scholarly journals Perceived Stigma and Fear of Unintended Disclosure are Barriers in Medication Adherence in Adolescents with Perinatal HIV in Botswana: A Qualitative Study

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Sphiwe Madiba ◽  
Unaswi Josiah
Keyword(s):  
Medication Adherence ◽  
Qualitative Study ◽  
Age Groups ◽  
Structural Factors ◽  
Hiv Status ◽  
Perceived Stigma ◽  
Major Barrier ◽  
Perinatal Hiv ◽  
Adherence Support ◽  
Clinic Visits

Background. Maintaining optimal adherence to antiretroviral treatment (ART) is a challenge for adolescents with perinatally HIV (ALPHIV), and there is little consensus on what factors contribute to adherence in this population. This study assessed self-reported medication adherence among ALPHIV and explored structural factors that hinder or motivate them to adhere. Methods. This qualitative study used in-depth interviews with ALPHIV at the infectious disease control centre of a teaching hospital in Botswana. Thirty adolescents aged 12–19 years who were aware of their HIV status were recruited purposively. Transcribed interviews were analysed using the thematic approach and NVivo data analysis software. Findings. Nonadherence was a problem across age groups and gender. Perceived stigma was a major barrier to ART adherence. The fear of stigma and unintended disclosure were more pronounced in those attending boarding school. The adolescents were not willing to take medication in front of roommates and outside of the home. They opted for hiding and taking medication in privacy which led to missed doses. The heightened fear of being seen collecting ART medication affected keeping appointments for clinic visits. Fear of stigma also influenced the choice of action when there was a clash between school activities, dosing times, and scheduled clinic appointments for ART refill. The home environment was the main facilitator for adherence. Support was the strongest motivator for adolescents to adhere and keep up with clinic visits. On a personal level, the desire to be healthy and live long was a major motivator to adhere. Conclusions. The fear of stigma shaped the adolescents’ adherence behaviour. Perceived stigma affected the time and place to take medication, the visit to the clinic for ART refill, and self-disclosure of HIV status. There is need to encourage adolescents to self-disclose their HIV status to friends since the fear of unintended disclosure fuelled perceived stigma. Planning of clinic appointments should also be consistent with realistic daily activities of adolescents.

Facilitators and barriers to medication adherence among HIV-positive patients with comorbid depressive disorders: A qualitative study

2011 ◽  
Author(s):  
Angela R. Wendorf ◽  
Samantha T. Bilkey ◽  
Diana Wollach ◽  
Kayla Ehlert ◽  
Lorianne Woolverton ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Qualitative Study ◽  
Depressive Disorders ◽  
Hiv Positive ◽  
Facilitators And Barriers

A Study on Knowledge, Attitude, Awareness and Practice About HIV/AIDS among different age group of Karachi, Pakistan

2017 ◽  
Vol 3 (3) ◽  
pp. 328-333
Author(s):  
Safia Mehmood ◽  
Sheema Zia ◽  
Nida Aziz ◽  
Omama Sajid
Keyword(s):  
Hiv Transmission ◽  
Age Groups ◽  
World Population ◽  
Major Barrier ◽  
Initial Stage ◽  
Awareness Programs ◽  
And Gender ◽  
Strongly Agree ◽  
High Level ◽  
Lack Of Knowledge

The AIDS is one of the most complicated health problems of the 21st century and it threatens the world population. AIDS spread at an alarming rate. This was a descriptive study to determine the knowledge, awareness, and practice about HIV among different age groups. The study carried out in Karachi, Pakistan during the period of January 2016-april 2016, in which 82 peoples are participated; 65 peoples having age in between 18-30, people’s lies in 31-40 years, while only 4 peoples having age above 40. From which 91% peoples thought HIV is dangerous virus and 51% peoples having misconception that it cause AIDS on initial stage and does not have any effect on CD4+. Majority of peoples aware about transmission of AIDS through intercourse, and during pregnancy. But the study show the high level of misbelieve also in mode of transmission that HIV transmit through sweat, saliva etc. Majority of the peoples have knowledge that HIV-1 is the most common type found worldwide. Also large number of peoples have knowledge that HIV weak immune system by destroying CD4+ and require long exposure to progress AIDS. Less than 15% of peoples strongly agree that AIDS is common in women. This misconception reflex the lack of knowledge and awareness in the HIV transmission and gender relation. Also majority of peoples thought that lack of knowledge is major barrier in the proper cure of disease. So increasing knowledge by awareness programs; sexual prevention; by starting national testing resources and curing poverty will cured AIDS in Pakistan. Newly drugs are introduced which can stop the progression of AIDS.

scholarly journals Perceived Stigma as a Contextual Barrier to Early Uptake of HIV Testing, Treatment Initiation, and Disclosure; The Case of Patients Admitted with AIDS-Related Illness in a Rural Hospital in South Africa

Healthcare ◽  
2021 ◽  
Vol 9 (8) ◽  
pp. 962
Author(s):  
Sphiwe Madiba ◽  
Evelyn Ralebona ◽  
Mygirl Lowane
Keyword(s):  
Adult Patients ◽  
Hiv Status ◽  
Perceived Stigma ◽  
Hospital Data ◽  
Hiv Diagnosis ◽  
Related Stigma ◽  
Enacted Stigma ◽  
Delayed Disclosure ◽  
Selective Disclosure ◽  
Close Family

We explored the extent to which perceived HIV-related stigma influences the disclosure and concealment of HIV status to family among adult patients hospitalised for AIDS-related illness, and described reports of negative responses and enacted stigma following disclosure. We conducted interviews with a purposeful sample of 28 adult patients in a rural South African hospital. Data analysis was deductive and inductive and followed the thematic approach. We found evidence of delayed HIV diagnosis and initiation of treatment. There was delayed and selective disclosure as well as concealment of the HIV-positive status. The disclosure was delayed for months or even years. During that time, there was active concealment of the HIV status to avoid stigma from family, friends, and community. When disclosure occurred, there was selective disclosure to close family members who would keep the secret and respond favorably. Although the participants disclosed mostly to close family, some of their post-disclosure experiences included incidents of enacted stigma and discrimination. The fear of perceived stigma and self-stigma influenced the active concealment of their HIV status from others. Continuous concealment of one’s HIV status and delayed disclosure limit the opportunities for support and care. There is a need to take into consideration the interaction between HIV-related stigma and disclosure to develop disclosure-counselling strategies in primary health care settings.

scholarly journals Improved adherence with Medicines Use Review service in Slovenia: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Urška Nabergoj Makovec ◽  
Igor Locatelli ◽  
Mitja Kos
Keyword(s):  
Medication Adherence ◽  
Controlled Trial ◽  
Test Group ◽  
Multiple Linear Regression Model ◽  
Relative Difference ◽  
Control Group ◽  
Adherence Support ◽  
Medicines Use ◽  
The Impact ◽  
Medicines Use Review

Abstract Background Based on several existing patient-oriented activities, Medicines Use Review (MUR) service was standardized and officially adopted in Slovenia in 2015. Service aims to provide adherence support and ensure safe and effective medicines use. Therefore, the aim of the study was to evaluate the benefits of MUR in Slovenia, primarily the impact on medication adherence. Methods A randomised controlled trial was performed in community pharmacies to compare MUR with standard care. Patients were randomised into either the test (patients received MUR by a certified MUR provider at visit 1), or control group. The study primary outcome was self-reported adherence to multiple medications, assessed by electronic ©Morisky Widget MMAS-8 Software at the first visit (V1) and after 12 weeks (V2). A sub-analysis of intentional and unintentional non-adherence was performed. MUR impact was defined as the relative difference in ©MMAS-8 score after 12 weeks between the test and control group. A multiple linear regression model was used to predict MUR impact based on baseline adherence (low versus medium and high). Several secondary outcomes (e.g. evaluation of drug-related problems (DRPs)) were also assessed. Results Data from 153 (V1) and 140 (V2) patients were analysed. Baseline adherence was low, moderate and high in 17.6, 48.4 and 34.0% patients, respectively. In the low adherence subpopulation, test group patients showed a 1.20 point (95% CI = 0.16–2.25) increase in total ©MMAS-8 score (p = 0.025) compared to control group patients. A 0.84 point (95% CI = 0.05–1.63) increase was due to intentional non-adherence (p = 0.038), and a 0.36 point (95% CI = − 0.23-0.95) was due to unintentional non-adherence (p = 0.226). Additionally, statistically significant decrease in the proportion of patients with manifested DRPs (p < 0.001) and concerns regarding chronic medicines use (p = 0.029) were revealed. Conclusion MUR service in Slovenia improves low medication adherence and is effective in addressing DRPs and concerns regarding chronic medicines use. Trial registration ClinicalTrials.gov - NCT04417400; 4th June 2020; retrospectively registered.

scholarly journals 1042. The Attitude of Patients With HIV about Telehealth for Their HIV Care

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S550-S551
Author(s):  
Dima Dandachi ◽  
Bich Dang ◽  
Thomas Giordano Giordano
Keyword(s):  
Hiv Transmission ◽  
Personal Information ◽  
Critical Role ◽  
Retention In Care ◽  
Hiv Care ◽  
Structural Factors ◽  
Personal Factors ◽  
Response Distribution ◽  
Related Factors ◽  
Clinic Visits

Abstract Background The world is facing a pandemic of SARS-CoV-2 that disrupted our healthcare system and the way we deliver healthcare. For people with HIV (PWH), the ability to be retained in care plays a critical role in improving health outcomes and in preventing HIV transmission. Several definitions exist for retention in care, but they are centered around outpatient clinic visits. It is now more important than ever to understand PWH’s attitudes about using telemedicine for HIV care instead of face-to face clinic visits. Methods We administered a one-time survey to PWH presenting to an outpatient HIV center in Houston, Texas, from February–June 2018. The survey items were used to assess PWH’s attitudes towards and concerns for telehealth and explanatory variables. Results 371 participants completed the survey; median age was 51, 36% were female, and 63% African-American. Overall, 57% of respondents were more likely to use telehealth for their HIV care if available, as compared to one-on-one in-person care, and 37% would use telehealth frequently or always as an alternative to clinic visits. Participants reported many benefits including ability to fit better their schedule, decreasing travel time, and privacy but expressed concerns about the ability to effective communication and examination and the safety of personal information. Factors associated with likelihood of using telehealth include personal factors (US-born, men who have sex with men, higher educational attainment, higher HIV-related stigma perception), HIV-related factors (long standing HIV), and structural factors (having difficulty attending clinic visits, not knowing about or not having the necessary technology). There was no association between participants with uncontrolled HIV, medication adherence, and likelihood of using telehealth. Survey items and response distribution Conclusion Telehealth programs for PWH can improve retention in care. A modification of the definition for retention in care, incorporating telehealth, should be considered. Availability and confidence using various telehealth technologies need to be addressed to increase acceptability and usage of telehealth among PWH. Disclosures All Authors: No reported disclosures

scholarly journals Doctors’ maintenance of professional competence: a qualitative study informed by the theory of planned behaviour

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anél Wiese ◽  
Emer Galvin ◽  
Janet O’Farrell ◽  
Jantze Cotter ◽  
Deirdre Bennett
Keyword(s):  
Qualitative Study ◽  
Theory Of Planned Behaviour ◽  
Professional Competence ◽  
Age Groups ◽  
Structured Interviews ◽  
Negative Attitudes ◽  
Planned Behaviour ◽  
Targeted Interventions ◽  
Research Findings ◽  
Meaningful Engagement

Abstract Background Medical regulators worldwide have implemented programmes of maintenance of professional competence (MPC) to ensure that doctors, throughout their careers, are up to date and fit to practice. The introduction of MPC required doctors to adopt a range of new behaviours. Despite high enrolment rates on these programmes, it remains uncertain whether doctors engage in the process because they perceive benefits like improvements in their practice and professional development or if they solely meet the requirements to retain medical registration. In this study, we aimed to explore the relationship between doctors’ beliefs, intention and behaviour regarding MPC through the lens of the Theory of Planned Behaviour (TPB) to make explicit the factors that drive meaningful engagement with the process. Methods We conducted a qualitative study using semi-structured interviews. From a pool of 1258 potential participants, we purposively selected doctors from multiple specialities, age groups, and locations across Ireland. We used thematic analysis, and the TPB informed the analytic coding process. Results Forty-one doctors participated in the study. The data analysis revealed doctors’ intention and behaviour and the factors that shape their engagement with MPC. We found that attitudes and beliefs about the benefits and impact of MPC mediated the nature of doctors’ engagement with the process. Some participants perceived positive changes in practice and other gains from participating in MPC, which facilitated committed engagement with the process. Others believed MPC was unfair, unnecessary, and lacking any benefit, which negatively influenced their intention and behaviour, and that was demonstrated by formalistic engagement with the process. Although participants with positive and negative attitudes shared perceptions about barriers to participation, such perceptions did not over-ride strongly positive beliefs about the benefits of MPC. While the requirements of the regulator strongly motivated doctors to participate in MPC, beliefs about patient expectations appear to have had less impact on intention and behaviour. Conclusions The findings of this study broaden our understanding of the determinants of doctors’ intention and behaviour regarding MPC, which offers a basis for designing targeted interventions. While the barriers to engagement with MPC resonate with previous research findings, our findings challenge critical assumptions about enhancing doctors’ engagement with the process. Overall, our results suggest that focused policy initiatives aimed at strengthening the factors that underpin the intention and behaviour related to committed engagement with MPC are warranted.

scholarly journals Disclosure and health-related outcomes among children living with HIV and their caregivers

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Margaret Amankwah-Poku ◽  
Delight Abla Klutsey ◽  
Kwaku Oppong Asante
Keyword(s):  
Medication Adherence ◽  
Psychological Health ◽  
Positive Impact ◽  
Well Being ◽  
Demographic Variables ◽  
Hiv Status ◽  
African Countries ◽  
Psychological Well Being ◽  
Adherence To Medication ◽  
Living With Hiv

Abstract Background The prevalence of disclosure of status to children living with the Human Immunodeficiency Virus (HIV) is low in most sub-Saharan African countries, leading to poor compliance and adverse psychological outcomes in these children. This study examined the influence of disclosure on health outcomes in children living with HIV and their caregivers. Methods Using a cross-sectional design, 155 HIV-positive children between age 6–15 years and their caregivers were administered standardized questionnaires measuring adherence to medication, children's psychological well-being, caregiver burden, and caregivers’ psychological health. Results Results indicated that only 33.5% of the children sampled knew their status. Disclosure of HIV status was significantly related to medication adherence, psychological wellbeing, the burden of caregiving, and the length of the disclosure. A child’s age and level of education were the only demographic variables that significantly predicted disclosure of HIV status. In a hierarchical analysis, after controlling for all demographic variables medication adherence, psychological well-being and burden of caregiving were found to be significant predictors of disclosure of status in children living with HIV. Conclusions Findings suggest the need for disclosure of status among children living with HIV for a positive impact on their medication adherence and psychological health. These findings underscore the need for the development of context-specific interventions that will guide and encourage disclosure of status by caregivers to children living with HIV.

scholarly journals Lockdowns, lives and livelihoods: the impact of COVID-19 and public health responses to conflict affected populations - a remote qualitative study in Baidoa and Mogadishu, Somalia

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Dorien H. Braam ◽  
Sharath Srinivasan ◽  
Luke Church ◽  
Zakaria Sheikh ◽  
Freya L. Jephcott ◽  
...  
Keyword(s):  
Public Health ◽  
Qualitative Study ◽  
Narrative Analysis ◽  
Grey Literature ◽  
Age Groups ◽  
Research Approach ◽  
Structured Interviews ◽  
Or Education ◽  
Public Health Response ◽  
The Impact

Abstract Background Authorities in Somalia responded with drastic measures after the first confirmed COVID-19 case in mid-March 2020, closing borders, schools, limiting travel and prohibiting most group functions. However, the impact of the pandemic in Somalia thereafter remained unclear. This study employs a novel remote qualitative research method in a conflict-affected setting to look at how some of the most at-risk internally displaced and host populations were impacted by COVID-19, what determined their responses, and how this affected their health and socio-economic vulnerability. Methods We conducted a remote qualitative study, using Katikati, a 1-to-1 conversation management and analysis platform using short message service (SMS) developed by Lark Systems with Africa’s Voices Foundation (AVF), for semi-structured interviews over three months with participants in Mogadishu and Baidoa. We recruited a gender balanced cohort across age groups, and used an analytical framework on the social determinants of health for a narrative analysis on major themes discussed, triangulating data with existing peer-reviewed and grey literature. Results The remote research approach demonstrated efficacy in sustaining trusted and meaningful conversations for gathering qualitative data from hard-to-reach conflict-affected communities. The major themes discussed by the 35 participants included health, livelihoods and education. Two participants contracted the disease, while others reported family or community members affected by COVID-19. Almost all participants faced a loss of income and/or education, primarily as a result of the strict public health measures. Some of those who were heavily affected economically but did not directly experienced disease, denied the pandemic. Religion played an important role in participants’ beliefs in protection against and salvation from the disease. As lockdowns were lifted in August 2020, many believed the pandemic to be over. Conclusions While the official COVID-19 burden has remained relatively low in Somalia, the impact to people’s daily lives, income and livelihoods due to public health responses, has been significant. Participants describe those ‘secondary’ outcomes as the main impact of the pandemic, serving as a stark reminder of the need to broaden the public health response beyond disease prevention to include social and economic interventions to decrease people’s vulnerability to future shocks.

Observational study of the populations accessing rapid point-of-care HIV testing in Winnipeg, Manitoba, Canada, through a retrospective chart review of site records

2017 ◽  
Vol 94 (3) ◽  
pp. 194-199 ◽  
Author(s):  
James Blain Johnston ◽  
Joss N Reimer ◽  
John L Wylie ◽  
Jared Bullard
Keyword(s):  
Viral Load ◽  
Hiv Testing ◽  
Clinical Outcomes ◽  
Point Of Care ◽  
Age Groups ◽  
Linkage To Care ◽  
Hiv Positive ◽  
Hiv Status ◽  
Viral Load Suppression ◽  
Hiv Test

ObjectivesHIV point-of-care testing (POCT) has been available in Manitoba since 2008. This study evaluated the effectiveness of POCT at identifying individuals with previously unknown HIV status, its effects on clinical outcomes and the characteristics of the populations reached.MethodsA retrospective database review was conducted for individuals who received HIV POCT from 2011 to 2014. Time to linkage to care and viral load suppression were compared between individuals who tested positive for HIV using POCT and controls identified as positive through standard screening. Testing outcomes for labouring women with undocumented HIV status accessing POCT during labour were also assessed.Results3204 individuals received POCT (1055 females (32.9%) and 2149 males (67.1%)), being the first recorded HIV test for 2205 (68.8%). Males were more likely to be targeted with POCT as their first recorded HIV test (adjusted OR (AOR) 1.40). Between the two main test sites (Main Street Project (MSP) and Nine Circles Community Health Centre), MSP tested relatively fewer males (AOR 0.79) but a higher proportion of members of all age groups over 30 years old (AOR 1.83, 2.51 and 3.64 for age groups 30–39, 40–49 and >50, respectively). There was no difference in time to linkage to care (p=0.345) or viral load suppression (p=0.405) between the POCT and standard screening cohorts. Of 215 women presenting in labour with unknown HIV status, one was identified as HIV positive.ConclusionsPOCT in Manitoba has been successful at identifying individuals with previously unknown HIV-positive status. Demographic differences between the two main testing sites support that this intervention is reaching unique populations. Given that we observed no significant difference in time to clinical outcomes, it is reasonable to continue using POCT as a targeted intervention.MeSH termsHIV infection; rapid HIV testing; vertical infectious disease transmission; community outreach; service delivery; marginalised populations.

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