scholarly journals My family sold a cow to pay for my Traditional doctor and now there’s no money to travel to the HIV clinic: barriers to antiretroviral adherence among rural-Indigenous peoples living with HIV in the Comarca Ngäbe-Buglé, Panamá

2021 ◽  
Author(s):  
Amanda Gabster ◽  
Eliana Socha ◽  
Juan Miguel Pascale ◽  
Gonzalo Cabezas Talavero ◽  
Alezander Castrellón ◽  
...  
Keyword(s):  
Psychological Health ◽  
Opportunistic Infections ◽  
Hiv Care ◽  
Structural Barriers ◽  
Medical Systems ◽  
Structured Interviews ◽  
Middle Income ◽  
Antiretroviral Adherence ◽  
Individual Level ◽  
Retention In Hiv Care

AbstractIntroductionThe Comarca Ngäbe-Buglé (CNB) is an administratively autonomous Indigenous region in Western Panama that is home to over 200,000 individuals of Ngäbe and Buglé ethnicities. The CNB is the most impoverished region in Panama and is relatively isolated from outside influences, with limited roads, electricity, and internet connection. Around 1.5% of all rapid HIV tests are positive, compared to a national prevalence of 0.9%; in CNB, diagnosis tends to be late where 56.3% of individuals had an initial CD4 count of <350 cells/mm3. In this region, antiretroviral treatment (ART) dropout is five times higher than the national average; there is high early mortality due to opportunistic infections. This study aims to describe some of the barriers associated with ART adherence and retention in HIV care among PLHIV the CNB. A better understanding of factors that obstruct adherence could lead to more effective HIV care and prevention in CNB.MethodsWe conducted 21 semi-structured interviews with PLHIV who reside across all three regions of the CNB and who have attended an ART clinic at least once. The interviews took place between November 2018 and December 2019.DiscussionPsychological health and social support and discrimination acted as both individual-level facilitators and barriers to adherence and retention. Notably, structural barriers included difficult access to ART care due to travel costs, ART shortages, and uncooperative Western/Traditional medical systems. Recommended interventions used in other Low- and Middle-Income settings include increasing peer and family-level support and community knowledge and understanding of HIV infection. Additionally, we suggest structural interventions, including decreasing cost and distance of travel to the ART clinic through decentralization of services and multi-month dispensing, decreasing food scarcity, and increasing collaboration between Western and Traditional providers.

scholarly journals Video-Based Intervention for Improving Maternal Retention and Adherence to HIV Treatment: Patient Perspectives and Experiences

2021 ◽  
Vol 18 (4) ◽  
pp. 1737
Author(s):  
Steven Masiano ◽  
Edwin Machine ◽  
Mtisunge Mphande ◽  
Christine Markham ◽  
Tapiwa Tembo ◽  
...  
Keyword(s):  
Positive Impact ◽  
Low Cost ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Structured Interviews ◽  
Convenience Sample ◽  
Long Term Conditions ◽  
Art Initiation ◽  
Retention In Hiv Care

VITAL Start is a video-based intervention aimed to improve maternal retention in HIV care and adherence to antiretroviral therapy (ART) in Malawi. We explored the experiences of pregnant women living with HIV (PWLHIV) not yet on ART who received VITAL Start before ART initiation to assess the intervention’s acceptability, feasibility, fidelity of delivery, and perceived impact. Between February and September 2019, we conducted semi-structured interviews with a convenience sample of 34 PWLHIV within one month of receiving VITAL Start. The participants reported that VITAL Start was acceptable and feasible and had good fidelity of delivery. They also reported that the video had a positive impact on their lives, encouraging them to disclose their HIV status to their sexual partners who, in turn, supported them to adhere to ART. The participants suggested using a similar intervention to provide health-related education/counseling to people with long term conditions. Our findings suggest that video-based interventions may be an acceptable, feasible approach to optimizing ART retention and adherence amongst PWLHIV, and they can be delivered with high fidelity. Further exploration of the utility of low cost, scalable, video-based interventions to address health counseling gaps in sub-Saharan Africa is warranted.

scholarly journals Provider Perceptions of Barriers to HIV Care Among Women with HIV in Miami-Dade County, Florida, and Possible Solutions: A Qualitative Study

2021 ◽  
Vol 20 ◽  
pp. 232595822110535
Author(s):  
Melissa K. Ward ◽  
Yazmine de la Cruz ◽  
Sofia B. Fernandez ◽  
Gladys E. Ibañez ◽  
Michèle Jean-Gilles ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Barriers To Care ◽  
Hiv Care ◽  
Dade County ◽  
Care Providers ◽  
Structural Barriers ◽  
Structured Interviews ◽  
Provider Perceptions ◽  
Medical Case ◽  
Women With Hiv

In Miami-Dade County, women with HIV (WWH) enrolled in Ryan White Program (RWP) services belong to groups that have historically faced structural barriers to care. To examine provider perceptions of WWH's barriers to care and elicit possible solutions, we conducted semi-structured interviews (n = 20) with medical case managers and human immunodeficiency virus (HIV) healthcare providers from medical case management sites serving WWH enrolled in the Miami-Dade RWP. Verbatim transcripts were analyzed thematically by two coders through an iterative process; disagreements were resolved through consensus. Barriers included lack of disclosure and stigma, additional psychosocial barriers to care, structural and logistical barriers, and negative interactions with health care providers. Participant suggestions to address these barriers included strategies that support women and foster individualized services that are responsive to their lived experiences and needs. Other solutions, such as those related to transportation, housing, and general funding for the RWP, will require advocacy and policy change.

scholarly journals Ethical issues in the use of SMS messaging in HIV care and treatment in low- and middle-income countries: case examples from Mozambique

2017 ◽  
Vol 25 (4) ◽  
pp. 423-427 ◽  
Author(s):  
Ezequiel B Ossemane ◽  
Troy D Moon ◽  
Martin C Were ◽  
Elizabeth Heitman
Keyword(s):  
Large Scale ◽  
Ethical Issues ◽  
Scale Up ◽  
Hiv Care ◽  
Ethical Framework ◽  
Middle Income ◽  
Middle Income Countries ◽  
Retention In Hiv Care ◽  
Care And Treatment ◽  
Low And Middle Income

Abstract The introduction of mobile communication technologies in health care in low- and middle-income countries offers an opportunity for increased efficiencies in provision of care, improved utilization of scarce resources, reductions in workload, and increased reach of services to a larger target population. Short message service (SMS) technologies offer promise, with several large-scale SMS-based implementations already under way. Still largely lacking in the research literature are evaluations of specific ethical issues that arise when SMS programs are implemented and studied in resource-limited settings. In this paper, we examine the ethical issues raised by the deployment of SMS messaging to support patient retention in HIV care and treatment and in the research conducted to evaluate that deployment. We use case studies that are based in Mozambique and ground our discussion in the ethical framework for international research proposed by Emanuel et al., highlighting ethical considerations needed to guide the design and implementation of future SMS-based interventions. Such guidance is increasingly needed in countries such as Mozambique, where the local capacity for ethical study design and oversight is still limited and the scale-up and study of mHealth initiatives are still driven predominantly by international collaborators. These issues can be complex and will need ongoing attention on a case-by-case basis to ensure that appropriate protections are in place, while simultaneously maximizing the potential benefit of new mHealth technologies.

Behind prison walls: HIV vulnerability of female Filipino prisoners

2019 ◽  
Vol 15 (3) ◽  
pp. 232-243
Author(s):  
Diana M. Palma ◽  
Jennifer Parr
Keyword(s):  
Management Practices ◽  
Ecological Model ◽  
The Philippines ◽  
Hiv Care ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Hiv Knowledge ◽  
Middle Income ◽  
Content Type ◽  
Hiv Vulnerability

Purpose The imprisoned population is increasing worldwide and is overrepresented in the HIV epidemic. The purpose of this paper is to explore the HIV vulnerability of female Filipinos who are pre-trial prisoners, as the specific needs of imprisoned women are poorly understood and fewer resources are granted to pre-trial detainees, especially in low and middle-income countries (LMICs). Design/methodology/approach This study was based on a Qualitative Descriptive Design. In total, 18 semi-structured interviews were conducted with prisoners and NGO directors. Data were analysed through Framework Analysis, using the individual, social and community categories of the Modified Socio-Ecological Model. Findings Results from this study suggest that the prison environment and management practices maximise the HIV vulnerability in the sample. This vulnerability is shaped by low HIV knowledge, combined with the existence of multiple social vulnerabilities prior to incarceration. Social implications HIV care in Filipino prisons needs urgent attention from government and international organisations, as it is a major public health and human rights concern. International goals of ending the epidemic by 2030 cannot be reached if efforts are not translated into action within this setting. Originality/value In the Philippines, few studies have addressed this issue and little is known about the conditions of Filipino prisons. This paper aims to fill a gap in literature regarding the vulnerability of imprisoned women in LMICs, which is even more limited in examining pre-trial detention.

scholarly journals Improving retention in HIV care among adolescents and adults in low- and middle-income countries: A systematic review of the literature

PLoS ONE ◽  
2017 ◽  
Vol 12 (9) ◽  
pp. e0184879 ◽  
Author(s):  
Kate R. Murray ◽  
Lisa S. Dulli ◽  
Kathleen Ridgeway ◽  
Leila Dal Santo ◽  
Danielle Darrow de Mora ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hiv Care ◽  
Review Of The Literature ◽  
Middle Income ◽  
Middle Income Countries ◽  
Retention In Hiv Care ◽  
Adolescents And Adults ◽  
Low And Middle Income

scholarly journals “Most of what they do, we cannot do!” How lay health workers respond to barriers to uptake and retention in HIV care among pregnant and breastfeeding mothers in Malawi

2020 ◽  
Vol 5 (6) ◽  
pp. e002220
Author(s):  
Stephanie M Topp ◽  
Nicole B Carbone ◽  
Jennifer Tseka ◽  
Linda Kamtsendero ◽  
Godfrey Banda ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Health System ◽  
Social Connectedness ◽  
Health Workers ◽  
Retention In Care ◽  
Hiv Care ◽  
Lay Health Workers ◽  
Structured Interviews ◽  
Retention In Hiv Care ◽  
Treat All

BackgroundIn the era of Option B+ and ‘treat all’ policies for HIV, challenges to retention in care are well documented. In Malawi, several large community-facility linkage (CFL) models have emerged to address these challenges, training lay health workers (LHW) to support the national prevention of mother-to-child transmission (PMTCT) programme. This qualitative study sought to examine how PMTCT LHW deployed by Malawi’s three most prevalent CFL models respond to known barriers to access and retention to antiretroviral therapy (ART) and PMTCT.MethodsWe conducted a qualitative study, including 43 semi-structured interviews with PMTCT clients; 30 focus group discussions with Ministry of Health (MOH)-employed lay and professional providers and PMTCT LHWs; a facility CFL survey and 2–4 hours of onsite observation at each of 8 sites and in-depth interviews with 13 programme coordinators and MOH officials. Thematic analysis was used, combining inductive and deductive approaches.ResultsAcross all three models, PMTCT LHWs carried out a number of ‘targeted’ activities that respond directly to a range of known barriers to ART uptake and retention. These include: (i) fulfilling counselling and educational functions that responded to women’s fears and uncertainties; (ii) enhancing women’s social connectedness and participation in their own care and (iii) strengthening service function by helping clinic-based providers carry out duties more efficiently and effectively. Beyond absorbing workload or improving efficiency, however, PMTCT LHWs supported uptake and retention through foundational but often intangible work to strengthen CFL, including via efforts to strengthen facility-side responsiveness, and build community members’ recognition of and trust in services.ConclusionPMTCT LHWs in each of the CFL models examined, addressed social, cultural and health system factors influencing client access to, and engagement with, HIV care and treatment. Findings underscore the importance of person-centred design in the ‘treat-all’ era and the contribution LHWs can make to this, but foreground the challenges of achieving person-centredness in the context of an under-resourced health system. Further work to understand the governance and sustainability of these project-funded CFL models and LHW cadres is now urgently required.

scholarly journals Why do patients interrupt and return to antiretroviral therapy? Retention in HIV care from the patient’s perspective in Johannesburg, South Africa

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0256540
Author(s):  
Melanie A. Bisnauth ◽  
Natasha Davies ◽  
Sibongile Monareng ◽  
Fezile Buthelezi ◽  
Helen Struthers ◽  
...  
Keyword(s):  
South Africa ◽  
Antiretroviral Therapy ◽  
Health Services ◽  
Healthcare Providers ◽  
Retention In Care ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Structured Interviews ◽  
Related Factors ◽  
Retention In Hiv Care

Background Retention in care is required for optimal clinical outcomes in people living with HIV (PLHIV). Although most PLHIV in South Africa know their HIV status, only 70% are on antiretroviral therapy (ART). Improved retention in care is needed to get closer to sustained ART for all. In January 2019, Anova Health Institute conducted a campaign to encourage patients who had interrupted ART to return to care. Methods Data collection was conducted in one region of Johannesburg. This mixed methods study consisted of two components: 1) healthcare providers entered data into a structured tool for all patients re-initiating ART at nine clinics over a nine-month period, 2) Semi-structured interviews were conducted with a sub-set of patients. Responses to the tool were analysed descriptively, we report frequencies, and percentages. A thematic approach was used to analyse participant experiences in-depth. Results 562 people re-initiated ART, 66% were women, 75% were 25–49 years old. The three most common reasons for disengagement from care were mobility (30%), ART related factors (15%), and time limitations due to work (10%). Reasons for returning included it becoming easier to attend the clinic (34%) and worry about not being on ART (19%). Mobile interview participants often forgot their medical files and expressed that managing their ART was difficult because they often needed a transfer letter to gain access to ART at another facility. On the other hand, clinics that had flexible and extended hours facilitated retention in care. Conclusion In both the quantitative data, and the qualitative analysis, changing life circumstances was the most prominent reason for disengagement from care. Health services were not perceived to be responsive to life changes or mobility, leading to disengagement. More client-centred and responsive health services should improve retention on ART.

scholarly journals Enlaces Por La Salud: A Personal Health Navigator Intervention Grounded in the Transnational Framework

2021 ◽  
Author(s):  
Lisa Hightow-Weidman ◽  
Joaquin Carcano ◽  
Seul Ki Choi ◽  
Lynne Sampson ◽  
Clare Barrington
Keyword(s):  
Hiv Care ◽  
Successful Implementation ◽  
Intervention Delivery ◽  
Individual Level ◽  
Implementation Outcomes ◽  
Retention In Hiv Care ◽  
Care Outcomes ◽  
Living With Hiv ◽  
Mexican Men ◽  
Disproportionate Burden

AbstractDespite the disproportionate burden of HIV among Latinxs, there is a paucity of culturally appropriate interventions that have shown efficacy at increasing their engagement and retention in HIV care. We describe the development and implementation of Enlaces, a six-session, individual-level intervention, guided by the transnational framework, to improve HIV care outcomes for newly diagnosed and out-of-care Mexican men and transgender women (TW). Descriptive statistics summarizing baseline data and implementation outcomes are provided. 91 participants enrolled between October 2014 and August 2017. Intervention engagement and satisfaction was high; 81.3% completed all six sessions and 100% were very satisfied/satisfied with their experience. Successful implementation of the ENLACES intervention was the result of establishing client trust and maintaining a flexible, supportive approach to intervention delivery. Use of the transnational framework provided a contextualized approach to engaging with Mexican men and TW living with HIV that can be adapted to other Latino populations.

scholarly journals Good Intentions: Women’s Narratives of Post-Release Anticipatory Desistance in the Context of Historical and Contemporary Disadvantage and Trauma

2020 ◽  
Vol 15 (5) ◽  
pp. 519-544
Author(s):  
Rachel Hale
Keyword(s):  
Incarcerated Women ◽  
Structural Barriers ◽  
Structured Interviews ◽  
Formerly Incarcerated ◽  
Individual Level ◽  
Women's Narratives ◽  
Perspective Drawing ◽  
Male Experience ◽  
Formerly Incarcerated Women ◽  
Criminalized Women

Desistance theorizing has concentrated on the male experience resulting in relatively less knowledge about how criminalized women negotiate nonoffending, particularly from a qualitative perspective. Drawing on semi-structured interviews with eight formerly incarcerated women in Victoria, Australia, this research explores the anticipation of desistance in the context of experiences preceding and following incarceration. The findings highlight how individual-level intentions to cease offending can be eclipsed by historical and ongoing disadvantage and trauma. In emphasizing the gendered socio-structural barriers affecting women’s desistance efforts, this article contributes to a small, yet important, emerging discourse—a form of critical feminist desistance.

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