An Exploratory Study of a Nurse-Led HIV Postexposure Prophylaxis Program

2018 ◽  
Vol 19 (1-2) ◽  
pp. 29-39
Author(s):  
Patrick O’Byrne ◽  
Jean Daniel Jacob ◽  
Lauren Orser
Keyword(s):  
Health Care Professionals ◽  
Qualitative Interviews ◽  
Community Settings ◽  
Emergency Rooms ◽  
Postexposure Prophylaxis ◽  
Community Based ◽  
Past Behavior ◽  
Extraneous Data ◽  
Hiv Acquisition ◽  
Hiv Negative

The provision of HIV medications to HIV-negative persons after exposure to HIV is known as postexposure prophylaxis (PEP). Because this prevention strategy is primarily only available in emergency rooms, we piloted a nurse-led community-based PEP program in Ottawa from September 2013 through August 2015. As part of evaluating this program, we conducted qualitative interviews with persons who initiated PEP. Twelve men who had engaged in condomless anal sex with other males participated. Thematic analysis of the interview transcripts highlighted that PEP was considered unmentionable because the participants’ saw it as proof of past behavior that was perceived negatively. Our results thus revealed that PEP was stigmatized, which made our participants reluctant to answer health care professionals’ “questions” about why they needed PEP. To do so was to be exposed to stigma. The use of PEP for our participants was a balance between wanting to minimize the risks of HIV acquisition against the risks of disclosing the unmentionable. We take these findings to mean that clinicians and health service policy workers should move PEP into community clinics (decentralizing it from hospitals, and increase the involvement of nurses); aim to provide all required PEP services in community settings (consolidate PEP provision in these clinics); and ensure PEP services are streamlined to remove extraneous data collection (meaning history and exam tools should be standardized to minimize needless questions that may impede PEP access). Together, these recommendations may increase patients’ access to PEP, and maximize its HIV prevention effects.

scholarly journals Rates and Correlates of HIV Incidence in Namibia’s Zambezi Region From 2014 to 2016: Sentinel, Community-Based Cohort Study

10.2196/17107 ◽  
2020 ◽  
Vol 6 (2) ◽  
pp. e17107
Author(s):  
Andrew D Maher ◽  
Tuli Nakanyala ◽  
Nicholus Mutenda ◽  
Karen M Banda ◽  
Dimitri Prybylski ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Rural Areas ◽  
Sub Saharan Africa ◽  
Hiv Incidence ◽  
Community Based ◽  
Home Based ◽  
Hiv Test ◽  
Hiv Acquisition ◽  
Hiv Negative

Background Direct measures of HIV incidence are needed to assess the population-level impact of prevention programs but are scarcely available in the subnational epidemic hotspots of sub-Saharan Africa. We created a sentinel HIV incidence cohort within a community-based program that provided home-based HIV testing to all residents of Namibia’s Zambezi region, where approximately 24% of the adult population was estimated to be living with HIV. Objective The aim of this study was to estimate HIV incidence, detect correlates of HIV acquisition, and assess the feasibility of the sentinel, community-based approach to HIV incidence surveillance in a subnational epidemic hotspot. Methods Following the program’s initial home-based testing (December 2014-July 2015), we purposefully selected 10 clusters of 60 to 70 households each and invited residents who were HIV negative and aged ≥15 years to participate in the cohort. Consenting participants completed behavioral interviews and a second HIV test approximately 1 year later (March-September 2016). We used Poisson models to calculate HIV incidence rates between baseline and follow-up and multivariable Cox proportional hazard models to assess the correlates of seroconversion. Results Among 1742 HIV-negative participants, 1624 (93.23%) completed follow-up. We observed 26 seroconversions in 1954 person-years (PY) of follow-up, equating to an overall incidence rate of 1.33 per 100 PY (95% CI 0.91-1.95). Among women, the incidence was 1.55 per 100 PY (95% CI 1.12-2.17) and significantly higher among those aged 15 to 24 years and residing in rural areas (adjusted hazard ratio [aHR] 4.26, 95% CI 1.39-13.13; P=.01), residing in the Ngweze suburb of Katima Mulilo city (aHR 2.34, 95% CI 1.25-4.40; P=.01), who had no prior HIV testing in the year before cohort enrollment (aHR 3.38, 95% CI 1.04-10.95; P=.05), and who had engaged in transactional sex (aHR 17.64, 95% CI 2.88-108.14; P=.02). Among men, HIV incidence was 1.05 per 100 PY (95% CI 0.54-2.31) and significantly higher among those aged 40 to 44 years (aHR 13.04, 95% CI 5.98-28.41; P<.001) and had sought HIV testing outside the study between baseline and follow-up (aHR 8.28, 95% CI 1.39-49.38; P=.02). No seroconversions occurred among persons with HIV-positive partners on antiretroviral treatment. Conclusions Nearly three decades into Namibia’s generalized HIV epidemic, these are the first estimates of HIV incidence for its highest prevalence region. By creating a sentinel incidence cohort from the infrastructure of an existing community-based testing program, we were able to characterize current transmission patterns, corroborate known risk factors for HIV acquisition, and provide insight into the efficacy of prevention interventions in a subnational epidemic hotspot. This study demonstrates an efficient and scalable framework for longitudinal HIV incidence surveillance that can be implemented in diverse sentinel sites and populations.

scholarly journals Rates and Correlates of HIV Incidence in Namibia’s Zambezi Region From 2014 to 2016: Sentinel, Community-Based Cohort Study (Preprint)

2019 ◽  
Author(s):  
Andrew D Maher ◽  
Tuli Nakanyala ◽  
Nicholus Mutenda ◽  
Karen M Banda ◽  
Dimitri Prybylski ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Rural Areas ◽  
Sub Saharan Africa ◽  
Hiv Incidence ◽  
Community Based ◽  
Home Based ◽  
Hiv Test ◽  
Hiv Acquisition ◽  
Hiv Negative

BACKGROUND Direct measures of HIV incidence are needed to assess the population-level impact of prevention programs but are scarcely available in the subnational epidemic hotspots of sub-Saharan Africa. We created a sentinel HIV incidence cohort within a community-based program that provided home-based HIV testing to all residents of Namibia’s Zambezi region, where approximately 24% of the adult population was estimated to be living with HIV. OBJECTIVE The aim of this study was to estimate HIV incidence, detect correlates of HIV acquisition, and assess the feasibility of the sentinel, community-based approach to HIV incidence surveillance in a subnational epidemic hotspot. METHODS Following the program’s initial home-based testing (December 2014-July 2015), we purposefully selected 10 clusters of 60 to 70 households each and invited residents who were HIV negative and aged ≥15 years to participate in the cohort. Consenting participants completed behavioral interviews and a second HIV test approximately 1 year later (March-September 2016). We used Poisson models to calculate HIV incidence rates between baseline and follow-up and multivariable Cox proportional hazard models to assess the correlates of seroconversion. RESULTS Among 1742 HIV-negative participants, 1624 (93.23%) completed follow-up. We observed 26 seroconversions in 1954 person-years (PY) of follow-up, equating to an overall incidence rate of 1.33 per 100 PY (95% CI 0.91-1.95). Among women, the incidence was 1.55 per 100 PY (95% CI 1.12-2.17) and significantly higher among those aged 15 to 24 years and residing in rural areas (adjusted hazard ratio [aHR] 4.26, 95% CI 1.39-13.13; <i>P</i>=.01), residing in the Ngweze suburb of Katima Mulilo city (aHR 2.34, 95% CI 1.25-4.40; <i>P</i>=.01), who had no prior HIV testing in the year before cohort enrollment (aHR 3.38, 95% CI 1.04-10.95; <i>P</i>=.05), and who had engaged in transactional sex (aHR 17.64, 95% CI 2.88-108.14; <i>P</i>=.02). Among men, HIV incidence was 1.05 per 100 PY (95% CI 0.54-2.31) and significantly higher among those aged 40 to 44 years (aHR 13.04, 95% CI 5.98-28.41; <i>P</i>&lt;.001) and had sought HIV testing outside the study between baseline and follow-up (aHR 8.28, 95% CI 1.39-49.38; <i>P</i>=.02). No seroconversions occurred among persons with HIV-positive partners on antiretroviral treatment. CONCLUSIONS Nearly three decades into Namibia’s generalized HIV epidemic, these are the first estimates of HIV incidence for its highest prevalence region. By creating a sentinel incidence cohort from the infrastructure of an existing community-based testing program, we were able to characterize current transmission patterns, corroborate known risk factors for HIV acquisition, and provide insight into the efficacy of prevention interventions in a subnational epidemic hotspot. This study demonstrates an efficient and scalable framework for longitudinal HIV incidence surveillance that can be implemented in diverse sentinel sites and populations.

scholarly journals Potential and Challenges of Community-Based Surveillance in Animal Health: A Pilot Study Among Equine Owners in Switzerland

2021 ◽  
Vol 8 ◽  
Author(s):  
Ranya Özçelik ◽  
Franziska Remy-Wohlfender ◽  
Susanne Küker ◽  
Vivianne Visschers ◽  
Daniela Hadorn ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Qualitative Interviews ◽  
Animal Health ◽  
Clinical Signs ◽  
Multivariate Logistic Regression Analysis ◽  
Added Value ◽  
Surveillance Systems ◽  
Online Questionnaire ◽  
Community Based ◽  
Good Proxy

Animal owners' potential to observe and report clinical signs, as the persons with the closest contact to their animals, is an often neglected source of information in surveillance. Allowing community members other than health care professionals, such as animal owners, to report health events can contribute to close current surveillance gaps and enhance early detection. In the present study, we tested a community-based surveillance (CBS) approach in the equine community in Switzerland. We aimed at revealing the attitudes and intentions of equine owners toward reporting clinical signs by making use of an online questionnaire. We further set up and operated an online CBS tool, named Equi-Commun. Finally, we investigated potential reasons for the lack of its use by applying qualitative telephone interviews. The majority of the respondents of the online questionnaire (65.5%, 707/1,078) answered that they could see themselves reporting clinical observations of their equine. The multivariate logistic regression analysis indicated that French-speaking equine owners and those belonging to the positive attitude cluster are more likely to report to a CBS tool. Equi-Commun operated between October 2018 and December 2019 yet received only four reports. With the addition of qualitative interviews, we identified three critical, interlinked issues that may have led to the non-use of Equi-Commun within the Swiss equine community: (1) for successfully implementing CBS, the need for surveillance within the community of interest must be given; (2) the respective population under surveillance, here the equine, needs to show enough clinical cases for owners to be able to maintain the memory of an existing tool and its possible use; and (3) targeted and high effort communication of the system is key for its success. While CBS relying only on lay animal owners, complementary to existing surveillance systems, could potentially provide a good proxy of timely surveillance data, it is questionable whether the added value of generated surveillance knowledge is in balance with efforts necessary to implement a successful system. With this study, we showcased both the potential and challenges of CBS in animal health, as this may be of relevance and guidance for future initiatives.

Are Communities Willing to Transition Into Learning Health Care Communities? A Community-Based Participatory Evaluation of Stakeholders’ Receptivity

2021 ◽  
pp. 104973232199864
Author(s):  
Nabil Natafgi ◽  
Olayinka Ladeji ◽  
Yoon Duk Hong ◽  
Jacqueline Caldwell ◽  
C. Daniel Mullins
Keyword(s):  
Health Care ◽  
Health Care Delivery ◽  
Health Care Professionals ◽  
Care Delivery ◽  
Lessons Learned ◽  
Community Members ◽  
Community Based ◽  
Care Community ◽  
Care Experience ◽  
National Initiative

This article aims to determine receptivity for advancing the Learning Healthcare System (LHS) model to a novel evidence-based health care delivery framework—Learning Health Care Community (LHCC)—in Baltimore, as a model for a national initiative. Using community-based participatory, qualitative approach, we conducted 16 in-depth interviews and 15 focus groups with 94 participants. Two independent coders thematically analyzed the transcripts. Participants included community members (38%), health care professionals (29%), patients (26%), and other stakeholders (7%). The majority considered LHCC to be a viable model for improving the health care experience, outlining certain parameters for success such as the inclusion of home visits, presentation of research evidence, and incorporation of social determinants and patients’ input. Lessons learned and challenges discussed by participants can help health systems and communities explore the LHCC aspiration to align health care delivery with an engaged, empowered, and informed community.

Combating IPV With Community Leaders in Honduras: An Evaluation of an IPV Training Program Among Teachers and Health Professionals

2021 ◽  
pp. 107780122110089
Author(s):  
Chunrye Kim ◽  
Joel A. Capellan ◽  
Hung-En Sung ◽  
Eduardo Rafael Orellana
Keyword(s):  
Training Program ◽  
Health Care Professionals ◽  
Partner Violence ◽  
Intimate Partner ◽  
Educational Opportunities ◽  
Safety Planning ◽  
Community Members ◽  
Community Based ◽  
Confidence Levels ◽  
The Impact

Intimate partner violence (IPV) among women in Latin America, including Honduras, is serious. To help IPV victims, a community-based educational program has been implemented. This study aims to examine the impact of IPV training among teachers and health care professionals ( n = 160) on increases in IPV knowledge, attitudes, and self-efficacy when dealing with IPV victims using a pretest and posttest design. We found that the treatment group who received IPV training showed significantly lower justification for IPV, higher gender equality attitudes, and higher IPV knowledge as well as higher confidence levels in identifying IPV victims and safety planning for victims. We concluded that the IPV training program using the community-based approaches has the potential to help IPV victims in Honduras. More efforts should be made to increase the educational opportunities the community members can receive.

scholarly journals Identifying and Managing Malnutrition, Frailty and Sarcopenia in the Community: A Narrative Review

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2316
Author(s):  
Shelley Roberts ◽  
Peter Collins ◽  
Megan Rattray
Keyword(s):  
Healthcare Professionals ◽  
Monitoring And Evaluation ◽  
Community Dwelling ◽  
Community Context ◽  
Care Process ◽  
Community Settings ◽  
Community Based ◽  
Comprehensive Overview ◽  
Nutrition Care ◽  
Community Dwelling Older Adults

Malnutrition, frailty and sarcopenia are becoming increasingly prevalent among community-dwelling older adults; yet are often unidentified and untreated in community settings. There is an urgent need for community-based healthcare professionals (HCPs) from all disciplines, including medicine, nursing and allied health, to be aware of, and to be able to recognise and appropriately manage these conditions. This paper provides a comprehensive overview of malnutrition, frailty and sarcopenia in the community, including their definitions, prevalence, impacts and causes/risk factors; and guidance on how these conditions may be identified and managed by HCPs in the community. A detailed description of the care process, including screening and referral, assessment and diagnosis, intervention, and monitoring and evaluation, relevant to the community context, is also provided. Further research exploring the barriers/enablers to delivering high-quality nutrition care to older community-dwelling adults who are malnourished, frail or sarcopenic is recommended, to inform the development of specific guidance for HCPs in identifying and managing these conditions in the community.

Spiritual issues and needs: Perspectives from patients with advanced cancer and nonmalignant disease. A qualitative study

2004 ◽  
Vol 2 (4) ◽  
pp. 371-378 ◽  
Author(s):  
ELIZABETH GRANT ◽  
SCOTT A. MURRAY ◽  
MARILYN KENDALL ◽  
KIRSTY BOYD ◽  
STEPHEN TILLEY ◽  
...  
Keyword(s):  
Advanced Cancer ◽  
Health Professionals ◽  
Health Care Professionals ◽  
Qualitative Interviews ◽  
Health Resources ◽  
Well Being ◽  
Spiritual Needs ◽  
Policy Makers ◽  
Self Identity ◽  
Nonmalignant Disease

Objective: Health care professionals and policy makers acknowledge that spiritual needs are important for many patients with life-limiting illnesses. We asked such patients to describe their spiritual needs and how these needs may impinge on their physical, psychological, and social well-being. Patients were also encouraged to explain in what ways their spiritual needs, if they had any, could be addressed.Methods: We conducted two qualitative interviews, 3 months apart, with 20 patients in their last year of life: 13 patients with advanced cancer and 7 with advanced nonmalignant illness. We also interviewed each patient's general practitioner. Sixty-six interviews were tape-recorded, transcribed, and analyzed.Results: Patients' spiritual needs centered around their loss of roles and self-identity and their fear of dying. Many sought to make sense of life in relation to a nonvisible or sacred world. They associated anxiety, sleeplessness, and despair with such issues, which at times resulted in them seeking support from health professionals. Patients were best able to engage their personal resources to meet these needs when affirmed and valued by health professionals.Significance of results: Enabling patients to deal with their spiritual needs through affirmative relationships with health professionals may improve quality of life and reduce use of health resources. Further research to explore the relationship between spiritual distress and health service utilization is indicated.

Resilience of Communities in Puerto Rico Following Hurricane Maria: Community-Based Preparedness and Communication Strategies

2021 ◽  
pp. 1-6
Author(s):  
Elizabeth L. Andrade ◽  
Nicole D. Barrett ◽  
Mark C. Edberg ◽  
Matthew W. Seeger ◽  
Carlos Santos-Burgoa
Keyword(s):  
Puerto Rico ◽  
Puerto Rican ◽  
Interpersonal Communication ◽  
Qualitative Interviews ◽  
First Responders ◽  
Risk Groups ◽  
Community Leader ◽  
Disaster Resilience ◽  
Community Based ◽  
Community Assets

Abstract Objective: This study aimed to examine factors that may have contributed to community disaster resilience following Hurricane Maria in Puerto Rico. Methods: In April 2018, qualitative interviews (n = 22) were conducted with stakeholders in 7 Puerto Rican municipalities (9% of total). Transcripts were deductively and inductively coded and analyzed to identify salient topics and themes, then examined according to strategic themes from the Federal Emergency Management Association’s (FEMA) Whole Community Approach. Results: Municipal preparedness efforts were coordinated, community-based, leveraged community assets, and prioritized vulnerable populations. Strategies included (1) multi-sectoral coordination and strategic personnel allocation; (2) neighborhood leader designation as support contacts; (3) leveraging of community leader expertise and social networks to protect vulnerable residents; (4) Censuses of at-risk groups, health professionals, and first responders; and (5) outreach for risk communication and locally tailored protective measures. In the context of collapsed telecommunications, communities implemented post-disaster strategies to facilitate communication with the Puerto Rican Government, between local first responders, and to keep residents informed, including the use of: (1) police radios; (2) vehicles with loudspeakers; (3) direct interpersonal communication; and (4) solar-powered Internet radio stations. Conclusions: Adaptive capacities and actions of Puerto Rican communities exemplify the importance of local solutions in disasters. Expanded research is recommended to better understand contributors to disaster resilience.

scholarly journals Assessing Health Promotion Interventions: Limitations of Traditional Research Methods in Community-Based Studies

2017 ◽  
Vol 19 (4) ◽  
pp. 573-580 ◽  
Author(s):  
Anne Dressel ◽  
Robert Schneider ◽  
Melissa DeNomie ◽  
Jennifer Kusch ◽  
Whitney Welch ◽  
...  
Keyword(s):  
Health Promotion ◽  
Research Methods ◽  
Low Income ◽  
Controlled Trial ◽  
Community Settings ◽  
Community Based ◽  
African American Adults ◽  
Randomized Controlled ◽  
Traditional Research ◽  
Health Promotion Interventions

Most low-income Americans fail to meet physical activity recommendations. Inactivity and poor diet contribute to obesity, a risk factor for multiple chronic diseases. Health promotion activities have the potential to improve health outcomes for low-income populations. Measuring the effectiveness of these activities, however, can be challenging in community settings. A “Biking for Health” study tested the impact of a bicycling intervention on overweight or obese low-income Latino and African American adults to reduce barriers to cycling and increase physical activity and fitness. A randomized controlled trial was conducted in Milwaukee, Wisconsin, in summer 2015. A 12-week bicycling intervention was implemented at two sites with low-income, overweight, or obese Latino and African American adults. We found that randomized controlled trial methodology was suboptimal for use in this small pilot study and that it negatively affected participation. More discussion is needed about the effectiveness of using traditional research methods in community settings to assess the effectiveness of health promotion interventions. Modifications or alternative methods may yield better results. The aim of this article is to discuss the effectiveness and feasibility of using traditional research methods to assess health promotion interventions in community-based settings.

scholarly journals Recruitment And Retention Of Participants From Socioeconomically Deprived Communities: Lessons From The Awareness And Beliefs About Cancer (ABACus3) Randomised Controlled Trial

2020 ◽  
Author(s):  
Vasiliki Kolovou ◽  
Yvonne Moriarty ◽  
Stephanie Gilbert ◽  
Harriet Quinn-Scoggins ◽  
Julia Townson ◽  
...  
Keyword(s):  
Financial Incentives ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Randomised Control Trial ◽  
Trial Participant ◽  
Community Settings ◽  
Research Strategies ◽  
Healthcare Settings ◽  
Randomised Controlled ◽  
Deprived Areas

Abstract Background Recruitment of research participants poses challenges in socioeconomically deprived areas. The Awareness and Beliefs About Cancer (ABACus) phase 3 Randomised Control Trial recruited adult participants from socioeconomically deprived areas using a combined healthcare/community engagement model. We report the strategies used to successfully recruit and retain our trial participant sample. Methods Community and healthcare settings in areas of high socioeconomic deprivation were identified by lay advisors who recruited participants opportunistically or by appointment. Follow-up was done by telephone or post at 2-weeks and 6-months after recruitment, and all participants were offered financial incentives. Qualitative interviews were conducted with lay advisors regarding their experience and reflections. Results The lay advisors identified and contacted 107 potential recruitment venues across South and West Yorkshire and South East Wales of which 41.1% (n = 42) were opened for recruitment. A total of 234 participants were recruited, with 91% (n = 212) retention at 2-weeks and 85% (n = 199) at 6-months. Community settings yielded 75% (n = 176) of participants. Participants had a mean age of 61.3 years and 63.3% (n = 148) were female, with 66% (n = 154) resident in the most deprived geographical areas. Lay advisors described recruitment as intensive, although engaging participants was easier in community settings. Conclusions The ABACus3 trial achieved recruitment and high retention with a population that is often “hard to reach” or entirely missed in health research. Strategies were specifically tailored to engage the venues and adult residents of highly deprived areas. Future studies recruiting adults living in the most deprived areas might benefit from community recruitment and from collaborating with local gatekeepers who are key to engagement.

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