Community HIV Screening Among MSM in Three Indonesian Cities

Background: Indonesia lags behind its peers with regard to ART coverage of PLHIV. Insufficient HIV testing among MSM and other key affected populations remains a barrier to increasing ART coverage. Objective: This report presents the results of the first government-endorsed implementation research study of a community screening approach to increasing the rate of HIV testing among MSM in three cities. Methods: All new MSM outreach contacts meeting eligibility criteria during March-June 2017 were included in the study. HIV testing at a government health facility, which is required to qualify for government-supported ART, was advised for all new contacts. Men refusing formal testing were offered an HIV screening test in a community setting using a saliva-based rapid test and advised to get a confirmatory test at a health facility. All outreach contacts and testing activities were recorded on individual client records. Results: Of 1,149 eligible MSM, 27% were willing to be referred to receive HIV testing at a health facility, among which 83% were confirmed to have been tested. Of the 838 study subjects refusing health facility testing, 38% accepted community screening. The screening positivity rate was 14.8%. Only 38% of men with reactive screening tests received a confirmatory test at a health facility, along with 8% of those with non-reactive tests. Conclusion: While community screening resulted in more MSM knowing their HIV status, reluctance to avail government health facility-based services, or indeed to be tested at all, must be addressed if community screening is to accelerate progress in getting HIV-positive MSM onto treatment.

A study regarding availability and utilization of services of the government health facility in village Nagkalan, district Amritsar, Punjab

Background: Health care expenses induced impoverishment in the poverty stricken strata of rural India is a major issue. The government of India has come up with various services in public health facilities, but there are various factors which curtail the utilization of available services and people have to visit some private health facility. The present study deals with the extent of utilization of services of government health facility and the factors impeding the utilization.Methods: The present cross sectional study was conducted in village Nagkalan, district Amritsar, where the eldest adult members present in the house at the time of the visit, and are interviewed using a semi-structured and predesigned questionnaire. A total of 1123 families were included in the final analysis. Data was compiled, analysed and valid conclusions drawn.Results: Almost all the respondents were aware about the existence of subsidiary health centre in the village. However, out of those who were aware, 40.8% never visited the centre. Utilization was more in the lower socio economic status. Immunization services followed by treatment for common ailments constituted the top two reasons for visiting the centre. Out of those visiting the centre, 80.7% were not satisfied with the current timings of the centre; only 20.2% were attended by the doctor and 33.3% reported that the prescribed medicines were never available at the centre.Conclusions: Regular supply of prescribed medicines, availability of the doctor and appropriate timings are critical for utilization of health care services at the government health facility.

Treatment Seeking Practices for Malaria: A Household Case of Uasin Gishu County, Kenya

Introduction: Malaria is among the leading cause of morbidity and mortality in Kenya. Malaria treatment seeking practices in epidemic areas in Africa such as Kenya are not well studied. The study aimed at assessing the treatment seeking practices in residents of Uasin-Gishu County following Malaria infection. Methods: Study was cross sectional study design. Stratified random sampling was used to identify 341 study participants. Principal component analysis was applied to compute the wealth index and the chisquare tests of association were carried out to determine factors associated with choice of treatment. Multivariate logistic regression determined predictors of treatment seeking practices. P<0.05 significance level was used during the study. Results: Fever was reported in 62.8% of all households; 94% sought treatment for the fever. Commonly assessed facility was government health facility (63%), chemists (15%), private clinics (12%) and traditional healers (2%). Educated persons’ were 8.7 fold more likely to seek care from a private hospital. Employed and business owners were 4.1 fold more likely to purchase medicines from chemists. There were significant negative associations between wealth index and education level and seeking care in a government health facility. Respondents in the middle and fourth quintile with tertiary education level rarely sought care from a government health facility respectively. Conclusion: Treatment practices among households were: through government health institutions, private/clinics and chemists. Wealth index, age category of household heads, education level and occupation influenced treatment seeking practice. Reccomendation: There is need for the government for the government to strength community-based interventions and health facilities

Patient participatory behaviours in healthcare service delivery

Purpose The purpose of this paper is to deepen the understanding on patient participatory behaviours in co-creation of value drawing from the perspective of self-determination theory (SDT) focussing on motivation in particular. Design/methodology/approach A model is proposed to suggest the influence of the various motivation types on a patient’s participatory behaviours drawing from SDT. Following survey design approach, data collected from 345 outpatients from a quasi-government health facility in Accra, Ghana are examined through structural equation modelling using SmartPLS (v. 3.2.3). Findings The findings reveal that patient participatory behaviours are influenced by both controlled and autonomous regulations leading to value attainment. External regulation (a more controlled form of extrinsic motivation) and patient participation in clinical encounters have no significant relationship with a patient’s commitment to compliance with medical instructions. The results reveal patient compliance is largely driven by autonomous regulation as proposed by SDT. However, active patient participation in clinical encounters and commitment to compliance with medical instructions positively and significantly influences perceived value outcomes. Research limitations/implications This research provides empirical evidence in support of understanding patient participatory behaviours in healthcare service delivery by testing theoretically grounded hypotheses developed from SDT perspective. The study focussed on outpatients from one quasi-government health facility, which could limit the generalisation of the findings reported. Practical implications This study illustrates the need for service providers to understand participant’s needs and motivation during the service encounter. This is essential as the various types of motivation influence the nature of the participation throughout the process, which could help improve on the value outcomes from the service. Originality/value This study makes a significant contribution to service literature through the application of SDT to explain patient participatory behaviours in healthcare service delivery, production and value outcomes. From a theoretical perspective, the developed model integrates multiple research disciplines (e.g. SDT, participatory behaviours, and value co-creation) and extends research on patient integration, participation, and compliance.

People's Perspective on Access to Health Care Services in a Rural District of Nepal

Introduction: Over the past several decades, Nepal has attempted to increase the access of health care services, however progress toward achieving high coverage of health care services in rural communities is still low. Therefore this study attempts to provide a perspective on access to basic healthcare services in government health facility. Methods: Descriptive cross-sectional study with quantitative and qualitative methods was designed and applied to identify the access to health care services. The study population were people who were sick within three months prior to the study where basic sampling unit was household. Total sample size was 96 through the application of simple random sampling method. Bivariate analysis with 95% confidence interval was used to identify the association of variables with access to health care services. Results: Among the total population, 28% of households in the study area received health care services at government health facility. The reasons for not accessing health care were insufficient drugs (61%), distance (22%), staff unavailability (19%), sickness (9%), money (7%), and facility hours (4%). Sex, ethnicity and distance were found significantly associated with access to health care services. Conclusions: Less than one third of households had access to health careservices in government health facility. Addressing the important factors such as drug problems, staff unavailability, long distance to health institutions and inconvenient health facility hours may help to increase access to health care services at government health facility. Keywords: Access, government health facility, health care services, perspective.

Perceptions of Malaria and pattern of treatment seeking behaviour among Tharu and Pahari communities of Jhalari

Background: Community understanding and practices relating to causation, transmission, prevention and treatment are the main socio-cultural factors that can influence malaria control but studies done social aspect of malaria control are limited in Nepal.Methods: Cross-sectional study was conducted in 2003 in Jhalari VDC of Kanchanpur district where both Tharus and Pahari communities coexist. Total of 184 households were included in the study through systematic random sampling procedure for household survey. Both qualitative and quantitative methods were applied for data collection.Results: Fever, headache, chills, shivering, joint pain and spasmodic fever were the most frequently mentioned symptoms of malaria. Though most people knew that mosquito bite might cause malaria fever, they had multiple notions of malaria causations such as hot weather, living near forest, season change, overwork and weakness. They were not clear how a mosquito gets infected and transmit the disease from one person to another. The results showed that people incorporated traditional and modern elements into their concepts of the diseases and treatment strategies. Home remedy with herbs and self-treatment with anti-malarial pills are rare in both communities. Use of government health facility is significantly higher in Paharis than in Tharus. Tharus initially consult their traditional healers and visit the drug retailers in the most cases and government facility in some cases. Tharus were less informed of free diagnosis and treatment of malaria at the government health facilities.Conclusion: Both Tharus and Paharis are aware of malaria fever and actively seeking medical help from available sources of treatment; however, they are poorly informed of dangerous falciparum malaria and process of the disease transmission through infected mosquitoes. Tharus have less access to the government health facility than Paharis. Thus the improved health services in terms of availability, quality and accessibility, and effective information and communication regarding diseases and services can go a long way in tackling the problem. Key words: Malaria; Fever; Knowledge; Perceptions; Treatment; Health-seeking behaviour.doi: 10.3126/jnhrc.v6i2.2189Journal of Nepal Health Research Council 2008 Oct;6(13) Page : 84-92