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Antonini M, Vettore MV, Øgård-Repål A, de Macêdo Rocha D, de Alencar Rocha KA, Elias HC, Barufaldi F, Santana RC, Gir E, Spire B, Reis RK. Patterns of Chlamydia trachomatis and Neisseria gonorrhoeae in different anatomical sites among Pre-Exposure Prophylaxis (PrEP) users in Brazil. BMC Infect Dis 2024; 24:260. [PMID: 38408940 PMCID: PMC10895759 DOI: 10.1186/s12879-024-09144-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/15/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND The presence of untreated sexually transmitted infections (STIs) significantly increases the chance of acquiring HIV. In Brazil, testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) among Pre-Exposure Prophylaxis (PrEP) users is insufficient, and syndromic treatment is a priority in clinical practice. Multi-site testing for CT/NG improves thescreening of asymptomatic cases and ensures timely treatment. Therefore, it is essential for HIV prevention. This study aims to test the importance of two-site testing for better screening of these pathogens and to determine whether the presence of symptoms is an indicator of CT/NG infection. METHODS This is a cross-sectional study carried out in four public infectious diseases clinics in São Paulo State, Brazil between January of 2022 and March of 2023. All participants had an anal swab and a first-pass or mid-stream urine collected for CT/NG analysis by Polymerase chain reaction (PCR). Data about sociodemographic, sexual behavioural and clinical aspects were collected. Pathway analysis was used to examine the direct and indirect relationships between variables according to the theoretical model. RESULTS We screened 171 PrEP users which had two samples collected, resulting in 342 samples. Comparing the anatomic sites, the urine samples showed lower sensitivity for CT and NG than anal samples. Gonorrhoea was directly linked to lower age (β= -0.161, p = 0.001). Time of PrEP use was directly associated with CT infection (β = 0.202; p = 0.042) and inversely associated with dysuria (β= -0.121, p = 0.009). Lower occurrence of yellow-green secretion was linked to detection of CT (β= -0.089, p = 0.005) and NG (β= -0.048, p = 0.002) infections. Foul-smelling discharge was directly associated with CT (β = 0.275, p = 0.004) and NG (β = 0.295, p = 0.037) infection. CONCLUSION The symptoms are a bad indicator of CT and NG infection, and the screening must be done in more than one site since most of the positive results would be missed if only urines were tested. In the case of testing only one anatomical site, specifically the urethra, the CT/NG incidence and prevalence would be underestimated. The two-sites testing improves detection rates of CT/NG, and PrEP follow-up benefits people offering STI testing.
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Affiliation(s)
- Marcela Antonini
- University of São Paulo (USP), Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil.
| | | | - Anita Øgård-Repål
- Department of Health and Nursing Sciences, University of Agder (UiA), Kristiansand, Vest- Agder, Norway
| | - Daniel de Macêdo Rocha
- University of São Paulo (USP), Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | | | - Henrique Ciabotti Elias
- University of São Paulo (USP), Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Felipe Barufaldi
- University of São Paulo, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | | | - Elucir Gir
- University of São Paulo (USP), Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | | | - Renata Karina Reis
- University of São Paulo (USP), Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
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Johnsen HM, Øgård-Repål A, Martinez SG, Fangen K, Bårdsen Aas K, Ersfjord EMI. Patients' perceptions of use, needs, and preferences related to a telemedicine solution for HIV care in a Norwegian outpatient clinic: a qualitative study. BMC Health Serv Res 2024; 24:209. [PMID: 38360650 PMCID: PMC10870609 DOI: 10.1186/s12913-024-10659-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/30/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Telemedicine in outpatient services for people living with human immunodeficiency virus (PLHIV) was scaled up during the COVID-19 pandemic as services transitioned to remote care. Many studies have reported on the challenges and advantages of telemedicine care during the pandemic. However, there is limited research on the provision of telemedicine human immunodeficiency virus (HIV) care beyond the COVID-19 pandemic, which entails different telemedicine components and focuses on ways to improve the telemedicine experience for patients. This study aimed to explore PLHIV's perceptions of use, needs, and preferences related to a telemedicine solution for HIV care in an outpatient clinic in Norway. The telemedicine solution included a pre-consultation questionnaire, asynchronous digital messages, and video consultation. METHODS Qualitative interviews were conducted with 12 PLHIV. The interviews were analysed using thematic analysis. RESULTS We identified four main themes that covered the participants' perceptions, needs, and preferences: (1) perceived usability, (2) maintaining confidentiality, (3) accommodating personal preferences, and (4) perceived usefulness. Some participants had difficulty logging into the telemedicine solution. Other participants suggested additional functionalities, such as picture sharing and access to test result. Telemedicine care enabled the avoidance of stigmatising clinic experiences, although a few participants reported concerns about confidentiality and data security. Accommodating personal preferences and needs in terms of the type of consultations (in-person or video) and frequency of visits was essential to the participants. With telemedicine care, participants felt more in control of their own lives, perceiving that it increased their perceived quality of life and saved them both time and money for travelling to the clinic. CONCLUSIONS Our study identified several specific needs and preferences related to the assessed technical solution and the provision of current and future telemedicine care services. Nevertheless, the telemedicine solution was perceived as a usable, flexible, and person-centred approach to HIV care, contributing to accommodating the participants' personal preferences. However, healthcare professionals need to ensure that individual requirements and preferences are consistent with evidence-based follow-up and supported by person-centred care. Thus, the practice of shared decision making is important in telemedicine care.
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Affiliation(s)
- Hege Mari Johnsen
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, 4898, Grimstad, PO Box 509, Norway.
| | - Anita Øgård-Repål
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, 4898, Grimstad, PO Box 509, Norway
| | - Santiago Gil Martinez
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, 4898, Grimstad, PO Box 509, Norway
| | - Kim Fangen
- Sørlandet Hospital, Kristiansand, Norway
| | | | - Ellen Margrete Iveland Ersfjord
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, 4898, Grimstad, PO Box 509, Norway
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Abstract
Peer support for people living with HIV has gained increasing traction and is considered a way to take an active role in self-management. The existing research examining peer support interventions has reported promising evidence of the benefits of peer support. The purpose of our scoping review was to describe research on peer support for people living with HIV. We included 53 studies and sorted them into analytic categories and conducted descriptive analyses. The studies that were published between November/December 2000 and May 2021, had a range of study designs and heterogeneous priority groups, and included 20,657 participants from 16 countries. We identified 43 evaluations of the effect of peer support and 10 evaluations of implementation, process, feasibility, cost of peer support. We also categorized peer support by key functions, finding that the most common key functions were linkage to clinical care and community resources and assistance in daily management, with only one study directly related to chronic care. There is growing research interest in peer support for people living with HIV, particularly in high-income countries and related to the evaluation of effects. The revealed gaps of prioritized functions of peer support have implications for further research. Further focus on interventions addressing secondary prevention related to noncommunicable diseases as part of a care package is recommended to meet people's needs and preferences and increase self-management related to a chronic lifelong condition.
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Affiliation(s)
- Anita Øgård-Repål
- University of Agder, Grimstad,
Aust-Agder, Norway,Anita Øgård-Repål, Centre for Caring
Research–Southern Norway, Department of Health and Nursing Science, University
of Agder, Grimstad, Østerveien 18, Kristiansand, 4631, Norway;
| | - Rigmor C. Berg
- Norwegian Institute of Public Health,
Oslo, Norway,University of Tromsø, Tromsø,
Norway
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Øgård-Repål A, Berg RC, Skogen V, Fossum M. "They make a difference": a qualitative study of providers' experiences of peer support in outpatient clinics for people living with HIV. BMC Health Serv Res 2022; 22:1380. [PMID: 36411443 PMCID: PMC9676711 DOI: 10.1186/s12913-022-08810-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/08/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although the life expectancy of people living with HIV has increased, they are still often disconnected from society through stigma and discrimination. Peer support has been found to increase social support. Given the limited research on peer support from the providers' perspective, this study explored how peer supporters experience their roles and contributions in outpatient clinics (OPCs). Additionally, healthcare professionals' perceptions of working with peer supporters in OPCs were examined. METHODS: This qualitative study included purposively selected peer supporters (n = 10) and healthcare professionals (n = 5) from five OPCs in Norway in 2020. In-depth interviews and focus group discussions were conducted in Norwegian or English, using interview guides. Interview transcripts were analysed in NVivo 12 using reflexive and collaborative thematic analysis. RESULTS The results show that peer supporters experience mutual support through emotional and honest interactions. Further, the peer supporters found it essential to negotiate with the service users about their preconception of HIV, confront their views through dialogue, and replicate positive experiences by being credible role models. The participants expressed that integrating peer support in the OPCs' usual care processes increased the prospect of equitable services. Quality of peer support and role clarity were identified as critical components. The results demonstrate that emotional and honest conversations promote support between peers and that peer supporters identify a need for a reframed understanding of HIV by modelling plausible alternative interpretations and coping experiences. CONCLUSIONS This study contributes to knowledge on how peer support can meet the needs of people living with HIV. Incorporating people living with HIV in the co-production and distribution of healthcare services may improve the knowledge and perspectives in healthcare services. However, the skill standards of peer supporters should be addressed when implementing peer support in usual care.
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Affiliation(s)
- Anita Øgård-Repål
- grid.23048.3d0000 0004 0417 6230Centre for Caring Research, Department of Health and Nursing Science, University of Agder, Southern Norway, Grimstad, Aust-Agder, Norway
| | - Rigmor C. Berg
- grid.418193.60000 0001 1541 4204Reviews and Health Technology Assessments, Norwegian Institute of Public Health, Oslo, Norway ,grid.10919.300000000122595234Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Vegard Skogen
- grid.10919.300000000122595234Institute for Clinical Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway ,grid.412244.50000 0004 4689 5540Department of Infectious Diseases, Medical Clinic, University Hospital of North Norway, Tromsø, Norway
| | - Mariann Fossum
- grid.23048.3d0000 0004 0417 6230Centre for Caring Research, Department of Health and Nursing Science, University of Agder, Southern Norway, Grimstad, Aust-Agder, Norway
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Øgård-Repål A, Berg RC, Skogen V, Fossum M. Peer support in an outpatient clinic for people living with human immunodeficiency virus: a qualitative study of service users' experiences. BMC Health Serv Res 2022; 22:549. [PMID: 35468797 PMCID: PMC9036816 DOI: 10.1186/s12913-022-07958-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although human immunodeficiency virus (HIV) has become a manageable condition with increasing life expectancy, people living with HIV (PLHIV) are still often isolated from society due to stigma and discrimination. Peer support provides one avenue for increased social support. Given the limited research on peer support from the perspective of PLHIV, this study explored their experiences of peer support organised by healthcare professionals in an outpatient clinical setting. METHODS The study used a qualitative, descriptive research design for an in-depth understanding of peer support provided to PLHIV in the context of outpatient clinics. Healthcare professionals contributed to the recruitment of 16 participants. We conducted in-depth interviews about participants' experiences of peer support, and performed a directed content analysis of the data. Further, we sorted the data into pre-determined categories. RESULTS The pre-determined categories constituted attachment, social integration, an opportunity for nurturance, reassurance of worth, reliable alliance, and guidance. The identified themes were: gained emotional support, disclosure behaviour allowed garnering of emotional support, non-disclosure promoted the need to meet a peer, experienced a sense of belonging, activated an opportunity for mutual support, means to re-establish belief in one's own worth, perceived a positive affirmation of disease management, facilitated dialogue about disease management, the outpatient clinic as a safe place, and a setting for flexible, individualised support. CONCLUSIONS This study highlights the peer support experiences of PLHIV in the context of outpatient clinics. The participants' experiences align with previous findings, showing that peer support contributes to mutual emotional support between peers. This is particularly important in cultures of non-disclosure where PLHIV experience intersectional stigma. Additionally, our results show outpatient clinics to be supportive surroundings for facilitating peer support, ensuring confidentiality in peer support outreach. Therefore, peer support contributes positively to individualising outpatient clinic services to meet the changing needs of PLHIV.
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Affiliation(s)
- Anita Øgård-Repål
- Centre for Caring Research- Southern Norway, Department of Health and Nursing Science, University of Agder, Grimstad, Aust-Agder, Norway.
| | - Rigmor C Berg
- Divison of Health Services, Norwegian Institute of Public Health, Oslo, Norway.,Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Vegard Skogen
- Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Infectious Diseases, Medical Clinic, University Hospital of North Norway, Tromsø, Norway
| | - Mariann Fossum
- Centre for Caring Research- Southern Norway, Department of Health and Nursing Science, University of Agder, Grimstad, Aust-Agder, Norway
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Abstract
People living with HIV receiving antiretroviral therapy need support related to linkage to care and self-management in everyday life. Peer support has been found to provide varied support according to the unique needs of the group. This scoping review aims to provide an overview of research on peer support provided to people living with HIV. A search was conducted in eight databases until May 2021, and two reviewers independently screened all identified studies. We sorted the included studies into categories and conducted descriptive analyses. For this communication, we included 34 studies representing three study categories: the experiences of peer support (n = 23), program descriptions (n = 6), and training of peer supporters (n = 5). The studies were published between 2000 and 2021 and included 4275 participants from 10 countries. The flexibility of peer support complements healthcare services, but there is a need to clarify and adjust the ongoing support when living with HIV.
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Affiliation(s)
| | - Rigmor C Berg
- 25563Norwegian Institute of Public Health, Oslo, Norway, and University of Tromsø, Tromsø, Norway
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Berg RC, Page S, Øgård-Repål A. The effectiveness of peer-support for people living with HIV: A systematic review and meta-analysis. PLoS One 2021; 16:e0252623. [PMID: 34138897 PMCID: PMC8211296 DOI: 10.1371/journal.pone.0252623] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 05/19/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The practice of involving people living with HIV in the development and provision of healthcare has gained increasing traction. Peer-support for people living with HIV is assistance and encouragement by an individual considered equal, in taking an active role in self-management of their chronic health condition. The objective of this systematic review was to assess the effects of peer-support for people living with HIV. METHODS We conducted a systematic review in accordance with international guidelines. Following systematic searches of eight databases until May 2020, two reviewers performed independent screening of studies according to preset inclusion criteria. We conducted risk of bias assessments and meta-analyses of the available evidence in randomised controlled trials (RCTs). The certainty of the evidence for each primary outcome was evaluated with the Grading of Recommendations Assessment, Development, and Evaluation system. RESULTS After screening 219 full texts we included 20 RCTs comprising 7605 participants at baseline from nine different countries. The studies generally had low risk of bias. Main outcomes with high certainty of evidence showed modest, but superior retention in care (Risk Ratio [RR] 1.07; Confidence Interval [CI] 95% 1.02-1.12 at 12 months follow-up), antiretroviral therapy (ART) adherence (RR 1.06; CI 95% 1.01-1.10 at 3 months follow-up), and viral suppression (Odds Ratio up to 6.24; CI 95% 1.28-30.5 at 6 months follow-up) for peer-support participants. The results showed that the current state of evidence for most other main outcomes (ART initiation, CD4 cell count, quality of life, mental health) was promising, but too uncertain for firm conclusions. CONCLUSIONS Overall, peer-support with routine medical care is superior to routine clinic follow-up in improving outcomes for people living with HIV. It is a feasible and effective approach for linking and retaining people living with HIV to HIV care, which can help shoulder existing services. TRIAL REGISTRATION CRD42020173433.
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Affiliation(s)
- Rigmor C. Berg
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Institute of Community Medicine, University of Tromsø, Tromsø, Norway
| | | | - Anita Øgård-Repål
- Department of Nursing and Health Science, University of Agder, Kristiansand, Norway
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Knutson de Presno Å, Øgård-Repål A, Fossum M. Simulations with Standardized Patients for Nursing Students in Preparation for Clinical Placements in Mental Health Care. Clin Simul Nurs 2021. [DOI: 10.1016/j.ecns.2021.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Øgård-Repål A, De Presno ÅK, Fossum M. Simulation with standardized patients to prepare undergraduate nursing students for mental health clinical practice: An integrative literature review. Nurse Educ Today 2018; 66:149-157. [PMID: 29704702 DOI: 10.1016/j.nedt.2018.04.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/23/2018] [Accepted: 04/13/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate the available evidence supporting the efficacy of using simulation with standardized patients to prepare nursing students for mental health clinical practice. DESIGN Integrative literature review. DATA SOURCES A systematic search of the electronic databases CINAHL (EBSCOhost), Embase, MEDLINE, PsycINFO, and SveMed+ was conducted to identify empirical studies published until November 2016. Multiple search terms were used. Original empirical studies published in English and exploring undergraduate nursing students' experiences of simulation with standardized patients as preparation for mental health nursing practice were included. A search of reference lists and gray literature was also conducted. In total, 1677 studies were retrieved; the full texts of 78 were screened by 2 of the authors, and 6 studies reminded in the review. REVIEW METHODS The authors independently reviewed the studies in three stages by screening the titles, abstracts, and full texts, and the quality of the included studies was assessed in the final stage. Design-specific checklists were used for quality appraisal. The thematic synthesizing method was used to summarize the findings of the included studies. RESULTS The studies used four different research designs, both qualitative and quantitative. All studies scored fairly low in the quality appraisal. The five themes identified were enhanced confidence, clinical skills, anxiety regarding the unknown, demystification, and self-awareness. CONCLUSIONS The findings of this study indicate that simulation with standardized patients could decrease students' anxiety level, shatter pre-assumptions, and increase self-confidence and self-awareness before entering clinical practice in mental health. More high-quality studies with larger sample sizes are required because of the limited evidence provided by the six studies in the present review.
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Affiliation(s)
- Anita Øgård-Repål
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, Centre for Caring Research, Southern Norway, University of Agder, P.O. Box 422, 4604 Kristiansand, Norway.
| | - Åsne Knutson De Presno
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, Centre for Caring Research, Southern Norway, University of Agder, Grimstad, Norway.
| | - Mariann Fossum
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, Centre for Caring Research, Southern Norway, University of Agder, Grimstad, Norway.
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