scholarly journals Pre-Implementation Barriers and Facilitators of an mHealth ART Adherence Counselling Intervention: Perspectives of NPO staff in South Africa (Preprint)

2020 ◽  
Author(s):  
Siobhan McCreesh-Toselli ◽  
John Torline ◽  
Hetta Gouse ◽  
Reuben N Robbins ◽  
Claude A Mellins ◽  
...  
Keyword(s):  
South Africa ◽  
Computer Literacy ◽  
High Volume ◽  
Barriers And Facilitators ◽  
Hiv Care ◽  
Successful Implementation ◽  
Art Adherence ◽  
Implementation Barriers ◽  
Persons Living With Hiv ◽  
Adherence Counselling

BACKGROUND Persons living with HIV (PLWH) in South Africa's expanding antiretroviral treatment (ART) program receive readiness counselling provided by Lay Counsellors (LCs). Both the delivery of content and counselling approach are difficult to standardize across multiple sites and providers. mHealth applications offer an opportunity in low resource settings to address these needs. OBJECTIVE The objective of this study was to explore the perceived pre-implementation barriers and facilitators of an mHealth intervention (“Masivukeni”) among staff at a large Cape Town-based HIV care non-profit organisation. METHODS Seven interviews and three focus groups were conducted with experienced LCs, their supervisors and managers. We used the Consolidated Framework for Implementation Research (CFIR) to explore perceived implementation barriers and facilitators of the Masivukeni intervention. RESULTS Several potential facilitators of the Masivukeni were identified, most notably interactive learning and facilitated updates. Barriers to implementation included security risks and costs of equipment, the high volume of patients needing to be counselled and variable computer literacy. CONCLUSIONS mHealth applications, such as Masivukeni, were perceived as being well-placed to address some needs of those who deliver ART adherence counselling in South Africa. However, the successful implementation of mHealth applications appeared to be dependent- on overcoming certain barriers in this setting.

scholarly journals Hypertension Care Cascade at a Large Urban HIV Clinic in Uganda: A Mixed Methods Study Using the Capability, Opportunity, Motivation for Behavior change (COM-B) model

2020 ◽  
Author(s):  
Martin Muddu ◽  
Isaac Ssinabulya ◽  
Simon P. Kigozi ◽  
Rebecca Ssennyonjo ◽  
Florence Ayebare ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Mixed Methods Study ◽  
Barriers And Facilitators ◽  
Hiv Care ◽  
Hiv Care Cascade ◽  
Care Cascade ◽  
Increased Risk ◽  
Persons Living With Hiv ◽  
One Year ◽  
Hiv Integration

Abstract Background: Persons Living with HIV (PLHIV) receiving antiretroviral therapy (ART) have a high prevalence of hypertension (HTN) and increased risk of mortality from cardiovascular diseases. HTN and HIV care integration is recommended in Uganda, though its implementation has lagged. In this study, we sought to analyze the HTN and HIV care cascades and explore barriers and facilitators of HTN/HIV integration within a large HIV clinic in urban Uganda.Methods: We conducted an explanatory sequential mixed methods study at Mulago ISS clinic in Kampala, Uganda. We determined proportions of patients in HTN and HIV care cascade steps of: Screened, Diagnosed, Initiated on treatment, Retained, and Controlled. Guided by the Capability, Opportunity, Motivation and Behavior (COM-B) model, we then conducted semi-structured interviews and focus group discussions with healthcare providers and hypertensive PLHIV (n=45). We coded the qualitative data deductively and analyzed the data thematically categorizing them as themes that influenced HTN care positively or negatively. These denoted barriers and facilitators, respectively.Results: Of 15,953 adult PLHIV, 99.1% were initiated on ART, 89.5% were retained in care and 98.0% achieved control (viral suppression) at one year. All 15,953 (100%) participants were screened for HTN, of whom 24.3% had HTN. HTN treatment initiation, one-year retention, and control were low at 1.0%, 15.4% and 5.0%, respectively. Barriers and facilitators of HTN/HIV integration appeared in all three COM-B domains. Barriers included low patient knowledge of HTN complications, less priority by patients for HTN treatment compared to ART, sub-optimal provider knowledge of HTN treatment, lack of HTN treatment protocols, inadequate supply of anti-hypertensive medicines and lack of HTN care performance targets. Facilitators included patients’ and providers’ interest in HTN/HIV integration, patients’ interest in PLHIV peers support, providers’ knowledge and skills for HTN screening, optimal ART adherence counseling, and availability of automated BP machines. Conclusion: The prevalence of HTN among PLHIV is high, but the HTN care cascade is sub-optimal in this successful HIV clinic. To close these gaps, models of integrated HTN/HIV care are urgently needed. These findings provide a basis for designing contextually appropriate interventions for HTN/HIV integration in Uganda and other low and middle-income countries.

scholarly journals The Views of Health Workforce Managers on the Implementation of Workload Indicators of Staffing Need (WISN) Method in Primary Healthcare Settings in South Africa

2017 ◽  
Vol 3 (1) ◽  
pp. 132
Author(s):  
Ntshengedzeni M. Ravhengani ◽  
Ntombifikile G. Mtshali
Keyword(s):  
South Africa ◽  
Health Workforce ◽  
Primary Healthcare ◽  
Workforce Planning ◽  
Implementation Process ◽  
Health Systems Strengthening ◽  
Management Approach ◽  
Successful Implementation ◽  
Implementation Barriers ◽  
African Countries

Background: Several African countries, including South Africa, are using the Workload Indicators of Staffing Need (WISN) method, as the preferred health workforce planning and management approach. Ineffective implementation of this method can however mean that health outcomes are not improved.Objectives: This study explored the views of health workforce managers regarding potential barriers and enablers to implementation of the WISN method in South African primary healthcare (PHC) settings.Method: This study adopted a qualitative approach and Grounded Theory research design. Following ethics clearance, a total of fourteen participants, PHC nurse managers and WISN coordinators were purposefully selected to participate in the study. Data were collected through focus group interviews and document analysis. Open, axial and selective coding was conducted to analyse data, including the use of Nvivo data analysis software to assist with the analysis.Findings: Participants in this study highlighted a number of conditions necessary for the successful implementation of the WISN method. These included political will and leadership, provision of necessary support to enable implementation process, collaborative and consultative approach by stakeholders, clear, efficient and consistent communication, resources availability, continued support in implementing WISN and stability in leadership and staff in PHC settings.Conclusions: The study concludes that successful WISN implementation requires addressing implementation barriers, such as unavailability of financial and human resources, and enhancing enablers, such as normative guides implementation guideline, technical capacity and availability of continuous support to implementers. This study’s results can be used to enhance WISN implementation and health systems strengthening.

scholarly journals 1037. Qualitative Findings from a Hybrid III Implementation-Effectiveness Study to Explore Perspectives of Health-care Staff on Early Implementation of Cabotegravir and Rilpivirine Long Acting (CAB+RPV LA) Injectable HIV treatment in the US (CUSTOMIZE)

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S549-S549
Author(s):  
Maggie Czarnogorski ◽  
Cindy Garris ◽  
Paul Wannamaker ◽  
Ronald D’Amico ◽  
Carolyn Selenski ◽  
...  
Keyword(s):  
Hiv Treatment ◽  
Barriers And Facilitators ◽  
Care Staff ◽  
Hiv Care ◽  
Patient Acceptance ◽  
Health Care Staff ◽  
Successful Implementation ◽  
Effectiveness Study ◽  
Research Support ◽  
Implementation Effectiveness

Abstract Background CAB+RPV LA administered monthly for HIV treatment is non-inferior to daily oral ART at maintaining HIV suppression but concerns about implementation of this novel treatment paradigm remain. CUSTOMIZE, an implementation-effectiveness study, examined barriers and facilitators to successful implementation of CAB+RPV LA in US HIV clinics. Methods Semi-structured qualitative interviews were conducted with physicians, injectors, and administrators across diverse clinics in US without previous CAB+RPV LA experience at Baseline (BL) (N=26) and after patients received the 4th monthly injection of CAB + RPV LA (interim) (N=24). Consolidated Framework for Implementation Research (CFIR) guided the interviews to evaluate barriers and facilitators to implementation. Interviews were recorded, transcribed, and coded using ATLAS.ti then analyzed for trends. Results At BL, 58% of study staff expected CAB+RPV LA would meet the needs of patients. Staff reported perceived advantages for patients: reduced stigma of pill bottles (38%), ability to live/travel in a “carefree” manner (31%) and removing the daily reminder of HIV (20%). At BL, most administrators had resource concerns: additional refrigeration, transportation, and staffing. Some clinics (38%) needed to purchase a refrigerator to store CAB+RPV LA. Some physicians noted a potential need for improved parking or expanded hours. At interim, most staff (71%) reported no change in official clinic hours; but 50% of injectors and 38% of administrators reported changing work hours to accommodate injection visits before clinic or at lunchtime. Existing appointment reminder systems and transportation support were reported as facilitators to implementation. Many staff (46%) noted additional visits increased coordination of other care needs. Most staff (67%) noted high patient acceptance and positive attitudes facilitated successful implementation of CAB + RPV LA. Conclusion Some staff had concerns about implementation initially, but at study interim minimal practice changes were needed to operationalize CAB+RPV LA effectively. Patient interest heightened staff desire to implement CAB+RPV LA in their clinics. Staff are optimistic that monthly CAB+RPV LA is manageable with minimal disruption to routine care in US HIV care settings. Disclosures Maggie Czarnogorski, MD, MPH, ViiV Healthcare (Employee) Cindy Garris, MSPH, GlaxoSmithKline (Other Financial or Material Support, Stockholder)ViiV Healthcare (Employee) Paul Wannamaker, BA, ViiV Healthcare (Employee) Ronald D’Amico, DO, MSc, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee) Carolyn Selenski, PhD, GSK (Employee, Shareholder) Colleen A. McHorney, PhD, Evidera (Employee) Larissa Stassek, MPH, Evidera (Employee) Gary I. Sinclair, MD, ViiV (Speaker’s Bureau) Leandro A. Mena, MD, MPH, Binx Health (Grant/Research Support)Evofem (Grant/Research Support)Gilead Science (Consultant, Grant/Research Support, Speaker’s Bureau)GSK (Grant/Research Support)Janssen (Grant/Research Support)Merck (Consultant, Grant/Research Support)Roche Molecular (Consultant, Grant/Research Support)SpeedDx (Grant/Research Support)ViiV Healthcare (Consultant, Grant/Research Support, Speaker’s Bureau) David Margolis, MD, MPH, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee)

scholarly journals Nurse-Delivered Cognitive Behavioral Therapy for Adherence and Depression Among People Living With HIV (the Ziphamandla Study): Protocol for a Randomized Controlled Trial (Preprint)

2019 ◽  
Author(s):  
John A Joska ◽  
Lena S Andersen ◽  
Rosana Smith-Alvarez ◽  
Jessica Magidson ◽  
Jasper S Lee ◽  
...  
Keyword(s):  
South Africa ◽  
Randomized Controlled Trial ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Art Adherence ◽  
First Line ◽  
Randomized Controlled ◽  
Persons Living With Hiv ◽  
Living With Hiv

BACKGROUND There is an unmet need to develop effective, feasible, and scalable interventions for poor adherence and depression in persons living with HIV in low- and middle-income countries (LMIC). OBJECTIVE This study aims to investigate the effectiveness of a nurse-delivered cognitive behavioral therapy (CBT) intervention for adherence and depression (CBT-AD) among persons living with HIV who are failing first-line antiretroviral therapy (ART) in Cape Town, South Africa. METHODS This study is a 2-arm randomized controlled trial of CBT-AD integrated into the HIV primary care setting in South Africa. A total of 160 participants who did not achieve viral suppression from their first-line ART and have a unipolar depressive mood disorder will be randomized to receive either 8 sessions of CBT-AD or enhanced treatment as usual. Participants will be assessed for major depressive disorder using the Mini International Neuropsychiatric Interview at baseline and 4, 8, and 12 months. The primary outcomes are depression on the Hamilton Depression Scale (HAM-D; as assessed by a blinded assessor) at the 4-month assessment and changes in ART adherence (assessed via real-time, electronic monitoring with Wisepill) between baseline and the 4-month assessment. Secondary outcomes are HIV viral load and CD4 cell count at the 12-month assessment as well as ART adherence (Wisepill) and depression (HAM-D) over follow-up (4-, 8-, and 12-month assessments). RESULTS The trial commenced in August 2015 and recruitment began in July 2016. Enrollment was completed in June 2019. CONCLUSIONS Results of this study will inform whether an existing intervention (CBT-AD) can be effectively administered in LMIC by nurses with training and ongoing supervision. This will present unique opportunities to further explore the scale-up of a behavioral intervention to enhance ART adherence among persons living with HIV with major depression in a high-prevalence setting, to move toward achieving The Joint United Nations Programme on HIV/AIDS 90-90-90 goals. CLINICALTRIAL ClincialTrials.gov NCT02696824; https://clinicaltrials.gov/ct2/show/NCT02696824 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/14200

scholarly journals A mixed methods investigation of implementation barriers and facilitators to a daily mobile phone sexual risk assessment for young women in Soweto, South Africa

PLoS ONE ◽  
2020 ◽  
Vol 15 (4) ◽  
pp. e0231086
Author(s):  
Janan J. Dietrich ◽  
Stefanie Hornschuh ◽  
Mamakiri Khunwane ◽  
Lerato M. Makhale ◽  
Kennedy Otwombe ◽  
...  
Keyword(s):  
South Africa ◽  
Risk Assessment ◽  
Mixed Methods ◽  
Mobile Phone ◽  
Sexual Risk ◽  
Young Women ◽  
Barriers And Facilitators ◽  
Implementation Barriers

scholarly journals Hypertension Care Cascade at a Large Urban HIV Clinic in Uganda: A Mixed Methods Study Using the Capability, Opportunity, Motivation for Behavior Change (COM-B) Model

2020 ◽  
Author(s):  
Martin Muddu ◽  
Isaac Ssinabulya ◽  
Simon P. Kigozi ◽  
Rebecca Ssennyonjo ◽  
Florence Ayebare ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Mixed Methods Study ◽  
Barriers And Facilitators ◽  
Hiv Care ◽  
Hiv Care Cascade ◽  
Care Cascade ◽  
Increased Risk ◽  
Persons Living With Hiv ◽  
One Year ◽  
Hiv Integration

Abstract Background: Persons Living with HIV (PLHIV) receiving antiretroviral therapy (ART) have a high prevalence of hypertension (HTN) and increased risk of mortality from cardiovascular diseases. HTN and HIV care integration is recommended in Uganda, though its implementation has lagged. In this study, we sought to analyze the HTN and HIV care cascades and explore barriers and facilitators of HTN/HIV integration within a large HIV clinic in urban Uganda.Methods: We conducted an explanatory sequential mixed methods study at Mulago ISS clinic in Kampala, Uganda. We determined proportions of patients in HTN and HIV care cascade steps of: Screened, Diagnosed, Initiated on treatment, Retained, and Controlled. Guided by the Capability, Opportunity, Motivation and Behavior (COM-B) model, we then conducted semi-structured interviews and focus group discussions with healthcare providers and hypertensive PLHIV (n=45). We coded the qualitative data deductively and analyzed the data thematically categorizing them as themes that influenced HTN care positively or negatively. These denoted barriers and facilitators, respectively.Results: Of 15,953 adult PLHIV, 99.1% were initiated on ART, 89.5% were retained in care and 98.0% achieved control (viral suppression) at one year. All 15,953 (100%) participants were screened for HTN, of whom 24.3% had HTN. HTN treatment initiation, one-year retention, and control were low at 1.0%, 15.4% and 5.0%, respectively. Barriers and facilitators of HTN/HIV integration appeared in all three COM-B domains. Barriers included low patient knowledge of HTN complications, less priority by patients for HTN treatment compared to ART, sub-optimal provider knowledge of HTN treatment, lack of HTN treatment protocols, inadequate supply of anti-hypertensive medicines and lack of HTN care performance targets. Facilitators included patients’ and providers’ interest in HTN/HIV integration, patients’ interest in PLHIV peers support, providers’ knowledge and skills for HTN screening, optimal ART adherence counseling, and availability of automated BP machines. Conclusion: The prevalence of HTN among PLHIV is high, but the HTN care cascade is sub-optimal in this successful HIV clinic. To close these gaps, models of integrated HTN/HIV care are urgently needed. These findings provide a basis for designing contextually appropriate interventions for HTN/HIV integration in Uganda and other low and middle-income countries.

Psychiatric Aspects of Care Engagement and Medication Adherence in Antiretroviral-Based HIV Treatment and Prevention

2017 ◽  
Author(s):  
Jeffrey J. Weiss ◽  
Michael J. Stirratt
Keyword(s):  
Hiv Infection ◽  
Treatment Adherence ◽  
Psychiatric Illness ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Art Adherence ◽  
Addictive Disorders ◽  
Persons Living With Hiv ◽  
Hiv Care Engagement ◽  
Living With Hiv

Care engagement and treatment adherence are directly related to HIV treatment outcomes and to mortality. Active drug use and psychiatric illness such as depressive and addictive disorders are significant barriers to care engagement and treatment adherence among persons living with HIV and those at high risk for HIV infection and eligible for pre-exposure prophylaxis (PrEP). This chapter addresses (1) psychiatric aspects of PrEP for HIV prevention, (2) the care continuum for individuals living with HIV infection, (3) psychiatric determinants of HIV care engagement, (4) behavioral interventions to improve HIV care engagement, (5) psychiatric determinants of antiretroviral (ART) adherence, (6) interventions to improve ART adherence, and (7) implications of research findings for the medical and mental health clinician working with patients with psychiatric illness who are living with HIV or at risk for infection.

scholarly journals Nurse-Delivered Cognitive Behavioral Therapy for Adherence and Depression Among People Living With HIV (the Ziphamandla Study): Protocol for a Randomized Controlled Trial

10.2196/14200 ◽  
2020 ◽  
Vol 9 (2) ◽  
pp. e14200 ◽  
Author(s):  
John A Joska ◽  
Lena S Andersen ◽  
Rosana Smith-Alvarez ◽  
Jessica Magidson ◽  
Jasper S Lee ◽  
...  
Keyword(s):  
South Africa ◽  
Randomized Controlled Trial ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Art Adherence ◽  
First Line ◽  
Randomized Controlled ◽  
Persons Living With Hiv ◽  
Living With Hiv

Background There is an unmet need to develop effective, feasible, and scalable interventions for poor adherence and depression in persons living with HIV in low- and middle-income countries (LMIC). Objective This study aims to investigate the effectiveness of a nurse-delivered cognitive behavioral therapy (CBT) intervention for adherence and depression (CBT-AD) among persons living with HIV who are failing first-line antiretroviral therapy (ART) in Cape Town, South Africa. Methods This study is a 2-arm randomized controlled trial of CBT-AD integrated into the HIV primary care setting in South Africa. A total of 160 participants who did not achieve viral suppression from their first-line ART and have a unipolar depressive mood disorder will be randomized to receive either 8 sessions of CBT-AD or enhanced treatment as usual. Participants will be assessed for major depressive disorder using the Mini International Neuropsychiatric Interview at baseline and 4, 8, and 12 months. The primary outcomes are depression on the Hamilton Depression Scale (HAM-D; as assessed by a blinded assessor) at the 4-month assessment and changes in ART adherence (assessed via real-time, electronic monitoring with Wisepill) between baseline and the 4-month assessment. Secondary outcomes are HIV viral load and CD4 cell count at the 12-month assessment as well as ART adherence (Wisepill) and depression (HAM-D) over follow-up (4-, 8-, and 12-month assessments). Results The trial commenced in August 2015 and recruitment began in July 2016. Enrollment was completed in June 2019. Conclusions Results of this study will inform whether an existing intervention (CBT-AD) can be effectively administered in LMIC by nurses with training and ongoing supervision. This will present unique opportunities to further explore the scale-up of a behavioral intervention to enhance ART adherence among persons living with HIV with major depression in a high-prevalence setting, to move toward achieving The Joint United Nations Programme on HIV/AIDS 90-90-90 goals. Trial Registration ClincialTrials.gov NCT02696824; https://clinicaltrials.gov/ct2/show/NCT02696824 International Registered Report Identifier (IRRID) DERR1-10.2196/14200

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