scholarly journals Determinants of Sputum Ordering for Tuberculosis Diagnosis in People Living with HIV in the Greater Accra Region, Ghana

2021 ◽  
Author(s):  
Daniel Kasozi ◽  
Philip Govule ◽  
Simon Peter Katongole ◽  
Bismark Sarfo
Keyword(s):  
Health Workers ◽  
Screen Test ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Presumptive Diagnosis ◽  
Treatment Services ◽  
Care And Treatment ◽  
Living With Hiv ◽  
Greater Accra Region ◽  
General Appearance

Abstract BackgroundTuberculosis (TB) remains a significant public health concern, and a leading cause of ill-health and death globally. More so, People living with HIV have been shown to carry an increased risk of developing TB with an estimated one-third of deaths in this population. The World Health Organization recommends systematic and routine screening of PLHIV for TB on every clinic visit and further testing using sputum for those with a positive TB screen test. Not all PLHIV with a positive TB screen test in Ghana are further tested for TB using sputum and the factors for this are not well understood. This study assessed factors associated with sputum ordering for TB diagnosis in PLHIV who were screened positive for TB in three hospitals providing HIV care and treatment services in the Greater Accra region of Ghana.MethodsMixed method study performed at three purposively selected hospitals providing HIV care and treatment services in the Greater Accra region. The study involved a cross sectional review of patients’ charts and in-depth interviews with health workers involved in the care and treatment of PLHIV. Quantitative data was analyzed using STATA version 15. Chi square test was used for bivariate analysis. Logistic regression was used for multivariate analysis. P≤ 0.05 was considered statistically significant. Inductive thematic analysis was used to determine emerging themes from the interviews. The major themes were represented with representative quotations.ResultsFour hundred (400) patient charts were reviewed of which 67.7% were female with median age of 39 (IQR 31-49). TB screening was recorded in 78% (95% CI 73.6, 82.0) of the patients of whom ninety-two (92) patients had a positive TB screen test. Only 53 (57.6%) who had a positive screen test had sputum ordered for further TB testing. In the multivariate analysis, patient general appearance described as abnormal (OR=3.05, p=0.036), having more than one TB symptom (OR=3.42, p=0.028) and presence of an alternative presumptive diagnosis (OR=0.34, p=0.023) were associated with having a sputum test ordered. High patient numbers, inability to produce sputum, unwillingness of the not so sick patients to provide sputum and the costs associated with chest X-ray were perceived as the challenges to further testing for TB.ConclusionTB screening in PLHIV is still lower than recommended and almost half of PLHIV with a positive TB screen test did not have a sputum test documented. Sputum testing was likely to be done in patients with an abnormal general appearance and more than one TB symptom and unlikely in those with an alternative presumptive diagnosis. High workload, costs of TB tests, lack of training for health workers and inability to produce sputum by patients were the barriers to sputum testing highlighted by the health workers.

scholarly journals Operating Characteristics of a Tuberculosis Screening Tool for People Living with HIV in Out-Patient HIV Care and Treatment Services, Rwanda

PLoS ONE ◽  
2016 ◽  
Vol 11 (9) ◽  
pp. e0163462 ◽  
Author(s):  
Kenneth Turinawe ◽  
Greet Vandebriel ◽  
David W. Lowrance ◽  
Francois Uwinkindi ◽  
Philippe Mutwa ◽  
...  
Keyword(s):  
Screening Tool ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Operating Characteristics ◽  
Tuberculosis Screening ◽  
Treatment Services ◽  
Care And Treatment ◽  
Living With Hiv

scholarly journals Factors hindering integration of care for non-communicable diseases within HIV care services in Dar es Salaam, Tanzania: The perspectives of health workers and people living with HIV

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0254436
Author(s):  
Tausi Haruna ◽  
Magreat Somba ◽  
Hellen Siril ◽  
Gladys Mahiti ◽  
Francis August ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Health Workers ◽  
Communicable Diseases ◽  
Dar Es Salaam ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Integration Of Care ◽  
Non Communicable Diseases ◽  
Care And Treatment ◽  
Living With Hiv

Background Global mortality attributable to non-communicable diseases (NCDs) occurs in more than 36 million people annually with 80% of these deaths occurring in resource limited countries. Among people living with HIV and AIDS (PLHA) studies have reported higher prevalence’s of NCDs compared to the general population but most studies do report a narrow range of NCDs commonly hypertension, diabetes and neoplasms and not all. In addition, there is limited reporting, integration of systematic screening and treatment for all NCDs among PLHA attending care, suggesting the NCD burden among PLHA is likely an underestimate. Little is known about factors facilitating or hindering integration of the care and treatment of NCDs within HIV care and treatment clinics (CTCs) in Tanzania. Objective To explore the perceptions of PLHA and health workers on factors facilitate or hinder the recognition and integration of care for NCDs within CTCs in Dar es Salaam. Methods Inductive content analysis of transcripts from 41 in-depth interviews were conducted with 5 CTC managers (CTC Managers), 9 healthcare providers (DHCP) and 27 people living with HIV (PLHA) attending CTCs and with co-morbid NCDs. Results Four themes emerged; the current situation of services available for care and treatment of NCDs among PLHA in CTCs, experiences of PLHA with co-morbid NCDs with access to care and treatment services for NCDs, facilitators of integrating care and treatment of NCDs within CTCs and perceived barriers for accessing and integration of care and treatment of NCDs within CTCs. Conclusions There was a positive attitude among PLHA and healthcare workers towards integration of NCD services within CTC services. This was enhanced by perceived benefits inherent to the services. Factors hindering integration of NCD care and services included; limited and inconsistent supplies such as screening equipment, medications; insufficient awareness of NCDs within PLHA; lack of adequate training of healthcare workers on management of NCD and treatment costs and payment systems.

scholarly journals Barriers to timely disclosure of HIV serostatus: A qualitative study at care and treatment centers in Dar es Salaam, Tanzania

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256537
Author(s):  
Neelam Ismail ◽  
Nancy Matillya ◽  
Riaz Ratansi ◽  
Columba Mbekenga
Keyword(s):  
Social Status ◽  
Disease Transmission ◽  
Qualitative Content Analysis ◽  
Dar Es Salaam ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Negative Consequences ◽  
Hiv Serostatus ◽  
Care And Treatment ◽  
Living With Hiv

Introduction Disclosure of Human Immunodeficiency Virus (HIV) status is important to prevent the spread of HIV and maintain the health of people living with HIV, their spouses, and the community. Despite the benefits of disclosure, many people living with HIV delay disclosing their status to those close to them thereby increasing the risk for disease transmission. This study aimed to determine the barriers to timely disclosure of HIV serostatus for people living with HIV in Dar es Salaam, Tanzania, and identify what motivated disclosure. Methods A qualitative descriptive study using in-depth individual interviews was conducted with10 participants attending HIV care and treatment centers in Dar es Salaam. The participants were people living with HIV who had delayed disclosing their serostatus for more than one month after diagnosis. Data was analyzed using qualitative content analysis. Results Three categories emerged from the analysis: Barriers hindering timely disclosure, motivation for disclosure of serostatus, and consequences of delayed disclosure. Barriers to timely disclosure included denial of one’s status, the fear of stigmatization, fear of being separated or divorced, the need to protect loved ones, and lack of adequate knowledge about the disease. Reasons that motivated disclosure included gaining social support, preventing disease transmission and wanting to be at peace. Conclusion Timely disclosure is hindered by stigma because HIV is negatively perceived by the public. People living with HIV prefer not to disclose to avoid the negative consequences of disclosure, especially because of fear of being discriminated against and losing their social status, which plays a major role in social status in Tanzania. Trust and adequate counseling from health care workers helps prompt disclosure.

‘What will it take’: addressing alcohol use among people living with HIV in South Africa

2019 ◽  
Vol 30 (11) ◽  
pp. 1049-1054 ◽  
Author(s):  
K Sorsdahl ◽  
NK Morojele ◽  
CD Parry ◽  
CT Kekwaletswe ◽  
N Kitleli ◽  
...  
Keyword(s):  
South Africa ◽  
Alcohol Use ◽  
Brief Intervention ◽  
Hiv Treatment ◽  
Hiv And Aids ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Screening And Brief Intervention ◽  
Treatment Services ◽  
Living With Hiv

Given that hazardous and harmful alcohol use has been identified as a significant barrier to adherence to antiretroviral therapy (ART) in South Africa, alcohol reduction interventions delivered within HIV treatment services are being investigated. Prior to designing and implementing an alcohol-focused screening and brief intervention (SBI), we explored patients’ perceptions of alcohol as a barrier to HIV treatment, the acceptability of providing SBIs for alcohol use within the context of HIV services and identifying potential barriers to patient uptake of this SBI. Four focus groups were conducted with 23 participants recruited from three HIV treatment sites in Tshwane, South Africa. Specific themes that emerged included: (1) barriers to ART adherence, (2) available services to address problematic alcohol use and (3) barriers and facilitators to delivering a brief intervention to address alcohol use within HIV care. Although all participants in the present study unanimously agreed that there was a great need for SBIs to address alcohol use among people living with HIV and AIDS, our study identified several areas that should be considered prior to implementing such a programme.

scholarly journals Impact of Isoniazid Preventive Therapy on Tuberculosis incidence among people living with HIV: A secondary data analysis using Inverse Probability Weighting of individuals attending HIV care and treatment clinics in Tanzania

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254082
Author(s):  
Werner M. Maokola ◽  
Bernard J. Ngowi ◽  
Michael J. Mahande ◽  
Jim Todd ◽  
Masanja Robert ◽  
...  
Keyword(s):  
Observational Studies ◽  
Cox Regression ◽  
Preventive Therapy ◽  
Isoniazid Preventive Therapy ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Clinical Settings ◽  
Inverse Probability ◽  
Care And Treatment ◽  
Living With Hiv

Background Information on how well Isoniazid Preventive Therapy (IPT) works on reducing TB incidence among people living with HIV (PLHIV) in routine settings using robust statistical methods to establish causality in observational studies is scarce. Objectives To evaluate the effectiveness of IPT in routine clinical settings by comparing TB incidence between IPT and non-IPT groups. Methods We used data from PLHIV enrolled in 315 HIV care and treatment clinic from January 2012 to December 2016. We used Inverse Probability of Treatment Weighting to adjust for the probability of receiving IPT; balancing the baseline covariates between IPT and non-IPT groups. The effectiveness of IPT on TB incidence was estimated using Cox regression using the weighted sample. Results Of 171,743 PLHIV enrolled in the clinics over the five years, 10,326 (6.01%) were excluded leaving 161,417 available for the analysis. Of the 24,800 who received IPT, 1.00% developed TB disease whereas of the 136,617 who never received IPT 6,085 (4.98%) developed TB disease. In 278,545.90 person-years of follow up, a total 7,052 new TB cases were diagnosed. Using the weighted sample, the overall TB incidence was 11.57 (95% CI: 11.09–12.07) per 1,000 person-years. The TB incidence among PLHIV who received IPT was 10.49 (95% CI: 9.11–12.15) per 1,000 person-years and 12.00 (95% CI: 11.69–12.33) per 1,000 person-years in those who never received IPT. After adjusting for other covariates there was 52% lower risk of developing TB disease among those who received IPT compared to those who never received IPT: aHR = 0.48 (95% CI: 0.40–0.58, P<0.001). Conclusion IPT reduced TB incidence by 52% in PLHIV attending routine CTC in Tanzania. IPTW adjusted the groups for imbalances in the covariates associated with receiving IPT to achieve comparable groups of IPT and non-IPT. This study has added evidence on the effectiveness of IPT in routine clinical settings and on the use of IPTW to determine impact of interventions in observational studies.

scholarly journals Acceptance and Completion of Rifapentine-based TB Preventive Therapy (3HP) Among People Living with HIV (PLHIV) in Kampala, Uganda – Patient and Health Worker Perspectives.

2020 ◽  
Author(s):  
Fred C. Semitala ◽  
Allan Musinguzi ◽  
Jackie Ssemata ◽  
Fred Welishe ◽  
Juliet Nabunje ◽  
...  
Keyword(s):  
Side Effects ◽  
Behavior Change ◽  
Health Workers ◽  
Scale Up ◽  
Preventive Therapy ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Potential Barriers ◽  
Behavior Change Interventions ◽  
Living With Hiv

Abstract Background: A 12-dose, once-weekly regimen of isoniazid and rifapentine (3HP) is effective in preventing tuberculosis (TB) among people living with HIV (PLHIV). We sought to identify potential barriers to and facilitators of 3HP implementation from the perspective of PLHIV and health workers in a routine HIV care setting in Kampala, Uganda.Methods: We conducted semi-structured interviews with 25 PLHIV and 10 health workers at an HIV/AIDS clinic in Kampala, Uganda. For both groups, we explored their understanding and interpretations of TB and TB preventive therapy (TPT), and perceptions about social and contextual factors that might influence willingness of PLHIV to initiate and complete 3HP. We analyzed the data using an inductive thematic approach and aligned the emergent themes to the Behavior Change Wheel framework to identify sources of behavior and targeted behavior change interventions.Results: Facilitators for uptake and completion of 3HP among PLHIV were fear of contracting TB, awareness of being potentially at risk of getting TB, willingness to take TPT, trust in health workers, and the perceived benefits of DOT and SAT. Barriers included inadequate understanding of TPT, fear of potential side effects, concerns about effectiveness of 3HP as well as the perceived challenges of DOT or SAT. Among health workers, perceived facilitators included knowledge that TB is a common cause of mortality, fear of getting TB, patient trust in their health workers, potential for once-weekly dosing and the benefits of TPT delivery. Health workers perceived potential barriers for PLHIV as being: inadequate understanding of TB and TPT, TB associated stigma, potential side effects, pill burden and challenges of taking TPT. Additional barriers included a lack of experience among health workers with the use of digital technology to monitor patient care.Conclusions: Using a formative qualitative and comprehensive theoretical approach, we identified key sources of behavior that could be used to guide selection of appropriate intervention to optimize 3HP scale up among PLHIV in high burden settings.

scholarly journals Acceptance and completion of rifapentine-based TB preventive therapy (3HP) among people living with HIV (PLHIV) in Kampala, Uganda—patient and health worker perspectives

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Fred C. Semitala ◽  
Allan Musinguzi ◽  
Jackie Ssemata ◽  
Fred Welishe ◽  
Juliet Nabunje ◽  
...  
Keyword(s):  
Side Effects ◽  
Behavior Change ◽  
Health Worker ◽  
Health Workers ◽  
Preventive Therapy ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Delivery Strategies ◽  
Living With Hiv

Abstract Background A 12-dose, once-weekly regimen of isoniazid and rifapentine (3HP) is effective in preventing tuberculosis (TB) among people living with HIV (PLHIV). We sought to identify potential barriers to and facilitators of acceptance and completion of 3HP treatment from the perspective of people living with HIV (PLHIV) and health workers in a routine HIV care setting in Kampala, Uganda. Methods We conducted semi-structured interviews with 25 PLHIV and 10 health workers at an HIV/AIDS clinic in Kampala, Uganda. For both groups, we explored their understanding and interpretations of TB and TB preventive therapy (TPT), and perceptions about social and contextual factors that might influence the willingness of PLHIV to initiate and complete 3HP. We analyzed the data using an inductive thematic approach and aligned the emergent themes to the Behavior Change Wheel framework to identify sources of behavior and targeted behavior change interventions. Results Facilitators of acceptance and completion of 3HP treatment among PLHIV were fear of contracting TB, awareness of being at risk of getting TB, willingness to take TPT, trust in health workers, and the perceived benefits of directly observed therapy (DOT) and self-administered therapy (SAT) 3HP delivery strategies. Barriers included inadequate understanding of TPT, fear of potential side effects, concerns about the effectiveness of 3HP, and the perceived challenges of DOT or SAT. Among health workers, perceived facilitators included knowledge that TB is a common cause of mortality for PLHIV, fear of getting TB, and trust in the health workers by PLHIV, the advantages of once-weekly 3HP dosing, and the benefits of DOT and SAT 3HP delivery strategies. Health worker-reported barriers for PLHIV included inadequate understanding of TB and benefits of TPT, TB-associated stigma, potential side effects pill burden, and challenges of DOT and SAT 3HP delivery strategies. Lack of experience in the use of digital technology to monitor patient care was identified as a health worker-specific barrier. Identified intervention functions to address the facilitators or barriers included education, persuasion, environmental restructuring, enablement, and training. Conclusions Using a formative qualitative and comprehensive theoretical approach, we identified key barriers, facilitators, and appropriate interventions, including patient education, enhancing trust, and patient-centered treatment support that could be used to optimize the delivery of 3HP to PLHIV in our setting. These interventions are likely generalizable to other clinical interventions in similar populations in sub-Saharan Africa and other TB high-burden settings.

scholarly journals Acceptance and Completion of Rifapentine-Based TB Preventive Therapy (3HP) Among People Living with HIV (PLHIV) in Kampala, Uganda – Patient and health Worker Perspectives.

2020 ◽  
Author(s):  
Fred C Semitala ◽  
Allan Musinguzi ◽  
Jackie Ssemata ◽  
Fred Welishe ◽  
Juliet Nabunje ◽  
...  
Keyword(s):  
Side Effects ◽  
Behavior Change ◽  
Health Workers ◽  
Scale Up ◽  
Preventive Therapy ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Structured Interviews ◽  
Potential Barriers ◽  
Living With Hiv

Abstract BackgroundA 12-dose, once-weekly regimen of isoniazid and rifapentine (3HP) is effective in preventing tuberculosis (TB) among people living with HIV (PLHIV). We sought to identify potential barriers to and facilitators of 3HP implementation from the perspective of PLHIV and health workers in a routine HIV care setting in Kampala, Uganda.MethodsWe conducted semi-structured interviews with 25 PLHIV and 10 health workers at an HIV/AIDS clinic in Kampala, Uganda. For both groups, we explored their understanding and interpretations of TB and TB preventive therapy (TPT), and perceptions about social and contextual factors that might influence willingness of PLHIV to initiate and complete 3HP. We analyzed the data using an inductive thematic approach and aligned the emergent themes to the Behavior Change Wheel framework to identify sources of behavior and targeted behavior change interventions.ResultsFacilitators for uptake and completion of 3HP among PLHIV were fear of contracting TB, awareness of being potentially at risk of getting TB, willingness to take TPT, trust in health workers, and the perceived benefits of DOT and SAT. Barriers included inadequate understanding of TPT, fear of potential side effects, concerns about effectiveness of 3HP as well as the perceived challenges of DOT or SAT. Among health workers, perceived facilitators included knowledge that TB is a common cause of mortality, fear of getting TB, patient trust in their health workers, potential for once-weekly dosing and the benefits of TPT delivery. Health workers perceived potential barriers for PLHIV as being: inadequate understanding of TB and TPT, TB associated stigma, potential side effects, pill burden and challenges of taking TPT. Additional barriers included a lack of experience among health workers with the use of digital technology to monitor patient care.Conclusions Using a formative qualitative and comprehensive theoretical approach, we identified key sources of behavior that could be used to guide selection of appropriate intervention to optimize 3HP scale up among PLHIV in high burden settings.

scholarly journals Hopefulness Fosters Affective and Cognitive Constructs for Actions to Cope and Enhance Quality of Life among People Living with HIV in Dar Es Salaam, Tanzania

2016 ◽  
Vol 16 (2) ◽  
pp. 140-148 ◽  
Author(s):  
Hellen Siril ◽  
Mary C. Smith Fawzi ◽  
Jim Todd ◽  
Monique Wyatt ◽  
Japheth Kilewo ◽  
...  
Keyword(s):  
Positive Emotions ◽  
Dar Es Salaam ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Health Seeking ◽  
Positive Health ◽  
Group Discussions ◽  
Health Seeking Behaviors ◽  
Care And Treatment ◽  
Living With Hiv

The aims of this study were to describe how people living with HIV (PLWH) perceive hope and illustrate implications for HIV care and treatment. This is a qualitative study done to explore perceptions and meanings of hope among PLWH attending care and treatment clinics in Dar es Salaam, Tanzania. In all, 10 focus group discussions and 9 in-depth interviews were conducted. People living with HIV described the following 3 dimensions of hope: cognitive, positive emotions, and normalization. Being cognizant of the effectiveness of antiretroviral treatment (ART) often led to positive emotions, such as feeling comforted or strengthened, which in turn was related to positive actions toward normalizing life. Improved treatment outcomes facilitated hope, while persistent health problems, such as ART side effects, were sources of negative emotions contributing to loss of hope among PLWH. Hope motivated positive health-seeking behaviors, including adherence to ART, and this may guide interventions to help PLWH cope and live positively with HIV.

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