scholarly journals Healthcare Workers’ Perspectives on the Barriers to Providing HIV Services to Children in Sub-Saharan Africa

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Chipo Mutambo ◽  
Khumbulani Hlongwana
Keyword(s):  
Hiv Testing ◽  
Healthcare Workers ◽  
Scale Up ◽  
Primary Caregivers ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Public Health Response ◽  
Hiv Services ◽  
Child Friendly ◽  
Sub Saharan

Background. In order to accelerate the HIV response to meet the UNAIDS 90-90-90 indicators for children, healthcare workers need to lead a scale-up of HIV services in primary healthcare settings. Such a scale-up will require investigation into existing barriers that prevent healthcare workers from effectively providing those services to children. Furthermore, if the identified barriers are not well understood, designing context-specific and effective public health response programmes may prove difficult. Objective. This study reviews the current literature pertaining to healthcare workers' perspectives on the barriers to providing HIV services to children in the primary care setting in Sub-Saharan Africa. Methods. English articles published between 2010 and April 2018 were searched in electronic databases including Sabinet, MEDLINE, PubMed, and Google Scholar. Key search words used during the search were “healthcare workers’ perspectives” and “barriers to providing HIV testing to children” OR “barriers to ART adherence AND children” and “barriers to HIV disclosure AND children.” Results. There are various barriers to provider-initiated counselling and testing (PICT) of children and disclosure of HIV status to children, including the following: lack of child-friendly infrastructure at clinics; lack of consensus on legal age of consent for both HIV testing and disclosure; healthcare worker unfamiliarity with HIV testing and disclosure guidelines; lack of training in child psychology; and confusion around the healthcare worker’s role, which most believed was only to provide health education and clinical services and to correct false information, but not to participate in disclosure. Additionally, primary caregivers were reported to be a barrier to care and treatment of children as they continue to refuse HIV testing for their children and delay disclosure. Conclusion. Training, mentoring, and providing healthcare workers with guidelines on how to provide child-focused HIV care have the potential to address the majority of the barriers to the provision of child-friendly HIV services to children. However, the need to educate primary caregivers on the importance of testing children and disclosing to them is equally important.

scholarly journals Readiness of Sub-Saharan Africa Healthcare Systems for the New Pandemic, Diabetes: A Systematic Review

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Bernardo Nuche-Berenguer ◽  
Linda E. Kupfer
Keyword(s):  
Systematic Review ◽  
Health Systems ◽  
Diabetes Care ◽  
Healthcare Workers ◽  
Scale Up ◽  
Sub Saharan Africa ◽  
Diagnostic Tools ◽  
Inclusion Criteria ◽  
Care Health ◽  
Sub Saharan

Background. Effective health systems are needed to care for the coming surge of diabetics in sub-Saharan Africa (SSA). Objective. We conducted a systematic review of literature to determine the capacity of SSA health systems to manage diabetes. Methodology. We used three different databases (Embase, Scopus, and PubMed) to search for studies, published from 2004 to 2017, on diabetes care in SSA. Results. Fifty-five articles met the inclusion criteria, covering the different aspects related to diabetes care such as availability of drugs and diagnostic tools, the capacity of healthcare workers, and the integration of diabetes care into HIV and TB platforms. Conclusion. Although chronic care health systems in SSA have developed significantly in the last decade, the capacity for managing diabetes remains in its infancy. We identified pilot projects to enhance these capacities. The scale-up of these pilot interventions and the integration of diabetes care into existing robust chronic disease platforms may be a feasible approach to begin to tackle the upcoming pandemic in diabetes. Nonetheless, much more work needs to be done to address the health system-wide deficiencies in diabetes care. More research is also needed to determine how to integrate diabetes care into the healthcare system in SSA.

scholarly journals Evaluating the Integrated Methadone and Anti-Retroviral Therapy Strategy in Tanzania Using the RE-AIM Framework

2019 ◽  
Vol 16 (5) ◽  
pp. 728
Author(s):  
Saria Hassan ◽  
Alexis Cooke ◽  
Haneefa Saleem ◽  
Dorothy Mushi ◽  
Jessie Mbwambo ◽  
...  
Keyword(s):  
Care Delivery ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Hiv Positive ◽  
Initiation Rate ◽  
Hiv Services ◽  
Art Initiation ◽  
Care Integration ◽  
Therapy Strategy ◽  
Sub Saharan

There are an estimated 50,000 people who inject drugs in Tanzania, with an HIV prevalence in this population of 42%. The Integrated Methadone and Anti-Retroviral Therapy (IMAT) strategy was developed to integrate HIV services into an opioid treatment program (OTP) in sub-Saharan Africa and increase anti-retroviral therapy (ART) initiation rates. In this paper, we evaluate the IMAT strategy using an implementation science framework to inform future care integration efforts in the region. IMAT centralized HIV services into an OTP clinic in Dar Es Salaam, Tanzania: HIV diagnosis, ART initiation, monitoring and follow up. A mixed-methods, concurrent design, was used for evaluation: quantitative programmatic data and semi-structured interviews with providers and clients addressed 4 out of 5 components of the RE-AIM framework: reach, effectiveness, adoption, implementation. Results showed high reach: 98% of HIV-positive clients received HIV services; effectiveness: 90-day ART initiation rate doubled, from 41% pre-IMAT to 87% post-IMAT (p < 0.001); proportion of HIV-positive eligible clients on ART increased from 71% pre-IMAT to 98% post-IMAT (p < 0.001). There was high adoption and implementation protocol fidelity. Qualitative results informed barriers and facilitators of RE-AIM components. In conclusion, we successfully integrated HIV care into an OTP clinic in sub-Saharan Africa with increased rates of ART initiation. The IMAT strategy represents an effective care integration model to improve HIV care delivery for OTP clients.

scholarly journals Accessing antiretroviral therapy for children: Caregivers' voices

2016 ◽  
Vol 21 ◽  
pp. 331-338
Author(s):  
Margaret Williams ◽  
Dalena R.M. Van Rooyen ◽  
Esmeralda J. Ricks
Keyword(s):  
Antiretroviral Therapy ◽  
Tertiary Care ◽  
Scale Up ◽  
Target Population ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Hiv Positive ◽  
Eastern Cape ◽  
Care Facilities ◽  
Sub Saharan

Despite efforts to scale up access to antiretroviral therapy (ART), particularly at primary health care (PHC) facilities, antiretroviral therapy (ART) continues to be out of reach formany human immunodeficiency virus (HIV)-positive children in sub-Saharan Africa. In resource limited settings decentralisation of ART is required to scale up access to essential medication. Traditionally, paediatric HIV care has been provided in tertiary care facilities which have better human and material resources, but limited accessibility in terms of distance for caregivers of HIV-positive children. The focus of this article is on the experiences of caregivers whilst accessing ART for HIV-positive children at PHC (decentralised care) facilities in Nelson Mandela Bay (NMB) in the Eastern Cape, South Africa. A qualitative, explorative, descriptive and contextual research design was used. The target population comprised caregivers of HIV-positive children. Data were collected by means of indepth individual interviews, which were thematically analysed. Guba's model was usedto ensure trustworthiness. Barriers to accessing ART at PHC clinics for HIV-positive children included personal issues, negative experiences, lack of support and finance, stigma and discrimination. The researchers recommend standardised programmes be developed and implemented in PHC clinics to assist in providing treatment, care and support for HIV positive children.

scholarly journals Strengthening Health Systems for Chronic Care: Leveraging HIV Programs to Support Diabetes Services in Ethiopia and Swaziland

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Miriam Rabkin ◽  
Zenebe Melaku ◽  
Kerry Bruce ◽  
Ahmed Reja ◽  
Alison Koler ◽  
...  
Keyword(s):  
Chronic Care ◽  
Rapid Assessment ◽  
Scale Up ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
The Status ◽  
Care Systems ◽  
Care And Treatment ◽  
Sub Saharan ◽  
Hiv Programs

The scale-up of HIV services in sub-Saharan Africa has catalyzed the development of highly effective chronic care systems. The strategies, systems, and tools developed to support life-long HIV care and treatment are locally owned contextually appropriate resources, many of which could be adapted to support continuity care for noncommunicable chronic diseases (NCD), such as diabetes mellitus (DM). We conducted two proof-of-concept studies to further the understanding of the status of NCD programs and the feasibility and effectiveness of adapting HIV program-related tools and systems for patients with DM. In Swaziland, a rapid assessment illustrated gaps in the approaches used to support DM services at 15 health facilities, despite the existence of chronic care systems at HIV clinics in the same hospitals, health centers, and clinics. In Ethiopia, a pilot study found similar gaps in DM services at baseline and illustrated the potential to rapidly improve the quality of care and treatment for DM by adapting HIV-specific policies, systems, and tools.

scholarly journals Effect of Female Sex Work Targeted Community-based Interventions Along the HIV Treatment Cascade in Sub-Saharan Africa: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Lydia Atuhaire ◽  
Olatunji Adetokunboh ◽  
Constance Shumba ◽  
Peter S Nyasulu
Keyword(s):  
Hiv Testing ◽  
Meta Analysis ◽  
Hiv Care ◽  
Hiv Diagnosis ◽  
Community Based Interventions ◽  
Community Based ◽  
Hiv Services ◽  
Hiv Care Cascade ◽  
Care Cascade ◽  
Sub Saharan

Abstract Background: Female Sex Workers are extremely vulnerable and highly susceptibility to being infected with human immunodeficiency virus. As a result, community based targeted interventions have been recommended as one of the models of care to improve access to HIV services and continued engagement in care. However little is known about the specific community intervention packages that have optimal effect on FSWs access and retention in HIV care. This paper synthesized evidence on the effectiveness of community-based interventions that provided HIV services to FSWs across all stages of HIV care cascade.Methods: We defined the 5 steps that make up the HIV care cascade and categorized them as outcomes, namely HIV testing, HIV diagnosis, linkage to care, ART use and viral suppression. We conducted a systematic search of randomized controlled trials, cohort and cross sectional studies done in sub-Saharan African countries and published from 2004 to 2020. We reviewed studies with data on the implementation of community interventions for any of the HIV care cascade stage. The data were analyzed using random effects meta-analysis where possible and for the rest of the studies, data were synthesized using summary statistics. Results: The significant impact of the community interventions was observed on HIV testing, HIV diagnosis and ART use. However, for HIV testing and ART use, the improvement was not sustained for the entire period of implementation. There were minimal interventions that had impact on HIV diagnosis, with only one community service delivery model showing significance. Generally, the interventions that had reasonable impact are those that implemented targeted and comprehensive package of HIV services provided at one location, and with unique strategies specific to each cascade stage.Conclusions: The effect of community-based interventions varies across the different stages of HIV care cascade with impact observed in specific strategies with features unique to each cascade stage. Moreover, positive effects of these strategies were short term and with small-scale implementation. As such, the information on long-term treatment outcomes, and the extent to which FSWs remain engaged in care is sparse. There is need to conduct a further research to deepen the assessment of the effectiveness of community-based interventions on HIV care cascade for FSWs. This will enhance identification of evidence based optimal interventions that will guide effective allocation of scarce resources for strategies that would have a significant impact on HIV service delivery.Systematic review registration: PROSPERO CRD42020157623.

scholarly journals Gendered relationship between HIV stigma and HIV testing among men and women in Mozambique: a cross-sectional study to inform a stigma reduction and male-targeted HIV testing intervention

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e029748 ◽  
Author(s):  
Judy H Ha ◽  
Lynn M Van Lith ◽  
Elizabeth C Mallalieu ◽  
Jose Chidassicua ◽  
Maria Dirce Pinho ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Sub Saharan Africa ◽  
Hiv Stigma ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Community Group ◽  
Cross Sectional ◽  
Men And Women ◽  
Sub Saharan ◽  
The Relationship

ObjectivesIncreasing and sustaining engagement in HIV care for people living with HIV are critical to both individual therapeutic benefit and epidemic control. Men are less likely to test for HIV compared with women in sub-Saharan African countries, and ultimately have delayed entry to HIV care. Stigma is known to impede such engagement, placing an importance on understanding and addressing stigma to improve HIV testing and care outcomes. This study aimed to assess the gendered differences in the relationship between stigma and HIV testing.Design and settingA cross-sectional, household probability survey was implemented between November and December 2016 in the Sofala province of Mozambique.ParticipantsData were restricted to men and women participants who reported no prior diagnosis of HIV infection (N=2731).MeasuresMeasures of sociodemographic characteristics, stigma and past exposure to HIV interventions were included in gender-stratified logistic regression models to estimate the relationship between stigma and recent testing for HIV, as well as to identify other relevant correlates.ResultsSignificantly fewer men (38.3%) than women (47.6%; p<0.001) had recently tested for HIV. Men who reported previous engagement in community group discussions about HIV had an increased odds of testing in the past 12 months compared to those who had not participated (adjusted OR (aOR)=1.92; 95% CI 1.51 to 2.44). Concerns about stigma were not a commonly reported barrier to HIV testing; however, men who expressed anticipated individual HIV stigma had a 35% lower odds of recent HIV testing (aOR=0.65; 95% CI 0.44 to 0.96). This association was not observed among women.ConclusionsMen have lower uptake of HIV testing in Mozambique when compared to women. Even amidst the beneficial effects of HIV messaging, individual stigma is negatively associated with recent HIV testing among men. Intervention efforts that target the unique challenges and needs of men are essential in promoting men’s engagement into the HIV care continuum in sub-Saharan Africa.

scholarly journals What has comprehensive HIV/AIDS knowledge got to do with HIV testing among men in Kenya and Mozambique? Evidence from Demographic and Health Surveys

2021 ◽  
pp. 1-14
Author(s):  
Eugene Budu ◽  
Abdul-Aziz Seidu ◽  
Ebenezer Kwesi Armah-Ansah ◽  
Aliu Mohammed ◽  
Collins Adu ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Health Surveys ◽  
Scale Up ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Odds Ratios ◽  
African Countries ◽  
Aids Knowledge ◽  
Sub Saharan ◽  
Hiv Aids

Abstract People living with undiagnosed HIV are big contributors to the transmission of the virus. Although measures have been made to scale up HIV prevention and voluntary counselling and testing in sub-Saharan Africa, testing coverage remains low in many sub-Saharan African countries, including Mozambique and Kenya, where most people live with HIV/AIDS. Studies have shown that, in most countries in sub-Saharan Africa, men are less likely to test for HIV compared with women. This study examined the relationship between comprehensive HIV/AIDS knowledge and HIV testing among men in Kenya and Mozambique. Data were from the men’s re-code file of the Demographic and Health Surveys of Mozambique and Kenya. Binary logistic regression models were generated and the results presented as crude odds ratios (cOR) and adjusted odds ratios (aOR). The prevalences of HIV testing in Kenya and Mozambique were 80.1% and 46.7%, respectively. Men in Mozambique who had comprehensive HIV/AIDS knowledge (aOR=1.26, CI: 1.07–1.47) were more likely to test for HIV compared with their counterparts who had no comprehensive HIV/AIDS knowledge. In Kenya, men who had comprehensive HIV/AIDS knowledge (aOR=1.23, CI: 1.09–1.39) were more likely to test for HIV compared with their counterparts who had no comprehensive HIV/AIDS knowledge. This study found a statistically strong significant association between comprehensive HIV/AIDS knowledge and HIV testing among men in Kenya and Mozambique. To improve HIV testing rate among men, it is important that interventions are geared towards improving men’s comprehensive HIV/AIDS knowledge, perhaps by expanding HIV/AIDS education programmes and campaigns. This could improve HIV testing rates and ensure the realization of the global HIV/AIDS target of 95-95-95 by the year 2030.

scholarly journals Low levels of frailty in HIV-positive older adults on antiretroviral therapy in northern Tanzania

2021 ◽  
Author(s):  
Clare Bristow ◽  
Grace George ◽  
Grace Hillsmith ◽  
Emma Rainey ◽  
Sarah Urasa ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
High Standard ◽  
Female Gender ◽  
Screening Tools ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Diagnostic Tools ◽  
Clinical Frailty Scale ◽  
Frailty Phenotype ◽  
Sub Saharan

Abstract There are over 3 million people in sub-Saharan Africa (SSA) aged 50 and over living with HIV. HIV and combined antiretroviral therapy (cART) exposure may accelerate the ageing in this population, and thus increase the prevalence of premature frailty. There is a paucity of data on the prevalence of frailty in an older HIV + population in SSA and screening and diagnostic tools to identify frailty in SSA. Patients aged ≥ 50 were recruited from a free Government HIV clinic in Tanzania. Frailty assessments were completed, using 3 diagnostic and screening tools: the Fried frailty phenotype (FFP), Clinical Frailty Scale (CFS) and Brief Frailty Instrument for Tanzania (B-FIT 2). The 145 patients recruited had a mean CD4 + of 494.84 cells/µL, 99.3% were receiving cART and 72.6% were virally suppressed. The prevalence of frailty by FFP was 2.758%. FFP frailty was significantly associated with female gender (p = 0.006), marital status (p = 0.007) and age (p = 0.038). Weight loss was the most common FFP domain failure. The prevalence of frailty using the B-FIT 2 and the CFS was 0.68%. The B-FIT 2 correlated with BMI (r = − 0.467, p = 0.0001) and CD4 count in females (r = − 0.244, p = 0.02). There is an absence of frailty in this population, as compared to other clinical studies. This may be due to the high standard of HIV care at this Government clinic. Undernutrition may be an important contributor to frailty. It is unclear which tool is most accurate for detecting the prevalence of frailty in this setting as levels of correlation are low.

scholarly journals Predictors of lost to follow up from antiretroviral therapy among adults in sub-Saharan Africa: a systematic review and meta-analysis

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Hafte Kahsay Kebede ◽  
Lillian Mwanri ◽  
Paul Ward ◽  
Hailay Abrha Gesesew
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Meta Analysis ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Care Services ◽  
Validity Assessment ◽  
Sub Saharan ◽  
Lost To Follow Up

Abstract Background It is known that ‘drop out’ from human immunodeficiency virus (HIV) treatment, the so called lost-to-follow-up (LTFU) occurs to persons enrolled in HIV care services. However, in sub-Saharan Africa (SSA), the risk factors for the LTFU are not well understood. Methods We performed a systematic review and meta-analysis of risk factors for LTFU among adults living with HIV in SSA. A systematic search of literature using identified keywords and index terms was conducted across five databases: MEDLINE, PubMed, CINAHL, Scopus, and Web of Science. We included quantitative studies published in English from 2002 to 2019. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for methodological validity assessment and data extraction. Mantel Haenszel method using Revman-5 software was used for meta-analysis. We demonstrated the meta-analytic measure of association using pooled odds ratio (OR), 95% confidence interval (CI) and heterogeneity using I2 tests. Results Thirty studies met the search criteria and were included in the meta-analysis. Predictors of LTFU were: demographic factors including being: (i) a male (OR = 1.2, 95% CI 1.1–1.3, I2 = 59%), (ii) between 15 and 35 years old (OR = 1.3, 95% CI 1.1–1.3, I2 = 0%), (iii) unmarried (OR = 1.2, 95% CI 1.2–1.3, I2 = 21%), (iv) a rural dweller (OR = 2.01, 95% CI 1.5–2.7, I2 = 40%), (v) unemployed (OR = 1.2, 95% CI 1.04–1.4, I2 = 58%); (vi) diagnosed with behavioral factors including illegal drug use(OR = 13.5, 95% CI 7.2–25.5, I2 = 60%), alcohol drinking (OR = 2.9, 95% CI 1.9–4.4, I2 = 39%), and tobacco smoking (OR = 2.6, 95% CI 1.6–4.3, I2 = 74%); and clinical diagnosis of mental illness (OR = 3.4, 95% CI 2.2–5.2, I2 = 1%), bed ridden or ambulatory functional status (OR = 2.2, 95% CI 1.5–3.1, I2 = 74%), low CD4 count in the last visit (OR = 1.4, 95% CI 1.1–1.9, I2 = 75%), tuberculosis co-infection (OR = 1.2, 95% CI 1.02–1.4, I2 = 66%) and a history of opportunistic infections (OR = 2.5, 95% CI 1.7–2.8, I2 = 75%). Conclusions The current review identifies demographic, behavioral and clinical factors to be determinants of LTFU. We recommend strengthening of HIV care services in SSA targeting the aforementioned group of patients. Trial registration Protocol: the PROSPERO Registration Number is CRD42018114418

scholarly journals Maintaining paediatric cardiac services during the COVID-19 pandemic in a developing country in sub-Saharan Africa: guidelines for a “scale up” in the face of a global “scale down”

2020 ◽  
Vol 30 (11) ◽  
pp. 1588-1594
Author(s):  
Ogochukwu J. Sokunbi ◽  
Ogadinma Mgbajah ◽  
Augustine Olugbemi ◽  
Bassey O. Udom ◽  
Ariyo Idowu ◽  
...  
Keyword(s):  
Scale Up ◽  
Global Scale ◽  
International Travel ◽  
Sub Saharan Africa ◽  
African Continent ◽  
Tertiary Centre ◽  
The Face ◽  
Scale Down ◽  
Sub Saharan ◽  
International Experts

AbstractThe COVID-19 pandemic is currently ravaging the globe and the African continent is not left out. While the direct effects of the pandemic in regard to morbidity and mortality appear to be more significant in the developed world, the indirect harmful effects on already insufficient healthcare infrastructure on the African continent would in the long term be more detrimental to the populace. Women and children form a significant vulnerable population in underserved areas such as the sub-Saharan region, and expectedly will experience the disadvantages of limited healthcare coverage which is a major fall out of the pandemic. Paediatric cardiac services that are already sparse in various sub-Saharan countries are not left out of this downsizing. Restrictions on international travel for patients out of the continent to seek medical care and for international experts into the continent for regular mission programmes leave few options for children with cardiac defects to get the much-needed care.There is a need for a region-adapted guideline to scale-up services to cater for more children with congenital heart disease (CHD) while providing a safe environment for healthcare workers, patients, and their caregivers. This article outlines measures adapted to maintain paediatric cardiac care in a sub-Saharan tertiary centre in Nigeria during the COVID-19 pandemic and will serve as a guide for other institutions in the region who will inadvertently need to provide these services as the demand increases.

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