scholarly journals Policy implementation analysis on access to healthcare among undocumented immigrants in seven autonomous communities of Spain, 2012–2018

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e045626
Author(s):  
Megi Gogishvili ◽  
Sergio A Costa ◽  
Karen Flórez ◽  
Terry T Huang
Keyword(s):  
Policy Implementation ◽  
Undocumented Immigrants ◽  
Healthcare Services ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Undocumented Migrants ◽  
Royal Decree ◽  
La Mancha ◽  
Free Healthcare ◽  
Implementation Analysis

BackgroundIn 2012, the Government of Spain enacted Royal Decree-Law (RDL) 16/2012 and Royal Decree (RD) 1192/2012 excluding undocumented immigrants from publicly funded healthcare services. We conducted a policy implementation analysis to describe and evaluate the legal and regulatory actions taken at the autonomous community (AC) level after enactment of 2012 RDL and RD and their impact on access to general healthcare and HIV services among undocumented immigrants.MethodsWe reviewed documents published by the governments of seven ACs (Andalucía, Aragón, Euskadi (Basque Country), Castilla-La Mancha, Galicia, Madrid, Valencia) from April 2012 to July 2018, describing circumstances under which undocumented immigrants would be able to access free healthcare services. We developed indicators according to the main systemic barriers presented in official documents to analyse access to free healthcare across the participating ACs. ACs were grouped under five access categories: high, medium-high, medium, medium-low and low.ResultsAndalucía provided the highest access to free healthcare for undocumented immigrants in both general care and HIV treatment. Medium-high access was provided by Euskadi and medium access by Aragón, Madrid and Valencia. Castilla-La Mancha provided medium-low access. Galicia had low access. Only Madrid and Galicia provided different and higher level of access to undocumented migrants in HIV care compared with general healthcare.ConclusionsImplementation of 2012 RDL and RD across the ACs varied significantly, in part due to the decentralisation of the Spanish healthcare system. The challenge of healthcare access among undocumented immigrants included persistent systemic restrictions, frequent and unclear rule changes, and the need to navigate differences across ACs of Spain.

scholarly journals HIV Treatment Outcomes in Rural Georgia Using Telemedicine

2021 ◽  
Author(s):  
Folake J Lawal ◽  
Moshood O Omotayo ◽  
Tae Jin Lee ◽  
Arni S R Srinivasan Rao ◽  
Jose A Vazquez
Keyword(s):  
Healthcare Access ◽  
Retrospective Chart Review ◽  
Healthcare Services ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Hiv Viral Load ◽  
Face To Face ◽  
U Statistics ◽  
Significant Difference ◽  
Hiv Treatment Outcomes

Abstract Background The increasing shortage of specialized healthcare services contributes to the ongoing HIV epidemic. Telemedicine (TM) is a potential tool to improve HIV care, but little is known about its effectiveness when compared to traditional (face-to-face) (F2F) care in rural populations. The objective of this study is to compare the effectiveness of HIV care delivered through TM with F2F model. Methods We conducted a retrospective chart review of a subset of patients with HIV who attended TM clinic in Dublin, Georgia and F2F clinic in Augusta, Georgia between May 2017 to April 2018. All TM patients were matched to F2F patients based on gender, age, and race. HIV Viral Load (VL) and CD4 count gain were compared using T-test and Mann-Whitney U Statistics. Results 385 patients were included in the analyses (F2F=200, TM=185). Mean CD4 in the TM group was higher (643.9 cells/mm3) than F2F group (596.3 cells/mm3) (p< 0.001). There was no statistically significant difference in VL reduction, control or mean VL (F2F = 416.8 cp/ml, TM = 713.4 cp/ml), (p = 0.30). Thirty-eight of eighty-five patients with detectable VL achieved viral suppression during the study period (F2F = 24/54, TM = 14/31), with a mean change of -3.34 x 10 4 and -1.24 x 10 4 respectively, p = 1.00. Conclusion TM was associated with outcome measures comparable to F2F. Increased access to specialty HIV care through TM can facilitate HIV control in communities with limited healthcare access in rural US. Rigorous prospective evaluation of TM for HIV care effectiveness is warranted.

scholarly journals Adherence to Antiretroviral Therapy among Older HIV-infected Persons Receiving Treatment in a Public Hospital in Gauteng Province

2020 ◽  
Vol 22 (2) ◽  
Author(s):  
Eucebious Lekalakala-Mokgele
Keyword(s):  
Antiretroviral Therapy ◽  
Older Persons ◽  
Public Hospital ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Gauteng Province ◽  
Individual Interviews ◽  
Purposive Sample

Adherence to antiretroviral therapy (ART) is a complex and dynamic process and remains an important issue in HIV care. Literature has highlighted sub-optimal adherence to ART across settings and populations, with many factors influencing the level of adherence. While older adults have been characterised as being more compliant, other studies have demonstrated at least 50% poor adherence. The aim of this study was to explore and describe own perspectives on adherence to ART among older persons receiving HIV treatment in a public hospital in Gauteng Province, South Africa. This study used a qualitative exploratory design that included a purposive sample of older HIV-infected men and women currently receiving HIV healthcare services from a public hospital in Gauteng Province. Individual interviews with 12 purposively selected older participants were conducted. The data were analysed using a thematic approach. Findings of the study revealed five main themes, namely: 1) disclosure, stigma and adherence; 2) drug-related side effects; 3) difficulties related to social factors and lifestyle; 4) support and adherence to ART; as well as 5) experience with the health system. Recommendations include empowering older persons in managing internalised stigma, monitoring of adherence by healthcare providers, and educating family and other support structures to form part of adherence enhancing strategies.

scholarly journals HIV TREATMENT OUTCOMES IN RURAL GEORGIA USING TELEMEDICINE

2020 ◽  
Author(s):  
Folake J. Lawal ◽  
Moshood O. Omotayo ◽  
Tae Jin Lee ◽  
Arni S.R. Srinivasan Rao ◽  
Jose A. Vazquez
Keyword(s):  
Healthcare Access ◽  
Retrospective Chart Review ◽  
Healthcare Services ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Remote Communities ◽  
Hiv Viral Load ◽  
Face To Face ◽  
Significant Difference ◽  
Hiv Treatment Outcomes

AbstractBackgroundThe dearth of specialized healthcare services contributes to the ongoing HIV epidemic. Telemedicine (TM) is a potential tool to improve HIV care, but little is known about its effectiveness when compared to traditional (face-to-face) (F2F) care in rural populations. The objective of this study is to examine the effectiveness of HIV care delivered through TM compared to F2F care.MethodsWe conducted a retrospective chart review of a subset of HIV patients who attended TM clinic in Dublin Georgia, and conventional F2F clinic in Augusta, Georgia between May 2017 to April 2018. All TM patients were matched to F2F patients based on gender, age, and race. HIV Viral Load (VL) and gain in CD4 counts were compared using T-test and Snedecor Statistics.Results385 patients were included in the analyses (F2F=200, TM=185). Mean CD4 in the TM group was higher (643.9 cells/mm3) than the F2F group (596.3 cells/mm3) (p< 0.001). There was no statistically significant difference in VL reduction and control. Thirty-eight of eighty-five patients with detectable VL achieved viral suppression during the study period (F2F = 24/54, TM =14/31), with a mean change of −3.34 × 104 and −1.24 × 104 respectively, p = 1.00. Mean VL was F2F = 416.8 cp/ml, TM = 713.4 cp/ml, p = 0.3.ConclusionTM was associated with outcome measures comparable to F2F. Increased access to specialty HIV care through TM can facilitate HIV control in communities with limited healthcare access in rural US. Rigorous prospective evaluation of TM for HIV care effectiveness is warranted.Article SummaryTelemedicine can be useful in improving access to specialist outpatient care for HIV and other chronic diseases, in remote communities with limited resources. Telemedicine can lead to similar outcomes when compared to traditional face-to-face outpatient consultations. This is especially true currently with COVID-19.

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 Gaps in the Continuum of HIV Care: Long Pretreatment Waiting Time between HIV Diagnosis and Antiretroviral Therapy Initiation Leads to Poor Treatment Adherence and Outcomes

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Shu Su ◽  
Shifu Li ◽  
Shunxiang Li ◽  
Liangmin Gao ◽  
Ying Cai ◽  
...  
Keyword(s):  
Treatment Adherence ◽  
Waiting Time ◽  
Cox Regression ◽  
Treatment Guidelines ◽  
Current Treatment ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Hiv Diagnosis ◽  
Treatment Data ◽  
Poor Treatment

Background.Criteria for antiretroviral treatment (ART) were adjusted to enable early HIV treatment for people living HIV/AIDS (PLHIV) in China in recent years. This study aims to determine how pretreatment waiting time after HIV confirmation affects subsequent adherence and outcomes over the course of treatment.Methods.A retrospective observational cohort study was conducted using treatment data from PLHIV in Yuxi, China, between January 2004 and December 2015.Results.Of 1,663 participants, 348 were delayed testers and mostly initiated treatment within 28 days. In comparison, 1,315 were nondelayed testers and the median pretreatment waiting time was 599 days, but it significantly declined over the study period. Pretreatment CD4 T-cell count drop (every 100 cells/mm3) contributed slowly in CD4 recovery after treatment initiation (8% less,P<0.01) and increased the risk of poor treatment adherence by 15% (ARR = 1.15, 1.08–1.25). Every 100 days of extensive pretreatment waiting time increased rates of loss to follow-up by 20% (ARR = 1.20, 1.07–1.29) and mortality rate by 11% (ARR = 1.11, 1.06–1.21), based on multivariable Cox regression.Conclusion.Long pretreatment waiting time in PLHIV can lead to higher risk of poor treatment adherence and HIV-related mortality. Current treatment guidelines should be updated to provide ART promptly.

scholarly journals Engaging the ‘Missing Men’ in the HIV Treatment Cascade: Creating a Tailored Intervention to Improve Men’s Uptake of HIV Care Services in Rural South Africa: A Study Protocol

2021 ◽  
Vol 18 (7) ◽  
pp. 3709
Author(s):  
Oluwafemi Adeagbo ◽  
Kammila Naidoo
Keyword(s):  
South Africa ◽  
Health Outcomes ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Treatment Cascade ◽  
Hiv Care Cascade ◽  
Care Services ◽  
The Social ◽  
Hiv Treatment Cascade ◽  
Male Specific

Men, especially young men, have been consistently missing from the HIV care cascade, leading to poor health outcomes in men and ongoing transmission of HIV in young women in South Africa. Although these men may not be missing for the same reasons across the cascade and may need different interventions, early work has shown similar trends in men’s low uptake of HIV care services and suggested that the social costs of testing and accessing care are extremely high for men, particularly in South Africa. Interventions and data collection have hitherto, by and large, focused on men in relation to HIV prevention in women and have not approached the problem through the male lens. Using the participatory method, the overall aim of this study is to improve health outcomes in men and women through formative work to co-create male-specific interventions in an HIV-hyper endemic setting in rural KwaZulu-Natal, South Africa.

Impact of the Ebola epidemic on clinical outcomes of HIV-infected soldiers and their dependents in Sierra Leone

2018 ◽  
Vol 30 (2) ◽  
pp. 106-112 ◽  
Author(s):  
Elizabeth Nagel ◽  
Michael J Blackowicz ◽  
Foday Sahr ◽  
Olamide D Jarrett
Keyword(s):  
Clinical Outcomes ◽  
Sierra Leone ◽  
Repeated Measures ◽  
Disease Outbreaks ◽  
Armed Forces ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Increased Risk ◽  
The Republic ◽  
The Impact

The impact of the 2014–2016 Ebola epidemic in West Africa on human immunodeficiency virus (HIV) treatment in Sierra Leone is unknown, especially for groups with higher HIV prevalence such as the military. Using a retrospective study design, clinical outcomes were evaluated prior to and during the epidemic for 264 HIV-infected soldiers of the Republic of Sierra Leone Armed Forces (RSLAF) and their dependents receiving HIV treatment at the primary RSLAF HIV clinic. Medical records were abstracted for baseline clinical data and clinic attendance. Estimated risk of lost to follow-up (LTFU), default, and number of days without antiretroviral therapy (DWA) were calculated using repeated measures general estimating equations adjusted for age and gender. Due to missing data, 262 patients were included in the final analyses. There was higher risk of LTFU throughout the Ebola epidemic in Sierra Leone compared to the pre-Ebola baseline, with the largest increase in LTFU risk occurring at the peak of the epidemic (relative risk: 3.22, 95% CI: 2.22–4.67). There was an increased risk of default and DWA during the Ebola epidemic for soldiers but not for their dependents. The risk of LTFU, default, and DWA stabilized once the epidemic was largely resolved but remained elevated compared to the pre-Ebola baseline. Our findings demonstrate the negative and potentially lasting impact of the Ebola epidemic on HIV care in Sierra Leone and highlight the need to develop strategies to minimize disruptions in HIV care with future disease outbreaks.

Smoke-Free Healthcare Services

1995 ◽  
pp. 489-490
Author(s):  
R. Masironi ◽  
T. Hurst
Keyword(s):  
Healthcare Services ◽  
Free Healthcare

scholarly journals Influence of Material Deprivation on Clinical Outcomes Among People Living with HIV in High-Income Countries: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Vasiliki Papageorgiou ◽  
Bethan Davies ◽  
Emily Cooper ◽  
Ariana Singer ◽  
Helen Ward
Keyword(s):  
Systematic Review ◽  
Social Determinants ◽  
Meta Analysis ◽  
Hiv Treatment ◽  
Material Deprivation ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Care Continuum ◽  
Care Continuum ◽  
Living With Hiv

AbstractDespite developments in HIV treatment and care, disparities persist with some not fully benefiting from improvements in the HIV care continuum. We conducted a systematic review to explore associations between social determinants and HIV treatment outcomes (viral suppression and treatment adherence) in high-income countries. A random effects meta-analysis was performed where there were consistent measurements of exposures. We identified 83 observational studies eligible for inclusion. Social determinants linked to material deprivation were identified as education, employment, food security, housing, income, poverty/deprivation, socioeconomic status/position, and social class; however, their measurement and definition varied across studies. Our review suggests a social gradient of health persists in the HIV care continuum; people living with HIV who reported material deprivation were less likely to be virologically suppressed or adherent to antiretrovirals. Future research should use an ecosocial approach to explore these interactions across the lifecourse to help propose a causal pathway.

scholarly journals Transition to adult care: Exploring factors associated with transition readiness among adolescents and young people in adolescent ART clinics in Uganda

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249971
Author(s):  
Scovia Nalugo Mbalinda ◽  
Sabrina Bakeera-Kitaka ◽  
Derrick Amooti Lusota ◽  
Philippa Musoke ◽  
Mathew Nyashanu ◽  
...  
Keyword(s):  
Young People ◽  
Tertiary Education ◽  
Multivariate Logistic Regression Analysis ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Transition To Adult Care ◽  
People Living With Hiv ◽  
Adult Care ◽  
Transition Readiness ◽  
Factors Associated

Background Transition readiness refers to a client who knows about his/her illness and oriented towards future goals and hopes, shows skills needed to negotiate healthcare, and can assume responsibility for his/ her treatment, and participate in decision-making that ensures uninterrupted care during and after the care transition to adult HIV care. There is a paucity of research on effective transition strategies. This study explored factors associated with adolescent readiness for the transition into adult care in Uganda. Methods A cross-sectional study was conducted among 786 adolescents, and young people living with HIV randomly selected from 9 antiretroviral therapy clinics, utilizing a structured questionnaire. The readiness level was determined using a pre-existing scale from the Ministry of Health, and adolescents were categorized as ready or not ready for the transition. Bivariate and multivariate analyses were conducted. Results A total of 786 adolescents were included in this study. The mean age of participants was 17.48 years (SD = 4). The majority of the participants, 484 (61.6%), were females. Most of the participants, 363 (46.2%), had no education. The majority of the participants, 549 (69.8%), were on first-line treatment. Multivariate logistic regression analysis found that readiness to transition into adult care remained significantly associated with having acquired a tertiary education (AOR 4.535, 95% CI 1.243–16.546, P = 0.022), trusting peer educators for HIV treatment (AOR 16.222, 95% CI 1.835–143.412, P = 0.012), having received counselling on transition to adult services (AOR 2.349, 95% CI 1.004–5.495, P = 0.049), having visited an adult clinic to prepare for transition (AOR 6.616, 95% CI 2.435–17.987, P = < 0.001) and being satisfied with the transition process in general (AOR 0.213, 95% CI 0.069–0.658, P = 0.007). Conclusion The perceived readiness to transition care among young adults was low. A series of individual, social and health system and services factors may determine successful transition readiness among adolescents in Uganda. Transition readiness may be enhanced by strengthening the implementation of age-appropriate and individualized case management transition at all sites while creating supportive family, peer, and healthcare environments.

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