Operational experiences associated with the implementation of near point-of-care early infant diagnosis of HIV in Myanmar: a qualitative study

Abstract Background Timely diagnosis and early initiation of life-saving antiretroviral therapy are critical factors in preventing mortality among HIV-infected infants. However, resource-limited settings experience numerous challenges associated with centralised laboratory-based testing, including low rates of testing, complex sample referral pathways and unacceptably long turnaround times for results. Point-of-care (POC) HIV testing for HIV-exposed infants can enable same-day communication of results and early treatment initiation for HIV-infected infants. However, complex operational issues and service integration can limit utility and must be well understood prior to implementation. We explored and documented the challenges and enabling factors in implementing the POC Xpert® HIV-1 Qual test (Cepheid, Sunnyvale, CA, USA) for early infant diagnosis (EID) as part of routine services in four public hospitals in Myanmar. Methods This sub-study was part of a randomised controlled stepped-wedge trial (Australian and New Zealand Clinical Trials Registry, number 12616000734460) designed to investigate the impact of POC testing for EID in Myanmar and Papua New Guinea. Infants recruited during the intervention phase underwent POC testing at the participating hospitals as part of routine care. Semi-structured interviews with 23 caregivers, 12 healthcare providers and 10 key informants were used to explore experiences of POC-EID testing. The research team and hospital staff documented and discussed implementation challenges throughout the study. Results Overall, caregivers and healthcare workers were satisfied with the short turnaround time of the POC test. Occasional delays in POC testing were mostly attributable to late receipt of samples by laboratory technicians and communication constraints among healthcare staff. Hospital staff valued technical assistance from the research group and the National Health Laboratory. Despite staff shortages and infrastructure challenges such as unreliable electricity supply and cramped space, healthcare workers and caregivers found the implementation of the POC test to be feasible at pilot sites. Conclusions As plans for national scale-up evolve, there needs to be a continual focus on staff training, communication pathways and infrastructure. Other models of care, such as allowing non-laboratory-trained personnel to perform POC testing, and cost effectiveness should also be evaluated.

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Improving the experience of facility-based delivery for vulnerable women through obstetric care navigation: a qualitative evaluation

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03842-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kirsten Austad ◽

Michel Juarez ◽

Hannah Shryer ◽

Patricia L. Hibberd ◽

Mari-Lynn Drainoni ◽

...

Keyword(s):

Health Workers ◽

Positive Impact ◽

Qualitative Evaluation ◽

Obstetric Care ◽

Hospital Staff ◽

Public Hospitals ◽

Future Research ◽

Care Seeking ◽

Structured Interviews ◽

The Impact

Abstract Background Global disparities in maternal mortality could be reduced by universal facility delivery. Yet, deficiencies in the quality of care prevent some mothers from seeking facility-based obstetric care. Obstetric care navigators (OCNs) are a new form of lay health workers that combine elements of continuous labor support and care navigation to promote obstetric referrals. Here we report qualitative results from the pilot OCN project implemented in Indigenous villages in the Guatemalan central highlands. Methods We conducted semi-structured interviews with 17 mothers who received OCN accompaniment and 13 staff—namely physicians, nurses, and social workers—of the main public hospital in the pilot’s catchment area (Chimaltenango). Interviews queried OCN’s impact on patient and hospital staff experience and understanding of intended OCN roles. Audiorecorded interviews were transcribed, coded, and underwent content analysis. Results Maternal fear of surgical intervention, disrespectful and abusive treatment, and linguistic barriers were principal deterrents of care seeking. Physicians and nurses reported cultural barriers, opposition from family, and inadequate hospital resources as challenges to providing care to Indigenous mothers. Patient and hospital staff identified four valuable services offered by OCNs: emotional support, patient advocacy, facilitation of patient-provider communication, and care coordination. While patients and most physicians felt that OCNs had an overwhelmingly positive impact, nurses felt their effort would be better directed toward traditional nursing tasks. Conclusions Many barriers to maternity care exist for Indigenous mothers in Guatemala. OCNs can improve mothers’ experiences in public hospitals and reduce limitations faced by providers. However, broader buy-in from hospital staff—especially nurses—appears critical to program success. Future research should focus on measuring the impact of obstetric care navigation on key clinical outcomes (cesarean delivery) and mothers’ future care seeking behavior.

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Point of Care (POC) for Early Infant Diagnosis (EID) in Nigeria? Healthcare Workers Opinion

TEXILA INTERNATIONAL JOURNAL OF PUBLIC HEALTH ◽

10.21522/tijph.2013.09.01.art009 ◽

2021 ◽

Vol 9 (1) ◽

pp. 87-94

Author(s):

Busari Olusegun

Keyword(s):

Healthcare Workers ◽

Point Of Care ◽

Standard Of Care ◽

Turnaround Time ◽

Early Infant Diagnosis ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Healthcare Facilities ◽

Early Infant ◽

Hiv Exposed

Without access to life-saving drugs, including antiretroviral, about one-third of HIV exposed infants (HEI) will die by age 1 year and 50% by age 2 years. A 75% reduction in disease progression and 76% reduction in HIV mortality in infants has been attributed to early diagnosis of HIV and early commencement on ART. Early Infant Diagnosis (EID) of HIV aids timely commencement on antiretroviral therapy (ART). Several challenges have been identified with the current process. Point of care (POC) technologies are recommended as a veritable means of addressing these challenges and improving EID uptake. With the aim of assessing the standard of care and the acceptability of POC for the provision of EID. A descriptive cross-sectional survey was conducted across eight healthcare facilities in Nigeria. The survey was conducted among 72 healthcare workers using self-administered questionnaire; with a recovery rate of 61(84.7%). Analysis of participants’ responses indicate that 100% of the respondents believes there is a need for EID. Most respondent reported an average turnaround time (TAT) of 3-4 weeks (35.8%) and >6 weeks (34.0%). Most respondents identified distance to the PCR laboratories (45.7%) and long TAT (34.8%) as key issues affecting the conduct of EID. On the benefit of POC for EID; 90.2% of respondent believe it is beneficial; while 81.5% of respondent believe that with the introduction and use of POC for EID there will be an increase in EID uptake. The POC is a viable and acceptable alternative for EID to increase uptake.

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The NSEBA Demonstration Project: Implementation of a point‐of‐care platform for early infant diagnosis of HIV in rural Zambia

Tropical Medicine & International Health ◽

10.1111/tmi.13627 ◽

2021 ◽

Author(s):

Catherine G. Sutcliffe ◽

Nkumbula Moyo ◽

Jessica L. Schue ◽

Jane N. Mutanga ◽

Mutinta Hamahuwa ◽

...

Keyword(s):

Point Of Care ◽

Demonstration Project ◽

Early Infant Diagnosis ◽

Project Implementation ◽

Early Infant ◽

Rural Zambia

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Opportunities and challenges for telemedicine oncology: Perspectives from the frontline (Preprint)

10.2196/preprints.29635 ◽

2021 ◽

Author(s):

Kea Turner ◽

Margarita Bobonis Babilonia ◽

Cristina Naso ◽

Oliver Nguyen ◽

Brian D. Gonzalez ◽

...

Keyword(s):

Patient Outcomes ◽

Cancer Care ◽

Healthcare Workers ◽

Healthcare Delivery ◽

Implementation Strategies ◽

Structured Interviews ◽

Biometric Data ◽

Quality Costs ◽

Workflow Integration ◽

The Impact

BACKGROUND Rapid implementation of telemedicine for cancer care during COVID-19 required innovative and adaptive solutions among healthcare workers. OBJECTIVE The objective of this qualitative study was to explore healthcare workers’ experiences with telemedicine implementation during COVID-19. METHODS We conducted semi-structured interviews with 40 oncology healthcare workers who implemented telemedicine during COVID-19. The interviews were recorded, transcribed verbatim, and analyzed for themes using Dedoose software (Version 4.12). RESULTS Approximately half of participants were physicians (55%) and one quarter of participants were APPs (25%). Other participants included social workers (n=3), psychologists (n=2), dieticians (n=2), and a pharmacist. Five key themes were identified: 1) establishing and maintaining patient-provider relationships, 2) coordinating care with other providers and informal caregivers, 3) adapting in-person assessments for telemedicine, 4) developing workflows and allocating resources, and 5) future recommendations. Participants described innovative strategies for implementing telemedicine, such as coordinating inter-disciplinary visits with multiple providers. Healthcare workers discussed key challenges, such as workflow integration, lack of physical exam and biometric data, and overcoming the digital divide. Participants recommended policy advocacy to support telemedicine (e.g., medical licensure policies) and monitoring how telemedicine affects patient outcomes and healthcare delivery. CONCLUSIONS To support the growth of telemedicine, implementation strategies are needed to ensure providers and patients have the tools necessary to effectively engage in telemedicine. At the same time, cancer care organizations will need to engage in advocacy to ensure policies are supportive of oncology telemedicine and develop systems to monitor the impact of telemedicine on patient outcomes, healthcare quality, costs, and equity. CLINICALTRIAL N/A

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Feasibility and acceptability of implementing early infant diagnosis of HIV in Papua New Guinea at the point of care: a qualitative exploration of health worker and key informant perspectives

BMJ Open ◽

10.1136/bmjopen-2020-043679 ◽

2020 ◽

Vol 10 (11) ◽

pp. e043679

Author(s):

Yasmin Mohamed ◽

Martha Kupul ◽

Janet Gare ◽

Steven G Badman ◽

Selina Silim ◽

...

Keyword(s):

Papua New Guinea ◽

Standard Care ◽

Health Workers ◽

Point Of Care ◽

Hiv Positive ◽

Early Infant Diagnosis ◽

Pmtct Programme ◽

Early Infant ◽

Qualitative Exploration ◽

Hiv 1

IntroductionEarly infant diagnosis (EID) of HIV and timely initiation of antiretroviral therapy can significantly reduce morbidity and mortality among HIV-positive infants. Access to EID is limited in many low-income and middle-income settings, particularly those in which standard care involves dried blood spots (DBS) sent to centralised laboratories, such as in Papua New Guinea (PNG). We conducted a qualitative exploration of the feasibility and acceptability of implementing a point-of-care (POC) EID test (Xpert HIV-1 Qualitative assay) among health workers and key stakeholders working within the prevention of mother-to-child transmission of HIV (PMTCT) programme in PNG.MethodsThis qualitative substudy was conducted as part of a pragmatic trial to investigate the effectiveness of the Xpert HIV-1 Qualitative test for EID in PNG and Myanmar. Semistructured interviews were undertaken with 5 health workers and 13 key informants to explore current services, experiences of EID testing, perspectives on the Xpert test and the feasibility of integrating and scaling up POC EID in PNG. Coding was undertaken using inductive and deductive approaches, drawing on existing acceptability and feasibility frameworks.ResultsHealth workers and key informants (N=18) felt EID at POC was feasible to implement and beneficial to HIV-exposed infants and their families, staff and the PMTCT programme more broadly. All study participants highlighted starting HIV-positive infants on treatment immediately as the main advantage of POC EID compared with standard care DBS testing. Health workers identified insufficient resources to follow up infants and caregivers and space constraints in hospitals as barriers to implementation. Participants emphasised the importance of adequate human resources, ongoing training and support, appropriate coordination and a sustainable supply of consumables to ensure effective scale-up of the test throughout PNG.ConclusionsImplementation of POC EID in a low HIV prevalence setting such as PNG is likely to be both feasible and beneficial with careful planning and adequate resources.Trial registration number12616000734460.

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Task shifting for point-of-care early infant diagnosis: a comparison of the quality of testing between nurses and laboratory personnel in Zimbabwe

Human Resources for Health ◽

10.1186/s12960-020-0449-2 ◽

2020 ◽

Vol 18 (1) ◽

Cited By ~ 1

Author(s):

Francis M. Simmonds ◽

Jennifer E. Cohn ◽

Haurovi W. Mafaune ◽

Tichaona H. Nyamundaya ◽

Agnes Mahomva ◽

...

Keyword(s):

Point Of Care ◽

Task Shifting ◽

Early Infant Diagnosis ◽

Laboratory Personnel ◽

Early Infant

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Experience of Burnout Syndrome In Resident Physicians

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1789 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S488-S488

Author(s):

P. Cigarroa-Vázquez ◽

I. Vargas-Huicochea

Keyword(s):

Basic Needs ◽

Well Being ◽

Phenomenological Approach ◽

Public Hospitals ◽

Burnout Syndrome ◽

Medical Residents ◽

Human Beings ◽

Structured Interviews ◽

Competing Interest ◽

The Impact

Medical residents, as a population that is in formation and that represents the workforce in public hospitals, are in a particularly vulnerable situation for the development of burnout syndrome (BOS), defined as a psychosocial disease in response to chronic stress in the work environment. This study analyzed the impact of BOS on a personal level, residents’ ways of coping, and the perceived needs to prevent it.ObjectivesTo analyze the experience of BOS in medical residents of Mexico City.MethodsQualitative design with a phenomenological approach. Semi-structured interviews were conducted. Participants were medical residents in training who agreed to participate. Data analysis was based meaning categorization and condensation, as well as some elements of discourse analysis.ResultsWe had interviews with residents of gynaecology, otorhinolaryngology, family medicine and psychiatry. We have found that there are some specific aspects that contribute to the development BOS:– the hidden curriculum that has become evident through unnecessary punishments;– various roles to be met simultaneously by residents;– the basic needs like sleeping and eating right are not being met due to excessive workload.– impact in general health.ConclusionsIt is necessary to make visible the complexity of the BOS and its impact on trainees to prevent deterioration in the quality of life and overall health status. It would be to achieve the satisfaction of basic needs as essential conditions for physical and mental well-being of all human beings, and more so for those whose task is to contribute to the health of others.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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