scholarly journals Factors influencing adherence to antiretroviral treatment among adults accessing care from private health facilities in Malawi

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Lusungu Chirambo ◽  
Martha Valeta ◽  
Tifiness Mary Banda Kamanga ◽  
Alinane Linda Nyondo-Mipando
Keyword(s):  
Retention In Care ◽  
Health Facilities ◽  
Hiv Care ◽  
Adherence Rate ◽  
Related Factors ◽  
The Public ◽  
Study Sites ◽  
Privacy And Confidentiality ◽  
Privately Owned

Abstract Background Private health facilities are increasingly being recognized as the neglected partner in the provision of HIV services. The non-adherence rate in the study sites ranged from 19 to 22%. This study explored the factors associated with non-adherence from antiretroviral therapy (ART) among adult patients accessing ART services at two privately owned urban health facilities in Malawi. Methods We conducted a descriptive qualitative approach employing in-depth interviews among adults who either defaulted or were retained in HIV care in two privately owned facilities in Malawi from March to July 2017. We purposively selected participants and interviewed a total of 6 ART providers and 24 ART clients. Data were analyzed manually using a thematic approach. Results Overall, participants identified four facilitators for retention in care and four broad categories of barriers namely individual, psychological, drug related and human resource related factors. The factors that facilitated retention in care included follow up visits after missing a visit, adequate information education and counseling, and supportive relationships. Conclusion The main reason for defaulting from antiretrovirals (ARVs) was fear of disclosing an HIV status to avert potential stigma and discrimination. In implementing ART clinics due consideration and strategies need to be adopted to ensure that privacy and confidentiality is preserved. Although adoption of all the key Malawi Implementing strategies like expert clients and a guardian may optimize retention in care, there is need for prior analysis of how those may lead to unintended disclosure which inadvertently affects adherence. Furthermore, private facilities should orient their clients to the public facilities within the catchment area so that clients have an option for alternative access to HIV care in the event of financial constraints.

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 Impact of a child -friendly clinic on retention of HIV-infected children in care: an intervention study

1970 ◽  
Vol 44 (4) ◽  
pp. 175-179
Author(s):  
OR Ugwu
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Retention Rate ◽  
Retention In Care ◽  
Hiv Care ◽  
Satisfaction Survey ◽  
Loss To Follow Up ◽  
Child Friendly ◽  
Children In Care ◽  
The Impact

Background: Certain researchers have reported that a child-friendly clinic may improve patient/caregiver satisfaction at clinic attendance. This could serve as an innovation for reducing loss-to-follow up and increasing retention in care.Aim: To assess the impact of making the clinic more child-friendly on clinic experience, retention in care and loss-to-follow up of HIV -infected children.Method: The study was carried out in three phases. Phase one was a satisfaction survey to find out the patient/caregivers’ satisfaction of the clinic environment and services provided using a selfadministered questionnaire. Phase two was the creation of the childfriendly environment and phase three was a post-provision of child-friendly clinic satisfaction survey. The loss-to-follow up rate (failure to return to clinic ≥3months after the last scheduled clinic appointment in a child not known to be dead or transferred out of the facility) and retention rate (remaining alive and receiving highly active antiretroviral therapy) were also determined before and after setting up the childfriendly clinic.Results: There were 146 respondents before the study and 206 respondents after the intervention. The retention rate increased from 62.5% to 82% (p=0.02), while the loss-to-follow up rate dropped from 27.7% to 7.0% (p=0.00).Conclusion: Making the clinic area child-friendly can impact greatly on HIV care by improving patient satisfaction and retention of HIVinfected children in care and reducing loss-to-follow up.Key words: HIV, child-friendly environment, retention in care, loss to follow-up.

scholarly journals HIV Pediatric Care Quality in Togo's Health Facilities in 2014

2018 ◽  
Vol 08 (01) ◽  
pp. e11-e17
Author(s):  
K. Azoumah ◽  
F. Agbéko ◽  
K. Djadou ◽  
K. Segbedji ◽  
A. Géraldo ◽  
...  
Keyword(s):  
Care Quality ◽  
Health Facilities ◽  
World Health ◽  
Hiv Care ◽  
Pediatric Care ◽  
People Living With Hiv ◽  
Average Delay ◽  
Z Scores ◽  
Weight For Age

AbstractIn 2013, children living with human immunodeficiency virus (HIV)(CLHIV) and on antiretroviral therapy (ART) in Togo accounted for 7.6% of people living with HIV on ART. Management faces many challenges due to insufficient qualified human resources. This study aimed to assess the availability of care offered to these children in health facilities. This was a retrospective descriptive study on 244 CLHIV (under 15 years) who were on ART and randomly selected in 26 sites providing HIV medical care in Togo from July 22 to September 06 2014. Evaluation forms on children's clinical, biological, and therapeutic parameters were analyzed. Forty percent of CLHIV were between the ages of 5 and 9 years. The average age was 5 years at testing for diagnosis; 49% of children were in the World Health Organization (WHO) stage III–IV. The sex ratio (male/female [M/F]) was 1:1. Almost 71% of CLHIV were underweight (weight-for-age <  − 2 Z scores Severely underweight : weight-for-age  <  −  3 Z scores). The patient height was not recorded in 81.6% of the cases. According to the guidelines, the criteria to be on ART were met for 90.2% of children. The average delay (from diagnosis) to be on ART was 216 days. First-line regimens were mostly zidovudine/lamivudine/nevirapine (AZT/3TC/NVP) (47.0%) and stavudine/lamivudine/nevirapine (d4T/3TC/NVP) (38.7%). Follow-up was characterized by a low rate of achievement of the biological semi-annual evaluation (19.8%), child compliance for 62.7%, a cotrimoxazole prophylaxis for 70.2%, and tuberculosis screening for 64.8%. The lost-to-follow-up (LFU) proportion was 8.9%. HIV pediatric diagnosis is still an issue in Togo. Early maternal and child healthcare and HIV care are not optimal. Recruitment and capacity building of health professionals, delegation of tasks to paramedics, and innovative motivation processes could improve care for HIV-infected children.

scholarly journals Factors Associated With Loss-To-Follow-Up Of Hiv-Positive Mothers And Their Infants Enrolled In Hiv Care Clinic: A Qualitative Study

2019 ◽  
Author(s):  
Samuel Lawrent Mpinganjira ◽  
Timothy Tchereni ◽  
Andrews Gunda ◽  
Victor Mwapasa
Keyword(s):  
Qualitative Study ◽  
Health Facilities ◽  
System Level ◽  
Hiv Care ◽  
Hiv Positive ◽  
Long Distance ◽  
Care Clinic ◽  
Loss To Follow Up ◽  
Factors Associated

Abstract Background In Malawi, loss to follow-up (LTFU) of HIV-positive pregnant and postpartum women on Option B+ regimen greatly contributes to sub-optimal retention, estimated 74% at 12 months postpartum. This threatens Malawi’s efforts to eliminate mother-to-child transmission of HIV. We investigated factors associated with LTFU among Mother-Infant Pairs. Methods We conducted a qualitative study, nested within the “Promoting Retention Among Infants and Mothers Effectively (PRIME)” study, a 3-arm cluster randomized trial assessing the effectiveness of strategies for improving retention of mother-infant pairs in HIV care in Salima and Mangochi districts, Malawi. From July to December 2016, we traced 19 LTFU women and conducted in-depth interviews with them and also with 30 healthcare workers from health facilities where the LTFU women were receiving care. Recorded interviews were transcribed and translated and, then, analysed using deductive content analysis. Results The following reasons were reported contributing to LTFU: lack of support from husbands or family members; long distance to health facilities; food insecurity; community-level stigma; ART side effects; perceived good health after taking ART and adoption of other alternative HIV treatment options. Conclusion Our study has found multiple factors at personal, family, community and health system level which contribute to poor retention of mother-infant pairs in HIV care. Key words PRIME, PMTCT, EMTCT, loss to follow up, mother-infant pairs, Option B+

scholarly journals The expansion of a patient tracer programme to identify and return patients loss to follow up at a large HIV clinic in Trinidad

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
R. Jeffrey Edwards ◽  
Nyla Lyons ◽  
Wendy Samaroo-Francis ◽  
Leon-Omari Lavia ◽  
Isshad John ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Retention In Care ◽  
Hiv Care ◽  
Loss To Follow Up ◽  
Targeted Interventions ◽  
The Status ◽  
Care Models ◽  
Clinic Medical ◽  
Lost To Follow Up

Abstract Background Patients who default from HIV care are usually poorly adherent to antiretroviral treatment which results in suboptimal viral suppression. The study assessed the outcomes of retention in care and viral suppression by expansion of an intervention using two patient tracers to track patients lost to follow up at a large HIV clinic in Trinidad. Methods Two Social Workers were trained as patient tracers and hired for 15 months (April 2017–June 2018) to call patients who were lost to follow up for 30 days or more during the period July 2016–May 2018 at the HIV clinic Medical Research Foundation of Trinidad and Tobago. Results Over the 15-month period, of the of 2473 patients who missed their scheduled visits for 1 month or more, 261 (10.6%) patients were no longer in active care—89 patients dead, 65 migrated, 55 hospitalized, 33 transferred to another treatment clinic and 19 incarcerated. Of the remaining 2212 patients eligible for tracing, 1869 (84.5%) patients were returned to care, 1278 (68.6%) were virally unsuppressed (viral load > 200 copies/ml) and 1727 (92.4%) were re-initiated on ART. Twelve months after their return, 1341 (71.7%) of 1869 patients were retained in care and 1154 (86.1%) of these were virally suppressed. Multivariate analysis using logistic regression showed that persons were more likely to be virally suppressed if they were employed (OR, 1.39; 95% CI 1.07–1.80), if they had baseline CD4 counts < 200 cells/mm3 (OR, 1.71; 95% CI 1.26–2.32) and if they were retained in care at 12 months (OR, 2.48; 95% CI 1.90–3.24). Persons initiated on ART for 4–6 years (OR, 3.09; 95% CI 1.13–8.48,), 7–9 years (OR, 3.97; 95% CI 1.39–11.31), > 10 years (OR, 5.99; 95% CI 1.74–20.64 were more likely to be retained in care. Conclusions Patient Tracing is a feasible intervention to identify and resolve the status of patients who are loss to follow up and targeted interventions such as differentiated care models may be important to improve retention in care.

scholarly journals Reasons for Missed Visits and Influence of Phone Call Reminders on Retention of HIV-Infected and Uninfected Children Followed in Cameroon: The ANRS-PEDIACAM Cohort

2020 ◽  
Author(s):  
Francis Jaudel YUYA SEPTOH ◽  
Jules Brice Tchatchueng ◽  
Francis Ateba Ndongo ◽  
Ida Calixte Penda ◽  
Georgette Guemkam ◽  
...  
Keyword(s):  
Economic Status ◽  
Retention In Care ◽  
Hiv Care ◽  
Phone Call ◽  
Categorical Variables ◽  
Relative Risk Ratio ◽  
Adjusted Relative Risk ◽  
Continuous Variables ◽  
Community Monitoring

Abstract BackgroundAs many longitudinal studies, follow-up in the ANRS-PEDIACAM study is disrupted by repeated absences of participants to scheduled visits. This lead to missing data which influence the quality of results. We describe reasons for participants absence or non-compliance (NC) and assess the influence of phone call reminders (CR) on retention in care.MethodsFrom November 2007 to 2011, 611 infants divided in three groups were included and followed in three referral hospital in Cameroon: HIV-infected children followed from the first week of life or not but diagnosed before seven month of life (n=210), HIV-uninfected children born to HIV-infected (HEU) (n=205) mothers or not (HUU) (n=196). From 2014 to 2017, CR were reinforced to record reasons of missing visits. we used frequency, chi-square or Fisher test for categorical variables; means, median (IQR) and non-parametric Kruskal Wallis test for continuous variables. A multistate transition modelling approach was used to analyse the retention care cascade. The R software was used to perform all statistical analysis.ResultsDuring the study period, 45.1% (246/546) of children were NC at least once of ​​which 16.3% (25/153), 58% (116/200), 54.4% (105/193) respectively among HIV-infected, HEU and HUU-children. Among NC, 69.5% (171/246) has been reachable at least once and 22.2% (38/171) of them returned to follow-up after a median delay of 32 days (IQR: [2.0 – 110]); 44.4% (109/246) were not seen throughout the study period (HIV-infected: 12/153, HEU-children: 57/200, HUU-children: 40/193). A total of 276 reasons have been reported among 54%(115/213) of the NC, mainly related to delocalisation (30.4%), lack of time (23.6%), wish to stop follow-up (11.6%), travelling (9.8%), schooling (9.4%), forgetting (7.2%). Comparing before and after period, CR allowed to divided by three adjusted relative risk ratio to miss one clinical visit (RRR [CI]: 0.35[0.24 – 0.52]), However CR effect was not significant among children who are non-compliant.ConclusionOur finding suggest that maternal HIV and socio-economic status are related to attendance of children in HIV care. Also, the CR are an effective strategy to improve attendance. However, to make this strategy effective for children who are non-compliant, it needs to be strengthened by community monitoring.

scholarly journals Factors associated with retention in HIV care at Sediba Hope Medical Centre

2015 ◽  
Vol 16 (1) ◽  
Author(s):  
Nishana Ramdas ◽  
Johanna C. Meyer ◽  
David Cameron
Keyword(s):  
Support Group ◽  
Retention In Care ◽  
Electronic System ◽  
Hiv Care ◽  
Work Related ◽  
Retention In Hiv Care ◽  
Close Proximity ◽  
Related Stress ◽  
Lost To Follow Up

Background: Lost to follow-up (LTFU) is a major challenge that hinders the success of antiretroviral treatment (ART).Objective: To identify factors conducted to a low LTFU rate.Methods: We conducted a two-part descriptive and quantitative study. Part 1 comprised interviews with clinic staff to determine their perspectives on LTFU and to establish the clinic’s follow-up procedures for patients on ART. Part 2 of the study was a retrospective review of clinic and patient records. LTFU patients were identified and those with contact details were contacted for telephonic interview to determine if they were still on ART and/or their reasons for becoming LTFU.Results: A low LTFU rate (7.9%; N = 683) was identified. Work-related stress, and lack of transport and funds were reported reasons for LTFU. Monthly visits, non-adherent defaulters and LTFU patients were tracked by an electronic system (SOZO). Factors contributing to high rates of retention in care were: location of the clinic in the inner city, thus in close proximity to patients’ homes or work; clinic operating on Saturdays, which was convenient for patients who could not attend during the week; an appointment/booking system that was in place and strictly adhered to; a reminder SMS being sent out the day before an appointment; individual counselling sessions at each visit and referrals where necessary; and a stable staff complement and support group at the clinic.Conclusion: Achieving a low LTFU rate is possible by having a patient-centred approach and monitoring systems in place.

scholarly journals The Phishing Funnel Model: A Design Artifact to Predict User Susceptibility to Phishing Websites

2021 ◽  
Author(s):  
Ahmed Abbasi ◽  
David Dobolyi ◽  
Anthony Vance ◽  
Fatemeh Mariam Zahedi
Keyword(s):  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Related Factors ◽  
The Public ◽  
Phishing Attacks ◽  
Internet Users ◽  
Competing Models ◽  
Security Incidents ◽  
Security Concern

Phishing is a significant security concern for organizations, threatening employees and members of the public. Phishing threats against employees can lead to severe security incidents, whereas those against the public can undermine trust, satisfaction, and brand equity. At the root of the problem is the inability of Internet users to identify phishing attacks even when using anti-phishing tools. We propose the phishing funnel model (PFM), a framework for predicting user susceptibility to phishing websites. PFM incorporates user, threat, and tool-related factors to predict actions during four key stages of the phishing process: visit, browse, consider legitimate, and intention to transact. We evaluated the efficacy of PFM in a 12-month longitudinal field experiment in two organizations involving 1,278 employees and 49,373 phishing interactions. PFM significantly outperformed competing models in terms of its ability to predict user susceptibility to phishing attacks. A follow-up three-month field study revealed that employees using PFM were significantly less likely to interact with phishing threats relative to comparison models and baseline warnings. Results of a cost-benefit analysis suggest that interventions guided by PFM could reduce annual phishing-related costs by nearly $1,900 per employee relative to comparison prediction methods.

scholarly journals OPT-In For Life: A Mobile Technology–Based Intervention to Improve HIV Care Continuum for Young Adults Living With HIV

2020 ◽  
Vol 21 (5) ◽  
pp. 727-737
Author(s):  
John Zurlo ◽  
Ping Du ◽  
Alexander Haynos ◽  
Verbenia Collins ◽  
Tarek Eshak ◽  
...  
Keyword(s):  
Mobile Technology ◽  
Mobile Application ◽  
Viral Suppression ◽  
Retention Rate ◽  
Retention In Care ◽  
Hiv Care ◽  
Hiv Care Continuum ◽  
Study Participants ◽  
Living With Hiv

Young adults living with HIV (YALH) have lower rates of retention in care and HIV viral suppression. Multiple barriers exist to engage YALH in care. We developed and implemented a multifaceted, mobile application-based intervention, “OPT-In for Life,” by targeting YALH to encourage retention in care and eventually viral suppression. The app integrated multiple user-friendly features for YALH to manage their HIV care, including a two-way secure messaging function, HIV-related laboratory results, and appointment or medication reminders. We recruited 92 YALH who were 18 to 34 years old and were newly diagnosed with HIV, had a history of falling out of care, or had a detectable HIV viral load into this intervention. Study participants used the app to manage their HIV care and to communicate and interact with their HIV care team. During the intervention period, the retention rate among our study participants increased from 41.3% at baseline to 78.6% at 6-month follow-up, maintained at 12-month follow-up (79.8%), and slightly decreased to 73.4% at 18-month follow-up but it was still significantly higher than the baseline retention rate ( p < .0001). The viral suppression rate (HIV RNA <200 copies/ml) increased from 64.1% at baseline to about 85% at 6-month and at 12-month follow-up and reached 91.4% at 18-month ( p = .0002) among participants who were retained in care. Our study demonstrated using a HIPAA-compliant mobile application as an effective intervention to engage YALH in care. This mobile technology–based intervention can be incorporated into routine clinical practice to improve HIV care continuum.

scholarly journals Case Identification, Retention and Blood Pressure Control: Lessons From a Large-Scale Hypertension Programme in Kenya

2019 ◽  
Author(s):  
Lilian Kagure Mbau ◽  
Rebecca Harisson ◽  
Walter Kizito ◽  
Collins Timire ◽  
Tecla Namusonge ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Large Scale ◽  
Retention In Care ◽  
Pressure Control ◽  
Sub Saharan Africa ◽  
Retention Rates ◽  
Older Individuals ◽  
Related Factors ◽  
Younger Patients

Abstract Background: The prevalence of hypertension in sub-Saharan Africa has been on the rise but remains underdiagnosed, undertreated and poorly controlled. In Kenya, 92% of patients are not on treatment and 3% controlled. This study aimed to assess the performance of a hypertension screening and treatment program in five counties in Kenya with reference to identification of individuals at risk, retention on treatment and blood pressure (BP) control.Methods: We conducted a retrospective cohort study using data routinely collected between March 2015 and December 2018. All patients 18 years and older screened and/or treated for hypertension at any of the program supported sites were included in the study. We calculated prevalence of high BP (systolic BP equal or more than 140 mmHg, diastolic BP equal or more than 90 mmHg) and related risk in the screening episodes, retention on treatment, BP control and related factors among patients enrolled for treatment of hypertension.Results: A total of 663,028 screening encounters were recorded of which 70.4% were female, median age was 34 years and majority (73.9%) were screened at the community level. Of the encounters, 19% had high BP, significantly higher among males and older individuals. A total of 66,981 patients were enrolled on treatment with majority being females (71.2%), median age 55 years, 40.4% aged 60+ years and 36.2% enrolled in Level 5 health facilities (county referral hospitals). Only 12% of patients were retained in care at 12 months with younger patients and individuals treated at higher level facilities (levels 4 and 5) having the lowest retention rates (p<0.05). By 12 months of treatment, BP was controlled in 48.6% of patients retained on treatment. Over a 36-month follow-up period, the mean systolic and diastolic BP gradually reduced by 8.9mmHg and 2.5mmHg, respectively.Conclusions: The program screened primarily females and younger individuals at lower risk of developing hypertension. Retention in care was poor especially among younger patients and those enrolled at higher level facilities. Close to half of the patients retained, attained blood pressure control by one year. Hypertension programs should target high risk populations, decentralize care and include retention and follow-up strategies.

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