scholarly journals Adherence to Antiretroviral Therapy among Older HIV-infected Persons Receiving Treatment in a Public Hospital in Gauteng Province

2020 ◽  
Vol 22 (2) ◽  
Author(s):  
Eucebious Lekalakala-Mokgele
Keyword(s):  
Antiretroviral Therapy ◽  
Older Persons ◽  
Public Hospital ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Gauteng Province ◽  
Individual Interviews ◽  
Purposive Sample

Adherence to antiretroviral therapy (ART) is a complex and dynamic process and remains an important issue in HIV care. Literature has highlighted sub-optimal adherence to ART across settings and populations, with many factors influencing the level of adherence. While older adults have been characterised as being more compliant, other studies have demonstrated at least 50% poor adherence. The aim of this study was to explore and describe own perspectives on adherence to ART among older persons receiving HIV treatment in a public hospital in Gauteng Province, South Africa. This study used a qualitative exploratory design that included a purposive sample of older HIV-infected men and women currently receiving HIV healthcare services from a public hospital in Gauteng Province. Individual interviews with 12 purposively selected older participants were conducted. The data were analysed using a thematic approach. Findings of the study revealed five main themes, namely: 1) disclosure, stigma and adherence; 2) drug-related side effects; 3) difficulties related to social factors and lifestyle; 4) support and adherence to ART; as well as 5) experience with the health system. Recommendations include empowering older persons in managing internalised stigma, monitoring of adherence by healthcare providers, and educating family and other support structures to form part of adherence enhancing strategies.

scholarly journals Policy implementation analysis on access to healthcare among undocumented immigrants in seven autonomous communities of Spain, 2012–2018

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e045626
Author(s):  
Megi Gogishvili ◽  
Sergio A Costa ◽  
Karen Flórez ◽  
Terry T Huang
Keyword(s):  
Policy Implementation ◽  
Undocumented Immigrants ◽  
Healthcare Services ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Undocumented Migrants ◽  
Royal Decree ◽  
La Mancha ◽  
Free Healthcare ◽  
Implementation Analysis

BackgroundIn 2012, the Government of Spain enacted Royal Decree-Law (RDL) 16/2012 and Royal Decree (RD) 1192/2012 excluding undocumented immigrants from publicly funded healthcare services. We conducted a policy implementation analysis to describe and evaluate the legal and regulatory actions taken at the autonomous community (AC) level after enactment of 2012 RDL and RD and their impact on access to general healthcare and HIV services among undocumented immigrants.MethodsWe reviewed documents published by the governments of seven ACs (Andalucía, Aragón, Euskadi (Basque Country), Castilla-La Mancha, Galicia, Madrid, Valencia) from April 2012 to July 2018, describing circumstances under which undocumented immigrants would be able to access free healthcare services. We developed indicators according to the main systemic barriers presented in official documents to analyse access to free healthcare across the participating ACs. ACs were grouped under five access categories: high, medium-high, medium, medium-low and low.ResultsAndalucía provided the highest access to free healthcare for undocumented immigrants in both general care and HIV treatment. Medium-high access was provided by Euskadi and medium access by Aragón, Madrid and Valencia. Castilla-La Mancha provided medium-low access. Galicia had low access. Only Madrid and Galicia provided different and higher level of access to undocumented migrants in HIV care compared with general healthcare.ConclusionsImplementation of 2012 RDL and RD across the ACs varied significantly, in part due to the decentralisation of the Spanish healthcare system. The challenge of healthcare access among undocumented immigrants included persistent systemic restrictions, frequent and unclear rule changes, and the need to navigate differences across ACs of Spain.

scholarly journals The impact of an integrated depression and HIV treatment program on mental health and HIV care outcomes among people newly initiating antiretroviral therapy in Malawi

PLoS ONE ◽  
2020 ◽  
Vol 15 (5) ◽  
pp. e0231872 ◽  
Author(s):  
Melissa A. Stockton ◽  
Michael Udedi ◽  
Kazione Kulisewa ◽  
Mina C. Hosseinipour ◽  
Bradley N. Gaynes ◽  
...  
Keyword(s):  
Mental Health ◽  
Antiretroviral Therapy ◽  
Treatment Program ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Care Outcomes ◽  
The Impact

scholarly journals Daily struggle to take antiretrovirals: a qualitative study in Papuans living with HIV and their healthcare providers

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e036832
Author(s):  
Elfride Irawati Sianturi ◽  
Elmiawati Latifah ◽  
Ari Probandari ◽  
Christantie Effendy ◽  
Katja Taxis
Keyword(s):  
Qualitative Study ◽  
Healthcare Providers ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Free Access ◽  
Personal Factors ◽  
Long Distance ◽  
Related Factors ◽  
Healthcare Environment ◽  
Living With Hiv

ObjectiveThe aim of the study was to explore the experiences of Papuans living with HIV to take antiretroviral therapy (ART) from the patient and the healthcare providers (HCPs) perspective.DesignThis was a qualitative study covering all five tribes located in Papua Provinces one of two Indonesian provinces on Papua Island. Semistructured interviews were conducted with Papuans living with HIV and their HCPs. Interviews were transcribed verbatim and coded to find themes.ResultsOverall, we conducted interviews with 13 Papuans living with HIV (mean age: 33 years, 61% female) and 14 HCPs (mean age: 42 years, 64% female) within five customary areas. HCPs included three physicians, nine nurses, two others. Two main themes were identified: (1) personal factors and (2) healthcare environment-related factors. Personal factors were beliefs and knowledge of ART, stigma from family, community and HCPs as well as practical problems such as transportation because of long distance. Within the theme of healthcare environment, the competences and attitudes of HCPs were particularly relevant. The findings are important in refining HIV treatment strategies implemented in Papua, especially when extending HIV care provided by community centres.ConclusionsDespite free access to ART, Papuans living with HIV struggle to remain on treatment. Considering local culture and religion in strategies to reduce stigma should be a priority.

scholarly journals Systemic Delays in the Initiation of Antiretroviral Therapy for Clinically Eligible HIV-Infected Patients in Houston, Texas

2018 ◽  
Vol 17 ◽  
pp. 232595821877404 ◽  
Author(s):  
Osaro Mgbere ◽  
Maria Rodriguez-Barradas ◽  
Karen Joan Vigil ◽  
Melanie McNeese ◽  
Fazal Tabassam ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Medical Care ◽  
Treatment Guidelines ◽  
Health Benefits ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Medical Decision ◽  
Care Providers ◽  
Harris County ◽  
Starting Point

Background: The current US HIV treatment guidelines support initiation of antiretroviral therapy (ART) for persons with HIV for personal health benefits and prevention of HIV transmission. However, high levels of adherence to ART are critical to maximize individual and public health benefits. We examined the nonclinical barriers to ART initiation for clinically eligible individuals and the provider- and patient-related factors associated with these barriers among HIV-infected patients in Houston/Harris County, Texas. Methods: We analyzed data obtained from a probability sample of HIV medical care providers (HMCPs) in 13 outpatient facilities in Houston/Harris County, Texas surveyed between June and September 2009. We used an inductive thematic approach to code HMCP responses to an open-ended question that asked the main reasons why providers may delay initiating ART for clinically eligible patients. Results: The reasons cited by providers for delaying ART for clinically eligible patients were adherence (42.5%; 95% confidence interval [CI]: 28.5-57.8), acceptance (30%; 95% CI: 18.1-45.4), and structural concerns (27.5%; 95% CI: 16.1-42.8), with significant variations ( P < .0001) noted across patients’ race/ethnicity and transmission category. HIV medical care providers with 6 to 10 years’ experience in HIV care and those providing medical care for more than 100 patients monthly were about 4 times (adjusted odds ratio [aOR]: 3.80; 95% CI: 1.20-5.92; P = .039) and 10 times (aOR: 10.36; 95% CI: 1.42-22.70; P = .019) more likely to state adherence and acceptance concerns, respectively, as reasons for delaying ART for clinically eligible patients. Conclusion: Our findings highlight the fact that clinical guidelines are only a starting point for medical decision-making process and that patients themselves play an important role. HMCP access to referrals for other medical issues, support services, and treatment education may help improve adherence and patient readiness for ART, thereby avoiding systemic delays.

scholarly journals HIV Treatment Outcomes in Rural Georgia Using Telemedicine

2021 ◽  
Author(s):  
Folake J Lawal ◽  
Moshood O Omotayo ◽  
Tae Jin Lee ◽  
Arni S R Srinivasan Rao ◽  
Jose A Vazquez
Keyword(s):  
Healthcare Access ◽  
Retrospective Chart Review ◽  
Healthcare Services ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Hiv Viral Load ◽  
Face To Face ◽  
U Statistics ◽  
Significant Difference ◽  
Hiv Treatment Outcomes

Abstract Background The increasing shortage of specialized healthcare services contributes to the ongoing HIV epidemic. Telemedicine (TM) is a potential tool to improve HIV care, but little is known about its effectiveness when compared to traditional (face-to-face) (F2F) care in rural populations. The objective of this study is to compare the effectiveness of HIV care delivered through TM with F2F model. Methods We conducted a retrospective chart review of a subset of patients with HIV who attended TM clinic in Dublin, Georgia and F2F clinic in Augusta, Georgia between May 2017 to April 2018. All TM patients were matched to F2F patients based on gender, age, and race. HIV Viral Load (VL) and CD4 count gain were compared using T-test and Mann-Whitney U Statistics. Results 385 patients were included in the analyses (F2F=200, TM=185). Mean CD4 in the TM group was higher (643.9 cells/mm3) than F2F group (596.3 cells/mm3) (p&lt; 0.001). There was no statistically significant difference in VL reduction, control or mean VL (F2F = 416.8 cp/ml, TM = 713.4 cp/ml), (p = 0.30). Thirty-eight of eighty-five patients with detectable VL achieved viral suppression during the study period (F2F = 24/54, TM = 14/31), with a mean change of -3.34 x 10 4 and -1.24 x 10 4 respectively, p = 1.00. Conclusion TM was associated with outcome measures comparable to F2F. Increased access to specialty HIV care through TM can facilitate HIV control in communities with limited healthcare access in rural US. Rigorous prospective evaluation of TM for HIV care effectiveness is warranted.

scholarly journals ASSESSING HOME DELIVERY MODEL OPTION FOR IMPROVING ACCESS TO ANTIRETROVIRAL THERAPY; PROTOCOL FOR A CLUSTER- RANDOMIZED TRIAL IN ANAMBRA STATE, NIGERIA.

2021 ◽  
Author(s):  
Nnenna A Ajagu ◽  
Ogochukwu Offu ◽  
Sunday Nduka ◽  
Obinna Ikechukwu Ekwunife
Keyword(s):  
Antiretroviral Therapy ◽  
Intervention Group ◽  
Home Delivery ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Secondary Outcome ◽  
Control Group ◽  
Anambra State ◽  
Cluster Randomized ◽  
Delivery Models

Background: Although different antiretroviral (ARV) agents delivery models have been explored in Nigeria, yet only about 55% and 35% of affected adults and children respectively are currently on these agents. This, therefore, underscores the need for the identification of newer effective antiretroviral therapy delivery models and best strategies to increase access to ARV therapy in Nigeria. Method and Analysis: The study will be a cluster randomized controlled trial, which will be conducted in two HIV treatment centers in Anambra State, Nigeria. Participants will be randomized into intervention and control arm. Home delivery personnel will be trained to deliver the ARV drugs at 3months intervals to the homes of those in the intervention group while those in the control group (Facility-based services group) will receive ARVs at the HIV treatment hospital. The primary outcome for the trial will be the difference between groups in the proportion with HIV viral load suppression (≤20 copies/mL) by 12 months and then 24months. Secondary outcome include adherence to ARVs, the cost-effectiveness of home delivery service, and patient satisfaction. Ethics and dissemination: Nnamdi Azikiwe University Teaching Hospital Health Research Ethics Committee (NAUTHHREC) approved this study (NAUTH/CS/66/VOL.13/VER III/23/2020/011) with a trial registration: Pan African Clinical Trials Registry, ID: PACTR202004535536808 on 8th April 2020. Study dissemination plans include holding advocacy meetings with stakeholders in HIV care, publishing study outcomes in an open-access peer-review journal, and presentation of the outcome at an international conference.

scholarly journals Determinants of the utilisation of sexual and reproductive healthcare services by male adolescents in the Tshwane Metropolitan Municipality in South Africa

2019 ◽  
Vol 24 ◽  
Author(s):  
Omari Shabani ◽  
Takalani G. Tshitangano
Keyword(s):  
Sexual And Reproductive Health ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Study Data ◽  
Human Beings ◽  
Male Adolescent ◽  
Individual Factor ◽  
Male Adolescents ◽  
Individual Interviews ◽  
Reproductive Healthcare

Background: Male adolescent sexual and reproductive health is one of the essential healthcare programmes in the world. However, male adolescents still face numerous challenges in this area. Determinants of the utilisation of these services need to be known to develop strategies to improve utilisation of the available services by male adolescents.Aim: The aim of this study was to identify the determinants of the utilisation of sexual and reproductive healthcare services by male adolescents in the Tshwane Metropolitan Municipality in South Africa.Setting: The study was conducted in the Tshwane Metropolitan Municipality in South Africa.Methods: An explorative, descriptive and qualitative approach was employed. The study was contextual in nature, and purposive sampling was used. The population of the study consisted of male adolescents (aged 18–24 years) living in the Tshwane metropolitan Municipality. Twenty male adolescents participated in the study. Data collected using semistructured individual interviews were analysed using Tesch’s method of data analysis, and measures to ensure trustworthiness and ethical consideration pertaining to the study were established.Results: The perception of existing services was found to be a significant individual factor influencing them negatively in utilising the services. This was linked to the violation of their rights as human beings by healthcare providers, their unmet expressed needs and the ineffectiveness as well as inefficiency of the support structures.Conclusion: These results suggest that utilisation of these services by male adolescents can be improved by changing their perception of the existing services through support from different structures of the society.

scholarly journals Violence and the perceived risks of taking antiretroviral therapy in US jails and prisons

2014 ◽  
Vol 10 (2) ◽  
pp. 94-110 ◽  
Author(s):  
Gabriel J. Culbert
Keyword(s):  
Antiretroviral Therapy ◽  
Interpersonal Violence ◽  
Treatment Interruption ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Treatment As Prevention ◽  
Hiv Status ◽  
Content Type ◽  
The Usa ◽  
Hiv Status Disclosure

Purpose – About one in five men living with HIV in the USA passes through a correctional center annually. Jails and prisons are seen therefore as key intervention sites to promote HIV treatment as prevention. Almost no research, however, has examined inmates’ perspectives on HIV treatment or their strategies for retaining access to antiretroviral therapy (ART) during incarceration. The purpose of this paper is to describe the results of an exploratory study examining men's perceptions of and experiences with HIV care and ART during incarceration. Design/methodology/approach – Semi-structured, in-depth interviews were conducted with 42 HIV positive male and male-to-female transgendered persons recently released from male correctional centers in Illinois, USA. Findings – Interpersonal violence, a lack of safety, and perceived threats to privacy were frequently cited barriers to one's willingness and ability to access and adhere to treatment. Over 60 percent of study participants reported missed doses or sustained treatment interruption (greater than two weeks) because of failure to disclose their HIV status, delayed prescribing, intermittent dosing and out-of-stock medications, confiscation of medications, and medication strikes. Research limitations/implications – Substantial improvements in ART access and adherence are likely to follow organizational changes that make incarcerated men feel safer, facilitate HIV status disclosure, and better protect the confidentiality of inmates receiving ART. Originality/value – This study identified novel causes of ART non-adherence among prisoners and provides first-hand information about how violence, stigma, and the pursuit of social support influence prisoner's decisions to disclose their HIV status or accept ART during incarceration.

scholarly journals Changing Clinician Practices and Attitudes Regarding the Use of Antiretroviral Therapy for HIV Treatment and Prevention

2016 ◽  
Vol 16 (1) ◽  
pp. 81-90 ◽  
Author(s):  
Kate Buchacz ◽  
Jennifer Farrior ◽  
Geetha Beauchamp ◽  
Laura McKinstry ◽  
Ann E. Kurth ◽  
...  
Keyword(s):  
New York ◽  
Antiretroviral Therapy ◽  
Treatment Guidelines ◽  
Hiv Treatment ◽  
Unprotected Sex ◽  
Hiv Care ◽  
Web Based ◽  
Treatment And Prevention ◽  
Clinician Practices

As part of the HPTN 065 study in the Bronx, New York and Washington, the authors, we surveyed clinicians to assess for shifts in their practices and attitudes around HIV treatment and prevention. Antiretroviral therapy (ART)-prescribing clinicians at 39 HIV care sites were offered an anonymous Web-based survey at baseline (2010-2011) and at follow-up (2013). The 165 respondents at baseline and 141 respondents at follow-up had similar characteristics—almost 60% were female, median age was 47 years, two-thirds were physicians, and nearly 80% were HIV specialists. The percentage who reported recommending ART irrespective of CD4 count was higher at follow-up (15% versus 68%), as was the percentage who would initiate ART earlier for patients having unprotected sex with partners of unknown HIV status (64% versus 82%), and for those in HIV-discordant partnerships (75% versus 87%). In line with changing HIV treatment guidelines during 2010 to 2013, clinicians increasingly supported early ART for treatment and prevention.

scholarly journals HIV Stigma and Discrimination: Perspectives and Personal Experiences of Healthcare Providers in Yogyakarta and Belu, Indonesia

2021 ◽  
Vol 8 ◽  
Author(s):  
Nelsensius Klau Fauk ◽  
Paul Russell Ward ◽  
Karen Hawke ◽  
Lillian Mwanri
Keyword(s):  
Healthcare Providers ◽  
Hiv Treatment ◽  
Hiv Stigma ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Community Members ◽  
Stigma And Discrimination ◽  
Personal Experiences ◽  
Living With Hiv ◽  
Hiv Aids

Stigma and discrimination are major challenges facing People Living with HIV/AIDS (PLWHA) globally due to their HIV status. As part of a larger qualitative study in Yogyakarta and Belu, Indonesia, using in-depth interviews with 92 PLWHA (52 women, 40 men) and 20 healthcare providers, this paper describes perspectives and personal experiences of the 20 healthcare providers, relating to HIV stigma and discrimination toward PLWHA in both study settings. The healthcare providers were recruited from healthcare facilities providing HIV-related healthcare services, using a snowball sampling technique. A qualitative framework analysis was used to guide data analysis. Health stigma and discrimination framework guided the conceptualisation and discussion of the findings. The findings presented the views and perspectives of healthcare providers that HIV stigma and discrimination toward PLWHA still occurred within families, communities and healthcare settings. These were reflected in negative labelling, separation of personal belongings, avoidance, denial of treatment and rejection of PLWHA by healthcare providers, family and community members. Some healthcare providers reported that they had personally stigmatised and discriminated against PLWHA. A lack of knowledge about HIV, fear of contracting HIV, personal values, religious thoughts and sociocultural values and norms, were reported as drivers or facilitators behind this HIV-related stigma and discrimination. The findings indicate the importance of continued HIV/AIDS education for families, community members and healthcare providers, to raise awareness and to ensure that healthy and professional support systems are in place for PLWHA. The findings indicate the need to enhance improvement within the healthcare or HIV care system to adequately address the needs of PLWHA, which may facilitate their early initiation of HIV treatment and better treatment adherence and retention to increase Cluster of Differentiation 4 (CD4) count and suppress viral load. Future studies are also needed to explore the role that government and non-government institutions can play in improving health service delivery for people newly diagnosed with HIV and those living with HIV/AIDS.

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