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Chitneni P, Owembabazi M, Muyindike W, Asiimwe S, Masete G, Mbalibulha Y, Nakku-Joloba E, Manabe YC, Haberer J, Matthews L, Van Der Pol B. Sexually Transmitted Infection Point-of-Care Testing in Resource-Limited Settings: A Narrative Review Guided by an Implementation Framework. Sex Transm Dis 2023; 50:e11-e16. [PMID: 37433000 PMCID: PMC10527944 DOI: 10.1097/olq.0000000000001848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
ABSTRACT Most sexually transmitted infections (STIs) are acquired in resource-limited settings (RLSs) where laboratory diagnostic access is limited. Advancements in point-of-care testing (POC) technology have the potential to bring STI testing to many RLSs. We define POC as performed near the patient and with results readily available to inform clinical practice. The World Health Organization Special Programme for Research and Training in Tropical Diseases further outlines desirable POC characteristics with the REASSURED criteria.Despite advantages related to immediate test-and-treat care, integrating POC into RLS health care systems can present challenges that preclude reliance on these tests. In 2018, we incorporated molecular near-POC for chlamydia, gonorrhea, and trichomoniasis and SDBioline treponemal immunochromatographic testing confirmed by rapid plasma reagin for syphilis diagnosis at the Mbarara University of Science and Technology Research Laboratory in rural southwestern Uganda. We describe our experiences with STI POC as a case example to guide a narrative review of the field using the Consolidated Framework for Implementation Research as a conceptual framework.Although POC and near-POC are described as easy to use, the challenges of limited person-power, health care processes, limited infrastructure/resources, high costs, and quality control obstacles can impede the impact of these tests. Increased investment in operators, training, and infrastructure, restructuring health care systems to accommodate increased POC access, and optimizing costs are all crucial to the successful implementation of STI POC in RLS. Expanded STI POC in RLS will increase access to accurate diagnoses, appropriate treatment, and engagement in partner notification, treatment, and prevention efforts.
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Affiliation(s)
- Pooja Chitneni
- Brigham and Women’s Hospital, Division of General Internal Medicine, Boston, MA, USA
- Massachusetts General Hospital, Center for Global Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Moran Owembabazi
- Mbarara Regional Referral Hospital and Mbarara University of Science and Technology, Mbarara, Uganda
| | - Winnie Muyindike
- Mbarara Regional Referral Hospital and Mbarara University of Science and Technology, Mbarara, Uganda
| | - Stephen Asiimwe
- Mbarara Regional Referral Hospital and Mbarara University of Science and Technology, Mbarara, Uganda
| | - Godfrey Masete
- Mbarara Regional Referral Hospital and Mbarara University of Science and Technology, Mbarara, Uganda
| | - Yona Mbalibulha
- Mbarara Regional Referral Hospital and Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Yukari C. Manabe
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Jessica Haberer
- Massachusetts General Hospital, Center for Global Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lynn Matthews
- University of Alabama at Birmingham Heersink School of Medicine, Division of Infectious Diseases, Birmingham, AL, USA
| | - Barbara Van Der Pol
- University of Alabama at Birmingham Heersink School of Medicine, Division of Infectious Diseases, Birmingham, AL, USA
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Okoroafor SC, Dela Christmals C. Health Professions Education Strategies for Enhancing Capacity for Task-Shifting and Task-Sharing Implementation in Africa: A Scoping Review. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023:00005141-990000000-00082. [PMID: 37341562 DOI: 10.1097/ceh.0000000000000517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
INTRODUCTION To compensate for the shortage of health workers and effectively use the available health workforce to provide access to health services at various levels of the health system, several countries are implementing task-shifting and task-sharing (TSTS). This scoping review was conducted to synthesize evidence on health professions education (HPE) strategies applied to enhance capacities for TSTS implementation in Africa. METHODS This scoping review was conducted using the enhanced Arksey and O'Malley's framework for scoping reviews. The sources of evidence included CINAHL, PubMed, and Scopus. RESULTS Thirty-eight studies conducted in 23 countries provided insights on the strategies implemented in various health services contexts including general health, cancer screenings, reproductive, maternal, newborn, child and adolescent health, HIV/AIDS, emergency care, hypertension, tuberculosis, eye care, diabetes, mental health, and medicines. The HPE strategies applied were in-service training, onsite clinical supervision and mentoring, periodic supportive supervision, provision of job aides, and preservice education. DISCUSSION Scaling up HPE based on the evidence from this study will contribute immensely to enhancing the capacity of health workers in contexts where TSTS are being implemented or planned to provide quality health services based on the population's health needs.
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Affiliation(s)
- Sunny C Okoroafor
- Dr. Okoroafor: Technical Officer, Health Systems Strengthening, Universal Health Coverage-Life Course Cluster, World Health Organization Country Office for Uganda, Kampala, Uganda. Dr. Dela Christmals: Associate Professor, Centre for Health Professions Education, Faculty of Health Sciences, North-West University, Potchefstroom Campus, Potchefstroom, South Africa
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Okoroafor SC, Christmals CD. Task Shifting and Task Sharing Implementation in Africa: A Scoping Review on Rationale and Scope. Healthcare (Basel) 2023; 11:1200. [PMID: 37108033 PMCID: PMC10138489 DOI: 10.3390/healthcare11081200] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
Numerous studies have reported task shifting and task sharing due to various reasons and with varied scopes of health services, either task-shifted or -shared. However, very few studies have mapped the evidence on task shifting and task sharing. We conducted a scoping review to synthesize evidence on the rationale and scope of task shifting and task sharing in Africa. We identified peer-reviewed papers from PubMed, Scopus, and CINAHL bibliographic databases. Studies that met the eligibility criteria were charted to document data on the rationale for task shifting and task sharing, and the scope of tasks shifted or shared in Africa. The charted data were thematically analyzed. Sixty-one studies met the eligibility criteria, with fifty-three providing insights on the rationale and scope of task shifting and task sharing, and seven on the scope and one on rationale, respectively. The rationales for task shifting and task sharing were health worker shortages, to optimally utilize existing health workers, and to expand access to health services. The scope of health services shifted or shared in 23 countries were HIV/AIDS, tuberculosis, hypertension, diabetes, mental health, eyecare, maternal and child health, sexual and reproductive health, surgical care, medicines' management, and emergency care. Task shifting and task sharing are widely implemented in Africa across various health services contexts towards ensuring access to health services.
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Affiliation(s)
- Sunny C. Okoroafor
- Universal Health Coverage—Life Course Cluster, World Health Organization Country Office for Uganda, Kampala, Uganda
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, Potchefstroom Campus, Building PC-G16, Office 101, 11 Hoffman Street, Potchefstroom 2520, South Africa
| | - Christmal Dela Christmals
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, Potchefstroom Campus, Building PC-G16, Office 101, 11 Hoffman Street, Potchefstroom 2520, South Africa
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Chenai Mathabire Rücker S, Lissouba P, Akinyi M, Vicent Lubega A, Stewart R, Tamayo Antabak N, Taremwa Mugisha I, Ohler L, Macuácua H, Atieno M, Muyindike W, Turyahabwe S, Odhiambo Okomo G, Mahomed Couto A, Musoke M, Bossard C, Hewison C, Ndlovu Z, Huerga H. Feasibility and acceptability of using the novel urine-based FujiLAM test to detect tuberculosis: a multi-country mixed-methods study. J Clin Tuberc Other Mycobact Dis 2022; 27:100316. [PMID: 35521634 PMCID: PMC9065638 DOI: 10.1016/j.jctube.2022.100316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
FujiLAM is feasible to implement at point-of-care using existing infrastructure. FujiLAM can be performed in laboratory and consultation or other spaces. FujiLAM adequately performed by any health worker including lay health workers. FujiLAM well accepted by users and managers, perceived as easy to perform. Selection of users should consider expected test demand and existing user workload.
Background The novel urine-based FujiLAM test identifies tuberculosis in HIV-positive patients but may be challenging to use at point-of-care (POC). Objectives We assessed the feasibility and acceptability of using the FujiLAM test at point of care in outpatient settings. Methods We conducted a mixed methods study in four outpatient settings in Kenya, Mozambique, South Africa, and Uganda between November 2020 and September 2021. The test was performed at POC in existing clinic laboratories and consultation spaces. We performed direct observations in the four health facilities, individual questionnaires, proficiency testing evaluations, and individual interviews among healthcare workers performing the FujiLAM test (healthcare workers), and group discussions with programme managers. Results Overall, 18/19 (95%) healthcare workers and 14/14 (100%) managers agreed to participate in the study. Most assessed healthcare workers, including lay health workers (10/11; 91%), met the minimum required theoretical knowledge and practical skill in performing the FujiLAM test. Most healthcare workers (17/18; 94%) found the FujiLAM test overall “Easy/Very easy” to perform. Some challenges were mentioned: many timed steps (5/18; 28%); ensuring correct incubation period (5/18; 28%); test result readability (4/18; 22%); and difficulties with cartridge buttons (3/18; 17%). Half of the healthcare workers regularly performing the test (4/7; 57%) found it “Easy” to integrate into routine activities. Most healthcare workers and managers believed that any healthcare worker could perform the test after adequate training. Conclusions Implementing the FujiLAM test in outpatient POC settings is feasible and acceptable to healthcare workers and managers. This test can be performed in various clinic locations by any healthcare worker. The timed, multi-step test procedure is challenging and may affect the workload in resource-constrained health facilities.
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Agutu CA, Oduor TH, Kombo BK, Mugo PM, Chira SM, Ogada FW, Rinke de Wit TF, Chege W, van der Elst EM, Graham SM, Sanders EJ. High patient acceptability but low coverage of provider-initiated HIV testing among adult outpatients with symptoms of acute infectious illness in coastal Kenya. PLoS One 2021; 16:e0246444. [PMID: 33544736 PMCID: PMC7864413 DOI: 10.1371/journal.pone.0246444] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/19/2021] [Indexed: 11/28/2022] Open
Abstract
Background Only approximately one in five adults are offered HIV testing by providers when seeking care for symptoms of acute illness in Sub-Saharan Africa. Our aims were to estimate testing coverage and identify predictors of provider-initiated testing and counselling (PITC) and barriers to PITC implementation in this population. Methods We assessed HIV testing coverage among adult outpatients 18–39 years of age at four public and two private health facilities in coastal Kenya, during a 3- to 6-month surveillance period at each facility. A subset of patients who reported symptoms including fever, diarrhoea, fatigue, body aches, sore throat or genital ulcers were enrolled to complete a questionnaire independently of PITC offer. We assessed predictors of PITC in this population using generalised estimating equations and identified barriers to offering PITC through focus group discussion with healthcare workers (HCW) at each facility. Results Overall PITC coverage was 13.7% (1600 of 11,637 adults tested), with 1.9% (30) testing positive. Among 1,374 participants enrolled due to symptoms, 378 (27.5%) were offered PITC and 352 (25.6%) were tested, of whom 3.7% (13) tested positive. Among participants offered HIV testing, 93.1% accepted it; among participants not offered testing, 92.8% would have taken an HIV test if offered. The odds of completed PITC were increased among older participants (adjusted odds ratio [aOR] 1.7, 95% confidence interval [CI] 1.4–2.1 for 30–39 years, relative to 18–24 years), men (aOR 1.3, 95% CI 1.1–1.7); casual labourers (aOR 1.3, 95% CI 1.0–1.7); those paying by cash (aOR 1.2, 95% CI 1.0–1.4) or insurance (aOR 3.0, 95% CI 1.5–5.8); participants with fever (aOR 1.5, 95% CI 1.2–1.8) or genital ulcers (aOR 4.0, 95% CI 2.7–6.0); and who had tested for HIV >1 year ago (aOR 1.4, 95% CI 1.0–2.0) or had never tested (aOR 2.2, 95% CI 1.5–3.1). Provider barriers to PITC implementation included lack of HCW knowledge and confidence implementing guidelines, limited capacity and health systems constraints. Conclusion PITC coverage was low, though most patients would accept testing if offered. Missed opportunities to promote testing during care-seeking were common and innovative solutions are needed.
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Affiliation(s)
- Clara A. Agutu
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- * E-mail:
| | - Tony H. Oduor
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Bernadette K. Kombo
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Peter M. Mugo
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Salome M. Chira
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Fred W. Ogada
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Tobias F. Rinke de Wit
- Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Wairimu Chege
- Prevention Sciences Program, Division of AIDS (DAIDS), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rockville, Maryland, United States of America
| | | | - Susan M. Graham
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Eduard J. Sanders
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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Seidu AA, Oduro JK, Ahinkorah BO, Budu E, Appiah F, Baatiema L, Ameyaw EK, Sambah F. Women's healthcare decision-making capacity and HIV testing in sub-Saharan Africa: a multi-country analysis of demographic and health surveys. BMC Public Health 2020; 20:1592. [PMID: 33092556 PMCID: PMC7583279 DOI: 10.1186/s12889-020-09660-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 10/08/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Global commitment to stop Human Immunodeficiency Virus (HIV) and ensure access to HIV treatment calls for women empowerment, as these efforts play major roles in mother-to-child transmission. We examined the association between women's healthcare decision-making capacity and uptake of HIV testing in sub-Saharan Africa. METHODS We used data from the current Demographic and Health Surveys (DHS) of 28 countries in sub-Saharan Africa, conducted between January 1, 2010 and December 31, 2018. At the descriptive level, we calculated the prevalence of HIV testing in each of the countries. This was followed by the distribution of HIV testing across the socio-demographic characteristics of women. Finally, we used binary logistic regression assess the likelihood of HIV testing uptake by women's health care decision-making capacity and socio-demographic characteristics. The results were presented as Crude Odds Ratios (COR) and Adjusted Odds Ratios (AOR) with their corresponding 95% confidence intervals signifying precision. Statistical significance was set at p-value < 0.05. RESULTS We found that prevalence of HIV testing uptake in the 28 sub-Saharan African countries was 64.4%, with Congo DR having the least (20.2%) and the highest occurred in Rwanda (97.4%). Women who took healthcare decisions alone [COR = 3.183, CI = 2.880-3.519] or with their partners [COR = 2.577, CI = 2.335-2.844] were more likely to test for HIV, compared to those whose healthcare decisions were taken by others, and this persisted after controlling for significant covariates: [AOR = 1.507, CI = 1.321-1.720] and [AOR = 1.518, CI = 1.334-1.728] respectively. CONCLUSION Sub-Saharan African countries intending to improve HIV testing need to incorporate women's healthcare decision-making capacity strategies. These strategies can include education and counselling. This is essential because our study indicates that the capacity of women to make healthcare decisions has an association with decision to test for their HIV status.
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Affiliation(s)
- Abdul-Aziz Seidu
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland Australia
| | - Joseph Kojo Oduro
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Bright Opoku Ahinkorah
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
| | - Eugene Budu
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Francis Appiah
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
- Berekum College of Education, Berekum, BA Ghana
| | - Linus Baatiema
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Edward Kwabena Ameyaw
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
| | - Francis Sambah
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
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Point-of-Care HIV Viral Load Testing: an Essential Tool for a Sustainable Global HIV/AIDS Response. Clin Microbiol Rev 2019; 32:32/3/e00097-18. [PMID: 31092508 DOI: 10.1128/cmr.00097-18] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The global public health community has set ambitious treatment targets to end the HIV/AIDS pandemic. With the notable absence of a cure, the goal of HIV treatment is to achieve sustained suppression of an HIV viral load, which allows for immunological recovery and reduces the risk of onward HIV transmission. Monitoring HIV viral load in people living with HIV is therefore central to maintaining effective individual antiretroviral therapy as well as monitoring progress toward achieving population targets for viral suppression. The capacity for laboratory-based HIV viral load testing has increased rapidly in low- and middle-income countries, but implementation of universal viral load monitoring is still hindered by several barriers and delays. New devices for point-of-care HIV viral load testing may be used near patients to improve HIV management by reducing the turnaround time for clinical test results. The implementation of near-patient testing using these new and emerging technologies may be an essential tool for ensuring a sustainable response that will ultimately enable an end to the HIV/AIDS pandemic. In this report, we review the current and emerging technology, the evidence for decentralized viral load monitoring by non-laboratory health care workers, and the additional considerations for expanding point-of-care HIV viral load testing.
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Toward Improving Accessibility of Point-of-Care Diagnostic Services for Maternal and Child Health in Low- and Middle-Income Countries. POINT OF CARE 2019; 18:17-25. [PMID: 30886544 PMCID: PMC6407818 DOI: 10.1097/poc.0000000000000180] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Point-of-care (POC) testing can improve health care provision in settings with limited access to health care services. Access to POC diagnostic services has shown potential to alleviate some diagnostic challenges and delays associated with laboratory-based methods in low- and middle-income countries. Improving accessibility to POC testing (POCT) services during antenatal and perinatal care is among the global health priorities to improve maternal and child health. This review provides insights on the availability of POC testing designed for diagnosing HIV, syphilis, and malaria in pregnancy to improve maternal and child health. In addition, factors such as accessibility of POC testing, training of health work force, and the efficiency of POC testing services delivery in low- and middle-income countries are discussed. A framework to help increase access to POC diagnostic services and improve maternal and child health outcomes in low- and middle-income countries is proposed.
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Jean Louis F, Excellent ML, Anselme R, Buteau J, Stanislas M, Boncy J, Domercant JW. External quality assessment for HIV rapid tests: challenges and opportunities in Haiti. BMJ Glob Health 2018; 3:e001074. [PMID: 30498590 PMCID: PMC6254742 DOI: 10.1136/bmjgh-2018-001074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/28/2018] [Accepted: 10/01/2018] [Indexed: 12/02/2022] Open
Abstract
HIV rapid diagnostic tests (RDTs) are instrumental in scaling-up HIV testing services (HTS) in low-income and middle-income countries (LMICs). HIV misdiagnosis is a growing concern in the era of expanded and decentralised access to HTS. External quality assurance (EQA) programme including proficiency testing (PT) for HIV RDTs is a priority to guarantee the accuracy and reliability of the patients’ result. Here we are sharing Haiti’s 11 years’ experience in implementing HIV RDTs EQA programme to help address some of the challenges faced by other LMICs. HTS is expanding beyond laboratory walls and HIV RDTs are increasingly performed by non-laboratory personnel and closer to the community. EQA programmes for HIV RDTs in Haiti have faced significant challenges. In expanded HTS settings, non-laboratory personnel (nurses, aid-nurses) involved in HIV RDT are usually undertrained and participate poorly in PT programs. In more than half of the lab enrolled in the PT programme in Haiti, the panels are always tested by the most experienced technician, defying the purpose of the program which is to evaluate the performance of the technician performing the test daily. EQA programme in Haiti and other LMICs are usually not tailored to address community HIV testing challenges. With decreased funding and absence of government financial commitment to HIV RDTs EQA programmes, more innovative and cost-efficient strategies are sought to ensure the quality of HIV diagnosis in LMICs. Qualified human resources, continuous training, supervision and community-tailored PT programmes remain key components for the success of HIV RDT quality management.
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Affiliation(s)
| | | | - Renette Anselme
- National Public Health Laboratory, Ministry of Public Health and population of Haiti, Port-au-Prince, Haiti
| | - Josiane Buteau
- National Public Health Laboratory, Ministry of Public Health and population of Haiti, Port-au-Prince, Haiti
| | - Magalie Stanislas
- National Public Health Laboratory, Ministry of Public Health and population of Haiti, Port-au-Prince, Haiti
| | - Jacques Boncy
- National Public Health Laboratory, Ministry of Public Health and population of Haiti, Port-au-Prince, Haiti
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Abstract
HIV diagnostics have played a central role in the remarkable progress in identifying, staging, initiating, and monitoring infected individuals on life-saving antiretroviral therapy. They are also useful in surveillance and outbreak responses, allowing for assessment of disease burden and identification of vulnerable populations and transmission "hot spots," thus enabling planning, appropriate interventions, and allocation of appropriate funding. HIV diagnostics are critical in achieving epidemic control and require a hybrid of conventional laboratory-based diagnostic tests and new technologies, including point-of-care (POC) testing, to expand coverage, increase access, and positively impact patient management. In this review, we provide (i) a historical perspective on the evolution of HIV diagnostics (serologic and molecular) and their interplay with WHO normative guidelines, (ii) a description of the role of conventional and POC testing within the tiered laboratory diagnostic network, (iii) information on the evaluations and selection of appropriate diagnostics, (iv) a description of the quality management systems needed to ensure reliability of testing, and (v) strategies to increase access while reducing the time to return results to patients. Maintaining the central role of HIV diagnostics in programs requires periodic monitoring and optimization with quality assurance in order to inform adjustments or alignment to achieve epidemic control.
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Wu KY, Oppert M, Wall KM, Inambao M, Simpungwe MK, Ahmed N, Abdallah JF, Tichacek A, Allen SA. Couples' voluntary HIV counseling and testing provider training evaluation, Zambia. Health Promot Int 2018; 33:580-588. [PMID: 28119330 PMCID: PMC6144772 DOI: 10.1093/heapro/daw108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
With the expansion of couples' voluntary HIV counseling and testing (CVCT) in urban Zambia, there is a growing need to evaluate CVCT provider trainings to ensure that couples are receiving quality counseling and care. We evaluated provider knowledge scores, pre- and post-training and predictors of pre- and post-training test scores. Providers operating in 67 government clinics in four Copperbelt Province cities were trained from 2008 to 2013 in three domains: counseling, rapid HIV laboratory testing and data management. Trainees received pre- and post-training tests on domain-specific topics. Pre- and post-training test scores were tabulated by provider demographics and training type, and paired t-tests evaluated differences in pre- and post-training test scores. Multivariable ANCOVA determined predictors of pre- and post-training test scores. We trained 1226 providers, and average test scores increased from 68.8% pre-training to 83.8% post-training (p < 0.001). Test scores increased significantly for every demographic group and training type (p < 0.001) with one exception-test scores did not significantly increase for those receiving counseling or data management training who had less than a high school education. In multivariable analysis, higher educational level and having a medical background were predictive of a higher pre-test score; higher pre-test scores and having a medical background were predictive of higher post-test scores. Pre- and post-test assessments are critical to ensure quality services, particularly as task-shifting from medical to lay staff becomes more common. Assessments showed that our CVCT trainings are successful at increasing knowledge, and that those with lower education may benefit from repeat trainings.
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Affiliation(s)
- Kathleen Y Wu
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Marydale Oppert
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Kristin M Wall
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
- Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia, USA
| | - Mubiana Inambao
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Matildah K Simpungwe
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
- Ministry of Community Development, Mother and Child Health, Ndola District Community Health Office, Ndola, Zambia
| | - Nurilign Ahmed
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Joseph F Abdallah
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Susan A Allen
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
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Qiao S, Zhang Y, Li X, Menon JA. Facilitators and barriers for HIV-testing in Zambia: A systematic review of multi-level factors. PLoS One 2018; 13:e0192327. [PMID: 29415004 PMCID: PMC5802917 DOI: 10.1371/journal.pone.0192327] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 01/22/2018] [Indexed: 11/19/2022] Open
Abstract
It was estimated that 1.2 million people live with HIV/AIDS in Zambia by 2015. Zambia has developed and implemented diverse programs to reduce the prevalence in the country. HIV-testing is a critical step in HIV treatment and prevention, especially among all the key populations. However, there is no systematic review so far to demonstrate the trend of HIV-testing studies in Zambia since 1990s or synthesis the key factors that associated with HIV-testing practices in the country. Therefore, this study conducted a systematic review to search all English literature published prior to November 2016 in six electronic databases and retrieved 32 articles that meet our inclusion criteria. The results indicated that higher education was a common facilitator of HIV testing, while misconception of HIV testing and the fear of negative consequences were the major barriers for using the testing services. Other factors, such as demographic characteristics, marital dynamics, partner relationship, and relationship with the health care services, also greatly affects the participants' decision making. The findings indicated that 1) individualized strategies and comprehensive services are needed for diverse key population; 2) capacity building for healthcare providers is critical for effectively implementing the task-shifting strategy; 3) HIV testing services need to adapt to the social context of Zambia where HIV-related stigma and discrimination is still persistent and overwhelming; and 4) family-based education and intervention should involving improving gender equity.
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Affiliation(s)
- Shan Qiao
- Department of Health Promotion, Education, and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| | - Yao Zhang
- School of Information, Kent State University, Kent, OH, United States of America
- * E-mail:
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| | - J. Anitha Menon
- Department of Psychology, University of Zambia, Central Administration Block Great East Road Campus, Lusaka, Zambia
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Use of expenditure analysis to enhance returns on investments in HIV services. Curr Opin HIV AIDS 2017. [PMID: 28639989 DOI: 10.1097/coh.0000000000000395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Globally, the response to the HIV epidemic is at a crisis point. International investments in the HIV response have been essentially flat for 8 years and domestic budgets in low and middle-income countries - still recovering from the global recession - have not been able to fill the resource gap to drive a full-fledged HIV response. Still, efficiencies and prioritization of evidence-based interventions enable a significant scale-up of treatment, but millions more people remain without treatment. This review looks at recent data and research to evaluate interventions that may help close gaps in service provision that undermine testing and treatment programs. RECENT FINDINGS The President's Emergency Plan for AIDS Relief recently began publicly releasing vast programmatic and expenditure data. These data reveal potential efficiency gaps in testing and treatment programs, particularly in the area of linkage and retention. Interventions such as HIV self-testing have been proposed to help, but whether they can deliver better results remains unclear. Same-day initiation on treatment improves initiation, retention, and viral suppression rates. SUMMARY Near real-time analysis of data and active response is critical in improving efficiencies in programs. More investment in implementation research is necessary to improve linkage to care and treatment to reach 90-90-90 goals.
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Ngangue P, Gagnon MP, Bedard E. Challenges in the delivery of public HIV testing and counselling (HTC) in Douala, Cameroon: providers perspectives and implications on quality of HTC services. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2017; 17:9. [PMID: 28390398 PMCID: PMC5385024 DOI: 10.1186/s12914-017-0118-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/29/2017] [Indexed: 11/12/2022]
Abstract
Background The Cameroon government has made HIV testing and counselling (HTC) a priority in its HIV/AIDS strategic plan. However, there is a dearth of literature on the perspectives of providers on the quality of HTC services. The aim of this study was to explore challenges in the provision of HTC services and their implications on quality of HTC services in Douala’s district hospitals. Methods Two primary data collection methods supported by the Donabedian’s model of healthcare were used to explain the challenges in the provision of HTC services and their implications on quality of HTC services. This consisted of semi-structured individual interviews with 6 nurses and 16 lay counsellors and a non-participant observation of the physical environment for HTC by site. The study sites were the prevention and voluntary testing and counselling centre (PVTCC) of the six district hospitals of the city of Douala. Results The study reveals concerns about confidentiality and privacy during the counselling sessions due to inadequate and limited space. An absence of consent, even verbal, was reported in one PVTCC. There is no specific accredited training curriculum that leads to a formal registration as a PVTCC staff, and some lay counsellors work without training. Lay counsellors carry the burden of HIV counselling, but the majority of them work for many years without remuneration and recognition. Another quality challenge is the high workload in the district hospitals’ lab, which leads to long waiting times for HIV test results, thus contributing to failure to return for results. Conclusion The findings of this study highlighted some issues such as lack of adequate space and equipment for HIV testing and counselling that hinder the quality of HTC services and should challenge the health authorities of Cameroon on the need to reorganize HTC services and create a national HIV quality assurance program. Electronic supplementary material The online version of this article (doi:10.1186/s12914-017-0118-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Patrice Ngangue
- Faculty of Nursing Sciences, Laval University, 1050, avenue de la medicine, Pavillon Vandry, Québec, Québec, G1V0A6, Canada. .,Population Health and Optimal Health Practices, CHU de Québec Research Center, 10, Rue de l'Espinay, D6, Québec, Québec, G1L 3L5, Canada.
| | - Marie-Pierre Gagnon
- Faculty of Nursing Sciences, Laval University, 1050, avenue de la medicine, Pavillon Vandry, Québec, Québec, G1V0A6, Canada.,Population Health and Optimal Health Practices, CHU de Québec Research Center, 10, Rue de l'Espinay, D6, Québec, Québec, G1L 3L5, Canada
| | - Emmanuelle Bedard
- Université du Québec à Rimouski (UQAR), 1595 Boul. Alphonse-Desjardins, UQAR, Campus de Lévis, Lévis, Québec, Canada
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