scholarly journals Reimagining the role of the nursing workforce in Uganda after more than a decade of ART scale-up

2020 ◽  
Author(s):  
Henry Zakumumpa
Keyword(s):  
Disease Management ◽  
Scale Up ◽  
Task Shifting ◽  
Health Facilities ◽  
Hiv Care ◽  
Scope Of Practice ◽  
Nursing Workforce ◽  
Hiv Disease ◽  
Wide Range

Abstract Background The expanding roles and increasing importance of the nursing workforce in health services delivery in resource-limited settings is not adequately documented and sufficiently recognized in the current literature. Drawing upon the theme of 2020 as the international year of the Nurse and Midwife, we set out to describe how the role of nurses expanded tremendously in health facilities in Uganda during the era of anti-retroviral therapy (ART) scale-up that commenced in June 2004.Methods We employed a mixed-methods sequential explanatory research design. Phase One entailed a cross-sectional health facility survey (n=195) to assess the extent to which human resource management strategies (such as task shifting) were common. Phase Two entailed a qualitative multiple case-study of 16 (of the 195) health facilities for an in-depth understanding of the strategies adopted (e.g. nurse-centred HIV care). Descriptive analyses were performed in STATA (v 13) while qualitative data were analyzed by thematic approach.Results We found that nurses were the most represented cadre of health workers involved in the overall leadership of HIV clinics across Uganda. Most nurse-led HIV clinics were based in rural settings however this trend was fairly even across setting (rural/urban/peri-urban). While 181(93%) health facilities allowed non-physician cadre to prescribe ART, a number of health facilities (n=36) or 18% deliberately adopted nurse-led HIV care models. Nurses were empowered to be multi-skilled with a wide range of competencies across the HIV care continuum right from HIV testing to mainstream clinical HIV disease management. In several facilities, nursing cadre were the backbone of ART service delivery. A select number of facilities devised differentiated models of task shifting from physicians to nurses in which the latter handled patients who were stable on ART. Conclusion Overall, our study reveals a wide expansion in the scope-of-practice of nurses during ART scale-up in Uganda. Nurses were thrust in roles of HIV disease management that were traditionally the preserve of physicians. Our study underscores the importance of reforming regulatory frameworks governing nursing workforce scope-of-practice such as the need for developing a policy on task shifting which is currently lacking in Uganda.

scholarly journals ‘Oh, she is just a nurse’ Re-imagining the role of the nursing workforce in Uganda after a decade of ART scale-up (2004-2014)

2020 ◽  
Author(s):  
Henry Zakumumpa
Keyword(s):  
Mixed Methods ◽  
Disease Management ◽  
Scale Up ◽  
Task Shifting ◽  
Health Facilities ◽  
Hiv Care ◽  
Scope Of Practice ◽  
Nursing Workforce ◽  
Hiv Disease

Abstract Background The expanding roles and increasing importance of the nursing workforce in health services delivery in resource-limited settings is not adequately documented and sufficiently recognized in the current literature. Drawing upon the theme of 2020 as the international year of the nurse and midwife, we set out to describe how the role of nurses had expanded tremendously in health facilities in Uganda during the era of anti-retroviral therapy (ART) scale-up between 2004 and 2014.Methods A mixed-methods study was conducted in two phases. Phase One entailed a cross-sectional health facility survey (n=195) to assess the extent to which human resource management strategies (such as task shifting) were common. Phase Two entailed qualitative case-studies of 16 (of the 195) health facilities for an in-depth understanding of the strategies adopted (e.g. nurse-centred HIV care). We adopted a qualitatively-led mixed methods approach whereby core thematic analyses were supported by descriptive statistics.Results We found that nurses were the most represented cadre of health workers involved in the overall leadership of HIV clinics across Uganda. Most of nurse-led HIV clinics were based in rural settings although this trend was fairly even across all settings (rural/urban/peri-urban). A number of health facilities in our sample (n=36) deliberately adopted nurse-led HIV care models. Nurses were empowered to be multi-skilled with a wide range of competencies across the HIV care continuum right from HIV testing to mainstream clinical HIV disease management. In several facilities, nursing cadre were the backbone of ART service delivery. A select number of facilities devised differentiated models of task shifting from physicians to doctors to nurses in which the latter handled patients who were stable on ART.Conclusion Overall, our study reveals a wide expansion in the scope-of-practice of nurses during the initial ART scale-up phase in Uganda. Nurses were thrust in roles of HIV disease management that were traditionally the preserve of medical doctors. Our study underscores the importance of reforming regulatory frameworks governing nursing workforce scope of practice in Uganda such as the need for evolving a policy on task shifting which is currently lacking in Uganda.

scholarly journals Barriers and facilitators associated with HIV testing uptake in South African health facilities offering HIV Counselling and Testing

2016 ◽  
Vol 21 ◽  
pp. 86-95 ◽  
Author(s):  
Neo Mohlabane ◽  
Bomkazi Tutshana ◽  
Karl Peltzer ◽  
Aziza Mwisongo
Keyword(s):  
Hiv Testing ◽  
South African ◽  
Health Workers ◽  
Scale Up ◽  
Health Facilities ◽  
Barriers And Facilitators ◽  
Hiv Care ◽  
Treatment Needs ◽  
Hiv Test ◽  
Hiv Counselling And Testing

Background: The scale-up of HIV Counselling and Testing (HCT) in South Africa to 4500 public health facilities and the service's provision in mobile and non-medical sites was aimed at increasing HCT uptake. However, some people still have never had an HIV test.Objective: An HCT survey was carried out to ascertain barriers and facilitators for HIV testing in South Africa.Methods: A cross-sectional survey of 67 HCT-offering health facilities in 8 South African provinces was undertaken. Individuals (n = 489) who had not tested for HIV on the day of the site visit were interviewed on awareness of HCT services, HIV testing history and barriers to HIV testing. Frequencies were run to describe the sample characteristics, barriers and facilitators to HIV testing. Bivariate and multivariate logistic regression was usedt o identify the association between never tested for HIV with socio-demographics, awareness of HCT services and type of HCT facilities.Results: In all 18.1% participants never had an HIV test. Major barriers to HCT uptake comprise being scared of finding out one's HIV test result or what people may say, shyness or embarrassment, avoidance of divulging personal information to health workers and fear of death. In multivariate analysis the age group 55 years and older, and not being recommended to have an HIV test were associated with never had an HIV test. Potential facilitators for HIV testing include community or household HIV testing, providing incentives for those who test for HIV, mandatory HIV testing and disclosure of HIV status by those who test HIV positive.Conclusion: The benefits of HCT which include the reduction of HIV transmission, the availability of HIV care and treatment needs to be emphasized to enhance HCT uptake.

scholarly journals Role of Fiber Morphology in Thermal Bonding

2002 ◽  
Vol os-11 (3) ◽  
pp. 1558925002OS-01
Author(s):  
Subhash Chand ◽  
Gajanan S. Bhat ◽  
Joseph E. Spruiell ◽  
Sanjiv Malkan
Keyword(s):  
Molecular Orientation ◽  
Bonding Temperature ◽  
Scale Up ◽  
Optimum Process ◽  
Process Conditions ◽  
Staple Fiber ◽  
Fiber Morphology ◽  
Thermal Bonding ◽  
Wide Range

The role of fiber morphology in a thermal point bonding operation was investigated. Primary objectives were to understand the changes taking place in fiber structure due to applied heat and pressure, and the role of fiber morphology in determining optimum process conditions and properties of the webs. To study fibers with varying morphology, i.e., from partially drawn as in spunbonding to fully drawn as in staple fiber nonwovens, fibers with a wide range of crystallinity and orientation were spun and characterized, from two polypropylene resins. Thermally bonded carded webs were produced, using these fibers, and characterized in order to understand thermal bonding behavior of fibers with different morphology. The fibers with different morphology differed significantly in their bonding behavior. The fibers with higher molecular orientation and crystallinity tended to form a weak and brittle bond due to lack of polymer flow and fibrillation of the fibers in the bonded regions. In general, fibers with lower molecular orientation and lower crystallinity yielded stronger and tougher webs. Fibers with relatively less developed morphology also exhibited lower optimum bonding temperature. Morphological changes in fibers were observed during the thermal bonding process, in bonded as well as unbonded regions of the web. As a final step to see how the observations from staple-fiber study translate to one of the relevant processes during scale-up, spunbond studies were also conducted in a similar way.

Human Immunodeficiency Virus Hematology

Hematology ◽  
2003 ◽  
Vol 2003 (1) ◽  
pp. 294-313 ◽  
Author(s):  
Paul A. Volberding ◽  
Kelty R. Baker ◽  
Alexandra M. Levine
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Hiv Care ◽  
Hiv Disease ◽  
Secondary Infections ◽  
Antiretroviral Drug ◽  
Immunodeficiency Virus ◽  
History Of ◽  
Relationship Of

Abstract The advent of potent antiretroviral therapy has altered the expected natural history of human immunodeficiency virus (HIV) infection and of many previously associated opportunistic complications, including malignancies. At the same time, HIV suppression hasn’t affected all of these complications equally and the longer expected survival of infected patients may allow the development of newer complications. Additionally, the use of potent antiretroviral combination therapy may itself lead to hematological toxicities. Together these changes affect the consultation role of the hematology-oncology specialist in comprehensive HIV care and demand ongoing education. In Section I, Dr. Paul Volberding reviews the biology of antiretroviral drug development and the progression in discovering new agents as the viral life cycle is further elucidated. He briefly summarizes the process of combining agents to achieve the degree of viral suppression required for long-term clinical benefit. In Section II, Dr. Kelty Baker reviews the effects of HIV and its therapy on hematologic dyscrasia and clotting disorders. She summarizes how therapy may decrease certain previously common manifestations of HIV disease while adding new problems likely to result in referral to the hematologist. In addition, she addresses the role of secondary infections, such as parvovirus, in this spectrum of disorders. In Section III, Dr. Alexandra Levine discusses the still challenging aspects of HIV associated non-Hodgkin’s lymphoma and the association between HIV infection and Hodgkin’s disease. She addresses current controversies in the pathogenesis of HIV related lymphomas and summarizes a number of recent trials of combination chemotherapy, with or without monoclonal antibodies, in their management. Additionally, she reviews the complex relationship of HIV disease with multicentric Castleman’s disease and recent attempts to manage this disorder.

scholarly journals Task Shifting for Scale-up of HIV Care: Evaluation of Nurse-Centered Antiretroviral Treatment at Rural Health Centers in Rwanda

PLoS Medicine ◽  
2009 ◽  
Vol 6 (10) ◽  
pp. e1000163 ◽  
Author(s):  
Fabienne Shumbusho ◽  
Johan van Griensven ◽  
David Lowrance ◽  
Innocent Turate ◽  
Mark A. Weaver ◽  
...  
Keyword(s):  
Rural Health ◽  
Antiretroviral Treatment ◽  
Scale Up ◽  
Task Shifting ◽  
Health Centers ◽  
Hiv Care ◽  
Rural Health Centers ◽  
Care Evaluation

scholarly journals Trends and Sex Differences in Access to HIV Care with Scale Up of National HIV Treatment Guidelines in Pune, India

2020 ◽  
Vol 19 ◽  
pp. 232595822093173
Author(s):  
Priyanka Raichur ◽  
Sonali Pankaj Salvi ◽  
Shashikala Sangle ◽  
Amol Chavan ◽  
Smita Nimkar ◽  
...  
Keyword(s):  
Sex Differences ◽  
Treatment Guidelines ◽  
Scale Up ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Initiation Time ◽  
Hiv Disease ◽  
Art Initiation ◽  
Testing Strategies ◽  
Advanced Hiv Disease

Test and treat is the current global standard, yet sex differences persist in access to HIV care. We assessed the differences in presentation and antiretroviral therapy (ART) uptake by sex and ART-eligibility period among ART-naive adults registered at a public ART center in India. Four ART eligibility periods were defined by programmatically determined CD4 criteria (periods I-IV: CD4 <200, <350, ≤500 cells/μL, and any CD4) between January 2005 and December 2017. Of 23 957 participants, 12 510 were male. Men consistently presented with lower median CD4 count (period I-IV, P < .05) and higher median age (period I-III, P < .001) than women. From period I to IV, median age increased in women ( P < .0001), ART initiation time decreased in both sexes ( P < .001), and median CD4 remained <200 cells/µL in men. Advanced HIV disease and increasing age at presentation are persistent sex-specific trends which warrant innovative HIV testing strategies in both sexes.

The Problem of Identifying and Modeling the Relationship between Monetary Factor and Inflation in the Russian Economy

2008 ◽  
pp. 61-76
Author(s):  
A. Porshakov ◽  
A. Ponomarenko
Keyword(s):  
Money Supply ◽  
Money Demand ◽  
Russian Economy ◽  
Long Run ◽  
Complex Approach ◽  
Wide Range ◽  
Long Time ◽  
The Relationship ◽  
Supply Side Factors

The role of monetary factor in generating inflationary processes in Russia has stimulated various debates in social and scientific circles for a relatively long time. The authors show that identification of the specificity of relationship between money and inflation requires a complex approach based on statistical modeling and involving a wide range of indicators relevant for the price changes in the economy. As a result a model of inflation for Russia implying the decomposition of inflation dynamics into demand-side and supply-side factors is suggested. The main conclusion drawn is that during the recent years the volume of inflationary pressures in the Russian economy has been determined by the deviation of money supply from money demand, rather than by money supply alone. At the same time, monetary factor has a long-run spread over time impact on inflation.

Introduction: Emotion, History and the Arts

2018 ◽  
Vol 7 (2) ◽  
pp. 117-128 ◽  
Author(s):  
Erin Sullivan ◽  
Marie Louise Herzfeld-Schild
Keyword(s):  
Historical Change ◽  
Carson Mccullers ◽  
Emotional Life ◽  
Review Section ◽  
The Arts ◽  
Wide Range ◽  
War Correspondents ◽  
History Of ◽  
Johan Huizinga

This introduction surveys the rise of the history of emotions as a field and the role of the arts in such developments. Reflecting on the foundational role of the arts in the early emotion-oriented histories of Johan Huizinga and Jacob Burkhardt, as well as the concerns about methodological impressionism that have sometimes arisen in response to such studies, the introduction considers how intensive engagements with the arts can open up new insights into past emotions while still being historically and theoretically rigorous. Drawing on a wide range of emotionally charged art works from different times and places—including the novels of Carson McCullers and Harriet Beecher-Stowe, the private poetry of neo-Confucian Chinese civil servants, the photojournalism of twentieth-century war correspondents, and music from Igor Stravinsky to the Beatles—the introduction proposes five ways in which art in all its forms contributes to emotional life and consequently to emotional histories: first, by incubating deep emotional experiences that contribute to formations of identity; second, by acting as a place for the expression of private or deviant emotions; third, by functioning as a barometer of wider cultural and attitudinal change; fourth, by serving as an engine of momentous historical change; and fifth, by working as a tool for emotional connection across communities, both within specific time periods but also across them. The introduction finishes by outlining how the special issue's five articles and review section address each of these categories, while also illustrating new methodological possibilities for the field.

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