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Xia J, Rutherford S, Ma Y, Wu L, Gao S, Chen T, Lu X, Zhang X, Chu C. Obstacles to the coordination of delivering integrated prenatal HIV, syphilis and hepatitis B testing services in Guangdong: using a needs assessment approach. BMC Health Serv Res 2015; 15:117. [PMID: 25889645 PMCID: PMC4378261 DOI: 10.1186/s12913-015-0760-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 02/23/2015] [Indexed: 11/30/2022] Open
Abstract
Background Integration of services for Prevention of Mother-To-Child Transmission of HIV (PMTCT) into routine maternal and child health care is promoted as a priority strategy by the WHO to facilitate the implementation of PMTCT. Integration of services emphasizes inter-sectoral coordination in the health systems to provide convenient services for clients. China has been integrating prenatal HIV, syphilis and hepatitis B testing services since 2009. However, as the individual health systems are complex, effective coordination among different health agencies is challenging. Few studies have examined the factors that affect the coordination of such complex systems. The aim of this study is to assess the effectiveness of and examine challenges for integrated service delivery. Findings will provide the basis for strategy development to enhance the effective delivery of integrated services. Methods The research was conducted in Guangdong province in 2013 using a needs assessment approach that includes qualitative and quantitative methods. Quantitative data was collected through a survey and from routine monitoring for PMTCT and qualitative data was collected through stakeholder interviews. Results Routine monitoring data used to assess key indicators of coordination suggested numerous coordination problems. The rates of prenatal HIV (95%), syphilis (47%) and hepatitis B (47%) test were inconsistent. An average of only 20% of the HIV positive mothers was referred in the health systems. There were no regular meetings among different health agencies and the clients indicated complicated service processes. The major obstacles to the coordination of delivering these integrated services are lack of service resource integration; and lack of a mechanism for coordination of the health systems, with no uniform guidelines, clear roles or consistent evaluation. Conclusions The key obstacles that have been identified in this study hinder the coordination of the delivery of integrated services. Our recommendations include: 1) Facilitate integration of the funding and information systems by fully combining the service resources of different health agencies into one unit; 2) Establish regular meetings to facilitate exchange of information and address problems; 3) Establish a client referral network between different health agencies with agreed guidelines, clear roles and consistent evaluation.
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Affiliation(s)
- Jianhong Xia
- Centre for Environment and Population Health, Nathan campus, Griffith University, 170 Kessels Road, Nathan, Brisbane, QLD, 4111, Australia. .,Guangdong Women and Children Health Care Hospital, 521-523 Xingnan Road, Panyu district, Guangzhou, Guangdong, 511442, China.
| | - Shannon Rutherford
- Centre for Environment and Population Health, Nathan campus, Griffith University, 170 Kessels Road, Nathan, Brisbane, QLD, 4111, Australia.
| | - Yuanzhu Ma
- Guangdong Women and Children Health Care Hospital, 521-523 Xingnan Road, Panyu district, Guangzhou, Guangdong, 511442, China.
| | - Li Wu
- Guangdong Women and Children Health Care Hospital, 521-523 Xingnan Road, Panyu district, Guangzhou, Guangdong, 511442, China.
| | - Shuang Gao
- Guangdong Women and Children Health Care Hospital, 521-523 Xingnan Road, Panyu district, Guangzhou, Guangdong, 511442, China.
| | - Tingting Chen
- Guangdong Women and Children Health Care Hospital, 521-523 Xingnan Road, Panyu district, Guangzhou, Guangdong, 511442, China.
| | - Xiao Lu
- Guangdong Women and Children Health Care Hospital, 521-523 Xingnan Road, Panyu district, Guangzhou, Guangdong, 511442, China.
| | - Xiaozhuang Zhang
- Guangdong Women and Children Health Care Hospital, 521-523 Xingnan Road, Panyu district, Guangzhou, Guangdong, 511442, China.
| | - Cordia Chu
- Centre for Environment and Population Health, Nathan campus, Griffith University, 170 Kessels Road, Nathan, Brisbane, QLD, 4111, Australia.
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Prevalence and correlates of HIV and hepatitis B virus coinfection in Northern Alberta. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2014; 25:e8-e13. [PMID: 24634693 DOI: 10.1155/2014/971546] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND HIV and hepatitis B virus (HBV) share transmission routes, and coinfection is associated with higher morbidity and mortality. To date, no Canadian studies have examined HIV-HBV coinfection. OBJECTIVES To examine the prevalence and correlates of HIV and HBV coinfections in Northern Alberta. METHODS The present study was a retrospective database review of all HIV-infected (HIV+) individuals in Northern Alberta from 1982 to 2010 and a chart review of HBV surface antigen-positive individuals for whom charts were available (46.2%). RESULTS Of 2844 HIV+ patients, 2579 (90.7%) had been tested for HBV surface antigen, and 143 (5.5%) of these were HBV coinfected. Coinfected males were primarily Caucasian (70.8%), and coinfected females were primarily black (56.4%) or Aboriginal (31.3%). Coinfected individuals were more likely to be male (88.1% versus 71.3%; P<0.001) and to have died (34.3% versus 17.9%; P<0.001). CONCLUSIONS The prevalence of coinfection with HBV in HIV-infected patients in Northern Alberta is lower than reported in other developed nations. The pattern of coinfections in Northern Alberta likely follows immigration trends. Recognition and management may be improving with time; however, further research and additional strategies are required to enhance the prevention, identification and management of HBV infection in HIV-infected individuals.
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The changing demographics of women living with HIV/AIDS in southern Alberta from 1982 to 2006. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2013; 23:e36-40. [PMID: 23730318 DOI: 10.1155/2012/501340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Women account for a growing proportion of HIV infections in Canada. This has implications with respect to prevention, diagnosis and treatment. OBJECTIVE To describe the female population presenting for HIV care in southern Alberta and to examine the impact of opt-out pregnancy screening. METHODS A retrospective review of demographic and clinical characteristics of all patients presenting to the Southern Alberta HIV Clinic (SAC) care program from 1982 to 2006, was performed. RESULTS The proportion of newly diagnosed patients who were female increased from 7.5% before 1998 to 21.5% after 1998. Women were more likely to be from vulnerable populations, such as intravenous drug users (31.3% versus 13.7%, P<0.001), aboriginals/Métis (21.5% versus 8.7%, P<0.001), blacks (28.9% versus 4.9%, P<0.001) and immigrants (36.6% versus 14.7%, P<0.001). Heterosexual intercourse was the main risk factor for HIV acquisition (43.7%). Women were less likely than men to have requested HIV testing (20.9% versus 37.8%, P<0.001). Opt-out pregnancy screening accounted for 12.7% of HIV-positive tests in women, following its introduction in 1998. Of the women diagnosed by pregnancy screening, 62.1% were from HIV-endemic countries. There was an association between reason for testing and CD4 count at presentation; women who requested their HIV test had higher median CD4 counts than those diagnosed because of illness (478 cells/mL, interquartile range [IQR]=370 cells/mL versus 174 cells/mL, IQR=328 cells/mL, P<0.001) or pregnancy screening (478 cells/mL, IQR=370 cells/mL versus 271 cells/mL, IQR=256 cells/mL, P=0.001). CONCLUSIONS Women were less likely than men to have requested HIV testing and were more likely to be diagnosed by population-based screening methods. Women, especially vulnerable groups, account for a growing number and proportion of newly diagnosed HIV infections in Alberta. The implications of expanded screening in this population merit further consideration.
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Tseng A, Foisy M, Hughes CA, Kelly D, Chan S, Dayneka N, Giguère P, Higgins N, Hills-Nieminen C, Kapler J, la Porte CJL, Nickel P, Park-Wyllie L, Quaia C, Robinson L, Sheehan N, Stone S, Sulz L, Yoong D. Role of the Pharmacist in Caring for Patients with HIV/AIDS: Clinical Practice Guidelines. Can J Hosp Pharm 2012; 65:125-45. [PMID: 22529405 PMCID: PMC3329905 DOI: 10.4212/cjhp.v65i2.1120] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Alice Tseng
- , BScPhm, PharmD, FSCHP, AAHIVP, is with the Immunodeficiency Clinic of the Toronto General Hospital, Toronto, Ontario
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Recommendations and reality: Perceived patient, provider, and policy barriers to implementing routine HIV screening and proposed solutions. Nurs Outlook 2012; 60:72-80. [DOI: 10.1016/j.outlook.2011.06.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 06/06/2011] [Accepted: 06/27/2011] [Indexed: 11/21/2022]
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Foisy M, Hughes C. Role of the pharmacist in perinatal management of HIV disease. Am J Health Syst Pharm 2011; 68:2116, 2118, 2120-2. [DOI: 10.2146/ajhp110094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Michelle Foisy
- Northern Alberta HIV Program Faculty of Pharmacy and Pharmaceutical Sciences University of Alberta 3126 Dentistry/Pharmacy Centre Edmonton, Alberta T6G 2N8, Canada
| | - Christine Hughes
- Northern Alberta HIV Program Faculty of Pharmacy and Pharmaceutical Sciences University of Alberta 3126 Dentistry/Pharmacy Centre Edmonton, Alberta T6G 2N8, Canada
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Swenson RR, Rizzo CJ, Brown LK, Vanable PA, Carey MP, Valois RF, DiClemente RJ, Romer D. HIV knowledge and its contribution to sexual health behaviors of low-income African American adolescents. J Natl Med Assoc 2010; 102:1173-82. [PMID: 21287898 PMCID: PMC3095017 DOI: 10.1016/s0027-9684(15)30772-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Although many factors contribute to racial disparities in human immunodeficiency virus (HIV)/AIDS among young African Americans, knowledge is a particularly modifiable factor. However, little information has been published about the current HIV knowledge of African American teens or to what extent knowledge independently contributes to their sexual behavior and health. This study aimed to describe the level of knowledge among this at-risk population and determine whether knowledge contributes to variance in sexual behavior and health beyond that of sociodemographic and psychological factors. METHODS African American adolescents (n = 1658) were recruited in 2 northeastern and 2 southeastern US cities (74% eligible for free or reduced-price school lunch). Analyses utilized data gathered from adolescents using an audio computer-assisted self-interview program. RESULTS On average, participants answered only 50% of HIV knowledge items correctly and were least accurate concerning effective condom use and HIV testing. Controlling tor associated sociodemographic and psychological factors, greater knowledge was associated with sexual experience and, among experienced adolescents, with sexually transmitted infection/HIV testing and--unexpectedly--less condom use. CONCLUSIONS HIV knowledge, which is modifiable, is limited among at-risk African American adolescents and is an important contributor to sexual behavior and health. Findings indicate a need for more comprehensive HIV/AIDS education, particularly with regard to condom use and the benefits of routine sexually transmitted infection/HIV testing. Although knowledge might not be sufficiently protective in and of itself, having accurate information about HIV may benefit sexual health by impacting health-promoting attitudes necessary for successful engagement in health care-seeking behavior.
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Affiliation(s)
- Rebecca R. Swenson
- Bradley/Hasbro Children’s Research Center of Rhode Island Hospital, Brown University, One Hoppin Street, Coro West Building, Suite 204, Providence, Rhode Island, USA, Phone: 401.444.8539 / Fax: 401.444.4645,
| | - Christie J. Rizzo
- Bradley/Hasbro Children’s Research Center of Rhode Island Hospital, Brown University, One Hoppin Street, Coro West Building, Suite 204, Providence, Rhode Island, USA, Phone: 401.444.8539 / Fax: 401.444.4645,
| | - Larry K. Brown
- Bradley/Hasbro Children’s Research Center of Rhode Island Hospital, Brown University, One Hoppin Street, Coro West Building, Suite 204, Providence, Rhode Island, USA, Phone: 401.444.8539 / Fax: 401.444.4645,
| | - Peter A. Vanable
- Department of Psychology and Center for Health and Behavior, Syracuse University, 430 Huntington Hall, Syracuse, New York, USA,
| | - Michael P. Carey
- Department of Psychology and Center for Health and Behavior, Syracuse University, 430 Huntington Hall, Syracuse, New York, USA,
| | - Robert F. Valois
- Arnold School of Public Health, University of South Carolina, 800 Sumter Street, Room 216, Columbia, South Carolina, USA,
| | - Ralph J. DiClemente
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Suite 554, Atlanta, Georgia, USA,
| | - Daniel Romer
- Annenberg Public Policy Center, University of Pennsylvania, 3535 Market Street, Suite 550, Philadelphia, Pennsylvania, USA,
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Boer K, Smit C, van der Flier M, de Wolf F. The comparison of the performance of two screening strategies identifying newly-diagnosed HIV during pregnancy. Eur J Public Health 2010; 21:632-7. [DOI: 10.1093/eurpub/ckq157] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Siemieniuk RAC, Jadavji T, Gill MJ. Limitations of opt-out HIV screening and mother-child HIV transmission. Am J Public Health 2010; 100:388-9; author reply 389. [PMID: 20075309 PMCID: PMC2820055 DOI: 10.2105/ajph.2009.181016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2009] [Indexed: 11/04/2022]
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