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Iliyasu Z, Haladu ZA, Iliyasu BZ, Kwaku AA, Nass NS, Amole TG, Abdullahi HM, Abdullahi AU, Tsiga-Ahmed FI, Abdullahi A, Bashir HA, Salihu HM, Aliyu MH. A Qualitative Study of HIV Testing Experiences and HIV Self-Testing Perspectives among Men in Northern Nigeria. Nurs Res Pract 2024; 2024:8810141. [PMID: 38682002 PMCID: PMC11055649 DOI: 10.1155/2024/8810141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/15/2024] [Accepted: 04/03/2024] [Indexed: 05/01/2024] Open
Abstract
HIV self-testing (HIVST) holds promise for accessing hard-to-reach populations by overcoming sociocultural and structural barriers to awareness of HIV status. This phenomenological qualitative study explored the experiences and perspectives of married men in Kano, northern Nigeria, regarding HIV testing and counseling (HTC) and HIVST. Twenty married men from diverse socioeconomic backgrounds participated in in-depth interviews conducted in the local language. Thematic analysis was employed to analyze the data, yielding key themes related to prior test experiences, knowledge of self-testing, and perceived ease of use, in addition to motivation for self-testing and concerns about reliability and counseling support. The findings shed light on the impact of facility-based HIV testing experiences on the perspectives of participants. Concerns related to delays, overcrowding, discomfort, fear, and unsupportive attitudes from healthcare providers influenced their perceptions. Among persons with previous self-testing experience, initial uneasiness was overcome with repeated use, highlighting the ease of use associated with HIVST. Motivations for self-testing included privacy, convenience, personal empowerment, improved infection detection, and efficiency. Concerns were raised regarding the reliability of self-testing results compared to hospital-based testing, and the absence of counseling support during self-testing. Our findings underscore the need to address infrastructural limitations, enhance counseling support, and promote awareness and knowledge of HIVST.
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Affiliation(s)
- Zubairu Iliyasu
- Department of Community Medicine, Bayero University, Kano, Nigeria
| | | | | | - Aminatu A. Kwaku
- Department of Community Medicine, Bayero University, Kano, Nigeria
| | - Nafisa S. Nass
- Department of Community Medicine, Bayero University, Kano, Nigeria
| | - Taiwo G. Amole
- Department of Community Medicine, Bayero University, Kano, Nigeria
| | | | | | | | - Auwal Abdullahi
- Department of Community Medicine, Bayero University, Kano, Nigeria
| | | | | | - Muktar H. Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
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Tshuma N, Ngbede ED, Nyengerai T, Mtapuri O, Moyo S, Mphuthi DD, Nyasulu P. Understanding health outcome drivers among adherence club patients in clinics of Gauteng, South Africa: a structural equation modelling (SEM) approach. AIDS Res Ther 2023; 20:71. [PMID: 37798794 PMCID: PMC10557202 DOI: 10.1186/s12981-023-00565-5] [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: 04/24/2023] [Accepted: 09/01/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND There has been growing interest in understanding the drivers of health outcomes, both in developed and developing countries. The drivers of health outcomes, on the other hand, are the factors that influence the likelihood of experiencing positive or negative health outcomes. Human Immunodeficiency Virus (HIV) continues to be a significant global public health challenge, with an estimated 38 million people living with the aim of this study was therefore to develop and empirically test a conceptual research model using SEM, aimed at explaining the magnitude of various factors influencing HIV and other health outcomes among patients attending Adherence Clubs. METHOD This was a cross sectional survey study design conducted in 16 health facilities in the City of Ekurhuleni in Gauteng Province, South Africa. A total of 730 adherence club patients were systematically sampled to participate in a closed ended questionnaire survey. The questionnaire was assessed by Cronbach's alpha coefficient for internal consistency. The proposed model was tested using structural equation modelling (AMOS software: ADC, Chicago, IL, USA). RESULTS A total of 730 adherence club members participated in the study. Of these, 425 (58.2%) were female and 305 (41.8%) were male. The overall results indicated a good reliability of all the scale involved in this study as Cronbach alphas ranged from 0.706 to 0.874, and composite reliability from 0.735 to 0.874. The structural model showed that the constructs health seeking behavior (β = 0.267, p = 0.000), health care services (β = 0.416, p = 0.000), stigma and discrimination (β = 0.135, p = 0.022) significantly predicted health outcomes and explained 45% of its variance. The construct healthcare service was the highest predictor of health outcomes among patients in adherence clubs. CONCLUSION Patient health seeking behaviour, healthcare services, stigma and discrimination were associated with perceived health outcomes. Since adherence clubs have been found to have a significant impact in improving patient outcomes and quality of life, there is a need to ensure replication of this model.
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Affiliation(s)
- Ndumiso Tshuma
- The Best Health Solutions, Johannesburg, Gauteng, South Africa.
- Texila American University and University of Central Nicaragua, Managua, Nicaragua.
| | - Elakpa Daniel Ngbede
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Tawanda Nyengerai
- The Best Health Solutions, Johannesburg, Gauteng, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Oliver Mtapuri
- The Best Health Solutions, Johannesburg, Gauteng, South Africa
- University of KwaZulu Natal, Durban, South Africa
| | - Sangiwe Moyo
- The Best Health Solutions, Johannesburg, Gauteng, South Africa
- Final Mile, Johannesburg, Gauteng, South Africa
| | - David D Mphuthi
- The Best Health Solutions, Johannesburg, Gauteng, South Africa
- Department of Health Studies, College of Human Sciences, University of South Africa, Pretoria, South Africa
| | - Peter Nyasulu
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Nyasulu PS, Tshuma N, Sigwadhi LN, Nyasulu J, Ogunrombi M, Chimoyi L. Factors associated with high HIV-related stigma among commuter populations in Johannesburg, South Africa. SAHARA J 2021; 18:149-155. [PMID: 34702146 PMCID: PMC8555515 DOI: 10.1080/17290376.2021.1989022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Stigma remains an important barrier to seeking and staying in care among individuals infected with Human Immunodeficiency Virus (HIV). Despite continued widespread information, education and communication campaigns to raise awareness about the infection. The aim of the study was to identify factors related to HIV stigma among a commuter population in the inner-city Johannesburg. A self-administered closed-ended questionnaire was loaded onto personal tablet computers during a community outreach campaign. The outcome was measured by asking the respondents to rate their perceptions of stigma as 'high or low'. About 1146 participants were enrolled in the study of which 585 (51.0%) reported high stigma levels. Overall, being married/cohabiting (Adjusted Prevalence Ratio (APR): 1.14 95%CI: 1.02-1.28), divorced (APR: 1.38 95%CI: 1.07-1.78), were associated with high levels of stigma; while being aware of HCT services (APR: 0.85 95%CI: 0.75-0.97) and employment status (APR: 0.78 95%CI: 0.71-0.87) were less likely associated with a high level of stigma. High HIV stigma still exists among those affected in our communities. Enhancement of health promotion intervention and reinforcing the benefits of knowing HIV status is essential to mitigate factors shown to influence stigma in the commuter population. Such an approach would help overcome stigma, an obstacle for expanding access to HIV testing and counselling.
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Affiliation(s)
- Peter S Nyasulu
- Division of Epidemiology & Biostatistics, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ndumiso Tshuma
- Best Health Solutions, Orange Grove, Johannesburg, South Africa
| | - Lovemore N Sigwadhi
- Division of Epidemiology & Biostatistics, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Juliet Nyasulu
- Division of Community Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Modupe Ogunrombi
- Department of Clinical Pharmacology, School of Medicine, Sefako Makgatho Health Science University, Pretoria, South Africa
| | - Lucy Chimoyi
- The Aurum Institute, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Shamu S, Chasela C, Slabbert J, Farirai T, Guloba G, Nkhwashu N. Social franchising of community-based HIV counselling and testing services to increase HIV testing and linkage to care in Tshwane, South Africa: study protocol for a non-randomised implementation trial. BMC Public Health 2020; 20:118. [PMID: 31996189 PMCID: PMC6988328 DOI: 10.1186/s12889-020-8231-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 01/16/2020] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Meeting the ambitious UN 90-90-90 HIV testing, treatment and viral load suppression targets requires innovative strategies and approaches in Sub-Saharan Africa. To date no known interventions have been tested with community health workers (counsellors) as social franchisees or owner-managed businesses in Community-based HIV counselling and testing (CBCT) work. The aim of this methods paper is to describe a Social franchise (SF) CBCT implementation trial to increase HIV testing and linkage to care for individuals at community levels in comparison with an existing CBCT programme methods. METHODS/DESIGN This is a two arm non-randomised community implementation trial with a once off round of post-test follow-up per HIV positive participant to assess linkage to care in low income communities. The intervention arm is a social franchise CBCT in which unemployed, self-employed or employed community members are recruited, contracted and incentivised to test at least 100 people per month, identifying at least 5 HIV positive tests and linking to care at least 4 of them. Social franchisees receive approximately $3.20 per HIV test and $8 per client linked to care. In the control arm, full-time employed HIV counsellors conduct CBCT on a fixed monthly salary. Primary study outcomes are HIV testing uptake rate, HIV positivity, Linkage to care and treatment rate and average counsellors' remuneration cost. Data collection will be conducted using both paper-based and electronic data applications by CBCT or SF counsellors. Data analysis will compare proportions of HIV testing, positivity, linkage to HIV care and treatment rates and counsellors' cost in the two study arms. DISCUSSION The study will provide important insight into whether the SF-delivered CBCT programme increases testing coverage and linkage to care as well as reducing CBCT cost per HIV test and per HIV positive person linked to care. TRIAL REGISTRATION Pan African Clinical Trial Registry PACTR201809873079121. The trial was retrospectively registered on 11 September 2018.
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Affiliation(s)
- Simukai Shamu
- Foundation for Professional Development, Health Systems Strengthening Division, Pretoria, South Africa. .,University of the Witwatersrand, School of Public Health, Johannesburg, South Africa.
| | - Charles Chasela
- University of the Witwatersrand, Department of Epidemiology and Biostatistics, School of Public Health, Johannesburg, South Africa.,Right to Care, EQUIP, Pretoria, South Africa
| | - Jean Slabbert
- Foundation for Professional Development, Health Systems Strengthening Division, Pretoria, South Africa
| | - Thato Farirai
- Foundation for Professional Development, Health Systems Strengthening Division, Pretoria, South Africa
| | - Geoffrey Guloba
- Foundation for Professional Development, Health Systems Strengthening Division, Pretoria, South Africa
| | - Nkhensani Nkhwashu
- Foundation for Professional Development, Health Systems Strengthening Division, Pretoria, South Africa
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Fischer A, Chadyiwa M, Tshuma N, Nkosi V. Acceptability of Mobile Health Interventions to Increase Diabetic Risk Factor Awareness Among the Commuter Population in Johannesburg: Descriptive Cross-Sectional Study. JMIR Diabetes 2019; 4:e12600. [PMID: 31586363 PMCID: PMC6779026 DOI: 10.2196/12600] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 04/01/2019] [Accepted: 05/31/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Developing countries are experiencing a shift from infectious diseases such as HIV and tuberculosis to noncommunicable diseases (NCDs) such as diabetes. Diabetes accounts for more disability-adjusted life years than any other NCD in South Africa, and research has identified a number of preventable risk factors; however, there is not enough evidence from lower resource settings as to how best to disseminate this information to the population. Today, 90% of the world's population lives in mobile phone coverage areas, and this provides a unique opportunity to reach large populations with health information. OBJECTIVE This study aimed to investigate how potential mobile health (mHealth) platforms should be paired with diabetes risk factor education so that at-risk communities are empowered with information to prevent and manage diabetes. METHODS A Likert-style survey was distributed to commuters in the City of Johannesburg in July 2018 that explored participants' background characteristics as well as their knowledge and awareness surrounding diabetic risk factors (such as exercise, smoking, and hypertension) and their comfort level with various information delivery methods (such as WhatsApp, short message service, and email). The grouped variables from diabetic risk factors and information delivery methods were described with mean Likert scores and then investigated for relationships with Spearman Rho correlation coefficients. RESULTS Background characteristics revealed that the self-reported prevalence of diabetes was twice as high in this studied commuter population than the national average. WhatsApp was the most favorable mHealth information delivery method and had a moderate correlation coefficient with diet and nutrition (0.338; P<.001) as well as a weaker correlation with physical activity (0.243; P<.001). Although not as robust as the WhatsApp correlations, each of the other information delivery methods also showed weaker, yet statistically significant, relationships with one or more of the risk factors. CONCLUSIONS The elevated self-reported diabetes prevalence reinforces the need for diabetes risk factor education in the studied commuter population of Johannesburg. The most feasible mHealth intervention for diabetic risk factor education should focus on WhatsApp messaging while also offering content across other mHealth and traditional platforms to remove barriers to access and enhance the user experience. The content should emphasize diet and nutrition as well as physical activity while also incorporating information on secondary risk factors.
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Affiliation(s)
- Alex Fischer
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Martha Chadyiwa
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | | | - Vusumuzi Nkosi
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa.,Environment and Health Research Unit, South African Medical Research Council, Johannesburg, South Africa.,School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Wand H, Reddy T, Ramjee G. Investigating spatial disparities in high-risk women and HIV infections using generalized additive models: Results from a cohort of South African women. Spat Spatiotemporal Epidemiol 2019; 30:100283. [PMID: 31421797 PMCID: PMC6914769 DOI: 10.1016/j.sste.2019.100283] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 03/04/2019] [Accepted: 05/09/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We identified the geographical clustering of HIV as well as those at highest risk of infection using a decade long data (2002-2012) from KwaZulu-Natal, South Africa. METHODS A total of 5,776 women who enrolled in several HIV prevention trials were included in the study. Geo-coded individual-level data were linked to the community-level characteristics using the South African Census. High-risk women were identified using a risk scoring algorithm. Generalized additive models were used to identify the significant geographical clustering of high-risk women and HIV. RESULTS Overall, 60% of the women were classified as high risk of HIV. HIV infection rates were estimated as high as 10 to 15 per 100 person year. Areas with high rates of HIV infections were spatially clustered and overlapped particularly in the Northern part of Durban. CONCLUSION Targeting multifactorial and complex nature of the epidemic is urgently needed to identify the "high transmission" areas.
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Affiliation(s)
- Handan Wand
- Kirby Institute, University of New South Wales, Kensington 2052, New South Wales, Australia.
| | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, Kwazulu-Natal, South Africa.
| | - Gita Ramjee
- HIV Prevention Research Unit, South African Medical Research Council, Westville, 3630 KwaZulu-Natal, South Africa; Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; Department of Global Health, School of Medicine, University of Washington, United States.
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Venter WDF, Fischer A, Lalla-Edward ST, Coleman J, Lau Chan V, Shubber Z, Phatsoane M, Gorgens M, Stewart-Isherwood L, Carmona S, Fraser-Hurt N. Improving Linkage to and Retention in Care in Newly Diagnosed HIV-Positive Patients Using Smartphones in South Africa: Randomized Controlled Trial. JMIR Mhealth Uhealth 2019; 7:e12652. [PMID: 30938681 PMCID: PMC6465976 DOI: 10.2196/12652] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/21/2018] [Accepted: 01/03/2019] [Indexed: 12/24/2022] Open
Abstract
Background South Africa provides free antiretroviral therapy for almost 5 million people living with HIV, but only 71% of the eligible people are on treatment, representing a shortfall in the care cascade, especially among men and youth. Many developing countries have expanded access to smartphones; success in health apps raises the possibility of improving this cascade. Objective SmartLink is a health app for Android smartphones providing HIV-related laboratory results, information, support, and appointment reminders to engage and link patients to care. This study aimed to evaluate the ability of SmartLink to improve linkage to care for HIV-positive smartphone owners. Methods This study was a multisite randomized controlled trial in Johannesburg. The intervention arm received the app (along with referral to a treatment site) and the control arm received the standard of care (referral alone). Linkage to care was confirmed by an HIV-related blood test reported on the National Health Laboratory Service database between 2 weeks and 8 months after initiation. Results A total of 345 participants were recruited into the study; 64.9% (224/345) of the participants were female and 44.1% (152/345) were aged less than 30 years. In addition, 46.7% (161/345) were employed full time, 95.9% (331/345) had at least secondary school education, and 35.9% (124/345) were from Zimbabwe. Linkage to care between 2 weeks and 8 months was 48.6% (88/181) in the intervention arm versus 45.1% (74/164) in the control (P=.52) and increased to 64.1% (116/181) and 61.0% (100/164) (P=.55), respectively, after the initial 8-month period. Moreover, youth aged 18 to 30-years showed a statistically significant 20% increase in linkage to care for the intervention group. Conclusions Youth aged less than 30 years have been historically difficult to reach with traditional interventions, and the SmartLink app provides a proof of concept that this population reacts to mobile health interventions that engage patients in HIV care. Trial Registration ClinicalTrials.gov NCT02756949; https://clinicaltrials.gov/ct2/show/NCT02756949 (Archived by WebCite at http://www.webcitation.org/6z1GTJCNW)
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Affiliation(s)
| | - Alex Fischer
- Wits Reproductive Health and HIV Institute, University of Witwatersrand, Johannesburg, South Africa
| | | | - Jesse Coleman
- Wits Reproductive Health and HIV Institute, University of Witwatersrand, Johannesburg, South Africa
| | - Vincent Lau Chan
- Wits Reproductive Health and HIV Institute, University of Witwatersrand, Johannesburg, South Africa
| | - Zara Shubber
- World Bank, World Bank Group, Washington, DC, United States
| | - Mothepane Phatsoane
- Wits Reproductive Health and HIV Institute, University of Witwatersrand, Johannesburg, South Africa
| | | | | | - Sergio Carmona
- National Health Laboratory Service, Johannesburg, South Africa
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Shamu S, Farirai T, Kuwanda L, Slabbert J, Guloba G, Johnson S, Khupakonke S, Masihleho N, Kamera J, Nkhwashu N. Social franchising of community-based HIV testing and linkage to HIV care and treatment services: an evaluation of a pilot study in Tshwane, South Africa. J Int AIDS Soc 2018; 21:e25216. [PMID: 30569625 PMCID: PMC6300754 DOI: 10.1002/jia2.25216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 11/14/2018] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Although HIV testing services (HTS) have been successfully task-shifted to lay counsellors, no model has tested the franchising of HTS to lay counsellors as independent small-scale business owners. This paper evaluates the effectiveness of a social franchisee (SF) HTS-managed pilot project compared to the Foundation for Professional Development (FPD) employee-managed HTS programme in testing and linking clients to care. METHODS Unemployed, formally employed or own business individuals were engaged as franchisees, trained and supported to deliver HTS services under a common brand in high HIV-prevalent communities in Tshwane district between 2016 and 2017. SFs were remunerated per-HIV test and received larger payments per-HIV-positive client linked to care. In the standard HTS, FPD employed counsellors received similar training and observed similar standards as in the SF HTS, but were remunerated through the normal payroll. We assessed the proportion of clients tested, HIV positivity, linkage to care and per-counsellor cost of HIV test and linkage to care in the two HTS groups. RESULTS The SF HTS had 19 HIV counsellors while FPD HTS employed 20. A combined total of 84,556 clients were tested by SFs (50.5%: 95% confidence interval (CI) 50.2 to 50.8)) and FPD (49.5%: 49.2 to 49.8). SFs tested more females than FPD (54.1%: 53.6 to 54.6 vs. 48%: 47.7 to 48.7). SFs identified more first-time testers than FPD (21.5%: 21.1 to 21.9 vs. 8.9%: 8.6 to 9.1). Overall, 8%: 7.9 to 8.2 tested positive with more clients testing positive in the SF (10.2%: 9.9 to 10.5) than FPD (5.9%: 5.6 to 6.1) group. The SFs identified more female HIV-positive clients (11.1%: 10.7 to 11.6) than FPD (6.5%: 6.2 to 6.9). The SFs linked fewer clients to HIV care and treatment (60.0%: 58.5 to 61.5) than FPD (80.3%: 78.7 to 81.9%). It cost four times less to conduct an HIV test using SFs ($3.90 per SF HIV test) than FPD ($13.98) and five times less to link a client to care with SFs ($62.74) than FPD ($303.13). CONCLUSIONS SF HTS was effective in identifying more clients, first-time HIV testers and more HIV-positive people, but less effective in linking clients to care than FPD HTS. The SF HTS model was cheaper than the FPD-employee model. We recommend strengthening SFs particularly their linkage to care activities.
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Affiliation(s)
- Simukai Shamu
- Foundation for Professional DevelopmentPretoriaSouth Africa
- School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Thato Farirai
- Foundation for Professional DevelopmentPretoriaSouth Africa
| | | | - Jean Slabbert
- Foundation for Professional DevelopmentPretoriaSouth Africa
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Tshuma N, Muloongo K, Nkwei ES, Alaba OA, Meera MS, Mokgobi MG, Nyasulu PS. The mediating role of self-efficacy in the relationship between premotivational cognitions and engagement in multiple health behaviors: a theory-based cross-sectional study among township residents in South Africa. J Multidiscip Healthc 2017; 10:29-39. [PMID: 28176923 PMCID: PMC5266094 DOI: 10.2147/jmdh.s112841] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Noncommunicable diseases (NCDs) are one of the major global health challenges in developed countries and are rapidly increasing globally. Perception of self-efficacy is important for complex activities and long-term changes in health behavior. This study aimed to determine whether self-efficacy mediates the effect of individual beliefs (perceived severity, susceptibility, benefits and barriers) among informal settlement residents' health behavior in relation to the prevention and management of NCDs. METHODS A cross-sectional survey was conducted using a closed-ended questionnaire among informal settlement residents in Diepsloot, Johannesburg. The proposed model was tested using structural equation modeling (AMOS software). RESULTS A total of 2,277 participants were interviewed during this survey, consisting of 1,236 (54.3%) females, with the majority of them aged between 20 and 29 years. All constructs in the questionnaire had a good reliability with a Cronbach's alpha of >0.7. Perceived benefits and perceived barriers were the strongest predictors of self-efficacy, with the highest beta values of 0.14 and 0.15, respectively. Once associated with perceived self-efficacy, the direct effect of perceived susceptibility and perceived benefits on health behavior was statistically nonsignificant (P=0.0894 and P=0.2839, respectively). Perceived benefits and perceived susceptibility were totally mediated by self-efficacy. The indirect effects of perceived severity and perceived barriers (through self-efficacy) on health behavior were significant. Thus, perceived severity and perceived barriers were partially mediated by self-efficacy. CONCLUSION Perceived susceptibility and perceived benefits did not affect health behavior unless associated with self-efficacy. In contrast, individual perception of the seriousness of NCDs and perceived barriers might still have a direct influence on health behavior even if the person does not feel able to prevent NCDs. However, this influence would be more significant when perceived severity and perceived barriers of NCDs are associated with self-efficacy.
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Affiliation(s)
- Ndumiso Tshuma
- Community AIDS Response, Norwood, Johannesburg
- Schoolof Health Sciences, Monash South Africa, Johannesburg
| | - Keith Muloongo
- Community AIDS Response, Norwood, Johannesburg
- Schoolof Health Sciences, Monash South Africa, Johannesburg
| | | | - Olufunke A Alaba
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Maheedhariah S Meera
- Department of Human Behaviour, College of Southern Nevada, Henderson, NV
- University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Peter S Nyasulu
- Schoolof Health Sciences, Monash South Africa, Johannesburg
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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10
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Point of care HIV testing with oral fluid among returnee migrants in a rural area of Bangladesh. Curr Opin HIV AIDS 2016; 11 Suppl 1:S52-8. [PMID: 26945144 PMCID: PMC4787103 DOI: 10.1097/coh.0000000000000267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives To determine HIV prevalence and assess the acceptability of HIV testing using oral fluid as a point of care (PoC) test method among returnee migrants in a rural area of Bangladesh. Design A cross-sectional study. Methods Matlab is a rural area southeast of Dhaka where icddr,b hosts a health and demographic surveillance system covering 225 826 people of whom 934 are returnee migrants. The sample size of 304 was proportionately distributed among randomly selected households. HIV antibodies in oral fluid were tested using OraQuick Rapid HIV 1/2 antibody test. To understand reasons of acceptability a short questionnaire was applied and 32 in-depth interviews were conducted. Results Of 304 returnee migrants approached, 97.4% accepted the test. The prevalence of HIV was 0.3% without a confirmatory blood test. Reasons for acceptance included easy accessibility of the test at the door-step which saved resources (i.e., time and money), comfortable test-procedure without any pain and fear, and receiving quick results with confidentiality. Some described knowing HIV status as a way to ‘get certified’ (of sexual fidelity) and to confront a prevailing silent stigma against migrants. Acceptability was moreover found to be grounded in icddr,b's institutional reputation and its close relationship with the local community. Conclusions The PoC oral fluid test for HIV has shown for the first time that assessment of HIV prevalence in rural-based returnee migrants is possible. Findings also suggest that PoC oral fluid test has the potential of increasing accessibility to HIV testing as it was found to be highly acceptable.
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