban Outpatient Clinic in Uganda: A Need for Structured Adherence Counseling and Third-Line Treatment Options. J Acquir Immune Defic Syndr 2019; 80:481-487. [PMID: 30633041 DOI: 10.1097/qai.0000000000001943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND HIV drug resistance and suboptimal adherence are the main reasons for treatment failure among HIV-infected individuals. As genotypic resistance testing is not routinely available in resource-limited settings such as Uganda, data on transmitted and acquired resistance are sparse. METHODS This observational follow-up study assessed the virological outcomes of patients diagnosed with virological failure or transmitted HIV drug resistance in 2015 at the adults' outpatient clinic of the Infectious Diseases Institute in Kampala, Uganda. Initially, 2430 patients on antiretroviral therapy (ART) underwent virological monitoring, of which 190 had virological failure and were subsequently eligible for this follow-up study. Nine patients diagnosed with transmitted drug resistance were eligible. In patients with a viral load > 1000 copies/mL, genotypic resistance testing was performed. RESULTS Of 190 eligible patients, 30 (15.8%) had either died or were lost to follow-up. A total of 148 (77.9%) were included, of which 98 had had a change of ART regimen, and 50 had received adherence counseling only. The majority was now on second-line ART (N = 130, 87.8%). The median age was 39 years (interquartile range: 32-46), and 109 (73.6%) were women. Virological failure was diagnosed in 29 (19.6%) patients, of which 24 (82.8%) were on second-line ART. Relevant drug resistance was found in 25 (86.2%) cases, of which 12 (41.3%) carried dual and 7 (24.1%) triple drug resistance. CONCLUSION Two years after initial virological failure, most patients followed up by this study had a successful virological outcome. However, a significant proportion either continued to fail or died or was lost to follow-up.
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Lwanga I, Nabaggala MS, Kiragga A, Calcagno A, Guaraldi G, Lamorde M, Castelnuovo B. Implementing routine physical function screening among elderly HIV-positive patients in Uganda. AIDS Care 2019; 32:1467-1470. [PMID: 31847531 DOI: 10.1080/09540121.2019.1703888] [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: 10/25/2022]
Abstract
We conducted a cross-sectional study to describe routine physical function assessment for HIV-infected adults aged ≥60 years attending a large urban HIV clinic in Kampala, Uganda. Assessed demographic and clinical factors associated with low physical function in the population, generalized linear regression model was used to estimate factors associated with low physical function. Of the 93 elderly patients that underwent the Short Physical Performance Battery (SPPB) assessment, 43/93 (44.1%) scored 1-8 points at the SPPB evaluation and were categorized as low function, 45/93 (48.4%) scored 9-11 points and were categorized as moderate function and 7/93 (7.5%) scored 12 points and were categorized as high (normal) function. Women (adjusted risk ratio (ARR) 2.57; 95% confidence interval (CI): 1.54-4.29, p = 0.000) had increased risk of low physical function compared to men. A one-year increase in age (ARR = 1.09; CI: 1.03-1.15, p = 0.004) and being overweight (BMI > 25.0, ARR = 1.96; CI: 1.89-3.24, p = 0.008) also carried an increased risk of low physical function status. A higher number 13/41(32%) of falls was recorded in female than among male 3/53(5.8%) patients (p = 0.001). The SPPB assessment is a starting point for clinicians to comprehensively evaluate and consider the management of physical function limitation among older HIV-positive patients.
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Affiliation(s)
- Isaac Lwanga
- Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda
| | | | - Agnes Kiragga
- Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda
| | - Andrea Calcagno
- Department of Medical Sciences, Unit of Infectious Diseases, University of Torino, Torino, Italy
| | - Giovanni Guaraldi
- Infectious Diseases Unit, The University of Modena and Reggio Emilia, Modena, Italy
| | - Mohammed Lamorde
- Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda
| | - Barbara Castelnuovo
- Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda
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Evaluation of the Management of Patients with Detectable Viral Load after the Implementation of Routine Viral Load Monitoring in an Urban HIV Clinic in Uganda. AIDS Res Treat 2019; 2019:9271450. [PMID: 31934447 PMCID: PMC6942703 DOI: 10.1155/2019/9271450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 09/18/2019] [Indexed: 11/18/2022] Open
Abstract
Objective To describe the clinical decisions taken for patients failing on treatment and possible implementation leakages within the monitoring cascade at a large urban HIV Centre in Kampala, Uganda. Methods As per internal clinic guidelines, VL results >1,000 copies/ml are flagged by a quality assurance officer and sent to the requesting clinician. The clinician fills a “decision form” choosing: (1) refer for adherence counselling, (2) repeat VL after 3 months, and (3) switch to second line. We performed data extraction on a random sample of 100 patients with VL test >1,000 copies/ml between January and August 2015. For each patient, we described the action taken by the clinicians. Results Of 6,438 patients with VL performed, 1,021 (16%) had >1,000 copies/ml. Of the 100 (10.1%) clinical files sampled, 61% were female, median age was 39 years (IQR: 32–47), 81% were on 1st-line ART, 19% on 2nd-line, median CD4 count was 249 cells/µL (IQR: 145–390), median log10 VL 4.42 (IQR: 3.98–4.92). Doctors' decisions were; refer for adherence counseling 49%, repeat VL for 25%, and switch to second line for 24% patients. Forty-one percent were not managed according to the guidelines. Of these, 29 (70.7%) were still active in care, 7 were tracked [5 (12.2%) lost to program, 2 (4.9%) dead] and 5 patients were not tracked. Conclusion Despite the implementation of internal systems to manage patients failing ART, we found substantial leakages in the monitoring “cascade”. Additional measures and stronger clinical supervision are needed to make every test count, and to ensure appropriate management of patients failing on ART.
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Correction of patient medical record errors through a file control method. HEALTH POLICY AND TECHNOLOGY 2019. [DOI: 10.1016/j.hlpt.2019.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Castelnuovo B, Mubiru F, Kalule I, Kiragga A. Reasons for first line ART modification over the years during the ART scale up in Uganda. AIDS Res Ther 2019; 16:31. [PMID: 31597561 PMCID: PMC6785877 DOI: 10.1186/s12981-019-0246-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/28/2019] [Indexed: 12/13/2022] Open
Abstract
Background During the initial scale up of ART in sub-Saharan Africa, prescribed regimens included drugs with high potential for toxicity (particularly stavudine). More recently a growing number of patients requires second line treatment due to treatment failure, especially following the expansion of viral load testing. We aim to determine the reasons and risk factors for modification of first line ART across the years. Methods We included patients started on standard first line ART (2NRTI + 1 NNRTI) between 2005 and 2016 at the Infectious Diseases Institute, Kampala, Uganda. We described the reasons for treatment modification categorized in (1) toxicity (2) treatment failure (3) other reason (new TB treatment, new pregnancy). We used Cox proportional hazard to identify factors associated with treatment modification due to toxicity. Results We included 14,261 patients; 9114 (63.9%), were female, the median age was 34 years (IQR: 29–40), 60.8% were in WHO stage 3 and 4. The median BMI and CD4 count were 21.9 (IQR: 19.6–24.8) and 188 cell/µL (IQR: 65–353) respectively; 27.5% were started on stavudine, 46% on zidovudine, and 26.5% on a tenofovir containing regimens. We observed 6248 ART modifications in 4868/14,261 patients (34.1%); 1615 were due to toxicity, 1077 to treatment failure, 1330 to contraindications, and 1860 patients following WHO recommendation of phasing out stavudine and substituting with another NRTI. Modification for drug toxicity declined rapidly after the phase out of stavudine (2008), while switches to second line regimes increased after the implementation of viral load monitoring (2015). Patients with normal BMI compared to underweight, (HR: 0.79, CI 0.69–0.91), with CD4 counts 200–350 cells/µL compared to < 200 cells/µL (HR: 0.81− CI 0.71–0.93), and started on zidovudine (HR: 0.51 CI 0.44–0.59) and tenofovir (HR: 0.16, CI 0.14–0.22) compared to stavudine were less likely to have ART modification due to toxicity. Older patients (HR: 1.14 per 5-year increase CI 1.11–1.18), those in WHO stage 3 and 4 (HR: 1.19, CI 1.06–1.34) were more likely to have ART modification due to toxicity. Conclusions Toxicity as reason for drugs substitution decreased over time mirroring the phase out of stavudine, while viral load expansion identified more patients in need of second line treatment.
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HIV-1 Drug Resistance Among Ugandan Adults Attending an Urban Out-Patient Clinic. J Acquir Immune Defic Syndr 2019; 78:566-573. [PMID: 29771783 DOI: 10.1097/qai.0000000000001717] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Little is known about prevalence of drug resistance among HIV-infected Ugandans, a setting with over 15 years of public sector access to antiretroviral therapy (ART) and where virological monitoring was only recently introduced. SETTING This study was conducted in the adults' out-patient clinic of the Infectious Diseases Institute, Kampala, Uganda. METHODS HIV genotyping was performed in ART-naive patients and in treatment-experienced patients on ART for ≥6 months with virological failure (≥1000 copies/mL). RESULTS A total of 152 ART-naive and 2430 ART-experienced patients were included. Transmitted drug resistance was detected in 9 (5.9%) patients. After a median time on ART of 4.7 years [interquartile range: 2.5-8.7], 190 patients (7.8%) had virological failure with a median viral load of 4.4 log10 copies per milliliter (interquartile range: 3.9-4.9). In addition, 146 patients had a viral load between 51 and 999 copies per milliliter. Most patients with virological failure (142, 74.7%) were on first-line ART. For 163 (85.8%) ART-experienced patients, genotype results were available. Relevant drug-resistance mutations were observed in 135 (82.8%), of which 103 (63.2%) had resistance to 2 drug classes, and 11 (6.7%) had resistance to all drug classes available in Uganda. CONCLUSION The prevalence of transmitted drug resistance was lower than recently reported by the WHO. With 92% of all patients virologically suppressed on ART, the prevalence of virological failure was low when a cutoff of 1000 copies per milliliter is applied, and is in line with the third of the 90-90-90 UNAIDS targets. However, most failing patients had developed multiclass drug resistance.
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Zawedde‐Muyanja S, Manabe YC, Musaazi J, Mugabe FR, Ross JM, Hermans S. Anti-retroviral therapy scale-up and its impact on sex-stratified tuberculosis notification trends in Uganda. J Int AIDS Soc 2019; 22:e25394. [PMID: 31529618 PMCID: PMC6747005 DOI: 10.1002/jia2.25394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 08/06/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION In order to end the tuberculosis (TB) epidemic by 2035, countries must achieve a 10% annual decline in tuberculosis incidence rates by 2025. Provision of antiretroviral therapy (ART) has been associated with population level decreases in TB notification rates. We aimed to assess whether the progressive scale-up of ART provision over the past nine years has had an effect on population level trends of TB notification in Uganda stratified by sex and HIV status. METHODS The study area consisted of Kampala and eight surrounding districts. Annual TB notifications and mid-year populations were used to calculate notification rates per 100,000 population from the study area. Numbers alive and retained on ART were used to calculate ART coverage, overall and by sex. TB notification rates (TBNRs) overall and stratified by sex and HIV status were calculated for the period 2009 to 2017. Trends in TBNRs before and after rollout of universal ART for pregnant women in 2013 were examined using Poisson regression models. To gain insight into the trends in CD4+ T-cell counts at ART initiation over the study period, we performed a sub analysis of patient level data from the Infectious Diseases Institute clinic. RESULTS From 2009 to 2017, ART coverage increased by 27.6% among men and by 35.4% among women. TBNRs declined during the same period. Overall, the average annual percentage decline in TBNRs was -3.5% (95%CI -3.7% to -3.3%), (-2.3% (95%CI -2.6% to -1.9%) in men and -5.4% (95%CI -5.7% to -5.0%) in women). ART coverage increased after 2013 but this was not associated with an accelerated decline in overall TBNRs among HIV-positive persons -3.6% before 2013 and -5.2% after 2013; p = 0.33. The proportion of patients initiating ART with CD4+ T-cell count ≤ 200 cells/mL did not decrease significantly after 2013 (42.2% to 32.2%, p = 0.05). CONCLUSIONS Although ART scale-up was temporally associated with a decline in TB notification rates, the achieved rates of decline are below those required to achieve the End TB Targets. Additional investments in tuberculosis control should include efforts to promote earlier care seeking and ART initiation among HIV-positive persons.
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Affiliation(s)
- Stella Zawedde‐Muyanja
- The Infectious Diseases InstituteCollege of Health SciencesMakerere UniversityKampalaUganda
| | - Yukari C Manabe
- The Infectious Diseases InstituteCollege of Health SciencesMakerere UniversityKampalaUganda
- Division of Infectious DiseasesDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Joseph Musaazi
- The Infectious Diseases InstituteCollege of Health SciencesMakerere UniversityKampalaUganda
| | - Frank R Mugabe
- Ministry of HealthNational Tuberculosis and Leprosy ProgramKampalaUganda
| | - Jennifer M Ross
- Departments of Global Health and MedicineUniversity of WashingtonSeattleWAUSA
| | - Sabine Hermans
- Department of Global HealthAmsterdam Institute for Global Health and DevelopmentAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
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Bervell B, Al-Samarraie H. A comparative review of mobile health and electronic health utilization in sub-Saharan African countries. Soc Sci Med 2019; 232:1-16. [PMID: 31035241 DOI: 10.1016/j.socscimed.2019.04.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 03/15/2019] [Accepted: 04/19/2019] [Indexed: 12/12/2022]
Abstract
This study distinguished between the application of e-health and m-health technologies in sub-Saharan African (SSA) countries based on the dimensions of use, targeted diseases or health conditions, locations of use, and beneficiaries (types of patients or health workers) in a country specific context. It further characterized the main opportunities and challenges associated with these dimensions across the sub-region. A systematic review of the literature was conducted on 66 published peer reviewed articles. The review followed the scientific process of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines of identification, selection, assessment, synthesis and interpretation of findings. The results of the study showed that m-health was prevalent in usage for promoting information for treatment and prevention of diseases as well as serving as an effective technology for reminders towards adherence. For e-health, the uniqueness lay in data acquisition and patients' records management; diagnosis; training and recruitment. While m-health was never used for monitoring or training and recruitment, e-health on the other hand could not serve the purpose of reminders or for reporting cases from the field. Both technologies were however useful for adherence, diagnosis, disease control mechanisms, information provision, and decision-making/referrals. HIV/AIDS, malaria, and maternal (postnatal and antenatal) healthcare were important in both m-health and e-health interventions mostly concentrated in the rural settings of South Africa and Kenya. ICT infrastructure, trained personnel, illiteracy, lack of multilingual text and voice messages were major challenges hindering the effective usage of both m-health and e-health technologies.
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Affiliation(s)
- Brandford Bervell
- E-learning & Technology Unit, College of Distance Education, University of Cape Coast, Cape Coast, Ghana
| | - Hosam Al-Samarraie
- Centre for Instructional Technology & Multimedia, Universiti Sains Malaysia, Penang, Malaysia.
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Kavuma M. The Usability of Electronic Medical Record Systems Implemented in Sub-Saharan Africa: A Literature Review of the Evidence. JMIR Hum Factors 2019; 6:e9317. [PMID: 30801251 PMCID: PMC6409508 DOI: 10.2196/humanfactors.9317] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 08/07/2018] [Accepted: 11/03/2018] [Indexed: 11/24/2022] Open
Abstract
Background Electronic medical record (EMR) systems hold the exciting promise of accurate, real-time access to patient health care data and great potential to improve the quality of patient care through decision support to clinicians. This review evaluated the usability of EMR systems implemented in sub-Saharan Africa based on a usability evaluation criterion developed by the Healthcare Information and Management Systems Society (HIMSS). Objective This review aimed to evaluate EMR system implementations in sub-Saharan Africa against a well-defined evaluation methodology and assess their usability based on a defined set of metrics. In addition, the review aimed to identify the extent to which usability has been an enabling or hindering factor in the implementation of EMR systems in sub-Saharan Africa. Methods Five key metrics for evaluating EMR system usability were developed based on the methodology proposed by HIMSS. These were efficiency, effectiveness, ease of learning, cognitive load, and user satisfaction. A 5-point rating system was developed for the review. EMR systems in 19 reviewed publications were scored based on this rating system. It awarded 5 points per metric to any EMR system that was identified as excellent, 4 points for good, 3 points for fair, 2 points for poor, and 1 point for bad. In addition, each of the 5 key metrics carried a maximum weighted score of 20. The percentage scores for each metric were then computed from the weighted scores from which the final overall usability score was derived. Results In possibly contributing to the usability of implemented EMR systems, ease of learning obtained the highest percentage score of 71% (SD 1.09) followed by cognitive load in second place with a score of 68% (SD 1.62). Effectiveness followed closely in third place at 67% (SD 1.47) and efficiency was in fourth place at 64% (SD 1.04). User satisfaction came in last at 63% (SD 1.70). The overall usability score for all systems was calculated to be 66%. Conclusions The usability of EMR systems implemented in sub-Saharan Africa has been good with ease of learning possibly being the biggest positive contributor to this rating. Cognitive load and effectiveness have also possibly positively influenced the usability of EMR systems, whereas efficiency and user satisfaction have perhaps contributed least to positively influencing EMR system usability.
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Affiliation(s)
- Michael Kavuma
- Department of Tele-Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,MedLite Systems Limited, Kampala, Uganda
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Ten years of antiretroviral therapy: Incidences, patterns and risk factors of opportunistic infections in an urban Ugandan cohort. PLoS One 2018; 13:e0206796. [PMID: 30383836 PMCID: PMC6211746 DOI: 10.1371/journal.pone.0206796] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 10/22/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Despite increased antiretroviral therapy (ART) coverage and the raised CD4 threshold for starting ART, opportunistic infections (OIs) are still one of the leading causes of death in sub-Saharan Africa. There are few studies from resource-limited settings on long-term reporting of OIs other than tuberculosis. METHODS Patients starting ART between April 2004 and April 2005 were enrolled and followed-up for 10 years in Kampala, Uganda. We report incidences, patterns and risk factors using Cox proportional hazards models of OIs among all patients and among patients with CD4 cell counts >200 cells/μL. RESULTS Of the 559 patients starting ART, 164 patients developed a total of 241 OIs during 10 years of follow-up. The overall incidence was highest for oral candidiasis (25.4, 95% confidence interval (CI): 20.5-31.6 per 1000 person-years of follow-up), followed by tuberculosis (15.3, 95% CI: 11.7-20.1), herpes zoster (12.3, 95% CI: 9.1-16.6) and cryptococcal meningitis (3.0, 95% CI: 1.7-5.5). Incidence rates for all OIs were highest in the first year after ART initiation and decreased with the increase of the current CD4 cell count. Factors independently associated with development of OIs were baseline nevirapine-based regimens, time-varying higher viral load, time-varying lower CD4 cell count and time-varying lower hemoglobin. In patients developing OIs at a current CD4 cell count >200 cells/μL, factors independently associated with OI development were time-varying increase in viral load and time-varying decrease in hemoglobin, whereas a baseline CD4 cell count <50 cells/μL was protective. CONCLUSION We report high early incidences of OIs, decreasing with increasing CD4 cell count and time spent on ART. Ongoing HIV replication and anemia were strong predictors for OI development independent of the CD4 cell count. Our findings support the recommendation for early initiation of ART and suggest close monitoring for OIs among patients recently started on ART, with low CD4 cell count, high viral load and anemia.
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A Comparison of Electronic Medical Record Data to Paper Records in Antiretroviral Therapy Clinic in Ethiopia: What is affecting the Quality of the Data? Online J Public Health Inform 2018; 10:e212. [PMID: 30349630 PMCID: PMC6194098 DOI: 10.5210/ojphi.v10i2.8309] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Anti-Retroviral Therapy (ART) care is a lifelong treatment, which needs
accurate and reliable data collected for long period of time. Poor quality
of medical records data remains a challenge and is directly related to the
quality of care of patients. To improve this, there is an increasing trend
to implement electronic medical record (EMR) in hospitals. However, there is
little evidence on the impact of EMR on the quality of health data in low-
resource setting hospitals like Ethiopia. This comparative study aims to
fill this evidence gap by assessing the completeness and reliability of
paper-based and electronic medical records and explore the challenges of
ensuring data quality at the Anti-Retroviral Therapy (ART) clinic at the
University of Gondar Referral Hospital in Northwest Ethiopia. Methods An institution-based comparative cross-sectional study, supplemented with a
qualitative approach was conducted from February 1 to March 30, 2017 at the
ART clinic of the University of Gondar Hospital. A total of 250 medical
records having both electronic and paper-based versions were collected and
assessed. A national ART registration form which consists of 40 ART data
elements was used as a checklist to assess completeness and reliability
dimensions of data quality on medical records of patients on HIV care. Kappa
statistics were computed to describe the level of data agreement between
paper-based and electronic records across patient characteristics. In-depth
interviews were conducted using semi-structured questionnaires with ten key
informants to explore the challenges related with the quality of medical
records. Responses of the key informant interviews were analyzed using
thematic analysis. Results The overall completeness of medical records was 78% with 95% CI (70.8% -
85.1%) in paper-based and 76% with 95%CI (67.8% - 83.2%) EMR. The data
reliability measured in Kappa statistics shows strong agreements on the
socio-demographic data such as educational status 0.93 (0.891, 0.963), WHO
staging 0.86 (0.808, 0.906); general appearance 0.83 (0.755, 0.892) and
patient referral record 0.87 (0.795, 0.932). The major challenges hindering
good data quality was the current side by side dual data documentation
practice (the need to document both on the paper and the EMR for a single
record), patient overload and low data documentation practice of health
workers. Conclusion The overall completeness of ART medical records was still slightly better in
paper-based records than EMR. The main reason affecting the EMR data quality
was the current dual documentation practice both on the paper and electronic
for each patient in the hospital and the high load of patients in the
clinic. The hospital management need to decide to use either the paper or
the electronic system and build the capacity of health workers to improve
data quality in the hospital.
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Bisaso KR, Karungi SA, Kiragga A, Mukonzo JK, Castelnuovo B. A comparative study of logistic regression based machine learning techniques for prediction of early virological suppression in antiretroviral initiating HIV patients. BMC Med Inform Decis Mak 2018; 18:77. [PMID: 30180893 PMCID: PMC6123949 DOI: 10.1186/s12911-018-0659-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/28/2018] [Indexed: 12/23/2022] Open
Abstract
Background Treatment with effective antiretroviral therapy (ART) lowers morbidity and mortality among HIV positive individuals. Effective highly active antiretroviral therapy (HAART) should lead to undetectable viral load within 6 months of initiation of therapy. Failure to achieve and maintain viral suppression may lead to development of resistance and increase the risk of viral transmission. In this paper three logistic regression based machine learning approaches are developed to predict early virological outcomes using easily measurable baseline demographic and clinical variables (age, body weight, sex, TB disease status, ART regimen, viral load, CD4 count). The predictive performance and generalizability of the approaches are compared. Methods The multitask temporal logistic regression (MTLR), patient specific survival prediction (PSSP) and simple logistic regression (SLR) models were developed and validated using the IDI research cohort data and predictive performance tested on an external dataset from the EFV cohort. The model calibration and discrimination plots, discriminatory measures (AUROC, F1) and overall predictive performance (brier score) were assessed. Results The MTLR model outperformed the PSSP and SLR models in terms of goodness of fit (RMSE = 0.053, 0.1, and 0.14 respectively), discrimination (AUROC = 0.92, 0.75 and 0.53 respectively) and general predictive performance (Brier score= 0.08, 0.19, 0.11 respectively). The predictive importance of variables varied with time after initiation of ART. The final MTLR model accurately (accuracy = 92.9%) predicted outcomes in the external (EFV cohort) dataset with satisfactory discrimination (0.878) and a low (6.9%) false positive rate. Conclusion Multitask Logistic regression based models are capable of accurately predicting early virological suppression using readily available baseline demographic and clinical variables and could be used to derive a risk score for use in resource limited settings.
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Affiliation(s)
- Kuteesa R Bisaso
- Makerere University Infectious Diseases Institute, P.O. Box 7072, Kampala, Uganda. .,Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda. .,Breakthrough Analytics Ltd, Kampala, Uganda.
| | - Susan A Karungi
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda.,Breakthrough Analytics Ltd, Kampala, Uganda
| | - Agnes Kiragga
- Makerere University Infectious Diseases Institute, P.O. Box 7072, Kampala, Uganda
| | - Jackson K Mukonzo
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Barbara Castelnuovo
- Makerere University Infectious Diseases Institute, P.O. Box 7072, Kampala, Uganda
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Assessing data quality and the variability of source data verification auditing methods in clinical research settings. J Biomed Inform 2018; 83:25-32. [PMID: 29783038 DOI: 10.1016/j.jbi.2018.05.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 03/22/2018] [Accepted: 05/17/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Data audits within clinical settings are extensively used as a major strategy to identify errors, monitor study operations and ensure high-quality data. However, clinical trial guidelines are non-specific in regards to recommended frequency, timing and nature of data audits. The absence of a well-defined data quality definition and method to measure error undermines the reliability of data quality assessment. This review aimed to assess the variability of source data verification (SDV) auditing methods to monitor data quality in a clinical research setting. MATERIAL AND METHODS The scientific databases MEDLINE, Scopus and Science Direct were searched for English language publications, with no date limits applied. Studies were considered if they included data from a clinical trial or clinical research setting and measured and/or reported data quality using a SDV auditing method. RESULTS In total 15 publications were included. The nature and extent of SDV audit methods in the articles varied widely, depending upon the complexity of the source document, type of study, variables measured (primary or secondary), data audit proportion (3-100%) and collection frequency (6-24 months). Methods for coding, classifying and calculating error were also inconsistent. Transcription errors and inexperienced personnel were the main source of reported error. Repeated SDV audits using the same dataset demonstrated ∼ 40% improvement in data accuracy and completeness over time. No description was given in regards to what determines poor data quality in clinical trials. CONCLUSIONS A wide range of SDV auditing methods are reported in the published literature though no uniform SDV auditing method could be determined for "best practice" in clinical trials. Published audit methodology articles are warranted for the development of a standardised SDV auditing method to monitor data quality in clinical research settings.
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Castelnuovo B, Mubiru F, Kiragga AN, Musomba R, Mbabazi O, Gonza P, Kambugu A, Ratanshi RP. Antiretroviral treatment Long-Term (ALT) cohort: a prospective cohort of 10 years of ART-experienced patients in Uganda. BMJ Open 2018; 8:e015490. [PMID: 29467129 PMCID: PMC5855467 DOI: 10.1136/bmjopen-2016-015490] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Little information is available on patients on antiretroviral treatment (ART) after a long-term period from sub-Saharan Africa, with the longest follow-up and related outcomes being after 10 years on ART. At the Infectious Diseases Institute (IDI) (Kampala, Uganda), we set up a cohort of patients already on ART for 10 years at the time of enrolment, who will be followed up for additional 10 years. PARTICIPANTS A prospective observational cohort of 1000 adult patients previously on ART for 10 years was enrolled between May 2014 and September 2015. Patients were eligible for enrolment if they were in their consecutive 10th year of ART regardless of the combination of drugs for both first- and second-line ART. Data were collected at enrolment and all annual study visits. Follow-up visits are scheduled once a year for 10 years. Biological samples (packed cells, plasma and serum) are stored at enrolment and follow-up visits. FINDINGS TO DATE Out of 1000 patients enrolled, 345 (34.5%) originate from a pre-existing research cohort at IDI, while 655 (65.5%) were enrolled from the routine clinic. Overall, 81% of the patients were on first line at the time of the enrolment in the ART long-term cohort, with the more frequent regimen being zidovudine plus lamivudine plus nevirapine (44% of the cohort), followed by zidovudine plus lamivudine plus efavirenz (22%) and tenofovir plus lamivudine or emtricitabine plus efavirenz (10%). At cohort enrolment, viral suppression was defined as HIV-RNA <400 copies/mL was 95.8%. FUTURE PLANS Through collaboration with other institutions, we are planning several substudies, including the evaluation of the risk for cardiovascular diseases, the assessment of bone mineral density, screening for liver cirrhosis using fibroscan technology and investigation of drug-drug interactions between ART and common drugs used for non-communicable diseases.
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Affiliation(s)
| | - Frank Mubiru
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Agnes N Kiragga
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Rachel Musomba
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Olive Mbabazi
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Paul Gonza
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Andrew Kambugu
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
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Rachel M, Barbara C, Murphy C, Komujuni C, Nyakato P, Ocama P, Lamorde M, Easterbrook P, Ratanshi RP. Uptake of hepatitis B-HIV co-infection screening and management in a resource limited setting. HEPATOLOGY, MEDICINE AND POLICY 2018; 3:3. [PMID: 30288326 PMCID: PMC5918698 DOI: 10.1186/s41124-017-0030-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 12/19/2017] [Indexed: 02/07/2023]
Abstract
Background WHO hepatitis B guidelines recommend testing all new HIV patients, treating them accordingly or providing immunization. At the Infectious Diseases Institute (IDI) following an audit done in 2012, only 46% patients had been screened for hepatitis B with variable management plans therefore new internal guidelines were implemented. This study describes the uptake of hepatitis B screening and management of patients with hepatitis B and HIV con-infection after the implementation. Methods Data included for all HIV positive patients in care at IDI by October 2015. Data are expressed as median with interquartile range (IQR) and percentages were compared using the chi square test. Statistical analysis was performed using STATA version 13. The IDI laboratory upper limit of normal for alanine aminotransferase (ALT) and aspartate aminotransferase (ASTs) was 40 IU/ml. Results Number of hepatitis B screening tests increased from 800 by 2012 to 1400 in 2015. By 2015 8042/8604(93.5%) patients had been screened for hepatitis B. Overall hepatitis B positive were 359 (4.6%). 166 (81.4%) hepatitis B positives were switched to a tenofovir (TDF) containing regimen. Conclusion Our study confirms the importance of screening for hepatitis B and of using ART regimens containing tenofovir in hepatitis B co-infected patients. Whilst our program has made improvements in care still 18.6% of patients with hepatitis B were not on tenofovir regimens, 98.1% had no hepatitis B viral loads done. Clinicians should recognize the potential for hepatitis B in HIV positive patients and the importance of early diagnosis and treatment to ensure optimal management of cases and follow up.
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Affiliation(s)
- Musomba Rachel
- Infectious Diseases Institute, Makerere University, Mulago Hospital, P.O. Box 22418, Kampala, Uganda
| | - Castelnuovo Barbara
- Infectious Diseases Institute, Makerere University, Mulago Hospital, P.O. Box 22418, Kampala, Uganda
| | - Claire Murphy
- Centre for Communicable Diseases, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Charlene Komujuni
- Infectious Diseases Institute, Makerere University, Mulago Hospital, P.O. Box 22418, Kampala, Uganda
| | - Patience Nyakato
- Infectious Diseases Institute, Makerere University, Mulago Hospital, P.O. Box 22418, Kampala, Uganda
| | - Ponsiano Ocama
- Infectious Diseases Institute, Makerere University, Mulago Hospital, P.O. Box 22418, Kampala, Uganda
| | - Mohammed Lamorde
- Infectious Diseases Institute, Makerere University, Mulago Hospital, P.O. Box 22418, Kampala, Uganda
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Shanbehzadeh M, Ahmadi M. Identification of the necessary data elements to report AIDS: a systematic review. Electron Physician 2017; 9:5920-5931. [PMID: 29560143 PMCID: PMC5843417 DOI: 10.19082/5920] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 07/23/2017] [Indexed: 11/21/2022] Open
Abstract
Background The main focus of the surveillance system of AIDS in Iran is on direct clinical care for HIV, and other supportive facilities and secondary programmes have been somewhat neglected. Creating templates for reporting AIDS in Iran that can fulfil the needs of all information stakeholders, is a necessity for the Public Health Information Exchange (PHIE) system. Objective The aim of this study was to develop a comprehensive reporting template of the PHIE system for HIV/AIDS in Iran. Methods This study was performed in 2017. Through a systematic review of the Web of Science, Science Direct, Scopus, PubMed databases and Google Scholar search engine from 2000 to 2016, the necessary data elements are identified by the main keywords of the “Minimum Data Set” and HIV / AIDS collection. Results As many as 28 studies were enrolled in the research. The MDS was designed for the following categories: 1) administrative, managerial, and policy-makers (with 10 data classes and 90 data elements), 2) Clinical and medical (six data classes and 83 data elements), and 3) support services, counselling and subsidiary (three data classes and 32 data elements). Conclusion Iran stands in a fortunate position in terms of clinical and care programmes for AIDS treatment. A fundamental challenge is the insufficient attention to support and consulting programmes as well as the lack of information for accurate and efficient policy and decision-making. A reporting format has been designed to meet the needs of all information requirements of beneficiaries related to HIV/AIDS care and management.
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Affiliation(s)
- Mostafa Shanbehzadeh
- Ph.D. Student of Health Information Management, Department of Health Information Management, School of Health Management and Information Science, Iran University of Medical Science, Tehran, Iran
| | - Maryam Ahmadi
- Ph.D. of Health Information Management, Professor, Department of Health Information Management, School of Health Management and Information Science, Iran University of Medical Science, Tehran, Iran
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Castelnuovo B, Mubiru F, Kalule I, Nakalema S, Kiragga A. Challenges in Assessing Outcomes among Infants of Pregnant HIV-Positive Women Receiving ART in Uganda. AIDS Res Treat 2017; 2017:3202737. [PMID: 29362673 PMCID: PMC5738585 DOI: 10.1155/2017/3202737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/24/2017] [Accepted: 08/27/2017] [Indexed: 11/17/2022] Open
Abstract
Since 2012, the WHO recommends lifelong ART with TDF+FTC/3TC+EFV for all HIV-positive pregnant and breastfeeding women (Option B-plus). In this analysis we describe the proportion of early and late transmission in mothers with high retention in Kampala, Uganda. We included 700 pregnant women from January 2012 to August 2014 with a follow-up extended to August 2016; the median age was 31 years (IQR: 26-35), 36.3% in WHO stage 3/4; median CD4 count was 447 cells/μL (IQR: 301-651) and 73.3% were already on ART for a median time of 28 (IQR: 10-57) months; 52% infants were male and median weight was 3.2 Kg (IQR: 2.5-3.5). Five hundred and sixty-five (80.7%) infants had at least one test for HIV; 22 (3.1%) infants died, all with unknown serostatus; 3 tested positive at week 6 and one additional at months 12 and 18. Two of the mothers of the 4 HIV-positive infants were ART-naïve at the time of pregnancy. We report very low documented HIV transmission comparable with those reported in clinical trials settings; however, demonstrating the efficacy of Option B-plus in terms of averted transmission in routine settings is challenging since high proportion of infants do not have documented HIV tests.
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Affiliation(s)
| | - Frank Mubiru
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Ivan Kalule
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Shadia Nakalema
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Agnes Kiragga
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
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Sekaggya-Wiltshire C, Castelnuovo B, von Braun A, Musaazi J, Muller D, Buzibye A, Gutteck U, Henning L, Ledergerber B, Corti N, Lamorde M, Fehr J, Kambugu A. Cohort profile of a study on outcomes related to tuberculosis and antiretroviral drug concentrations in Uganda: design, methods and patient characteristics of the SOUTH study. BMJ Open 2017; 7:e014679. [PMID: 28928173 PMCID: PMC5623357 DOI: 10.1136/bmjopen-2016-014679] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Tuberculosis (TB) is a leading cause of death among people living with HIV in sub-Saharan Africa. Several factors influence the efficacy of TB treatment by leading to suboptimal drug concentrations and subsequently affecting treatment outcome. The aim of this cohort is to determine the association between anti-TB drug concentrations and TB treatment outcomes. PARTICIPANTS Patients diagnosed with new pulmonary TB at the integrated TB-HIV outpatient clinic in Kampala, Uganda, were enrolled into the study and started on first-line anti-TB treatment. FINDINGS TO DATE Between April 2013 and April 2015, the cohort enrolled 268 patients coinfected with TB/HIV ; 57.8% are male with a median age of 34 years (IQR 29-40). The median time between the diagnosis of HIV and the diagnosis of TB is 2 months (IQR 0-22.5). The majority of the patients are antiretroviral therapy naive (75.4%). Our population is severely immunosuppressed with a median CD4 cell count at enrolment of 163 cells/µL (IQR 46-298). Ninety-nine per cent of the patients had a diagnosis of pulmonary TB confirmed by sputum microscopy, Xpert/RIF or culture and 203 (75.7%) have completed TB treatment with 5099 aliquots of blood collected for pharmacokinetic analysis. FUTURE PLANS This cohort provides a large database of well-characterised patients coinfected with TB/HIV which will facilitate the description of the association between serum drug concentrations and TB treatment outcomes as well as provide a research platform for future substudies including evaluation of virological outcomes. TRIAL REGISTRATION NUMBER NCT01782950; Pre-results.
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Affiliation(s)
| | - Barbara Castelnuovo
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Amrei von Braun
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
- Division of Infectious Diseases and Infection Control, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Joseph Musaazi
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Daniel Muller
- Department of Clinical Chemistry, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Allan Buzibye
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ursula Gutteck
- Department of Clinical Chemistry, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lars Henning
- Division of Infectious Diseases and Infection Control, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bruno Ledergerber
- Division of Infectious Diseases and Infection Control, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Natascia Corti
- Division of Clinical Pharmacology and Toxicology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Mohammed Lamorde
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jan Fehr
- Division of Infectious Diseases and Infection Control, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andrew Kambugu
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
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Odekunle FF, Odekunle RO, Shankar S. Why sub-Saharan Africa lags in electronic health record adoption and possible strategies to increase its adoption in this region. Int J Health Sci (Qassim) 2017; 11:59-64. [PMID: 29085270 PMCID: PMC5654179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Poor health information system has been identified as a major challenge in the health-care system in many developing countries including sub-Saharan African countries. Electronic health record (EHR) has been shown as an important tool to improve access to patient information with attendance improved quality of care. However, EHR has not been widely implemented/adopted in sub-Saharan Africa. This study sought to identify factors that affect the adoption of an EHR in sub-Saharan Africa and strategies to improve its adoption in this region. A comprehensive literature search was conducted on three electronic databases: PubMed, Medline, and Google Scholar. Articles of interest were those published in English that contained information on factors that limit the adoption of an EHR as well as strategies that improve its adoption in sub-Saharan African countries. The available evidence indicated that there were many factors that hindered the widespread adoption of an EHR in sub-Saharan Africa. These were high costs of procurement and maintenance of the EHR system, lack of financial incentives and priorities, poor electricity supply and internet connectivity, and primary user's limited computer skills. However, strategies such as implementation planning, financial supports, appropriate EHR system selection, training of primary users, and the adoption of the phased implementation process have been identified to facilitate the use of an EHR. Wide adoption of an EHR in sub-Saharan Africa region requires a lot more effort than what is assumed because of the current poor level of technological development, lack of required computer skills, and limited resources.
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Affiliation(s)
- Florence Femi Odekunle
- Department of Health Informatics, Rutgers School of Health Professions, The State University of New Jersey, USA
| | | | - Srinivasan Shankar
- Department of Health Informatics, Rutgers School of Health Professions, The State University of New Jersey, USA
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Musomba R, Mubiru F, Nakalema S, Mackline H, Kalule I, Kiragga AN, Ratanshi RP, Castelnuovo B. Describing Point of Entry into Care and Being Lost to Program in a Cohort of HIV Positive Pregnant Women in a Large Urban Centre in Uganda. AIDS Res Treat 2017; 2017:3527563. [PMID: 28469942 PMCID: PMC5392405 DOI: 10.1155/2017/3527563] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/19/2017] [Accepted: 02/19/2017] [Indexed: 11/24/2022] Open
Abstract
Introduction. We aim to describe the time of entry into care and factors associated with being lost to program (LTP) in pregnant women on Option B Plus in an integrated HIV and antenatal care (ANC) clinic in Uganda. Methods. We included all pregnant women enrolled into the integrated HIV-ANC clinic from January 2012 to 31st July 2014, while the follow up period extended up to October 30th 2015. LTP was defined as being out of care for ≥3 months. Results. Overall 856 women were included. Only 36.4% (86/236) of the women were enrolled in the first trimester. Overall 69 (8.1%) were LTP. In the multivariate analysis older women (HR: 0.80 per five-year increase, CI: 0.64-1.0, and P = 0.060) and women on ART at the time of pregnancy (0.58, CI: 0.34-0.98, and P = 0.040) were more likely not to be LTP. Among women already on ART at the time of pregnancy no factor was associated with LTP. Conclusion. Our results suggest the need for interventions to enhance prompt linkage of HIV positive women to HIV services for ART initiation and for increased retention particularly in young and ART naive women.
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Affiliation(s)
- Rachel Musomba
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Frank Mubiru
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Shadia Nakalema
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Hope Mackline
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Ivan Kalule
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Agnes N. Kiragga
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Rosalind Parkes Ratanshi
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
- Cambridge Institute of Public Health, Cambridge, UK
| | - Barbara Castelnuovo
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
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Stanczyk NE, Crutzen R, Sewuster N, Schotanus E, Mulders M, Cremers HP. Differences in Sociocognitive Beliefs between Involved and Noninvolved Employees during the Implementation of an Electronic Health Record System. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2017; 14:1c. [PMID: 28566986 PMCID: PMC5430131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Electronic health records (EHRs) can improve quality and efficiency in patient care. However, the intention to work with such a new system is often relatively low among employees because the work processes of the healthcare organization may change. Involving employees in an EHR implementation may increase their beliefs and perceived capabilities concerning the new system. The current study aimed to assess the role of involvement and its effects on sociocognitive beliefs regarding the implementation of a new EHR system. METHODS The study was performed in June 2015 among all eligible employees of a hospital in the Netherlands. Both involved and noninvolved employees were invited to complete a paper-based questionnaire concerning their sociocognitive beliefs (i.e., attitude, social influence, self-efficacy, and intention) related to the EHR implementation. Independent sample t-tests were used to assess potential differences in sociocognitive beliefs between employees who were involved in the implementation process and those who were not. Effect sizes (Cohen's d) were calculated to indicate the standardized difference between the means. RESULTS A total of 359 participants completed the paper-based questionnaire and were included in the analyses. Involved employees (n = 94) reported significantly higher levels of attitude (p < .001, d = .62), perceived self-efficacy (p = .01, d = .31), social support (p < .001, d = .68), and a higher intention to work with the new EHR system (p < .001, d = .60), compared with the group of employees who were not involved in the implementation process (n = 265). CONCLUSION Involving employees during an EHR implementation appears to enhance employees' sociocognitive beliefs and increases their intention to work with the new system.
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Jawhari B, Ludwick D, Keenan L, Zakus D, Hayward R. Benefits and challenges of EMR implementations in low resource settings: a state-of-the-art review. BMC Med Inform Decis Mak 2016; 16:116. [PMID: 27600269 PMCID: PMC5011989 DOI: 10.1186/s12911-016-0354-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/19/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The intent of this review is to discover the types of inquiry and range of objectives and outcomes addressed in studies of the impacts of Electronic Medical Record (EMR) implementations in limited resource settings in sub-Saharan Africa. METHODS A state-of-the-art review characterized relevant publications from bibliographic databases and grey literature repositories through systematic searching, concept-mapping, relevance and quality filter optimization, methods and outcomes categorization and key article analysis. RESULTS From an initial population of 749 domain articles published before February 2015, 32 passed context and methods filters to merit full-text analysis. Relevant literature was classified by type (e.g., secondary, primary), design (e.g., case series, intervention), focus (e.g., processes, outcomes) and context (e.g., location, organization). A conceptual framework of EMR implementation determinants (systems, people, processes, products) was developed to represent current knowledge about the effects of EMRs in resource-constrained settings and to facilitate comparisons with studies in other contexts. DISCUSSION This review provides an overall impression of the types and content of health informatics articles about EMR implementations in sub-Saharan Africa. Little is known about the unique effects of EMR efforts in slum settings. The available reports emphasize the complexity and impact of social considerations, outweighing product and system limitations. Summative guides and implementation toolkits were not found but could help EMR implementers. CONCLUSION The future of EMR implementation in sub-Saharan Africa is promising. This review reveals various examples and gaps in understanding how EMR implementations unfold in resource-constrained settings; and opportunities for new inquiry about how to improve deployments in those contexts.
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Affiliation(s)
- Badeia Jawhari
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Clinical Sciences Building, 8440-112 St NW 5th floor, 5-112E, T6G 2B7 Edmonton, AB Canada
- Innovative Canadians for Change, Edmonton, AB Canada
| | - Dave Ludwick
- Sherwood Park Primary Care Network, Sherwood Park, AB Canada
| | - Louanne Keenan
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Clinical Sciences Building, 8440-112 St NW 5th floor, 5-112E, T6G 2B7 Edmonton, AB Canada
| | - David Zakus
- Faculty of Community Services, School of Occupational and Public Health, Ryerson University, Toronto, ON Canada
| | - Robert Hayward
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Clinical Sciences Building, 8440-112 St NW 5th floor, 5-112E, T6G 2B7 Edmonton, AB Canada
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Castelnuovo B, Musomba R, Musaazi J, Kiragga AN. Different modalities of entry in a large urban clinic in Uganda and impact on outcomes of patients assessing HIV care and treatment. AIDS Care 2016; 29:259-262. [PMID: 27684099 DOI: 10.1080/09540121.2016.1211604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In resource-limited settings, a number of patients do not receive continuous HIV care. In this analysis, we compared outcomes in patients who entered care by different modality of entry. This was a retrospective analysis of all patients started on antiretroviral treatment (ART) at a large urban center in Uganda from 2005 to 2012. Patients were categorized into three groups (1) Front door: started on ART without interruption during follow-up; (2) drop-out side door: restarted on ART after having an interruption >6 months and (3) transfer-in side door: transferred-in after being started on ART somewhere else. We compared characteristics at enrollment in the three groups and investigated the following outcomes: (1) retention in care (2) switch to second line. In the study period 11,528 (87.2%) were enrolled through the front door, 1159 (8.7%) resumed ART after dropping out, while 527 (4%) patients were transferred in on ART. The three groups were generally comparable, although patients transferred in were sicker. A larger proportion of patients entered through the drop-out side door died or was lost to follow-up (37.3%), as compared to patients in the front door group (24.9%) and transferred-in side door group (17.7%). More patients in the front door group (32.1%) were transferred out during the follow-up. The highest probability of switching to second line was found in the transferred-in group. Patients who re-enter our program after dropping out are at higher risk of dropping out of care and often need to be switched to second-line ART. The high demand for second-line therapy among patients in transfer-in side door reflects failure in management of complicated patients who are usually require "up-transfer" to better treatment centers. In future understanding, the different modes of entry into HIV care will be key in reshaping the general cascade of HIV care.
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Affiliation(s)
- Barbara Castelnuovo
- a Infectious Diseases Institute, Makerere University College of Health Sciences , Kampala , Uganda
| | - Rachel Musomba
- a Infectious Diseases Institute, Makerere University College of Health Sciences , Kampala , Uganda
| | - Joseph Musaazi
- a Infectious Diseases Institute, Makerere University College of Health Sciences , Kampala , Uganda
| | - Agnes N Kiragga
- a Infectious Diseases Institute, Makerere University College of Health Sciences , Kampala , Uganda
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Jawhari B, Keenan L, Zakus D, Ludwick D, Isaac A, Saleh A, Hayward R. Barriers and facilitators to Electronic Medical Record (EMR) use in an urban slum. Int J Med Inform 2016; 94:246-54. [PMID: 27573333 DOI: 10.1016/j.ijmedinf.2016.07.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 07/14/2016] [Accepted: 07/24/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Rapid urbanization has led to the growth of urban slums and increased healthcare burdens for vulnerable populations. Electronic Medical Records (EMRs) have the potential to improve continuity of care for slum residents, but their implementation is complicated by technical and non-technical limitations. This study sought practical insights about facilitators and barriers to EMR implementation in urban slum environments. METHOD Descriptive qualitative method was used to explore staff perceptions about a recent open-source EMR deployment in two primary care clinics in Kibera, Nairobi. Participants were interviewed using open-ended, semi-structured questions. Content analysis was used when exploring transcribed data. RESULTS Three major themes - systems, software, and social considerations - emerged from content analysis, with sustainability concerns prevailing. Although participants reported many systems (e.g., power, network, Internet, hardware, interoperability) and software (e.g., data integrity, confidentiality, function) challenges, social factors (e.g., identity management, training, use incentives) appeared the most important impediments to sustainability. DISCUSSION These findings are consistent with what others have reported, especially the importance of practical barriers to EMR deployments in resource-constrained settings. Other findings contribute unique insights about social determinants of EMR impact in slum settings, including the challenge of multiple-identity management and development of meaningful incentives to staff compliance. CONCLUSIONS This study exposes front-line experiences with opportunities and shortcomings of EMR implementations in urban slum primary care clinics. Although the promise is great, there are a number of unique system, software and social challenges that EMR advocates should address before expecting sustainable EMR use in resource-constrained settings.
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Affiliation(s)
- Badeia Jawhari
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Innovative Canadians for Change, Edmonton, Alberta, Canada.
| | - Louanne Keenan
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - David Zakus
- Faculty of Community Services, School of Occupational and Public Health, Ryerson University, Toronto, Ontario, Canada
| | - Dave Ludwick
- Sherwood Park Primary Care Network, Sherwood Park, Alberta, Canada
| | - Abraam Isaac
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Innovative Canadians for Change, Edmonton, Alberta, Canada
| | - Abdullah Saleh
- Innovative Canadians for Change, Edmonton, Alberta, Canada
| | - Robert Hayward
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Tweya H, Feldacker C, Gadabu OJ, Ng'ambi W, Mumba SL, Phiri D, Kamvazina L, Mwakilama S, Kanyerere H, Keiser O, Mwafilaso J, Kamba C, Egger M, Jahn A, Simwaka B, Phiri S. Developing a point-of-care electronic medical record system for TB/HIV co-infected patients: experiences from Lighthouse Trust, Lilongwe, Malawi. BMC Res Notes 2016; 9:146. [PMID: 26945749 PMCID: PMC4779573 DOI: 10.1186/s13104-016-1943-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 02/17/2016] [Indexed: 11/21/2022] Open
Abstract
Background Implementation of user-friendly, real-time, electronic medical records for patient management may lead to improved adherence to clinical guidelines and improved quality of patient care. We detail the systematic, iterative process that implementation partners, Lighthouse clinic and Baobab Health Trust, employed to develop and implement a point-of-care electronic medical records system in an integrated, public clinic in Malawi that serves HIV-infected and tuberculosis (TB) patients. Methods Baobab Health Trust, the system developers, conducted a series of technical and clinical meetings with Lighthouse and Ministry of Health to determine specifications. Multiple pre-testing sessions assessed patient flow, question clarity, information sequencing, and verified compliance to national guidelines. Final components of the TB/HIV electronic medical records system include: patient demographics; anthropometric measurements; laboratory samples and results; HIV testing; WHO clinical staging; TB diagnosis; family planning; clinical review; and drug dispensing. Results Our experience suggests that an electronic medical records system can improve patient management, enhance integration of TB/HIV services, and improve provider decision-making. However, despite sufficient funding and motivation, several challenges delayed system launch including: expansion of system components to include of HIV testing and counseling services; changes in the national antiretroviral treatment guidelines that required system revision; and low confidence to use the system among new healthcare workers. To ensure a more robust and agile system that met all stakeholder and user needs, our electronic medical records launch was delayed more than a year. Open communication with stakeholders, careful consideration of ongoing provider input, and a well-functioning, backup, paper-based TB registry helped ensure successful implementation and sustainability of the system. Additional, on-site, technical support provided reassurance and swift problem-solving during the extended launch period. Conclusion Even when system users are closely involved in the design and development of an electronic medical record system, it is critical to allow sufficient time for software development, solicitation of detailed feedback from both users and stakeholders, and iterative system revisions to successfully transition from paper to point-of-care electronic medical records. For those in low-resource settings, electronic medical records for integrated care is a possible and positive innovation. Electronic supplementary material The online version of this article (doi:10.1186/s13104-016-1943-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hannock Tweya
- The International Union Against Tuberculosis and Lung Disease, Paris, France. .,Lighthouse Trust, Lilongwe, Malawi. .,Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
| | - Caryl Feldacker
- Lighthouse Trust, Lilongwe, Malawi. .,International Training and Education Center for Health (I-TECH), University of Washington, 901 Boren Avenue, Suite 1100, Seattle, WA, 98104, USA.
| | | | | | - Soyapi L Mumba
- Baobab Health Trust, Lilongwe, Malawi. .,Department of Biomedical Informatics, Center for Health Informatics for the Underserved, University of Pittsburgh, Pittsburgh, PA, USA.
| | | | | | | | | | - Olivia Keiser
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
| | | | - Chancy Kamba
- Bwaila District Hospital, TB clinic, Lilongwe, Malawi.
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
| | - Andreas Jahn
- International Training and Education Center for Health (I-TECH), University of Washington, 901 Boren Avenue, Suite 1100, Seattle, WA, 98104, USA. .,Central Monitoring and Evaluation Division/Department for HIV and AIDS, Ministry of Health, Lilongwe, Malawi.
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Mammucari M, Gigliotti S, Pucino A, Capezza M, Santé G. The management of chronic osteoarticular pain in the outpatient setting: results of an ASON audit. JOINTS 2016; 3:146-50. [PMID: 26889471 DOI: 10.11138/jts/2015.3.3.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED The management of patients with chronic osteoarticular pain requires a comprehensive clinical evaluation and a multidisciplinary approach. Thirty specialists (orthopedic specialists, rheumatologists, physiatrists), members of the National Association of Osteoarticular Specialists (ASON), attended a specific training course in the use of a standardized medical record designed for the management of osteoarticular pain in outpatients. An audit on 888 medical records was later conducted and it showed that use of this instrument led to an improvement in the diagnostic-therapeutic approach. A complete and accurate medical record compilation process may also promote collaborative interaction among the healthcare practitioners involved and this can result in greater efficiency and continuity of care. ASON recommends expediting the use of electronic tools to facilitate information-sharing among pain care specialists. This study shows that the use of electronic tools facilitates the exchange of information between healthcare providers. ASON supports the adoption of similar instruments in order to improve the management of chronic pain. LEVEL OF EVIDENCE Level III, cross-sectional survey.
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Castelnuovo B, Kiragga A, Musaazi J, Sempa J, Mubiru F, Wanyama J, Wandera B, Kamya MR, Kambugu A. Outcomes in a Cohort of Patients Started on Antiretroviral Treatment and Followed up for a Decade in an Urban Clinic in Uganda. PLoS One 2015; 10:e0142722. [PMID: 26642214 PMCID: PMC4671641 DOI: 10.1371/journal.pone.0142722] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 10/25/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Short-medium term studies from sub-Saharan Africa show that, despite high early mortality, substantial loss to program, and high rates toxicity, patients on antiretroviral treatment have achieved outcomes comparable to those in developed settings. However, these studies were unable to account for long term outcomes of patients as they stayed longer on treatment. OBJECTIVES We aim to describe ten years outcomes of one of the first cohort of HIV positive patients started on antiretroviral treatment (ART) in Sub-Saharan Africa. METHODS We report 10-years outcomes including mortality, retention, CD4-count response, virological outcomes, ART regimens change from a prospective cohort of 559 patients initiating ART and followed up for 10 years Uganda. RESULTS Of 559 patients, 69.1% were female, median age (IQR) was 38 (33-44) years, median CD4-count (IQR) 98 (21-163) cell/μL; 74% were started on stavudine, lamivudine and nevirapine, 26% on zidovudine, lamivudine and efavirenz. After 10 years 361 (65%) patients were still in the study; 127 (22.7%) had died; 30 (5%) were lost to follow-up; 27 (5%) transferred; 18 (3%) withdrew consent. The probability of death was high in the first year (0.15, 95%, CI 0.12-0.18). The median CD4 count increased from 98 to 589 cell/μL (IQR: 450-739 cell/μL) with a median increase of 357 cells/μL (IQR: 128-600 cells/μL); 7.4% never attained initial viral suppression and of those who did 31.7% experienced viral failure. Three hundred and two patients had at least one drug substitution while on first line after a median of 40 months; 66 (11.9%) of the patients were switched to a second line PI-based regimen due to confirmed treatment failure. CONCLUSIONS Despite the high rate of early mortality due to advanced disease at presentation the outcomes from this cohort are encouraging, particularly the remarkable and incremental immune-recovery and a satisfactory rate of virologic suppression.
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Affiliation(s)
- Barbara Castelnuovo
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
- * E-mail:
| | - Agnes Kiragga
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Joseph Musaazi
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Joseph Sempa
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Frank Mubiru
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Jane Wanyama
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Bonnie Wandera
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Moses Robert Kamya
- School of medicine, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Andrew Kambugu
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
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A structured approach to recording AIDS-defining illnesses in Kenya: A SNOMED CT based solution. J Biomed Inform 2015; 56:387-94. [PMID: 26184057 DOI: 10.1016/j.jbi.2015.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 06/01/2015] [Accepted: 07/07/2015] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Several studies conducted in sub-Saharan Africa (SSA) have shown that routine clinical data in HIV clinics often have errors. Lack of structured and coded documentation of diagnosis of AIDS defining illnesses (ADIs) can compromise data quality and decisions made on clinical care. METHODS We used a structured framework to derive a reference set of concepts and terms used to describe ADIs. The four sources used were: (i) CDC/Accenture list of opportunistic infections, (ii) SNOMED Clinical Terms (SNOMED CT), (iii) Focus Group Discussion (FGD) among clinicians and nurses attending to patients at a referral provincial hospital in western Kenya, and (iv) chart abstraction from the Maternal Child Health (MCH) and HIV clinics at the same hospital. Using the January 2014 release of SNOMED CT, concepts were retrieved that matched terms abstracted from approach iii & iv, and the content coverage assessed. Post-coordination matching was applied when needed. RESULTS The final reference set had 1054 unique ADI concepts which were described by 1860 unique terms. Content coverage of SNOMED CT was high (99.9% with pre-coordinated concepts; 100% with post-coordination). The resulting reference set for ADIs was implemented as the interface terminology on OpenMRS data entry forms. CONCLUSION Different sources demonstrate complementarity in the collection of concepts and terms for an interface terminology. SNOMED CT provides a high coverage in the domain of ADIs. Further work is needed to evaluate the effect of the interface terminology on data quality and quality of care.
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Mortality and immunological recovery among older adults on antiretroviral therapy at a large urban HIV clinic in Kampala, Uganda. J Acquir Immune Defic Syndr 2015; 67:382-9. [PMID: 25171733 DOI: 10.1097/qai.0000000000000330] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND We describe older (>50 years) HIV-infected adults after antiretroviral therapy (ART) initiation, evaluating immunological recovery by age category, considering individual trajectories based on the pretreatment CD4. We also describe mortality on ART and its risk factors by age category including the contribution of poor immunological recovery at a large urban clinic in Kampala, Uganda. METHODS We performed a cohort analysis of adult (>18 years) HIV-infected patients who initiated ART between January 1, 2004 and January 3, 2012. Immunological response was evaluated using mixed-effects linear regression. We described mortality using Kaplan-Meier survival methods analyzing for risk factors of mortality using multivariate Weibull survival regression stratified by age category. RESULTS Among 9806 individuals who initiated ART, mean age was 37 years (SD: 8.8), average follow-up 5.7 years (SD: 1.7), and median baseline CD4 was 115 cells per cubic millimeter (interquartile range: 42-184). Adults younger than 50 years had on average a higher CD4 increase of 45 cells per cubic millimeter (95% confidence interval: 17 to 72; P = 0.001) compared with counterparts aged 60 years and older. Mortality was highest among older adults compared with younger counterparts. Only CD4 count <100 cells per cubic millimeter after 1 year on ART and a CD4 count less than baseline were associated with a statistically significant higher rate of death among older adults. CONCLUSIONS Older adults had a slower immunological response, which was associated with mortality, but this mortality was not typically associated with opportunistic infections. Future steps would require more evaluation of possible causes of death among these older individuals if survival on ART is to be further improved.
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Oluoch T, Katana A, Ssempijja V, Kwaro D, Langat P, Kimanga D, Okeyo N, Abu-Hanna A, de Keizer N. Electronic medical record systems are associated with appropriate placement of HIV patients on antiretroviral therapy in rural health facilities in Kenya: a retrospective pre-post study. J Am Med Inform Assoc 2014; 21:1009-14. [PMID: 24914014 PMCID: PMC4215039 DOI: 10.1136/amiajnl-2013-002447] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 04/14/2014] [Accepted: 05/14/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVE There is little evidence that electronic medical record (EMR) use is associated with better compliance with clinical guidelines on initiation of antiretroviral therapy (ART) among ART-eligible HIV patients. We assessed the effect of transitioning from paper-based to an EMR-based system on appropriate placement on ART among eligible patients. METHODS We conducted a retrospective, pre-post EMR study among patients enrolled in HIV care and eligible for ART at 17 rural Kenyan clinics and compared the: (1) proportion of patients eligible for ART based on CD4 count or WHO staging who initiate therapy; (2) time from eligibility for ART to ART initiation; (3) time from ART initiation to first CD4 test. RESULTS 7298 patients were eligible for ART; 54.8% (n=3998) were enrolled in HIV care using a paper-based system while 45.2% (n=3300) were enrolled after the implementation of the EMR. EMR was independently associated with a 22% increase in the odds of initiating ART among eligible patients (adjusted OR (aOR) 1.22, 95% CI 1.12 to 1.33). The proportion of ART-eligible patients not receiving ART was 20.3% and 15.1% for paper and EMR, respectively (χ(2)=33.5, p<0.01). Median time from ART eligibility to ART initiation was 29.1 days (IQR: 14.1-62.1) for paper compared to 27 days (IQR: 12.9-50.1) for EMR. CONCLUSIONS EMRs can improve quality of HIV care through appropriate placement of ART-eligible patients on treatment in resource limited settings. However, other non-EMR factors influence timely initiation of ART.
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Affiliation(s)
- Tom Oluoch
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention,Nairobi, Kenya
| | - Abraham Katana
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention,Nairobi, Kenya
| | - Victor Ssempijja
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention,Nairobi, Kenya
| | - Daniel Kwaro
- Kenya Medical Research Institute, CDC Collaborative Program, Kisumu, Kenya
| | - Patrick Langat
- Kenya Medical Research Institute, CDC Collaborative Program, Kisumu, Kenya
| | - Davies Kimanga
- Ministry of Health, National AIDS and STI Control Program, Nairobi, Kenya
| | - Nicky Okeyo
- Kenya Medical Research Institute, CDC Collaborative Program, Kisumu, Kenya
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicolette de Keizer
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Anema A, Fielden SJ, Castleman T, Grede N, Heap A, Bloem M. Food security in the context of HIV: towards harmonized definitions and indicators. AIDS Behav 2014; 18 Suppl 5:S476-89. [PMID: 24292252 DOI: 10.1007/s10461-013-0659-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Integration of HIV and food security services is imperative to improving the health and well-being of people living with HIV. However, consensus does not exist on definitions and measures of food security to guide service delivery and evaluation in the context of HIV. This paper reviews definitions and indicators of food security used by key agencies; outlines their relevance in the context of HIV; highlights opportunities for harmonized monitoring and evaluation indicators; and discusses promising developments in data collection and management. In addition to the commonly used dimensions of food availability, access, utilization and stability, we identify three components of food security-food sufficiency, dietary quality, and food safety-that are useful for understanding and measuring food security needs of HIV-affected and other vulnerable people. Harmonization across agencies of food security indicators in the context of HIV offers opportunities to improve measurement and tracking, strengthen coordination, and inform evidence-based programming.
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Affiliation(s)
- Aranka Anema
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada,
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Association between age at antiretroviral therapy initiation and 24-month immune response in West-African HIV-infected children. AIDS 2014; 28:1645-55. [PMID: 24804858 DOI: 10.1097/qad.0000000000000272] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We describe the association between age at antiretroviral therapy (ART) initiation and 24-month CD4 cell response in West African HIV-infected children. METHODS All HIV-infected children from the IeDEA paediatric West African cohort, initiating ART, with at least two CD4 cell count measurements, including one at ART initiation (baseline) were included. CD4 cell gain on ART was estimated using a multivariable linear mixed model adjusted for baseline variables: age, CD4 cell count, sex, first-line ART regimen. Kaplan-Meier survival curves and a Cox proportional hazards regression model compared immune recovery for age within 24 months post-ART. RESULTS Of the 4808 children initiated on ART, 3014 were enrolled at a median age of 5.6 years; 61.2% were immunodeficient. After 12 months, children at least 4 years at baseline had significantly lower CD4 cell gains compared with children less than 2 years, the reference group (P<0.001). However, by 24 months, we observed higher CD4 cell gain in children who initiated ART between 3 and 4 years compared with those less than 2 years (P<0.001). The 24-month CD4 cell gain was also strongest in immunodeficient children at baseline. Among these children, 75% reached immune recovery: 12-month rates were significantly highest in all those aged 2-5 years at ART initiation compared with those less than 2 years. Beyond 12 months on ART, immune recovery was significantly lower in children initiated more than 5 years (adjusted hazard ratio: 0.69, 95% confidence interval: 0.56-0.86). CONCLUSION These results suggest that both the initiation of ART at the earliest age less than 5 years and before any severe immunodeficiency is needed for improving 24-month immune recovery on ART.
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Antiretroviral treatment response of HIV-infected children after prevention of mother-to-child transmission in West Africa. J Int AIDS Soc 2014; 17:18737. [PMID: 24894377 PMCID: PMC4048591 DOI: 10.7448/ias.17.1.18737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 12/03/2013] [Accepted: 04/17/2014] [Indexed: 01/06/2023] Open
Abstract
Introduction We assessed the rate of treatment failure of HIV-infected children after 12 months on antiretroviral treatment (ART) in the Paediatric IeDEA West African Collaboration according to their perinatal exposure to antiretroviral drugs for preventing mother-to-child transmission (PMTCT). Methods A retrospective cohort study in children younger than five years at ART initiation between 2004 and 2009 was nested within the pWADA cohort, in Bamako-Mali and Abidjan-Côte d’Ivoire. Data on PMTCT exposure were collected through a direct review of children’s medical records. The 12-month Kaplan-Meier survival without treatment failure (clinical or immunological) was estimated and their baseline factors studied using a Cox model analysis. Clinical failure was defined as the appearance or reappearance of WHO clinical stage 3 or 4 events or any death occurring within the first 12 months of ART. Immunological failure was defined according to the 2006 World Health Organization age-related immunological thresholds for severe immunodeficiency. Results Among the 1035 eligible children, PMTCT exposure was only documented for 353 children (34.1%) and remained unknown for 682 (65.9%). Among children with a documented PMTCT exposure, 73 (20.7%) were PMTCT exposed, of whom 61.0% were initiated on a protease inhibitor-based regimen, and 280 (79.3%) were PMTCT unexposed. At 12 months on ART, the survival without treatment failure was 40.6% in the PMTCT-exposed group, 25.2% in the unexposed group and 18.5% in the children with unknown exposure status (p=0.002). In univariate analysis, treatment failure was significantly higher in children unexposed (HR 1.4; 95% CI: 1.0–1.9) and with unknown PMTCT exposure (HR 1.5; 95% CI: 1.2–2.1) rather than children PMTCT-exposed (p=0.01). In the adjusted analysis, treatment failure was not significantly associated with PMTCT exposure (p=0.15) but was associated with immunodeficiency (aHR 1.6; 95% CI: 1.4–1.9; p=0.001), AIDS clinical events (aHR 1.4; 95% CI: 1.0–1.9; p=0.02) at ART initiation and receiving care in Mali compared to Côte d’Ivoire (aHR 1.2; 95% CI: 1.0–1.4; p=0.04). Conclusions Despite a low data quality, PMTCT-exposed West African children did not have a poorer 12-month response to ART than others. Immunodeficiency and AIDS events at ART initiation remain the main predictors associated with treatment failure in this operational context.
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Myers B, Petersen Z, Kader R, Koch JR, Manderscheid R, Govender R, Parry CDH. Identifying perceived barriers to monitoring service quality among substance abuse treatment providers in South Africa. BMC Psychiatry 2014; 14:31. [PMID: 24499037 PMCID: PMC3917424 DOI: 10.1186/1471-244x-14-31] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 02/04/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND A performance measurement system is planned for South African substance abuse treatment services. Provider-level barriers to implementing these systems have been identified in the United States, but little is known about the nature of these barriers in South Africa. This study explored the willingness of South African substance abuse treatment providers' to adopt a performance measurement system and perceived barriers to monitoring service quality that would need to be addressed during system development. METHODS Three focus group discussions were held with treatment providers from two of the nine provinces in South Africa. These providers represented the diverse spread of substance abuse treatment services available in the country. The final sample comprised 21 representatives from 12 treatment facilities: eight treatment centres in the Western Cape and four in KwaZulu-Natal. Content analysis was used to extract core themes from these discussions. RESULTS Participants identified barriers to the monitoring of service quality that included outdated modes of collecting data, personnel who were already burdened by paperwork, lack of time to collect data, and limited skills to analyse and interpret data. Participants recommended that developers engage with service providers in a participatory manner to ensure that service providers are invested in the proposed performance measurement system. CONCLUSION Findings show that substance abuse treatment providers are willing to adopt a performance measurement system and highlight several barriers that need to be addressed during system development in order to enhance the likelihood that this system will be successfully implemented.
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Affiliation(s)
- Bronwyn Myers
- Alcohol and Drug Abuse Research Unit, Medical Research Council, Cape Town, South Africa.
| | - Zainonisa Petersen
- Alcohol and Drug Abuse Research Unit, Medical Research Council, Cape Town, South Africa
| | - Rehana Kader
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - J Randy Koch
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ron Manderscheid
- National Association of County Behavioral Health and Developmental Disability Directors, Washington DC, USA
| | - Rajen Govender
- Department of Sociology and Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Charles DH Parry
- Alcohol and Drug Abuse Research Unit, Medical Research Council, Cape Town, South Africa,Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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