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Ngcobo SJ, Makhado L, Sehularo LA. Registered nurses' experiences regarding operational factors influencing the implementation of HIV care services in the mobile health clinics of eThekwini Municipality in KwaZulu-Natal. BMC Nurs 2024; 23:102. [PMID: 38321401 PMCID: PMC10848521 DOI: 10.1186/s12912-024-01764-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/25/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Registered nurses working in the mobile health clinics (MHCs) play an important role in enabling HIV care access to populations in remote areas through Nurse Initiated Antiretroviral Therapy program (NIMART). AIM To explore and describe the nurses' experiences regarding operational factors influencing the implementation of HIV care services in the mobile health clinics (MHCs) of eThekwini Municipality in KwaZulu Natal. METHODS Qualitative Exploratory Descriptive (QED) method was used after permission was granted from North-West University Human Research Ethics Committee provincial and local health authorities. Data saturation informed sample size of thirteen MHCs nurses were purposefully sampled to participate. Audio-recorded, semi-structured, online, one-on-one interviews guided by open-ended questions were done for data collection, and including demographic profile. The interview transcripts were analysed using Atlas-TI and SPSS descriptive statistics was used for demographics. RESULTS Eleven subthemes emerged under patient-related, nurse-related, and organisational-related themes which influence the operational factors in the MHCs, namely: patient defaulting treatment, lack of privacy, unavailability of phones, stressful and demotivating MHCs, nurses feel unsafe, lack of support from management, lack of budget, unavailability of computers, shortage of medical equipment, shortage of nursing staff and absence of data capturers. CONCLUSION Structured contextual coaching and support program for nurses is imperative to ensure effective and strengthened operations in MHCs, further supported by improvement in human resource for health allocation for MHCs in light of expanding health care programs CONTRIBUTIONS: Evaluation of health care programmes, and human resource for health quality improvement needs in the clinical practice of HIV care of MHCs nurses which advocate for specific policy formulations.
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Affiliation(s)
- Silingene Joyce Ngcobo
- Lifestyle Diseases Research Focus Area, Faculty of Health Sciences, North-West University, Mmabatho, South Africa.
- School of Nursing and Public Health, College Health Sciences, University of KwaZulu Natal, Durban, South Africa.
| | - Lufuno Makhado
- Department of Public Health, Faculty of Health Sciences, University of Venda, Thohoyandou, South Africa
| | - Leepile Alfred Sehularo
- Lifestyle Diseases Research Focus Area, Faculty of Health Sciences, North-West University, Mmabatho, South Africa
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Ntuli S. Challenges faced by nurses in managing patients with foot pathologies at primary healthcare clinics in Johannesburg-South Africa. Foot (Edinb) 2023; 57:101964. [PMID: 37865068 DOI: 10.1016/j.foot.2023.101964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/30/2022] [Accepted: 01/22/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Foot health (podiatric) services remain inaccessible in many primary healthcare clinics across South Africa. As first-line contact practitioners at primary health care clinics, nurses manage all patients, including those presenting with foot pathologies. Anecdotal evidence suggests that nurses have challenges and are limited in their capability to assess the foot. In most cases, they do not assess the foot as part of the routine patient assessment. The primary aim of this study was to investigate the challenges nurses face in managing patients presenting with foot pathologies at primary healthcare clinics. METHODS The study used a qualitative design to explore nurses' challenges in managing patients presenting with foot complaints. A purposive sampling strategy was used to select participants from primary health care clinics in Johannesburg to participate in a focus group discussion. Data were analysed using Giorgi's qualitative thematic analysis to reveal themes based on similarities and relationships between the collected data. RESULTS Six PHC nurses participated in the focus group discussion. Participants confirmed challenges in managing patients presenting with foot pathologies. These include poor guidelines, limited training, consultation times, and a lack of defined referral pathways for patients with foot pathologies. Nurses indicated that due to challenges at the PHC level, foot assessment is not a mandatory part of patient assessment. All participants agreed on the need for structured foot health services. CONCLUSION Primary healthcare nurses have challenges in managing patients with foot pathologies. There is a need for structured foot health services and training for nurses to coordinate care for this patient group effectively. Further studies should establish the need and demand for podiatric services to distribute the limited podiatry resources equitably, such as placement of podiatrists at community healthcare centres which serve as the first referral point for primary healthcare clinics.
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Affiliation(s)
- Simiso Ntuli
- Department of Podiatry, Faculty of Health Sciences, University of Johannesburg, P O Box 524 Auckland Park 2006, Gauteng, South Africa.
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Fassinou LC, Hien H, Yombi JC, Nagot N, Kirakoya-Samadoulougou F. Availability and readiness of the health facilities to provide HIV counseling and testing and prevention of mother-to-child transmission services in Burkina Faso: a trend analysis from 2012 to 2018. BMC Health Serv Res 2023; 23:757. [PMID: 37452422 PMCID: PMC10347843 DOI: 10.1186/s12913-023-09757-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/27/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Provider-Initiated HIV Testing and Counseling (PITC) and Prevention of Mother-To-Child Transmission (PMTCT) are key services for achieving the goal of complete elimination of HIV. However, there is limited evidence on the ability of health facilities to provide these services in Burkina Faso. Therefore, we aimed to assess the trends and disparities in the availability and readiness of health facilities to provide PITC and PMTCT services in Burkina Faso between 2012 and 2018. METHODS We performed a secondary analysis of facility-level data from the World Health Organization's Service Availability and Readiness Assessment (SARA) surveys conducted in 2012, 2014, 2016, and 2018 in Burkina Faso. The availability and readiness of health facilities were assessed using SARA's manual, and linear regressions were used to examine trends. RESULTS Between 2012 and 2018, the mean proportion of health facilities providing PITC services increased, but not significantly, from 82.9% to 83.4% (p = 0.11), with the mean readiness index significantly decreasing from 71.5% to 65.4% (p < 0.001). This decrease concerned the staff and guidelines (73.8% to 50.5%; p < 0.001), equipment (79.0% to 77.4%; p < 0.001), and medicines and commodities (54.2% to 45.2%; p < 0.001) domains. Regarding the PMTCT services, the mean proportion of health facilities globally providing the service significantly decreased from 83.7% in 2012 to 67.7% (p = 0.030) in 2018, and the mean readiness significantly decreased from 53.2% in 2012 to 50.9% in 2018 (p = 0.004). This decreasing trend was related to the staff and training (80.3% to 57.6%; p < 0.001) and medicines and commodities (9.2% to 6.5%; p < 0.001) domains. The global significant negative trend of readiness was mainly observed at the primary level of healthcare (52.7% to 49.4%; p = 0.030). Four regions experienced a significant decrease in the readiness index of health facilities to provide PMTCT services: Cascades, Centre, Centre-Sud, and Sud-Ouest, while Haut-Bassins and Nord regions showed increasing trends. CONCLUSION Availability and readiness of health facilities to provide PITC and PMTCT remain suboptimal in Burkina Faso. Actions to strengthen the skills of professionals and enhance the availability of medicines and commodities while focusing more on health regions with significant decreasing trends are urgently needed to improve the quality of services for HIV.
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Affiliation(s)
- Lucresse Corine Fassinou
- Centre de Recherche en Epidémiologie, Biostatistiques Et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | - Hervé Hien
- Institut National de Santé Publique, Ouagadougou, Burkina Faso
| | - Jean Cyr Yombi
- Department of Internal Medicine, Infectious and Tropical Diseases, AIDS Reference Centre, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Nicolas Nagot
- Pathogenesis & Control of Chronic and Emerging Infections, University of Montpellier, INSERM, University of Antilles, Etablissement Français du Sang, Montpellier, France
| | - Fati Kirakoya-Samadoulougou
- Centre de Recherche en Epidémiologie, Biostatistiques Et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium.
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Guan M, Guan H. Associations between treatment burden, self-reported treatment qualities, antiretroviral therapy obtainment, and health-related quality of life among Ugandan PLWH. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:25. [PMID: 37041641 PMCID: PMC10091552 DOI: 10.1186/s12962-023-00434-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 03/17/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Understanding related risk factors of health-related quality of life (HRQoL) could avoid treatment failure and provide an insight of personalized treatment approach among people living with HIV/AIDS (PLWH). The objective of this study was to identify factors associated with self-reported treatment qualities and domains of health-related quality of life (HRQoL) among PLWH in Uganda. METHOD Data were from "Life on antiretroviral therapy: People's adaptive coping and adjustment to living with HIV as a chronic condition in Wakiso District, Uganda" in English. The World Health Organization Quality of Life Brief Version (WHOQOL-BREF) questionnaire was used to assess the HRQoL of 263 PLWH in the sample. Considering variance inflation factors, multiple regression analyses were performed to assess the associations between demographic factors, ART obtainment, treatment burden, and self-reported treatment qualities, associations between demographic factors, self-reported treatment qualities, and HRQoL, and association between ART obtainment and HRQoL. Controlling for the confounding effects, several regression anatomies were employed to explore the associations between self-reported treatment qualities and six domains of HRQoL. RESULTS In the sample, the geographical distribution were urban (5.70%), semi-urban (37.26%), and rural (57.03%). 67.30% of the participants were females. The mean age of the sample was 39.82 years (standard deviation = 9.76) ranging from 22 to 81 years. Multiple logistic regressions reported statistically significant associations of distance to ART facility with self-reported quality of services, advice, manners, and counseling, statistically significant association between self-reported manners quality and four domains of HRQoL, and statistically significant association between TASO membership and domains of HRQoL. Plots from regression anatomies reported that self-reported treatment qualities had statistically significant associations with six domains of HRQoL. CONCLUSIONS Treatment burden, self-reported treatment qualities, ART obtainment, and TASO were possible determinants of individual domains of HRQoL among PLWH in Uganda. PLWH's HRQoL might be improved by promoting medical quality and optimizing ART obtainment in the healthcare providers' practice. Findings in this study had important implications for the redesign of clinical guidelines, healthcare delivery, and health care co-ordination among PLWH globally.
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Affiliation(s)
- Ming Guan
- Family Issues Center, Xuchang University, Xuchang City, Henan province, China
- International Issues Center, Xuchang University, Xuchang City, Henan province, China
- School of Business, Xuchang University, Xuchang City, Henan province, China
| | - Hongyi Guan
- Middle School of Xuchang City, Grade 7 Class 18, No, Xuchang City, Henan province, China.
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Li L, Lin C, Liang LJ, Nguyen DB, Pham LQ, Le TA, Nguyen TA. Community Capacity Building for HIV and Addiction Service Integration: An Intervention Trial in Vietnam. AIDS Behav 2022; 26:123-131. [PMID: 34228251 PMCID: PMC8733056 DOI: 10.1007/s10461-021-03363-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 11/20/2022]
Abstract
Scientific findings and policy guidelines recommend integrating HIV and drug addiction prevention and care into community-based settings. Systematic capacity-building efforts are warranted to provide technical support for community health workers and improve their confidence in the integrated service provision. An intervention trial was conducted between 2018 and 2019 with 120 community health workers (CHW) from 60 communes in Vietnam’s four provinces. The 60 intervention CHW received in-person training to enhance their HIV/addiction-related service knowledge and skills. Online support groups were established between trained CHW and local HIV and addiction specialists. The intervention outcomes were assessed using mixed-effects regression models with the data collected at baseline and every 3 months for 1 year. Adjusted analyses showed that intervention CHW reported a significant increase in the interaction with other treatment providers than the control group at 6 months and remained at the 12-month follow-up. The difference in the improvement of confidence in HIV/addiction-related service delivery between the intervention and control groups was significant at 6-month but became insignificant at the 12-month. Male CHW were more confident in providing services than female CHW at baseline, and gender differences in the changing patterns were observed over time. This capacity-building intervention demonstrated promising outcomes on CHW inter-agency collaborations and confidence in service delivery. Gender divides in healthcare professionals should be attended to in future studies.
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Ramirez JA, Maddali MV, Nematollahi S, Li JZ, Shah M. New Strategies in Clinical Guideline Delivery: Randomized Trial of Online, Interactive Decision Support Versus Guidelines for Human Immunodeficiency Virus Treatment Selection by Trainees. Clin Infect Dis 2021; 72:1608-1614. [PMID: 32211758 DOI: 10.1093/cid/ciaa299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 03/17/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Support for clinicians in human immunodeficiency virus (HIV) medicine is critical given national HIV-provider shortages. The US Department of Health and Human Services (DHHS) guidelines are comprehensive but complex to apply for antiretroviral therapy (ART) selection. Human immunodeficiency virus antiretroviral selection support and interactive search tool (HIV-ASSIST) (www.hivassist.com) is a free tool providing ART decision support that could augment implementation of clinical practice guidelines. METHODS We conducted a randomized study of medical trainees at Johns Hopkins University, in which participants were asked to select an ART regimen for 10 HIV case scenarios through an electronic survey. Participants were randomized to receive either DHHS guidelines alone, or DHHS guidelines and HIV-ASSIST to support their decision making. ART selections were graded "appropriate" if consistent with DHHS guidelines, or concordant with regimens selected by HIV experts at 4 academic institutions. RESULTS Among 118 trainees, participants randomized to receive HIV-ASSIST had a significantly higher percentage of appropriate ART selections compared to those receiving DHHS guidelines alone (percentage of appropriate responses in DHHS vs HIV-ASSIST arms: median [Q1, Q3], 40% [30%, 50%] vs 90% [80%, 100%]; P < .001). The effect was seen for all case types, but most pronounced for complex cases involving ART-experienced patients with ongoing viremia (DHHS vs HIV-ASSIST: median [Q1, Q3], 0% [0%, 33%] vs 100% [66%, 100%]). CONCLUSIONS Trainees using HIV-ASSIST were significantly more likely to choose appropriate ART regimens compared to those using guidelines alone. Interactive decision support tools may be important to ensure appropriate implementation of HIV guidelines. CLINICAL TRIALS REGISTRATION NCT04080765.
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Affiliation(s)
- Jesus A Ramirez
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Manoj V Maddali
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Saman Nematollahi
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jonathan Z Li
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Maunank Shah
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Ramirez JA, Maddali MV, Budak JZ, Li JZ, Lampiris H, Shah M. Evaluating the Concordance of Clinician Antiretroviral Prescribing Practices and HIV-ASSIST, an Online Clinical Decision Support Tool. J Gen Intern Med 2020; 35:1498-1503. [PMID: 31792870 PMCID: PMC7210320 DOI: 10.1007/s11606-019-05531-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/10/2019] [Accepted: 10/28/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Individualized selection of antiretroviral (ARV) therapy is complex, considering drug resistance, comorbidities, drug-drug interactions, and other factors. HIV-ASSIST (www.hivassist.com) is a free, online tool that provides ARV decision support. HIV-ASSIST synthesizes patient and virus-specific attributes to rank ARV combinations based upon a composite objective of achieving viral suppression and maximizing tolerability. OBJECTIVE To evaluate concordance of HIV-ASSIST recommendations with ARV selections of experienced HIV clinicians. DESIGN Retrospective cohort study. PATIENTS New and established patients at the Johns Hopkins Bartlett HIV Clinic and San Francisco Veterans Affairs HIV Clinic completing clinic visits were included. Chart reviews were conducted of the most recent clinic visit to generate HIV-ASSIST recommendations, which were compared to prescribed regimens. MAIN MEASURES For each provider-prescribed regimen, we assessed its corresponding HIV-ASSIST "weighted score" (scale of 0 to 10 +, scores of < 2.0 are preferred), rank within HIV-ASSIST's ordered listing of ARV regimens, and concordance with the top five HIV-ASSIST ranked outputs. KEY RESULTS Among 106 patients (16% female), 23 (22%) were ARV-naïve. HIV-ASSIST outputs for ARV-naïve patients were 100% concordant with prescribed regimens (median rank 1 [IQR 1-3], median weighted score 1.1 [IQR 1-1.2]). For 18 (17%) ARV-experienced patients with ongoing viremia, HIV-ASSIST outputs were 89% concordant with prescribed regimens (median rank 2 [IQR 1-3], median weighted score 1 [IQR 1-1.2]). For 65 (61.3%) patients that were suppressed on a current ARV regimen, HIV-ASSIST recommendations were concordant 88% of the time (median rank 1 [IQR 1-1], median weighted score 1.1 [IQR 1-1.6]). In 18% of cases, HIV-ASSIST weighted score suggested that the prescribed regimen would be considered "less preferred" (score > 2.0) than other available alternatives. CONCLUSION HIV-ASSIST is an educational decision support tool that provides ARV recommendations concordant with experienced HIV providers from two major academic centers for a diverse set of patient scenarios.
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Affiliation(s)
- Jesus A Ramirez
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
- Virginia Commonwealth University, School of Medicine, Richmond, VA, USA.
| | - Manoj V Maddali
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jehan Z Budak
- Division of Infectious Diseases, University of California San Francisco, San Francisco, CA, USA
| | - Jonathan Z Li
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Harry Lampiris
- Division of Infectious Diseases, University of California San Francisco, San Francisco, CA, USA
- Infectious Disease Section, Medical Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Maunank Shah
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Nkosi B, Seeley J, Ngwenya N, Mchunu SL, Gumede D, Ferguson J, Doyle AM. Exploring adolescents and young people's candidacy for utilising health services in a rural district, South Africa. BMC Health Serv Res 2019; 19:195. [PMID: 30922372 PMCID: PMC6438017 DOI: 10.1186/s12913-019-3960-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We use the 'candidacy framework' to describe adolescents' and young people's (AYP) experiences of health services in a rural KwaZulu-Natal district, South Africa. METHODS A qualitative approach was used including group discussions, in-depth and key informant interviews with a purposive sample of AYP (n = 70), community leaders (n = 15), school health teams (n = 10), and health service providers (n = 6). RESULTS Findings indicate tacit understanding among AYP that they are candidates for general health services. However, HIV stigma, apprehensions and misconceptions about sexual and reproductive health, and socio-cultural views which disapprove of AYP pre-marital sex undermine their candidacy for sexual and reproductive services. CONCLUSION Consideration and understanding of the vulnerabilities and reasons AYP exclude themselves will inform interventions to address their health needs. AYP's participation in the design of health services will increase their acceptability and encourage uptake of services.
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Affiliation(s)
- Busisiwe Nkosi
- Africa Health Research Institute, Nelson R. Mandela School of Medicine, 3rd Floor, K-RITH Tower Building, 719 Umbilo Road, Congella, Durban, KwaZulu-Natal 4001 South Africa
| | - Janet Seeley
- Africa Health Research Institute, Nelson R. Mandela School of Medicine, 3rd Floor, K-RITH Tower Building, 719 Umbilo Road, Congella, Durban, KwaZulu-Natal 4001 South Africa
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Nothando Ngwenya
- Africa Health Research Institute, Nelson R. Mandela School of Medicine, 3rd Floor, K-RITH Tower Building, 719 Umbilo Road, Congella, Durban, KwaZulu-Natal 4001 South Africa
| | - S. Lerato Mchunu
- Africa Health Research Institute, Nelson R. Mandela School of Medicine, 3rd Floor, K-RITH Tower Building, 719 Umbilo Road, Congella, Durban, KwaZulu-Natal 4001 South Africa
| | - Dumile Gumede
- Africa Health Research Institute, Nelson R. Mandela School of Medicine, 3rd Floor, K-RITH Tower Building, 719 Umbilo Road, Congella, Durban, KwaZulu-Natal 4001 South Africa
| | - Jane Ferguson
- Africa Health Research Institute, Nelson R. Mandela School of Medicine, 3rd Floor, K-RITH Tower Building, 719 Umbilo Road, Congella, Durban, KwaZulu-Natal 4001 South Africa
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Aoife M. Doyle
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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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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Tshililo AR, Mangena-Netshikweta L, Nemathaga LH, Maluleke M. Challenges of primary healthcare nurses regarding the integration of HIV and AIDS services into primary healthcare in Vhembe district of Limpopo province, South Africa. Curationis 2019; 42:e1-e6. [PMID: 30843402 PMCID: PMC6417489 DOI: 10.4102/curationis.v42i1.1849] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 07/13/2018] [Accepted: 07/24/2018] [Indexed: 11/12/2022] Open
Abstract
Background Integration of human immunodeficiency virus and acquired immune deficiency syndrome (HIV and AIDS) services into primary healthcare (PHC) is a key public health approach to achieving universal access to antiretroviral therapy (ART). Despite the government’s efforts of integrating HIV services into PHC, an insufficient number of PHC staff and inadequate infrastructure are challenging when integrating HIV and AIDS services into PHC. This study explored the challenges of PHC nurses regarding the integration of HIV and AIDS services into PHC. Objectives The aim of the study was to explore the challenges of PHC nurses regarding the integration of HIV and AIDS services into PHC. Method An exploratory, descriptive and contextual qualitative research design utilising face-to-face semi-structured interviews was conducted with 12 PHC nurses from selected clinics and health centres in the Vhembe district of Limpopo province. Results Two main themes emerged from data analysis which included challenges related to healthcare recipients and challenges related to healthcare providers. Conclusion Clear policies on the integration of HIV and AIDS services into PHC should be available and should include strategies to promote HIV testing and counselling, adherence to ART and scheduled appointments, disclosure of HIV status as well as revising the human resource policy to reduce workload.
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Tshililo RA, Mangena-Netshikweta L, Nemathaga LH, Maluleke M. Challenges of primary healthcare nurses regarding the integration of HIV and AIDS services into primary healthcare in Vhembe district of Limpopo province, South Africa. Curationis 2018. [DOI: 10.4102/curationis.v41i1.1849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Rawat A, Uebel K, Moore D, Cingl L, Yassi A. Patient Responses on Quality of Care and Satisfaction with Staff After Integrated HIV Care in South African Primary Health Care Clinics. J Assoc Nurses AIDS Care 2018; 29:698-711. [PMID: 29857926 DOI: 10.1016/j.jana.2018.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 04/30/2018] [Indexed: 10/16/2022]
Abstract
HIV care integrated into primary health care (PHC) encourages reorganized service delivery but could increase workload. In 2012-2013, we surveyed 910 patients and caregivers at two time points after integration in four clinics in Free State, South Africa. Likert surveys measured quality of care (QoC) and satisfaction with staff (SwS). QoC scores were lower for females, those older than 56 years, those visiting clinics every 3 months, and child health participants. Regression estimates showed QoC scores higher for ages 36-45 versus 18-25 years, and lower for those attending clinics for more than 10 years versus 6-12 months. Overall, SwS scores were lower for child health attendees and higher for tuberculosis attendees compared to chronic disease care attendees. Research is needed to understand determinants of disparities in QoC and SwS, especially for child health, diabetes, and hypertension attendees, to ensure high-quality care experiences for all patients attending PHC clinics with integrated HIV care.
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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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Pham MD, Romero L, Parnell B, Anderson DA, Crowe SM, Luchters S. Feasibility of antiretroviral treatment monitoring in the era of decentralized HIV care: a systematic review. AIDS Res Ther 2017; 14:3. [PMID: 28103895 PMCID: PMC5248527 DOI: 10.1186/s12981-017-0131-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 01/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Regular monitoring of HIV patients who are receiving antiretroviral therapy (ART) is required to ensure patient benefits and the long-term effectiveness and sustainability of ART programs. Prompted by WHO recommendations for expansion and decentralization of HIV treatment and care in low and middle income countries, we conducted a systematic review to assess the feasibility of treatment monitoring in these settings. METHODS A comprehensive search strategy was developed using a combination of MeSH and free text terms relevant to HIV treatment and care, health service delivery, health service accessibility, decentralization and other relevant terms. Five electronic databases and two conference websites were searched to identify relevant studies conducted in LMICs, published in English between Jan 2006 and Dec 2015. Outcomes of interest included the proportion of patients who received treatment monitoring and health system factors related to monitoring of patients on ART under decentralized HIV service delivery models. RESULTS From 5363 records retrieved, twenty studies were included in the review; all but one was conducted in sub-Saharan African countries. The majority of studies (15/20) had relatively short follow-up duration (≤24 months), and only two studies were specifically designed to assess treatment monitoring practices. The most frequently studied follow-up period was 12 months and a wide range of treatment monitoring coverage was observed. The reported proportions of patients on ART who received CD4 monitoring ranged from very low (6%; N = 2145) to very high (95%; N = 488). The median uptake of viral load monitoring was 86% with studies in program settings reporting coverage as low as 14%. Overall, the longer the follow-up period, the lower the proportion of patients who received regular monitoring tests; and programs in rural areas reported low coverage of laboratory monitoring. Moreover, uptake in the context of research had significantly better where monitoring was done by dedicated research staff. In the absence of point of care (POC) testing, the limited capacity for blood sample transportation between clinic and laboratory and poor quality of nursing staff were identified as a major barrier for treatment monitoring practice. CONCLUSIONS There is a paucity of data on the uptake of treatment monitoring, particularly with longer-term follow-up. Wide variation in access to both virological and immunological regular monitoring was observed, with some clinics in well-resourced settings supported by external donors achieving high coverage. The feasibility of treatment monitoring, particularly in decentralized settings of HIV treatment and care may thus be of concern and requires further study. Significant investment in POC diagnostic technologies and, improving the quality of and training for nursing staff is required to ensure effective scale up of ART programs towards the targets of 90-90-90 by the year 2020.
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15
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Mathibe MD, Hendricks SJH, Bergh AM. Clinician perceptions and patient experiences of antiretroviral treatment integration in primary health care clinics, Tshwane, South Africa. Curationis 2015; 38. [PMID: 26841916 PMCID: PMC6091789 DOI: 10.4102/curationis.v38i1.1489] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 08/09/2015] [Accepted: 07/09/2015] [Indexed: 11/05/2022] Open
Abstract
Background Primary Health Care (PHC) clinicians and patients are major role players in the South African antiretroviral treatment programme. Understanding their perceptions and experiences of integrated care and the management of people living with HIV and AIDS in PHC facilities is necessary for successful implementation and sustainability of integration. Objective This study explored clinician perceptions and patient experiences of integration of antiretroviral treatment in PHC clinics. Method An exploratory, qualitative study was conducted in four city of Tshwane PHC facilities. Two urban and two rural facilities following different models of integration were included. A self-administered questionnaire with open-ended items was completed by 35 clinicians and four focus group interviews were conducted with HIV-positive patients. The data were coded and categories were grouped into sub-themes and themes. Results Workload, staff development and support for integration affected clinicians’ performance and viewpoints. They perceived promotion of privacy, reduced discrimination and increased access to comprehensive care as benefits of service integration. Delays, poor patient care and patient dissatisfaction were viewed as negative aspects of integration. In three facilities patients were satisfied with integration or semi-integration and felt common queues prevented stigma and discrimination, whilst the reverse was true in the facility with separate services. Single-month issuance of antiretroviral drugs and clinic schedule organisation was viewed negatively, as well as poor staff attitudes, poor communication and long waiting times. Conclusion Although a fully integrated service model is preferable, aspects that need further attention are management support from health authorities for health facilities, improved working conditions and appropriate staff development opportunities.
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Affiliation(s)
- Maphuthego D Mathibe
- School of Health Systems and Public Health, University of Pretoria and Health and Social Development & SRAC, City of Tshwane.
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