1
|
Zakumumpa H, Rujumba J, Kwiringira J, Kiplagat J, Namulema E, Muganzi A. Understanding the persistence of vertical (stand-alone) HIV clinics in the health system in Uganda: a qualitative synthesis of patient and provider perspectives. BMC Health Serv Res 2018; 18:690. [PMID: 30185191 PMCID: PMC6126041 DOI: 10.1186/s12913-018-3500-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/28/2018] [Indexed: 12/04/2022] Open
Abstract
Background Although there is mounting evidence and policy guidance urging the integration of HIV services into general health systems in countries with a high HIV burden, vertical (stand-alone) HIV clinics are still common in Uganda. We sought to describe the specific contexts underpinning the endurance of vertical HIV clinics in Uganda. Methods A qualitative research design was adopted. Semi-structured interviews were conducted with the heads of HIV clinics, clinicians and facility in-charges (n = 78), coupled with eight focus group discussions (64 participants) with patients from 16 health facilities purposively selected, from a nationally-representative sample of 195 health facilities across Uganda, because they run stand-alone HIV clinics. Data were analyzed by thematic approach as guided by the theory proposed by Shediac-Rizkallah & Bone (1998) which identifies; Intervention characteristics, organizational context, and broader environment factors as potentially influential on health programme sustainability. Results Intervention characteristics: Provider stigma was reported to have been widespread in the integrated care experience of participating health facilities which necessitated the establishment of stand-alone HIV clinics. HIV disease management was described as highly specialized which necessitated a dedicated workforce and vertical HIV infrastructure such as counselling rooms. Organizational context: Participating health facilities reported health-system capacity constraints in implementing integrated systems of care due to a shortage of ART-proficient personnel and physical space, a lack of laboratory capacity to concurrently conduct HIV and non-HIV tests and increased workloads associated with implementing integrated care. Broader environment factors: Escalating HIV client loads and external HIV funding architectures were perceived to have perpetuated verticalized HIV programming over the past decade. Conclusion Our study offers in-depth, contextualized insights into the factors contributing to the endurance of vertical HIV clinics in Uganda. Our analysis suggests that there is a complex interaction in supply-side constraints (shortage of ART-proficient personnel, increased workloads, laboratory capacity deficiencies) and demand-side factors (escalating demand for HIV services, psychosocial barriers to HIV care) as well as the specialized nature of HIV disease management which pose challenges to the integrated-health services agenda.
Collapse
Affiliation(s)
- Henry Zakumumpa
- School of Public Health, Makerere University, Kampala, Uganda.
| | - Joseph Rujumba
- School of Medicine, Makerere University, Kampala, Uganda
| | | | | | - Edith Namulema
- Home care and counselling department, Mengo Hospital, Kampala, Uganda
| | - Alex Muganzi
- The Infectious Diseases Institute, Makerere University, Kampala, Uganda
| |
Collapse
|
3
|
O'Hara LM, Yassi A, Zungu M, Malotle M, Bryce EA, Barker SJ, Darwin L, Mark FitzGerald J. The neglected burden of tuberculosis disease among health workers: a decade-long cohort study in South Africa. BMC Infect Dis 2017; 17:547. [PMID: 28784107 PMCID: PMC5547542 DOI: 10.1186/s12879-017-2659-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 08/01/2017] [Indexed: 11/23/2022] Open
Abstract
Background Health workers (HWs) in resource-limited settings are at high-risk of exposure to tuberculosis (TB) at work. The aim of this study was to estimate the rate of TB disease among HWs in the Free State Province of South Africa between 2002 and 2012 and to compare demographic and clinical characteristics between HWs and the general population with TB. This study also explores the effect of occupational variables on risk of TB among HWs. Methods Probabilistic record linkage was utilized to identify HWs who were also registered as TB patients. This historical prospective cohort study calculated incidence rate ratios (IRR) for TB disease among HWs in Free State from 2002 to 2012. Generalized linear mixed-effects regression was used to model the association between sex, race, facility type, occupation, duration of employment, and the rate of TB. Results There were 2677 cases of TB diagnosed among HWs from 2002 to 2012 and 1280 cases were expected. The overall TB incidence rate in HWs during the study period was 1496·32 per 100,000 compared to an incidence rate of 719·37 per 100,000 in the general population during the same time period. IRR ranged from 1·14 in 2012 to 3·12 in 2005. HWs who were male, black, coloured and employed less than 20 years had higher risk of TB. Facility type and occupation were not associated with increased risk of TB when adjusted for other covariates. Conclusion HWs in South Africa have higher rates of TB than the general population. Improved infection prevention and control measures are necessary in all high-burden TB healthcare settings. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2659-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Lyndsay M O'Hara
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.
| | - Annalee Yassi
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Muzimkhulu Zungu
- National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa.,School of Health Systems and Public Health, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Molebogeng Malotle
- National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa
| | - Elizabeth A Bryce
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Stephen J Barker
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Lincoln Darwin
- National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa
| | - J Mark FitzGerald
- Division of Respiratory Medicine, University of British Columbia, Vancouver, Canada
| |
Collapse
|
4
|
Wouters E, Masquillier C, le Roux Booysen F. The Importance of the Family: A Longitudinal Study of the Predictors of Depression in HIV Patients in South Africa. AIDS Behav 2016; 20:1591-602. [PMID: 26781870 DOI: 10.1007/s10461-016-1294-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
As a chronic illness, HIV/AIDS requires life-long treatment adherence and retention-and thus sufficient attention to the psychosocial dimensions of chronic disease care in order to produce favourable antiretroviral treatment (ART) outcomes in a sustainable manner. Given the high prevalence of depression in chronic HIV patients, there is a clear need for further research into the determinants of depression in this population. In order to comprehensively study the predictors of depressive symptoms in HIV patients on ART, the socio-ecological theory postulates to not only incorporate the dominant individual-level and the more recent community-level approaches, but also incorporate the intermediate, but crucial family-level approach. The present study aims to extend the current literature by simultaneously investigating the impact of a wide range individual-level, family-level and community-level determinants of depression in a sample of 435 patients enrolled in the Free State Province of South Africa public-sector ART program. Structural equation modeling is used to explore the relationships between both latent and manifest variables at two time points. Besides a number of individual-level correlates-namely education, internalized and external stigma, and avoidant and seeking social support coping styles-of depressive symptoms in HIV patients on ART, the study also revealed the important role of family functioning in predicting depression. While family attachment emerged as the only factor to continuously and negatively impact depression at both time points, the second dimension of family functioning, changeability, was the only factor to produce a negative cross-lagged effect on depression. The immediate and long-term impact of family functioning on depression draws attention to the role of family dynamics in the mental health of people living with HIV/AIDS. In addition to individual-level and community-based factors, future research activities should also incorporate the role of the family context in research into the mental health of HIV patients, as our results demonstrate that the familial context in which a person with HIV on ART resides is inextricably interconnected with his/her health outcomes.
Collapse
Affiliation(s)
- Edwin Wouters
- Department of Sociology and Centre for Longitudinal and Life Course Studies, University of Antwerp, Sint-Jacobstraat 2, 2000, Antwerp, Belgium.
- Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, Republic of South Africa.
| | - Caroline Masquillier
- Department of Sociology and Centre for Longitudinal and Life Course Studies, University of Antwerp, Sint-Jacobstraat 2, 2000, Antwerp, Belgium
| | - Frederik le Roux Booysen
- Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, Republic of South Africa
- Department of Economics, University of the Free State, Bloemfontein, Republic of South Africa
| |
Collapse
|
6
|
Jemmott LS, Jemmott JB, Ngwane Z, Icard L, O’Leary A, Gueits L, Brawner B. 'Let Us Protect Our Future' a culturally congruent evidenced-based HIV/STD risk-reduction intervention for young South African adolescents. HEALTH EDUCATION RESEARCH 2014; 29:166-81. [PMID: 23962491 PMCID: PMC3894663 DOI: 10.1093/her/cyt072] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Accepted: 06/10/2013] [Indexed: 05/31/2023]
Abstract
One of the worst HIV/AIDS epidemics in the world is occurring in South Africa, where heterosexual exposure is the main mode of HIV transmission. Young people 15-24 years of age, particularly women, account for a large share of new infections. Accordingly, there is an urgent need for behavior-change interventions to reduce the incidence of HIV among adolescents in South Africa. However, there are few such interventions with proven efficacy for South African adolescents, especially young adolescents. A recent cluster-randomized controlled trial of the 'Let Us Protect Our Future!' HIV/STD risk-reduction intervention for Grade 6 South African adolescents (mean age = 12.4 years) found significant decreases in self-reported sexual risk behaviors compared with a control intervention. This article describes the intervention, the use of the social cognitive theory and the reasoned action approach to develop the intervention, how formative research informed its development and the acceptability of the intervention. Challenges in designing and implementing HIV/STD risk-reduction interventions for young adolescents in sub-Saharan Africa are discussed.
Collapse
Affiliation(s)
- L. S. Jemmott
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Department of Psychiatry, Perelman School of Medicine, and Center for Health Behavior and Communication Research, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, Department of Anthropology, Haverford College, Haverford, PA 19041, USA, College of Health Professions and Social Work, Temple University, Philadelphia, PA 19122, USA and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - J. B. Jemmott
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Department of Psychiatry, Perelman School of Medicine, and Center for Health Behavior and Communication Research, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, Department of Anthropology, Haverford College, Haverford, PA 19041, USA, College of Health Professions and Social Work, Temple University, Philadelphia, PA 19122, USA and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Z. Ngwane
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Department of Psychiatry, Perelman School of Medicine, and Center for Health Behavior and Communication Research, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, Department of Anthropology, Haverford College, Haverford, PA 19041, USA, College of Health Professions and Social Work, Temple University, Philadelphia, PA 19122, USA and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - L. Icard
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Department of Psychiatry, Perelman School of Medicine, and Center for Health Behavior and Communication Research, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, Department of Anthropology, Haverford College, Haverford, PA 19041, USA, College of Health Professions and Social Work, Temple University, Philadelphia, PA 19122, USA and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - A. O’Leary
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Department of Psychiatry, Perelman School of Medicine, and Center for Health Behavior and Communication Research, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, Department of Anthropology, Haverford College, Haverford, PA 19041, USA, College of Health Professions and Social Work, Temple University, Philadelphia, PA 19122, USA and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - L. Gueits
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Department of Psychiatry, Perelman School of Medicine, and Center for Health Behavior and Communication Research, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, Department of Anthropology, Haverford College, Haverford, PA 19041, USA, College of Health Professions and Social Work, Temple University, Philadelphia, PA 19122, USA and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - B. Brawner
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Department of Psychiatry, Perelman School of Medicine, and Center for Health Behavior and Communication Research, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, Department of Anthropology, Haverford College, Haverford, PA 19041, USA, College of Health Professions and Social Work, Temple University, Philadelphia, PA 19122, USA and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| |
Collapse
|