scholarly journals Pathways to care and preferences for improving tuberculosis services among tuberculosis patients in Zambia: A discrete choice experiment

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0252095
Author(s):  
Andrew D. Kerkhoff ◽  
Mary Kagujje ◽  
Sarah Nyangu ◽  
Kondwelani Mateyo ◽  
Nsala Sanjase ◽  
...  
Keyword(s):  
Discrete Choice ◽  
Symptom Onset ◽  
Choice Experiment ◽  
Treatment Initiation ◽  
Tertiary Hospital ◽  
Wait Times ◽  
Hiv Positive ◽  
Care Seeking ◽  
Test Results ◽  
Hiv Negative

Background Delays in the diagnosis of tuberculosis (TB) contribute to a substantial proportion of TB-related mortality, especially among people living with HIV (PLHIV). We sought to characterize the diagnostic journey for HIV-positive and HIV-negative patients with a new TB diagnosis in Zambia, to understand drivers of delay, and characterize their preferences for service characteristics to inform improvements in TB services. Methods We assessed consecutive adults with newly microbiologically-confirmed TB at two public health treatment facilities in Lusaka, Zambia. We administered a survey to document critical intervals in the TB care pathway (time to initial care-seeking, diagnosis and treatment initiation), identify bottlenecks and their reasons. We quantified patient preferences for a range of characteristics of health services using a discrete choice experiment (DCE) that assessed 7 attributes (distance, wait times, hours of operation, confidentiality, sex of provider, testing incentive, TB test speed and notification method). Results Among 401 patients enrolled (median age of 34 years, 68.7% male, 46.6% HIV-positive), 60.9% and 39.1% were from a first-level and tertiary hospital, respectively. The median time from symptom onset to receipt of TB treatment was 5.0 weeks (IQR: 3.6–8.0) and was longer among HIV-positive patients seeking care at a tertiary hospital than HIV-negative patients (6.4 vs. 4.9 weeks, p = 0.002). The time from symptom onset to initial presentation for evaluation accounted for the majority of time until treatment initiation (median 3.0 weeks, IQR: 1.0–5.0)–an important minority of 11.0% of patients delayed care-seeking ≥8 weeks. The DCE found that patients strongly preferred same-day TB test results (relative importance, 37.2%), facilities close to home (18.0%), and facilities with short wait times (16.9%). Patients were willing to travel to a facility up to 7.6 kilometers further away in order to access same-day TB test results. Preferences for improving current TB services did not differ according to HIV status. Conclusions Prolonged intervals from TB symptom onset to treatment initiation were common, especially among PLHIV, and were driven by delayed health-seeking. Addressing known barriers to timely diagnosis and incorporating patients’ preferences into TB services, including same-day TB test results, may facilitate earlier TB care engagement in high burden settings.

scholarly journals Slow clinical improvement after treatment initiation in Leishmania/HIV coinfected patients

2012 ◽  
Vol 45 (2) ◽  
pp. 147-150 ◽  
Author(s):  
Guenael Freire de Souza ◽  
Fernando Biscione ◽  
Dirceu Bartolomeu Greco ◽  
Ana Rabello
Keyword(s):  
Hiv Infection ◽  
Clinical Response ◽  
Clinical Picture ◽  
Treatment Initiation ◽  
Early Recognition ◽  
Response To Treatment ◽  
Hiv Positive ◽  
Large Area ◽  
Belo Horizonte ◽  
Hiv Negative

INTRODUCTION: In Brazil there is a large area of overlap of visceral leishmaniasis (VL) and HIV infection, which favored a increased incidence of coinfection Leishmania/HIV. METHODS: This study evaluated 65 consecutive patients with VL and their clinical response to treatment in two health care settings in Belo Horizonte, Brazil. RESULTS: At baseline, the clinical picture was similar between both groups, although diarrhea and peripheral lymphadenomegaly were more frequent in HIV-infected subjects. HIV-positive patients had lower median blood lymphocyte counts (686/mm³ versus 948/mm³p = 0.004) and lower values of alanine aminotransferase (ALT) (48IU/L versus 75.6IU/L p = 0.016) than HIV-negative patients. HIV-positive status (hazard ratio = 0.423, p = 0.023) and anemia (HR = 0.205, p = 0.002) were independent negative predictors of complete clinical response following antileishmanial treatment initiation. CONCLUSIONS: This study reinforces that all patients with VL should be tested for HIV infection, regardless of their clinical picture. This practice would allow early recognition of coinfection with initiation of antiretroviral therapy and, possibly, reduction in treatment failure.

Barriers to contraception among HIV-positive women in a periurban district of Uganda

2012 ◽  
Vol 23 (9) ◽  
pp. 661-666 ◽  
Author(s):  
A K Mbonye ◽  
K S Hansen ◽  
F Wamono ◽  
P Magnussen
Keyword(s):  
Hiv Testing ◽  
Household Survey ◽  
Hiv Positive ◽  
Care Seeking ◽  
Test Results ◽  
Group Discussions ◽  
Effective Interventions ◽  
Hiv Positive Women ◽  
Hiv Test ◽  
Negative Perceptions

This study explored perceptions and care-seeking practices for HIV testing and contraception in order to obtain data for designing effective interventions to increase contraception among HIV-positive women. A triangulation of methods (household survey, focus group discussions and key informant interviews) were conducted in Wakiso district, central Uganda from January to April 2009. Results show that a majority of women, 2062/2896 (71.2%) would like to have an HIV test, while access to antiretroviral therapy (ART) was low at 237/879 (27%). Of the women who were on ART, 133/266 (50.0%) could not use contraception due to negative perceptions that a combination of ART and contraceptives would weaken them, as these drugs were perceived to be ‘strong’. Fear of side-effects for contraceptives and resistance from spouses were other main reasons. Constraints to HIV testing included fear of clients knowing their own HIV status and fear of their spouses’ reactions to the test results. Private midwives were identified as a potential outlet for delivering contraception to HIV-positive women.

scholarly journals HIV post-test practices: an online survey examining perceived delivery of HIV test results, post-test discussion and referral in healthcare settings across the WHO European Region

Sexual Health ◽  
2016 ◽  
Vol 13 (3) ◽  
pp. 205 ◽  
Author(s):  
Stephen Bell ◽  
Jordi Casabona ◽  
Nino Tsereteli ◽  
Dorthe Raben ◽  
John de Wit
Keyword(s):  
Hiv Testing ◽  
Positive Test ◽  
European Region ◽  
Hiv Positive ◽  
Test Results ◽  
Negative Test ◽  
Hiv Test ◽  
Post Test ◽  
Test Result ◽  
Hiv Negative

Background The aim of this study was to assess perceptions of health professionals involved in HIV testing policy and practice in national settings across the WHO European Region regarding the delivery of HIV test results, post-test discussion and referral to specialist HIV services as recommended in authoritative guidelines. Methods: An online self-report survey was completed by a convenience sample of 338 respondents (response rate 34.1%) from 55 countries. Respondents worked with non-government organisations (49.4%), health services (32.8%), non-health service government agencies (6.2%) or other organisations (11.5%; e.g. prisons, education and research, international development). Results: Experts’ perceptions indicate that delivery of HIV-positive test results and related post-test discussion in their country generally corresponded to recommendations. However, results pointed to a significant gap perceived by experts between recommendations and the practice of delivering HIV-negative test results. Fewer respondents thought that suitable time is taken to deliver a negative HIV-test result (54.1%) than a positive result (73.1%). Also, fewer respondents thought there was a procedure for referral to specialist treatment, care and support services for people receiving a HIV-negative test result (34.9%) than for people receiving an HIV-positive test result (86.2%). Experts also reported low perceived use of communication technologies (i.e. telephone, email, text messaging, a secure website) for delivering HIV test results. Conclusions: This expert survey offers new insight into perceived HIV post-test practices in almost all national settings across the WHO European Region. The findings provide valuable guidance for future HIV testing guidelines for the WHO European Region.

scholarly journals Understanding HIV-positive patients' preferences for healthcare services: a protocol for a discrete choice experiment

BMJ Open ◽  
2016 ◽  
Vol 6 (7) ◽  
pp. e008549 ◽  
Author(s):  
Elaney Youssef ◽  
Vanessa Cooper ◽  
Alec Miners ◽  
Carrie Llewellyn ◽  
Alex Pollard ◽  
...  
Keyword(s):  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Healthcare Services ◽  
Hiv Positive

scholarly journals Performance of urine lipoarabinomannan assays for paediatric tuberculosis in Tanzania

2015 ◽  
Vol 46 (3) ◽  
pp. 761-770 ◽  
Author(s):  
Inge Kroidl ◽  
Petra Clowes ◽  
Klaus Reither ◽  
Bariki Mtafya ◽  
Gabriel Rojas-Ponce ◽  
...  
Keyword(s):  
Treatment Initiation ◽  
Positive Impact ◽  
Hiv Positive ◽  
Monitoring Tool ◽  
Antituberculous Treatment ◽  
Suspected Tuberculosis ◽  
Low Body Mass Index ◽  
A Prospective Study ◽  
Paediatric Tuberculosis ◽  
Hiv Negative

We evaluated the diagnostic performance of two tests based on the release of lipoarabinomannan (LAM) into the urine, the MTB-LAM-ELISA assay and the Determine TB-LAM-strip assay, in children with suspected tuberculosis (TB) in a high TB/HIV-prevalence setting.In a prospective study, 132 children with suspected active TB were assigned to diagnostic subgroups. Urine samples were subjected to testing by both assays to ascertain sensitivity and specificity. Host factors associated with positive LAM results were investigated and LAM excretion monitored after antituberculous treatment initiation.18 (13.6%) children had culture-confirmed pulmonary TB. The assays' sensitivity was higher in HIV-positiveversusHIV-negative children: 70% (95% confidence interval 35–93%)versus13% (0–53%) for MTB-LAM-ELISA and 50% (19–81%)versus0% (0–37%) for Determine TB-LAM. In 35 (27%) children with excluded active TB, both assays showed a specificity of 97.1% (85–100%). Proteinuria and low body mass index were independently associated with LAM positivity. In most patients, LAM excretion declined to zero during or at conclusion of antituberculous treatment.HIV/TB co-infected children might benefit from LAM-based tests to aid early TB diagnosis and subsequent positive impact on morbidity and mortality. Using LAM as a rule-in and treatment-monitoring tool may also show further potential.

The Etiology of Intraocular Inflammation in HIV Positive and HIV Negative Adults at a Tertiary Hospital in Cape Town, South Africa

2018 ◽  
Vol 27 (2) ◽  
pp. 203-210 ◽  
Author(s):  
Derrick P. Smit ◽  
Tonya M. Esterhuizen ◽  
David Meyer ◽  
Joke H. de Boer ◽  
Jolanda D. F. de Groot-Mijnes
Keyword(s):  
South Africa ◽  
Cape Town ◽  
Tertiary Hospital ◽  
Intraocular Inflammation ◽  
Hiv Positive ◽  
Hiv Negative

scholarly journals HIV self-test performance among female sex workers in Kampala, Uganda: a cross-sectional study

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e022652 ◽  
Author(s):  
Katrina F Ortblad ◽  
Daniel Kibuuka Musoke ◽  
Thomson Ngabirano ◽  
Aidah Nakitende ◽  
Geoffrey Taasi ◽  
...  
Keyword(s):  
Sex Workers ◽  
Female Sex Workers ◽  
Hiv Positive ◽  
Test Results ◽  
Negative Consequences ◽  
Female Sex ◽  
Self Testing ◽  
Self Test ◽  
Research Assistants ◽  
Hiv Negative

ObjectiveTo evaluate HIV self-testing performance and results interpretation among female sex workers (FSWs) in Kampala, Uganda, who performed unassisted HIV self-testing.MethodsIn October 2016, 104 participants used an oral HIV self-test while under observation by research assistants. Participants were not assisted on HIV self-test use prior to or during testing, and were only given the manufacturer’s pictorial and written instructions to guide them. Research assistants recorded if participants completed and/or had difficulties with steps in the HIV self-testing process on a prespecified checklist. Randomly drawn, used HIV self-tests were interpreted by FSWs. We calculated the concordance between FSWs’ interpretations of self-test results with those indicated in the manufacturer’s instructions.ResultsOnly 33% (34/104) of participants completed all of the key steps in the HIV self-testing process, and the majority (86%, 89/104) were observed having difficulties with at least one of these steps. Misinterpretation of HIV self-test results were common among FSWs: 23% (12/56) of FSWs interpreted HIV-negative self-test results as HIV positive and 8% (3/37) of FSWs interpreted HIV-positive self-test results as HIV negative. The concordance between FSWs’ interpretations of self-test results and that indicated in the instructions was 73% (95% CI 56% to 86%) for HIV-positive self-tests and 68% (95% CI 54% to 80%) for HIV-negative self-tests.ConclusionsFSWs in Kampala, who performed unassisted HIV self-testing, skipped steps in the HIV self-testing process and had difficulties correctly interpreting self-test results. Training on use and interpretation of HIV self-tests may be necessary to prevent errors in the HIV self-testing process and to avoid the negative consequences of false-positive and false-negative HIV self-test results among FSWs.Trial registration numberNCT02846402.

Sign in / Sign up

Export Citation Format

Share Document