scholarly journals Alcohol consumption increases non-adherence to ART among people living with HIV enrolled to the community-based care model in rural northern Uganda

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242801
Author(s):  
Norbert Adrawa ◽  
John Bosco Alege ◽  
Jonathan Izudi
Keyword(s):  
Alcohol Consumption ◽  
Psychosocial Support ◽  
Statistical Significance ◽  
Binary Logistic Regression Analysis ◽  
Northern Uganda ◽  
People Living With Hiv ◽  
Community Based ◽  
Delivery Model ◽  
Community Based Art ◽  
Art Delivery

Background Non-adherence to anti-retroviral therapy (ART) is associated with considerable morbidity and mortality among people living with Human Immunodeficiency Virus (PLHIV). Community-based ART delivery model offers a decentralized and patient-centered approach to care for PLHIV, with the advantage of improved adherence to ART hence good treatment outcomes. However, data are limited on the magnitude of non-adherence to ART among PLHIV enrolled to the community-based ART model of care. In this study, we determined the frequency of non-adherence to ART and the associated factors among PLHIV enrolled to the community-based ART delivery model in a large health facility in rural northern Uganda. Methods This analytic cross-sectional study randomly sampled participants from 21 community drug distribution points at the AIDS Support Organization (TASO) in Gulu district, northern Uganda. Data were collected using a standardized and pre-tested questionnaire, entered in Epi-Data and analyzed in Stata at univariate, bivariate, and multivariate analyses levels. Binary logistic regression analysis was used to determine factors independently associated with non-adherence to ART, reported using odds ratio (OR) and 95% confidence level (CI). The level of statistical significance was 5%. Results Of 381 participants, 25 (6.6%) were non-adherent to ART and this was significantly associated with alcohol consumption (Adjusted (aOR), 3.24; 95% CI, 1.24–8.34). Other factors namely being single/or never married (aOR, 1.97; 95% CI, 0.62–6.25), monthly income exceeding 27 dollars (aOR, 1.36; 95% CI, 0.52–3.55), being on ART for more than 5 years (aOR, 0.60; 95% CI, 0.23–1.59), receipt of health education on ART side effects (aOR, 0.36; 95% CI, 0.12–1.05), and disclosure of HIV status (aOR, 0.37; 95% CI, 0.04–3.20) were not associated with non-adherence in this setting. Conclusion Non-adherence to ART was low among PLHIV enrolled to community-based ART delivery model but increases with alcohol consumption. Accordingly, psychosocial support programs should focus on alcohol consumption.

scholarly journals Adapting a community-based ART delivery model to the patients’ needs: a mixed methods research in Tete, Mozambique

2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Freya Rasschaert ◽  
Tom Decroo ◽  
Daniel Remartinez ◽  
Barbara Telfer ◽  
Faustino Lessitala ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Mixed Methods Research ◽  
Community Based ◽  
Delivery Model ◽  
Community Based Art ◽  
Art Delivery

scholarly journals Acceptability of point-of-care viral load testing to facilitate differentiated care: a qualitative assessment of people living with HIV and nurses in South Africa

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Lindani Msimango ◽  
Andrew Gibbs ◽  
Hlengiwe Shozi ◽  
Hope Ngobese ◽  
Hilton Humphries ◽  
...  
Keyword(s):  
Point Of Care ◽  
Task Shifting ◽  
People Living With Hiv ◽  
Community Based ◽  
Community Based Art ◽  
Professional Nurses ◽  
Living With Hiv ◽  
Differentiated Care ◽  
Art Delivery ◽  
And Task

Abstract Background Providing viral load (VL) results to people living with HIV (PLHIV) on antiretroviral therapy (ART) remains a challenge in low and middle-income countries. Point-of-care (POC) VL testing could improve ART monitoring and the quality and efficiency of differentiated models of HIV care. We assessed the acceptability of POC VL testing within a differentiated care model that involved task-shifting from professional nurses to less highly-trained enrolled nurses, and an option of collecting treatment from a community-based ART delivery programme. Methods We undertook a qualitative sub-study amongst clients on ART and nurses within the STREAM study, a randomized controlled trial of POC VL testing and task-shifting in Durban, South Africa. Between March and August 2018, we conducted 33 semi-structured interviews with clients, professional and enrolled nurses and 4 focus group discussions with clients. Interviews and focus groups were audio recorded, transcribed, translated and thematically analysed. Results Amongst 55 clients on ART (median age 31, 56% women) and 8 nurses (median age 39, 75% women), POC VL testing and task-shifting to enrolled nurses was acceptable. Both clients and providers reported that POC VL testing yielded practical benefits for PLHIV by reducing the number of clinic visits, saving time, travel costs and days off work. Receiving same-day POC VL results encouraged adherence amongst clients, by enabling them to see immediately if they were ‘good’ or ‘bad’ adherers and enabled quick referrals to a community-based ART delivery programme for those with viral suppression. However, there was some concern regarding the impact of POC VL testing on clinic flows when implemented in busy public-sector clinics. Regarding task-shifting, nurses felt that, with extra training, enrolled nurses could help decongest healthcare facilities by quickly issuing ART to stable clients. Clients could not easily distinguish enrolled nurses from professional nurses, instead they highlighted the importance of friendliness, respect and good communication between clients and nurses. Conclusions POC VL testing combined with task-shifting was acceptable to clients and healthcare providers. Implementation of POC VL testing and task shifting within differentiated care models may help achieve international treatment targets. Trial registration NCT03066128, registered 22/02/2017.

scholarly journals Community-based model for the delivery of antiretroviral therapy in Cambodia: a quasi-experimental study protocol

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sovannary Tuot ◽  
Alvin Kuo Jing Teo ◽  
Kiesha Prem ◽  
Pheak Chhoun ◽  
Chamroen Pall ◽  
...  
Keyword(s):  
Experimental Study ◽  
Antiretroviral Therapy ◽  
Scale Up ◽  
Economic Evaluations ◽  
People Living With Hiv ◽  
Cad Model ◽  
Community Based ◽  
Quasi Experimental ◽  
Living With Hiv ◽  
Art Delivery

Abstract Background Multi-month dispensing (MMD) is the mainstay mechanism for clinically stable people living with HIV in Cambodia to refill antiretroviral therapy (ART) every 3-6 months. However, less frequent ART dispensing through the community-based ART delivery (CAD) model could further reduce the clients’ and health facilities’ burden. While community-based services have been recognized as an integral component of HIV response in Cambodia, their role and effectiveness in ART delivery have yet to be systematically assessed. This study aims to evaluate the CAD model’s effectiveness on the continuum of care and treatment outcomes for stable people living with HIV in Cambodia. Methods We will conduct this quasi-experimental study in 20 ART clinics across the capital city and nine provinces between May 2021 and April 2023. Study sites were purposively selected based on the availability of implementing partners, the number of people living with HIV each clinic serves, and the accessibility of the clinics. In the intervention arm, approximately 2000 stable people living with HIV will receive ART and services from the CAD model. Another 2000 stable people living with HIV in the control arm will receive MMD—a standard care model for stable people living with HIV. The primary outcomes will be retention in care, viral load suppression, and adherence to ART. The secondary endpoints will include health providers’ work burden, the model’s cost-effectiveness, quality of life, mental health, social support, stigma, and discrimination. We will compare the outcome indicators within each arm at baseline, midline, and endline using descriptive and inferential statistics. We will evaluate the differences between the intervention and control arms using the difference-in-differences method. We will perform economic evaluations to determine if the intervention is cost-effective. Discussion This study will build the evidence base for future implementation and scale-up of CAD model in Cambodia and other similar settings. Furthermore, it will strengthen engagements with community stakeholders and further improve community mobilization, a vital pillar of the Cambodian HIV response. Trial registration ClinicalTrials.gov, NCT04766710. Registered 23 February 2021, Version 1.

scholarly journals Community-based model for the delivery of antiretroviral therapy in Cambodia: a quasi-experimental study protocol

2021 ◽  
Author(s):  
Sovannary Tuot ◽  
Alvin Kuo Jing Teo ◽  
Kiesha Prem ◽  
Pheak Chhoun ◽  
Chamroen Pall ◽  
...  
Keyword(s):  
Experimental Study ◽  
Antiretroviral Therapy ◽  
Scale Up ◽  
Economic Evaluations ◽  
People Living With Hiv ◽  
Cad Model ◽  
Community Based ◽  
Quasi Experimental ◽  
Living With Hiv ◽  
Art Delivery

Abstract BackgroundMulti-month dispensing (MMD) is the mainstay mechanism for clinically stable people living with HIV in Cambodia to refill antiretroviral therapy (ART) every three to six months. However, less frequent ART dispensing through the community-based ART delivery (CAD) model could further reduce the clients’ and health facilities' burden. While community-based services have been recognized as an integral component of HIV response in Cambodia, their role and effectiveness in ART delivery have yet to be systematically assessed. This study aims to evaluate the CAD model's effectiveness on the continuum of care and treatment outcomes for stable people living with HIV in Cambodia.MethodsWe will conduct this quasi-experimental study in 20 ART clinics across the capital city and 10 provinces between May 2021 and April 2023. Study sites were purposively selected based on the availability of implementing partners, the number of people living with HIV each clinic serves, and the accessibility of the clinics. In the intervention arm, approximately 2,000 stable people living with HIV will receive ART and services from the CAD model. Another 2000 stable people living with HIV in the control arm will receive MMD—a standard care model for stable people living with HIV. The primary outcomes will be retention in care, viral load suppression, and the healthcare providers’ work burden. The secondary endpoints will include the model’s cost-effectiveness, quality of life, mental health, social support, stigma, and discrimination. We will compare the outcome indicators within each arm at baseline, midline, and endline using descriptive and inferential statistics. We will evaluate the differences between the intervention and control arms using the difference-in-differences method. We will perform economic evaluations to determine if the intervention is cost-effective.DiscussionThis study will build the evidence base for future implementation and scale-up of CAD model in Cambodia and other similar settings. Furthermore, it will strengthen engagements with community stakeholders and further improve community mobilization, a vital pillar of the Cambodian HIV response.Trial registrationClinicalTrials.gov, NCT04766710. Registered 23 February 2021,

scholarly journals Dispensing antiretrovirals during Covid-19 lockdown: re-discovering community-based ART delivery models in Uganda

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Henry Zakumumpa ◽  
Christopher Tumwine ◽  
Kiconco Milliam ◽  
Neil Spicer
Keyword(s):  
Health System ◽  
National Level ◽  
Hiv Care ◽  
District Health ◽  
Community Based ◽  
Community Based Art ◽  
System Resilience ◽  
Delivery Models ◽  
Art Delivery

Abstract Background The notion of health-system resilience has received little empirical attention in the current literature on the Covid-19 response. We set out to explore health-system resilience at the sub-national level in Uganda with regard to strategies for dispensing antiretrovirals during Covid-19 lockdown. Methods We conducted a qualitative case-study of eight districts purposively selected from Eastern and Western Uganda. Between June and September 2020, we conducted qualitative interviews with district health team leaders (n = 9), ART clinic managers (n = 36), representatives of PEPFAR implementing organizations (n = 6).In addition, six focus group discussions were held with recipients of HIV care (48 participants). Qualitative data were analyzed using thematic approach. Results Five broad strategies for distributing antiretrovirals during ‘lockdown’ emerged in our analysis: accelerating home-based delivery of antiretrovirals,; extending multi-month dispensing from three to six months for stable patients; leveraging the Community Drug Distribution Points (CDDPs) model for ART refill pick-ups at outreach sites in the community; increasing reliance on health information systems, including geospatial technologies, to support ART refill distribution in unmapped rural settings. District health teams reported leveraging Covid-19 outbreak response funding to deliver ART refills to homesteads in rural communities. Conclusion While Covid-19 ‘lockdown’ restrictions undoubtedly impeded access to facility-based HIV services, they revived interest by providers and demand by patients for community-based ART delivery models in case-study districts in Uganda.

Effect of the Covid-19 Italian lockdown on human health: the analysis of alcohol consumption for aware quarantine (Preprint)

2020 ◽  
Author(s):  
Chiara Mazzarella ◽  
Annamaria Spina ◽  
Marcello Dallio ◽  
Antonietta Gerarda Gravina ◽  
Mario Romeo ◽  
...  
Keyword(s):  
Alcohol Consumption ◽  
Alcohol Abuse ◽  
Psychosocial Factors ◽  
Alcohol Drinking ◽  
Psychosocial Support ◽  
Human Life ◽  
Stressful Event ◽  
Drinking Behaviour ◽  
Drinking Habits ◽  
Specific Subset

BACKGROUND Italy has been one of the first western countries seriously involved in the COVID-19 pandemic in the first months of 2020 and so that the national government was forced to impose a long lockdown period, stopping all the people aggregation outdoor and indoor activities. From a social point of view this period of domestic confinement resulted in deep changes of behaviours and lifestyles, promoting in many people the onset of psychological symptoms and signs (including anxiety, depression, insomnia, and irritability among others) already known as associated with drug and alcohol abuse OBJECTIVE this study aims to assess the variation of alcohol drinking habits in a sample of Italian citizens during the COVID-19 lockdown and to identify the psychosocial factors surrounding it, in order to assess the specific subset of the population that could need psychosocial support during these events METHODS An online anonymous questionnaire was created and submitted from 9th April 2020 to 28th April 2020 using social medias and e-mails. Questions were related to personal details such as age, work, instruction, and, moreover, to alcohol drinking habits during the lockdown, including Alcohol Use Disorders Identification Test (AUDIT C) test questions RESULTS A total of 1234 surveys were filled out by subjects with an age range from 18 to 80 years old. An increase in both anxiety and fear has been detected in most of the participants (63% and 61% respectively) with a direct (r=0.652; p<0.001) relationship between them. Participants older than 50 years showed the strongest correlation between alcohol consumption, fear, and anxiety, (r=0.830, P <0.001 and r=0.741, P<0.001, respectively). Subjects living alone experienced a stronger association between anxiety, fear, and higher level of alcohol consumption (r: 0.529; P<0.001; r: 0.628, P<0.001 respectively). Moreover, 18% of participants increased alcohol consumption drinking during the lockdown. These subjects showed a lower frequency of alcohol consumption before the lockdown in comparison to the rest of the study population (2.5±0.96 vs 3±1.03, P<0.0001 respectively). Moreover, comparing the abovementioned groups, the percentage of subjects who experienced higher alcohol assumption before the 11th of March was higher in those that didn't change their drinking behaviour during the lockdown in comparison to that portion of them that experienced a worsening of alcohol abuse (r: 30.422, P<0.0001) CONCLUSIONS according to these data, during the Italian lockdown due to COVID 19 pandemic, different kind of people experienced an increase in alcohol drinking. Several psychosocial factors are involved in determining the increase in harmful alcohol consumption during this extraordinary stressful event and they must be addressed by the healthcare support in order to avoid awful lockdown impact on human life

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