The Perceived determinants and recommendations by mothers and healthcare professionals on the Loss-To-Follow-Up in Option B+ program and child mortality in the Amhara Region, Ethiopia.

Abstract Background: The third United Nations Sustainable Development Goal includes a commitment to end AIDS-related death by 2030. In line with the Goal, Option B+ programs hold a great promise for eliminating vertical transmission of HIV. Option B+ was introduced in 2013 in Ethiopia. The Global Plan identified Ethiopia as one of 22 high priority countries requiring improvement in the prevention of mother to child HIV transmission services. Despite HIV treatment being free in Ethiopia, only 59% of children are on treatment. The discrepancies in high uptake of Option B+ and low numbers of children in Ethiopia can be attributed to Loss-to-follow-up, which is estimated from 16% to 80%. While LFTU is expected in the region, no-to-minimal evidence exists on the magnitude and its determinants, which hampers the development of interventions and strategies to reduce LFTU.Purpose: To explore the perception of mothers and healthcare providers on determinants of and recommendations to reduce LTFU and HIV exposed infants’ mortality. Methods: An explorative, descriptive qualitative study conducted in five zones in Amhara region. The sample consisted of mothers enrolled in the option B+ programs at the five referral hospitals PMTCT departments, nurses and midwives working in those departments, and HIV officers in the zonal departments. Data were collected in 2019 using in-depth interviews. Data were analyzed using content analysis and deduced to themes. Results: Overall, nine themes were identified from the interviews. Five themes represented the determinants of LTFU and mortality while four themes addressed the recommendations to reduce LFTU among mothers and their children and infant mortality. The determinants themes centered on apathy, stigma and discrimination, poor access to services, healthcare providers behavior and attitudes, and social determinants of health. While recommendations themes suggested that improving access, capitalizing on psychosocial support, education and awareness, and empowerment. Conclusions: Social and structural issues are major contributors to low retention of mothers and death of children due to HIV. A multi-stakeholder approach, including structural changes, are required to support women and their children to ensure that individuals, communities and country enjoy the full benefits of option B+ and lead to an HIV free generation.

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The perceived determinants and recommendations by mothers and healthcare professionals on the loss-to-follow-up in Option B+ program and child mortality in the Amhara region, Ethiopia

BMC Infectious Diseases ◽

10.1186/s12879-020-05583-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Mesfin Wudu Kassaw ◽

Samuel T. Matula ◽

Ayele Mamo Abebe ◽

Ayelign Mengesha Kassie ◽

Biruk Beletew Abate

Keyword(s):

Structural Changes ◽

Hiv Transmission ◽

Psychosocial Support ◽

Healthcare Providers ◽

Hiv Treatment ◽

Great Promise ◽

Amhara Region ◽

Loss To Follow Up ◽

Multi Stakeholder

Abstract Background The third United Nations Sustainable Development Goal includes a commitment to end AIDS-related death by 2030. In line with the Goal, Option B+ programs hold a great promise for eliminating vertical transmission of HIV. Option B+ was introduced in 2013 in Ethiopia. The Global Plan identified Ethiopia as one of 22 high priority countries requiring improvement in prevention of mother to child HIV transmission services. Despite HIV treatment being free in Ethiopia, only 59% of children are on treatment. The discrepancies in high uptake of Option B+ and low numbers of children in Ethiopia can be attributed to Loss-to-follow-up, which is estimated from 16 to 80%. While LFTU is expected in the region, no-to-minimal evidence exists on the magnitude and its determinants, which hampers the development of interventions and strategies to reduce LFTU. The purpose of this study is to explore perception of mothers and healthcare providers on determinants of and recommendations to reduce LTFU and HIV exposed infants’ mortality. Method Explorative, descriptive qualitative study conducted in five zones of Amhara region. The sample consisted of mothers enrolled to the option B+ programs at the five referral hospitals PMTCT departments, nurses and midwives working in those departments, and HIV officers in zonal departments. Data were collected in 2019 using in-depth interviews. Data were analyzed using content analysis and deduced to themes. Results Overall, nine themes were identified from the interviews. Five themes represented the determinants of LTFU and mortality while four themes addressed the recommendations to reduce LFTU among mothers and their infant mortality. The determinants themes centered on apathy, stigma and discrimination, poor access to services, healthcare providers behavior and attitudes, and social determinants of health. While recommendations themes suggested that improving access, capitalizing on psychosocial support, education and awareness, and empowerment. Conclusions Social and structural issues are major contributors to low retention of mothers and death of children due to HIV. A multi-stakeholder approach, including structural changes, are required to support women and their children to ensure that individuals, communities and country enjoy the full benefits of option B+ and lead to an HIV free generation.

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The Perceived determinants and recommendations by mothers and healthcare professionals on the Loss-To-Follow-Up in Option B+ program and child mortality in the Amhara Region, Ethiopia.

10.21203/rs.3.rs-57983/v3 ◽

2020 ◽

Author(s):

Mesfin Wudu Kassaw ◽

Samuel T. Matula ◽

Ayele Mamo ◽

Ayelign Kassie ◽

Biruk Abate

Keyword(s):

Structural Changes ◽

Hiv Transmission ◽

Psychosocial Support ◽

Healthcare Providers ◽

Hiv Treatment ◽

Great Promise ◽

Amhara Region ◽

Loss To Follow Up ◽

Multi Stakeholder

Abstract Background: The third United Nations Sustainable Development Goal includes a commitment to end AIDS-related death by 2030. In line with the Goal, Option B+ programs hold a great promise for eliminating vertical transmission of HIV. Option B+ was introduced in 2013 in Ethiopia. The Global Plan identified Ethiopia as one of 22 high priority countries requiring improvement in prevention of mother to child HIV transmission services. Despite HIV treatment being free in Ethiopia, only 59% of children are on treatment. The discrepancies in high uptake of Option B+ and low numbers of children in Ethiopia can be attributed to Loss-to-follow-up, which is estimated from 16% to 80%. While LFTU is expected in the region, no-to-minimal evidence exists on the magnitude and its determinants, which hampers the development of interventions and strategies to reduce LFTU. The purpose of this study is to explore perception of mothers and healthcare providers on determinants of and recommendations to reduce LTFU and HIV exposed infants’ mortality.Method: Explorative, descriptive qualitative study conducted in five zones of Amhara region. The sample consisted of mothers enrolled to the option B+ programs at the five referral hospitals PMTCT departments, nurses and midwives working in those departments, and HIV officers in zonal departments. Data were collected in 2019 using in-depth interviews. Data were analyzed using content analysis and deduced to themes.Results: Overall, nine themes were identified from the interviews. Five themes represented the determinants of LTFU and mortality while four themes addressed the recommendations to reduce LFTU among mothers and their infant mortality. The determinants themes centered on apathy, stigma and discrimination, poor access to services, healthcare providers behavior and attitudes, and social determinants of health. While recommendations themes suggested that improving access, capitalizing on psychosocial support, education and awareness, and empowerment.Conclusions: Social and structural issues are major contributors to low retention of mothers and death of children due to HIV. A multi-stakeholder approach, including structural changes, are required to support women and their children to ensure that individuals, communities and country enjoy the full benefits of option B+ and lead to an HIV free generation.

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Digital adherence technologies for the management of tuberculosis therapy: mapping the landscape and research priorities

BMJ Global Health ◽

10.1136/bmjgh-2018-001018 ◽

2018 ◽

Vol 3 (5) ◽

pp. e001018 ◽

Cited By ~ 51

Author(s):

Ramnath Subbaraman ◽

Laura de Mondesert ◽

Angella Musiimenta ◽

Madhukar Pai ◽

Kenneth H Mayer ◽

...

Keyword(s):

Treatment Outcomes ◽

Healthcare Providers ◽

Research Priorities ◽

Directly Observed Therapy ◽

Loss To Follow Up ◽

Individualised Care ◽

Health System Efficiency ◽

Tuberculosis Therapy

Poor medication adherence may increase rates of loss to follow-up, disease relapse and drug resistance for individuals with active tuberculosis (TB). While TB programmes have historically used directly observed therapy (DOT) to address adherence, concerns have been raised about the patient burden, ethical limitations, effectiveness in improving treatment outcomes and long-term feasibility of DOT for health systems. Digital adherence technologies (DATs)—which include feature phone–based and smartphone-based technologies, digital pillboxes and ingestible sensors—may facilitate more patient-centric approaches for monitoring adherence, though available data are limited. Depending on the specific technology, DATs may help to remind patients to take their medications, facilitate digital observation of pill-taking, compile dosing histories and triage patients based on their level of adherence, which can facilitate provision of individualised care by TB programmes to patients with varied levels of risk. Research is needed to understand whether DATs are acceptable to patients and healthcare providers, accurate for measuring adherence, effective in improving treatment outcomes and impactful in improving health system efficiency. In this article, we describe the landscape of DATs that are being used in research or clinical practice by TB programmes and highlight priorities for research.

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Patterns of changing pregnancy intentions among women living with HIV in Canada

BMC Women s Health ◽

10.1186/s12905-021-01492-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lashanda Skerritt ◽

Angela Kaida ◽

Nadia O’Brien ◽

Ann N. Burchell ◽

Gillian Bartlett ◽

...

Keyword(s):

Hiv Transmission ◽

Healthcare Providers ◽

Undetectable Viral Load ◽

Subsequent Pregnancy ◽

Reproductive Age ◽

Pregnancy Intentions ◽

Women Living With Hiv ◽

Living With Hiv ◽

Health Cohort Study

Abstract Background Women with an undetectable viral load can become pregnant and have children with no risk of HIV transmission to their sexual partners and low risk of transmission to their infants. Contemporary pregnancy intentions of women living with HIV in Canada are poorly understood, evidenced by high rates of unintended pregnancy and low uptake of contraceptives. Methods We used longitudinal survey data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) to measure and compare pregnancy intentions (Yes vs No vs Unsure) at baseline, 18-months and 36-months follow-up (from 2013 to 2018) among women living with HIV of reproductive age (16–49 years) and potential. We used Sankey diagrams to depict changes in pregnancy intentions over time and multivariable logistic regression to examine the relationship between pregnancy intention within 2 years and subsequent pregnancy. Results At baseline, 41.9% (119/284) of women intended to become pregnant, 43.3% did not, and 14.8% were unsure. Across 36-months of follow-up, 41.9% (119/284) of women changed their pregnancy intentions, with 25% changing from intending to not intending to become pregnant and 13.1% vice versa. Pregnancy intentions were not strongly associated with subsequent pregnancy between baseline and 18-months (aOR 1.44; 95% CI 0.53, 3.72) or between 18 and 36-months (aOR 2.17; 95% CI 0.92, 5.13). Conclusions Our findings underscore the need for healthcare providers to engage in ongoing discussions with women living with HIV to support their dynamic pregnancy intentions.

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Universal Definition of Loss to Follow-Up in HIV Treatment Programs: A Statistical Analysis of 111 Facilities in Africa, Asia, and Latin America

PLoS Medicine ◽

10.1371/journal.pmed.1001111 ◽

2011 ◽

Vol 8 (10) ◽

pp. e1001111 ◽

Cited By ~ 111

Author(s):

Benjamin H. Chi ◽

Constantin T. Yiannoutsos ◽

Andrew O. Westfall ◽

Jamie E. Newman ◽

Jialun Zhou ◽

...

Keyword(s):

Latin America ◽

Statistical Analysis ◽

Hiv Treatment ◽

Treatment Programs ◽

Loss To Follow Up ◽

Universal Definition ◽

Definition Of

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Healthcare Providers in Africa Face HIV and AIDS Challenges in Providing Services to a Key Population: Infant and Young Child Feeding

TEXILA INTERNATIONAL JOURNAL OF PUBLIC HEALTH ◽

10.21522/tijph.2013.09.04.art005 ◽

2021 ◽

Vol 9 (4) ◽

pp. 48-61

Author(s):

Nebiyu Lera Alaro

Keyword(s):

Young Child ◽

Hiv Transmission ◽

Treatment Guidelines ◽

Healthcare Providers ◽

Hiv Treatment ◽

Hiv And Aids ◽

Child Feeding ◽

Young Child Feeding ◽

Guidelines Implementation ◽

Infant And Young Child

There is agreement on the benefits of exclusive breastfeeding for 6 months and the introduction of appropriate complementary foods at 6 months, followed by continued breastfeeding, for all infants. However, infant, and young child feeding (IYCF) guidelines for HIV-positive mothers have changed on a regular basis since 2000. Considering new HIV treatment guidelines, implementation challenges, and knowledge gaps, this article investigates issues and Evidence related to IYCF for the prevention and care of paediatric HIV in resource-limited settings. The effectiveness of antiretroviral medications (ARVs) in decreasing the incidence of HIV transmission from mother to child prompted WHO to urge countries to support either avoidance or treatment. Significant progress has been made in terms of preserving the lives of moms but also decreasing the spread of HIV among children, but long-term political, financial, and scientific commitment is essential for ensuring effective postnatal HIV prevention programs and providing for the nutritional requirements of HIV-exposed and HIV-infected infants.

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