scholarly journals Provider perspectives on the acceptability and tolerability of dolutegravir-based anti-retroviral therapy after national roll-out in Uganda: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Henry Zakumumpa ◽  
Freddy Eric Kitutu ◽  
Helen Byomire Ndagije ◽  
Nakitto-Kesi Diana ◽  
Jacquellyn Nambi Ssanyu ◽  
...  
Keyword(s):  
World Health ◽  
Viral Load Suppression ◽  
Group Discussions ◽  
Ownership Type ◽  
Provider Perspectives ◽  
Number Of Patients ◽  
Study Sites ◽  
Health Organization ◽  
Patients Experience ◽  
Roll Out

Abstract Background The World Health Organization recommends dolutegravir (DTG) as the for first-line and second-line antiretroviral therapy (ART) worldwide. However, little is known about the acceptability and tolerability of DTG-based ART at routine points-of-care in Uganda. We set out to explore the perceptions of clinicians in ART clinics regarding the acceptability and tolerability of DTG-based ART since national roll-out in March 2018 in Uganda. Methods We adopted a qualitative exploratory design involving 49 participants. Between September 2020 and February 2021, we conducted 22 in-depth interviews with clinicians in the ART clinics of 12 purposively selected health facilities across Uganda. The selection of study sites ensured diversity in facility ownership-type (public/private), level of service delivery (tertiary/secondary/primary) and the four major geographic sub-regions of Uganda. We conducted three focus group discussions with 27 clinicians in the participating facilities. Data were analyzed by thematic approach. Results Clinicians in ART clinics acknowledged that DTG-based ART is well tolerated by the majority of their patients who appreciate the reduced pill burden, perceived less side effects and superior viral load suppression. However, they reported that a number of their patients experience adverse drug reactions (ADRs) after being transitioned to DTG. Hyperglycemia is, by far, the most commonly reported suspected ADR associated with DTG-based regimens and was cited in all but two participating facilities. Insomnia, weight gain and reduced libido are among the other frequently cited suspected ADRs. In addition, clinicians in ART clinics perceived some of the suspected ADRs as resulting from drug interactions between dolutegravir and isoniazid. Weak diagnostic capacities and shortage of associated commodities (e.g. glucometers and test kits) were reported as impediments to understanding the full extent of ADRs associated DTG-based ART. Conclusion While DTG-based regimens were perceived by clinicians in ART clinics to be well tolerated by the majority of their patients, they also reported that a number of patients experience suspected ADRs key among which were hyperglycemia, insomnia and reduced libido. Based on the perspectives of clinicians, we recommend that future studies examine the prevalence of dolutegravir-induced hyperglycemia in patients in Uganda.

scholarly journals Dolutegravir-Based ART: Exploring Patient Safety and Acceptability Following National Roll-Out in Uganda

2021 ◽  
Author(s):  
Henry Zakumumpa ◽  
Freddy Eric Kitutu ◽  
Helen Bomire Ndagije ◽  
Nakitto-Kesi Diana ◽  
Jacquellyn Nambi Ssanyu ◽  
...  
Keyword(s):  
Glucose Monitoring ◽  
Blood Glucose Monitoring ◽  
World Health ◽  
Viral Load Suppression ◽  
Ownership Type ◽  
Number Of Patients ◽  
Qualitative Descriptive ◽  
Study Sites ◽  
Health Organization ◽  
Roll Out

Abstract BACKGROUNDThe World Health Organization recommends dolutegravir (DTG) as the backbone for first-line and second-line antiretroviral therapy (ART) worldwide. However, little is known about the acceptability and tolerability of DTG-based ART at routine points-of-care in Uganda. We set out to explore the perceptions of ART clinic managers regarding the acceptability and tolerability of DTG-based ART since national roll-out in March 2018 in Uganda.METHODSWe adopted a qualitative descriptive design involving 49 ART clinic managers and clinicians. Between September 2020 and February 2021, we conducted 22 in-depth interviews with ART clinic managers and clinicians in 12 purposively selected health facilities across Uganda. The selection of study sites ensured diversity in facility ownership-type (public/private), level of service delivery (tertiary/secondary/primary) and the four major geographic sub-regions of Uganda. We conducted three focus group discussions with 27 ART clinicians in the participating facilities. Data were analyzed by thematic approach. RESULTSThe participants acknowledged that DTG-based ART is well tolerated by the majority of their patients who appreciate the reduced pill burden, perceived less side effects and superior viral load suppression. However, they reported that a number of patients experience adverse drug reactions (ADRs) after being transitioned to DTG. Hyperglycemia is, by far, the most commonly reported suspected ADR associated with DTG-based regimens and was cited in all but two participating facilities. Insomnia, weight gain and reduced libido are among the other frequently cited suspected ADRs. In addition, ART clinic managers perceived some of the suspected ADRs as resulting from drug interactions between dolutegravir and isoniazid. Weak diagnostic capacities and shortage of associated commodities (e.g. glucometers and test kits) were reported as impediments to understanding the full extent of ADRs associated DTG-based ART. CONCLUSIONWhile DTG-based regimens were perceived to be well tolerated by the majority of patients at participating facilities, a number of patients were reported to experience suspected ADRs key among which were hyperglycemia, insomnia and reduced libido. We recommend interventions aimed at strengthening blood glucose monitoring for patients taking DTG-based regimens and precautionary assessment of all patients prior to initiating them on DTG for known risk factors for DTG related ADRs.

scholarly journals The Mentor Mothers Program in the Department of Defense in Nigeria: An Evaluation of Healthcare Workers, Mentor Mothers, and Patients’ Experiences

Healthcare ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 328
Author(s):  
Josephine Moshe Ibu ◽  
Euphemia Mbali Mhlongo
Keyword(s):  
Department Of Defense ◽  
Healthcare Workers ◽  
Psychosocial Support ◽  
Hiv Infections ◽  
Health Facilities ◽  
World Health ◽  
Group Discussions ◽  
Analysis Technique ◽  
Hiv Awareness ◽  
Health Organization

Nigeria contributes the highest to the global burden of HIV/AIDS and also accounts for the largest proportion of new vertically transmitted HIV infections among children. The Mentor Mothers program in the Nigerian Department of Defense was introduced in accordance with the World Health Organization and its implementing partner guidelines to curb the high incidence of vertically acquired HIV infections. Understanding the experiences of participants could serve as a gateway to evaluating the effectiveness of the program to better provide quality services within targeted health facilities. This qualitative study employed key informant interviews with six healthcare workers as well as two focus group discussions with six mentor mothers and six prevention of mother-to-child transmission (PMTCT) patients in four selected hospitals in the Nigerian Department of Defense to explore their experiences of the Mentor Mothers program. A thematic analysis technique was used to analyze the collated data. As a result, four main themes emerged, with the program perceived by most participants as providing psychosocial support to the patients, a valuable educational resource for raising HIV awareness, a valuable resource for promoting exclusive breastfeeding and mitigating vertical transmission of the virus, and functioning as a link between patients and the healthcare system. The participants reported that the program had effectively decreased HIV infections in children, reduced child and maternal mortality, and supported the livelihood and development of women, families, and communities in and around the Nigerian Department of Defense health facilities.

Patterns of skull base meningioma progression after failed radiosurgery

2007 ◽  
Vol 106 (1) ◽  
pp. 30-35 ◽  
Author(s):  
William T. Couldwell ◽  
Chad D. Cole ◽  
Ossama Al-Mefty
Keyword(s):  
Skull Base ◽  
Stereotactic Radiosurgery ◽  
Growth Patterns ◽  
World Health ◽  
Benign Tumors ◽  
Subtotal Resection ◽  
Surgical Removal ◽  
Skull Base Meningioma ◽  
Number Of Patients ◽  
Health Organization

Object Stereotactic radiosurgery has been reported to be an effective alternative to surgical removal of small to medium benign meningiomas as well as an adjuvant treatment modality to reduce the risk of tumor progression after subtotal resection. Its efficacy has been proved by excellent short-term radiosurgically demonstrated control rates, which have been reported to approach or exceed 90% in many contemporary studies involving the use of either linear accelerator–based systems or the Gamma Knife. Little is known, however, regarding the growth patterns of meningiomas that fail to stabilize after radiosurgery. Methods The authors report 13 cases of benign skull base meningiomas (World Health Organization Grade I) that demonstrated progression after radiosurgical treatment as a primary or an adjuvant therapy. Several tumors demonstrated rapid growth immediately after radiosurgical treatment, whereas other lesions progressed in a very delayed manner in some patients (up to 14 years after treatment). Regardless of the interval after which it occurs, tumor growth can be quite aggressive once it has begun. Conclusions Skull base meningioma growth can be aggressive after failed radiosurgery in some patients, and treatment failure can occur at long intervals following treatment. Special attention must be devoted to such significant occurrences given the increasing number of patients undergoing stereotactic radiosurgery for benign tumors, and careful extended (> 10 years) follow up must be undertaken in all patients after radiosurgery.

Digital transformation of face-to-face focus group methodology: engaging a globally dispersed audience in management of institutional change (Preprint)

2021 ◽  
Author(s):  
Mohamed Mahmoud ◽  
Anna TOKAR ◽  
Melissa ARRIAS ◽  
Christos MYLONAS ◽  
Heini UTUNEN ◽  
...  
Keyword(s):  
Focus Group ◽  
Learning Strategy ◽  
Transformation Process ◽  
World Health ◽  
Global Learning ◽  
Group Discussions ◽  
Face To Face ◽  
Global Workforce ◽  
The World ◽  
Health Organization

UNSTRUCTURED As part of its transformation process to meet the health challenges of the 21st century by creating a motivated and fit-for-purpose global workforce, the World Health Organization (WHO) is developing the first-ever global Learning Strategy for health personnel around the world. Focus group discussions (FGDs) were organized as part of in-depth qualitative research on staff views, visions, and suggestions. Due to the pandemic, a flexible, multi-linguistic, participatory, iterative methodology for digitization of face-to-face FDGs to engage a globally dispersed workforce was implemented.

scholarly journals A PIECEWISE GROWTH MODEL FOR MODELING THE ACCUMULATED NUMBER OF COVID-19 CASES IN THE CITY OF CAMPO GRANDE

2021 ◽  
Vol 39 (1) ◽  
pp. 240
Author(s):  
Erlandson Ferreira SARAIVA ◽  
Leandro SAUER ◽  
Basílio De Bragança PEREIRA ◽  
Carlos Alberto de Bragança PEREIRA
Keyword(s):  
Growth Model ◽  
Health Department ◽  
World Health ◽  
Mathematical Study ◽  
Number Of Patients ◽  
Technical Report ◽  
The World ◽  
The Government ◽  
Health Organization ◽  
The City

In December of 2019, a new coronavirus was discovered in the city of Wuhan, China. The World Health Organization officially named this coronavirus as COVID-19. Since its discovery, the virus has spread rapidly around the world and is currently one of the main health problems, causing an enormous social and economic burden. Due to this, there is a great interest in mathematical models capable of projecting the evolution of the disease in countries, states and/or cities. This interest is mainly due to the fact that the projections may help the government agents in making decisions in relation to the prevention of the disease. By using this argument, the health department of the city (HDC) of Campo Grande asked the UFMS for the development of a mathematical study to project the evolution of the disease in the city. In this paper, we describe a modeling procedure used to fit a piecewise growth model for the accumulated number of cases recorded in the city. From the fitted model, we estimate the date in which the pandemic peak is reached and project the number of patients who will need treatment in intensive care units. Weekly, was sent to HDC a technical report describing the main results.

scholarly journals Market penetration of Xpert MTB/RIF in high tuberculosis burden countries: A trend analysis from 2014 - 2016

2018 ◽  
Vol 2 ◽  
pp. 35 ◽  
Author(s):  
Danielle Cazabon ◽  
Tripti Pande ◽  
Sandra Kik ◽  
Wayne Van Gemert ◽  
Hojoon Sohn ◽  
...  
Keyword(s):  
Public Sector ◽  
World Health ◽  
Sputum Smear ◽  
Positive Trend ◽  
Market Penetration ◽  
The Public ◽  
Control Programs ◽  
Full Capacity ◽  
Health Organization ◽  
Roll Out

Background: Xpert® MTB/RIF, a rapid tuberculosis (TB) molecular test, was endorsed by the World Health Organization in 2010. Since then, 34.4 million cartridges have been procured under concessional pricing. Although the roll out of this diagnostic is promising, previous studies showed low market penetration. Methods: To assess 3-year trends of market penetration of Xpert MTB/RIF in the public sector, smear and Xpert MTB/RIF volumes for the year 2016 were assessed and policies from 2014-2016 within 22 high-burden countries (HBCs) were studied. A structured questionnaire was sent to representatives of 22 HBCs. The questionnaires assessed the total smear and Xpert MTB/RIF volumes, number of modules and days of operation of GeneXpert machines in National TB Programs (NTPs). Data regarding the use of NTP GeneXpert machines for other diseases and GeneXpert procurement by other disease control programs were collected. Market penetration was estimated by the ratio of total sputum smear volume for initial diagnosis divided by the number of Xpert MTB/RIF tests procured in the public sector. Results: The survey response rate was 21/22 (95%). Smear/Xpert ratios decreased in 17/21 countries and increased in four countries, since 2014. The median ratio decreased from 32.6 (Q1:14.3, Q3: 58.9) in 2014 to 6.0 (Q1: 1.6, Q3: 17.0) in 2016. Nineteen countries (19/19; 100%) were not using GeneXpert machines to their full capacity, however seven countries (7/19; 37%) were running tests for other diseases on their NTP-procured GeneXpert systems in 2017, such as HIV, hepatitis-C virus (HCV), Chlamydia trachomatis, and Neisseria gonorrhoeae. Five (5/15; 33%) countries reported GeneXpert procurement by HIV or HCV programs in 2016 and/or 2017. Conclusions: Our results show a positive trend for Xpert MTB/RIF market penetration in 21 HBC public sectors. However, GeneXpert machines were under-utilized for TB, and inadequately exploited as a multi disease technology.

Can luteolin be a therapeutic molecule for both colon cancer and diabetes?

2018 ◽  
Vol 18 (4) ◽  
pp. 230-239 ◽  
Author(s):  
Rashmi K Ambasta ◽  
Rohan Gupta ◽  
Dhiraj Kumar ◽  
Saurabh Bhattacharya ◽  
Aditi Sarkar ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Signaling Pathway ◽  
World Health ◽  
Molecular Signaling ◽  
Immunofluorescence Analysis ◽  
Number Of Patients ◽  
Patients With Diabetes ◽  
Health Organization ◽  
Multiple Signaling

Abstract Diabetes and colon cancer are the leading cause of mortality worldwide. According to World Health Organization, the number of patients with diabetes and cancer is going to be elevated by 50% in 2020. However, several flavonoids have been known to be useful in reducing the chance of cancer/diabetes but the hunt of a single biomolecule that can act as therapeutic and preventive molecules for future epidemic continues. In this review, we aim to perform an illustration of all researches done that target molecular signaling using luteolin in cancer/diabetes and predicted target protein using PharmMapper. The search confirms that luteolin can be a remedial molecule for both cancer and diabetes via acting on variety of signaling pathway. Furthermore, we also intend to illustrate/compare the predicted and verified molecular modes of action of luteolin. Fluorescence in situ hybridization analysis confirms the expression of CCND1 in colon cancer while immunofluorescence analysis confirms the CDK4 in diabetes. Finally, an effort has been made to map docking of marker protein-luteolin at a particular site using docking software. This review gives a holistic overview about luteolin as a therapeutic molecule for cancer/diabetes via acting on multiple signaling cascade such as p53, Wnt, eNOS, iNOS, SOD and MMP9, with especial emphasis on the cyclin-CDK pathway. Altogether, the review concludes that luteolin can be a molecule for the therapy of both cancer and diabetes by acting on broad signaling pathway.

scholarly journals Development of the Troponin Detection System Based on the Nanostructure

Micromachines ◽  
2019 ◽  
Vol 10 (3) ◽  
pp. 203 ◽  
Author(s):  
Taek Lee ◽  
Jae-Hyuk Ahn ◽  
Jinha Choi ◽  
Yeonju Lee ◽  
Jin-Myung Kim ◽  
...  
Keyword(s):  
Detection System ◽  
Surface Enhanced Raman Spectroscopy ◽  
The Body ◽  
World Health ◽  
Detection Techniques ◽  
Number Of Patients ◽  
Creatine Kinase Mb ◽  
High Death ◽  
Surface Enhanced Raman ◽  
Health Organization

During the last 30 years, the World Health Organization (WHO) reported a gradual increase in the number of patients with cardiovascular disease (CVD), not only in developed but also in developing countries. In particular, acute myocardial infarction (AMI) is one of the severe CVDs because of the high death rate, damage to the body, and various complications. During these harmful effects, rapid diagnosis of AMI is key for saving patients with CVD in an emergency. The prompt diagnosis and proper treatment of patients with AMI are important to increase the survival rate of these patients. To treat patients with AMI quickly, detection of a CVD biomarker at an ultra-low concentration is essential. Cardiac troponins (cTNs), cardiac myoglobin (cMB), and creatine kinase MB are typical biomarkers for AMI detection. An increase in the levels of those biomarkers in blood implies damage to cardiomyocytes and thus is related to AMI progression. In particular, cTNs are regarded as a gold standard biomarker for AMI diagnosis. The conventional TN detection system for detection of AMI requires long measurement time and is labor-intensive and tedious. Therefore, the demand for sensitive and selective TN detection techniques is increasing at present. To meet this demand, several approaches and methods have been applied to develop a TN detection system based on a nanostructure. In the present review, the authors reviewed recent advances in TN biosensors with a focus on four detection systems: (1) An electrochemical (EC) TN nanobiosensor, (2) field effect transistor (FET)-based TN nanobiosensor, (3) surface plasmon resonance (SPR)-based TN nanobiosensor and (4) surface enhanced Raman spectroscopy (SERS)-based TN nanobiosensor.

scholarly journals Insights on exclusive breastfeeding norms in Kinshasa: findings from a qualitative study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Francine E. Wood ◽  
Anastasia J. Gage ◽  
Dieudonné Bidashimwa
Keyword(s):  
Social Norms ◽  
Exclusive Breastfeeding ◽  
Democratic Republic Of Congo ◽  
Cultural Beliefs ◽  
Optimal Growth ◽  
Capital City ◽  
World Health ◽  
Group Discussions ◽  
Nationally Representative ◽  
Health Organization

Abstract Background For optimal growth and development, the World Health Organization recommends that children be exclusively breastfed for the first 6 months of life. However, according to the nationally-representative 2013–2014 Demographic and Health Survey, under 50% of babies in the Democratic Republic of Congo are exclusively breastfed. Although breastfeeding was common in the capital city of Kinshasa, one in five newborns received alternatives to breastmilk during the first 3 days of life. This analysis aimed to identify social norms influencing exclusive breastfeeding, the role of a young first-time mother’s (FTM’s) social network for her choice to exclusively breastfeed, and perceived social sanctions associated with breastfeeding practices in Kinshasa. Methods The qualitative analysis was based on a vignette presented during 14 focus group discussions, with a purposively selected sample (n = 162) of FTMs age 15–24, and the male partners, mothers and mothers-in-law of FTMs age 15–24 in three health zones in Kinshasa in 2017. Thematic content analysis was performed to identify concepts and patterns in the participants’ discussions. Results Overall, community norms were not supportive of exclusive breastfeeding. The main barriers to exclusive breastfeeding were the belief held by most FTMs that exclusive breastfeeding was an uncommon practice; the desire to avoid negative sanctions such as name-calling and mockery for refusal to give babies water in the first 6 months of life; the desire to please key members of their social networks, specifically their mothers and friends, by doing what these influencers expected or preferred them to do; FTMs’ own lack of experience with infant feeding; and trust placed in their mothers and friends. Conclusion Social norms can be maintained by the belief about what others do, perceived expectations about what individuals ought to do, the negative sanctions they can face and their preference to conform to social expectations. Thus, addressing cultural beliefs and targeting sensitization efforts to key influencers that provide support to FTMs are needed to promote exclusive breastfeeding in Kinshasa. In doing so, strategies should address the barriers to exclusive breastfeeding including related misconceptions, and improve FTMs’ self-efficacy to overcome the influence of others.

scholarly journals Correlation between knowledge of HIV, attitudes and perceptions of HIV and a willingness to test for HIV at a regional hospital in KwaZulu-Natal, South Africa

2012 ◽  
Vol 4 (1) ◽  
Author(s):  
Emeka E. Orisakwe ◽  
Andrew J. Ross ◽  
Peter O. Ocholla
Keyword(s):  
Health Belief ◽  
Immune Deficiency Syndrome ◽  
Deficiency Syndrome ◽  
World Health ◽  
Number Of Patients ◽  
Significant Difference ◽  
Hiv Counselling And Testing ◽  
Knowledge And Attitude ◽  
Health Organization ◽  
Belief Model

Background: With millions of South Africans infected with human immunodeficiency virus (HIV) and less than 10% of the population aware of their HIV status, HIV counselling and testing (HCT) is the first step in any attempt to reduce the number of new infections. For those who test negative, HCT personalises the risks and reinforces preventative messages whilst for those who are positive, it is the gateway to accessing counselling and care. The Health Belief Model postulates that knowledge and attitude influence behaviour. The aim of this study was to determine whether knowledge of HIV and the attitude of patients referred for HCT correlated with a willingness to test for HIV.Methods: One hundred and seventy two patients referred for HCT were randomly selected over a three month period. Data were collected by a research assistant using the modified standardised World Health Organization (WHO)–Global AIDS Project (GAP) questionnaire.Results: Ninety per cent of the participants demonstrated sound knowledge of HIV, acquired immune deficiency syndrome (AIDS) and HCT. Despite the 90% of the participants with sound knowledge only 71.5% of the participants tested for HIV. There was no statistically significant difference in knowledge between those who tested and those who did not test for HIV. Twenty five per cent of those who refused to test stated that they had already made up their mind not to test for HIV before the counselling session.Conclusions: Despite excellent knowledge of HIV, a significant number of patients referred for HCT do not test for HIV.

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