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1.
Background
The increase in tuberculosis and HIV/AIDS patients in many countries in Africa including Tanzania, is outstripping the ability of public health services to cope. This calls for a closer collaboration between tuberculosis programmes and other stakeholders involved in HIV/AIDS care.Objective
To determine the feasibility of establishing collaboration between the tuberculosis programme and an NGO in TB/HIV care at a district level in Tanzania.Methods
Quantitative and qualitative study designs involving TB as well as HIV suspects and patients together with health workers, were conducted between December, 2001 and September, 2002.Results
A total of 72 patients and 28 key informants were involved. The collaboration was in the following areas; voluntary counselling and testing for HIV, diagnosis and treatment of TB, referral and follow up of patients and suspects, home based care, psychological support and training. . Both the tuberculosis programme and NGO benefited from the collaboration. TB case detection among PLWA increased more than three folds and TB treatment was integrated in home based care of NGO. The main barriers identified in this study were; poor communication, poor referral system and lack of knowledge and skills among health staff.Conclusion
The study has shown that it is possible for a tuberculosis programme and a non governmental organisation to collaborate in TB/HIV care. The study has also identified potential areas of collaboration and barriers that needed to be overcome in order to provide such comprehensive services at a district level. 相似文献2.
Sexual, reproductive health needs and rights of young people with perinatally acquired HIV in Uganda
Background
Numbers of young people with perinatally acquired HIV is growing significantly. With antiretroviral drugs, children who get infected at birth with HIV have an opportunity to graduate into adolescence and adulthood. This achievement notwithstanding, new challenges have emerged in their care and support needs. The most dynamic being, their sexual and reproductive health needs and rights (SRHR).Objectives
This paper aimed at establishing the gaps at policy, program and health systems level as far as addressing sexual and reproductive health needs of young people who have lived with HIV since infancy is concerned.Methods
This paper is based on a desk review of existing literature on sexual and reproductive health needs and rights of young positives.Results
The results indicate young positives are sexually active and are engaging in risky sexual encounters. Yet, existing policies, programs and services are inadequate in responding to their sexual and reproductive health needs and rights.Conclusion
Against these findings, it is important, that policies specifically targeting this subgroup are formulated and to make sure that such policies result in programs and services that are youth friendly. It is also important that integration of Sexual Reproductive Health (SRH) and HIV services is prioritized. 相似文献3.
Background
The impact and management of HIV/AIDS in Lesotho in the context of disaster management was investigated.Objectives
Lesotho health care workers'' perception on HIV/AIDS progression, whether HIV/AIDS was managed as a disaster, and the impact on the demographic profile was investigated.Methods
The empirical investigation included a literature study, and primary and secondary data analyses. Questionnaires (n=116) determined health care workers'' perception of HIV/AIDS. Interviews with officers of Lesotho Disaster Management determined how HIV/AIDS was managed as a disaster. National population censuses and data from surveys were summarised to describe the impact of HIV/AIDS on the population structure.Results
Respondents'' modal age group was 25 to 39 years, 28.4% viewed HIV/AIDS related deaths as very high and perceived that HIV/AIDS changed the age composition, sex and dependency ratio of the population. Although HIV/AIDS was declared a disaster, the Lesotho Disaster Management Authority only aided the National AIDS Commission. There was evidence that HIV/AIDS caused the population pyramid base to shrink, and an indentation in the active population.Conclusion
Health care workers attributed HIV/AIDS to changing the demographic profile of Lesotho, also reflected in the population pyramid. Lesotho Disaster Management Authority played a supporting role in HIV/AIDS disaster management. 相似文献4.
David Musoke Petra Boynton Ceri Butler Miph Boses Musoke 《African health sciences》2014,14(4):1046-1055
Background
The health seeking behaviour of a community determines how they use health services. Utilisation of health facilities can be influenced by the cost of services, distance to health facilities, cultural beliefs, level of education and health facility inadequacies such as stock-out of drugs.Objectives
To assess the health seeking practices and challenges in utilising health facilities in a rural community in Wakiso district, Uganda.Methods
The study was a cross sectional survey that used a structured questionnaire to collect quantitative data among 234 participants. The sample size was obtained using the formula by Leslie Kish.Results
While 89% of the participants were aware that mobile clinics existed in their community, only 28% had received such services in the past month. The majority of participants (84%) did not know whether community health workers existed in their community. The participants'' health seeking behaviour the last time they were sick was associated with age (p = 0.028) and occupation (p = 0.009). The most significant challenges in utilising health services were regular stock-out of drugs, high cost of services and long distance to health facilities.Conclusions
There is potential to increase access to health care in rural areas by increasing the frequency of mobile clinic services and strengthening the community health worker strategy. 相似文献5.
AC Ubesie 《African health sciences》2012,12(3):297-304
Background
Sub-Saharan Africa has the largest burden of pediatric HIV in the world. Global target has been set for eradication of pediatric HIV by 2015 but there are still so many complex issues facing HIV infected and affected children in the sub-continent.Objective
To review the current and emerging challenges facing pediatric HIV care in sub-Saharan Africa; and proffer solutions that could help in tackling these challenges.Method
A Medline literature search of recent publications was performed to identify articles on “pediatric HIV”, “HIV and children”, “HIV and infants”, “HIV and adolescents” in sub-Saharan Africa.Result
There are a number of challenges and emerging complex issues facing children infected and affected by HIV in sub-Saharan Africa. These include late presentation, limited access to pediatric HIV services, delayed diagnosis, infant feeding choices, malnutrition, limited and complex drug regimen, disclosure, treatment failure and reproductive health concerns. A holistic cost effective preventive, diagnostic and treatment strategies are required in order to eliminate pediatric HIV in SSA.Conclusion
HIV infected children and their families in sub-Saharan Africa face myriad of complex medical and psychosocial issues. A holistic health promotional approach is being advocated as the required step for eradication of pediatric HIV in Africa. 相似文献6.
Freda Mold Simon de Lusignan Aziz Sheikh Azeem Majeed Jeremy C Wyatt Tom Quinn Mary Cavill Christina Franco Umesh Chauhan Hannah Blakey Neha Kataria Theodoros N Arvanitis Beverley Ellis 《The British journal of general practice》2015,65(632):e141-e151
Background
Online access to medical records by patients can potentially enhance provision of patient-centred care and improve satisfaction. However, online access and services may also prove to be an additional burden for the healthcare provider.Aim
To assess the impact of providing patients with access to their general practice electronic health records (EHR) and other EHR-linked online services on the provision, quality, and safety of health care.Design and setting
A systematic review was conducted that focused on all studies about online record access and transactional services in primary care.Method
Data sources included MEDLINE, Embase, CINAHL, Cochrane Library, EPOC, DARE, King’s Fund, Nuffield Health, PsycINFO, OpenGrey (1999–2012). The literature was independently screened against detailed inclusion and exclusion criteria; independent dual data extraction was conducted, the risk of bias (RoB) assessed, and a narrative synthesis of the evidence conducted.Results
A total of 176 studies were identified, 17 of which were randomised controlled trials, cohort, or cluster studies. Patients reported improved satisfaction with online access and services compared with standard provision, improved self-care, and better communication and engagement with clinicians. Safety improvements were patient-led through identifying medication errors and facilitating more use of preventive services. Provision of online record access and services resulted in a moderate increase of e-mail, no change on telephone contact, but there were variable effects on face-to-face contact. However, other tasks were necessary to sustain these services, which impacted on clinician time. There were no reports of harm or breaches in privacy.Conclusion
While the RoB scores suggest many of the studies were of low quality, patients using online services reported increased convenience and satisfaction. These services positively impacted on patient safety, although there were variations of record access and use by specific ethnic and socioeconomic groups. Professional concerns about privacy were unrealised and those about workload were only partly so. 相似文献7.
Barbara Farquharson Marie Johnston Carol Bugge 《The British journal of general practice》2011,61(585):267-273
Background
How people present symptoms to health services may influence the care they subsequently receive. Leventhal''s Commonsense Model of Self-Regulation (CS-SRM) posits that individuals develop cognitive illness representations elaborated around five main components (identity, timeline, cause, consequences, and cure/control), coherence, and emotional representations.Aim
To examine whether initial presentations to health services consist of the components of illness representation proposed by the CS-SRM.Design and setting
A CS-SRM-based content analysis of calls to the Scottish national telephone advice service, NHS 24.Method
A random sample of callers to NHS 24 was identified. A quota sample of 60 consented to participate. Their consultations were transcribed verbatim. Responses to an initial open question regarding the reason for calling were identified and divided into ‘meaning units’. A coding schedule was developed using Leventhal''s definitions of illness representations. Meaning units were coded independently by two researchers.Results
Fifty-nine eligible initial presentations contained between 1 and 13 coding units, (mean = 4). A total of 230 coding units were available for coding. Overall, 202 (88%) coding units were coded to at least one component of illness representation. All 59 (100%) participants made reference to identity, 26 (44%) to timeline, nine (15%) to cause, eight (14%) to consequences, 22 (37%) to cure/control, and 11 (19%) to the degree of coherence. Emotional representations were identified in six (10%) participants'' presentations.Conclusion
Leventhal''s CS-SRM accounts for a large proportion of initial presentations to health services. Most people offer identity plus at least one additional component of illness representation. It may be necessary for clinicians to prompt remaining components to obtain a comprehensive understanding of patients'' representations of illness. 相似文献8.
H DN Nyamogoba G Mbuthia S Mining G Kikuvi R Biegon S Mpoke D Menya P G Waiyaki 《African health sciences》2012,12(3):305-311
Background
Tuberculosis (TB) and HIV co-infections have a global prevalence with devastating morbidity and massive mortality, Sub-Saharan Africa being the worst hit.Objectives
To evaluate the prevalence of TB-HIV co-infection and demonstrate the confusion caused by NTM and HIV/AIDS co-infection in TB diagnosis and treatment in western Kenya.Methods
In a cross-sectional study carried out at 10 hospitals in western Kenya, sputa from consenting 872 TB suspects underwent microscopy, and culture on Lowenstein-Jensen and Mycobacteria Growth Index Tube media. Isolates were identified using the Hain''s GenoType® Mycobacterium CM and GenoType® Mycobacterium AS kits. A total of 695 participants were screened for HIV using Uni-Gold™ test and positives confirmed with the enzyme linked immunosorbent assay.Results
A total of 346 (39.7%) participants were diagnosed with TB. Out of the 346 TB cases, 263 (76%) were tested for HIV infection and 110 (41.8%) of these were sero-positive (co-infected). The female to male TB-HIV co-infection prevalence ratio (PR) was 1.35. This study reports isolation of non-tuberculous mycobacteria from TB suspects at a rate of 1.7%.Conclusion
A high TB-HIV co-infection rate was observed in this study. The NTM disease could be misdiagnosed and treated as TB in western Kenya. 相似文献9.
Tiyani E Mabunda Nalezani J Ramalivhana Yoswa M Dambisya 《African health sciences》2014,14(4):849-854
Background
South Africa has a high tuberculosis burden, and Limpopo Province experienced higher than national average TB mortality rates between 1997 and 2008.Objective
To establish factors associated with TB mortality in Limpopo Province in 2008.Design
Retrospective study using provincial data for patients who died after commencing TB treatment between 01 January 2008 and 31 December 2008.Results
In 2008, some 18074 patients started treatment: 15995 (88.5%) had pulmonsry TB (PTB), while 2079 (11.5%) had Extra pulmonary TB (EPTB). Overall, 2242 (12.4%) patients died, mainly PTB patients (n=1906; 85%), more males (n=1159, 51.7%), mainly those aged 25 to 54 years (n=1749, 78.0%), and new cases (1914; 85.4%). TB mortality was significantly higher among smear negative than smear positive patients (17% vs 13.8%; P<0.001), among those with EPTB compared to PTB patients (P<0.001), and among re-treatment cases (P<0.001). Only 4237 (23.4%) patients had HIV status known, with higher mortality found among HIV positive than the HIV negative patients (P<0.0001); but HIV status was not known for the majority who died (n=1685, 75.2%).Conclusion
Higher mortality was associated with age 22–55 years; smear negativity, EPTB, HIV infection, and re-treatment. The findings call for greater integration of TB control efforts and HIV services, especially among the 22–55 year age group. 相似文献10.
Background
Introduction of the new general medical services contract offered UK general practices the option to discontinue providing out-of-hours (OOH) care. This aimed to improve GP recruitment and retention by offering a better work–life balance, but put primary care organisations under pressure to ensure sustainable delivery of these services. Many organisations arranged this by re-purchasing provision from individual GPs.Aim
To analyse which factors influence an individual GP''s decision to re-provide OOH care when their practice has opted out.Design of study
Cross-sectional questionnaire survey.Setting
Rural and urban general practices in Scotland, UK.Method
A postal survey was sent to all GPs working in Scotland in 2006, with analyses weighted for differential response rates. Analysis included logistic regression of individuals'' decisions to re-provide OOH care based on personal characteristics, work and non-work time commitments, income from other sources, and contracting primary care organisation.Results
Of the 1707 GPs in Scotland whose practice had opted out, 40.6% participated in OOH provision. Participation rates of GPs within primary care organisations varied from 16.7% to 74.7%. Males with young children were substantially more likely to participate than males without children (odds ratio [OR] 2.44, 95% confidence interval [CI] = 1.36 to 4.40). GPs with higher-earning spouses were less likely to participate. This effect was reinforced if GPs had spouses who were also GPs (OR 0.52, 95% CI = 0.37 to 0.74). GPs with training responsibilities (OR 1.36, 95% CI = 1.09 to 1.71) and other medical posts (OR 1.38, 95% CI = 1.09 to 1.75) were more likely to re-provide OOH services.Conclusion
The opportunity to opt out of OOH care has provided flexibility for GPs to raise additional income, although primary care organisations vary in the extent to which they offer these opportunities. Examining intrinsic motivation is an area for future study. 相似文献11.
Objectives
To determine potential partners for pregnant women in the prevention of mother to child transmission of HIV and to determine pregnant women''s perceptions towards selected potential HIV prevention effortsDesign
Cross sectional, questionnaire-administered studySetting
Ante-natal clinics of eleven public health centers and the major referral and university teaching hospital of Queen Elizabeth Central Hospital (QECH) in Blantyre, MalawiSubjects
A total of 321 pregnant women attending ante-natal clinicsResults
Antenatal women in Blantyre, Malawi obtain health information on HIV/AIDS from the radio (96.3%), health workers (82.2%), religious gatherings (66.7%), friends (54.8%) and newspapers (39.3%). The majority intend to be accompanied by own mother and sister for delivery (52.4% and 15.4% respectively). Almost all (99%) planned to breast feed with 91.8% reporting an intended breastfeeding period of at least 6 months. About 97% of married women reported desire to tell spouse in case of HIV sero-positive results while only 65.1% had ever discussed about HIV with spouse, and only 5.2% had ever attended antenatal clinic with spouse. Whether woman had ever discussed about HIV/AIDS with spouse or not did not influence desire to disclose HIV status to spouse.Conclusion
Close relatives, spouse and the media are important stakeholders in the health of pregnant women. Programs aimed at prevention of mother to child transmission of HIV should give serious consideration to these partners. 相似文献12.
The dilemma of safe sex and having children: challenges facing HIV sero-discordant couples in Uganda
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Jolly Beyeza-Kashesya Frank Kaharuza Florence Mirembe Stella Neema Anna Mia Ekstrom Asli Kulane 《African health sciences》2009,9(1):2-12
Background
Sixty percent of new HIV infections in Uganda occur in stable relationships between HIV discordant couples. Given the importance of fertility in Uganda, we hypothesized that unsafe sexual practices may be used to found a family/replace a dead child. Thus, we explored sexual practices to understand to what extent these are influenced by the desire to have children and the implications for HIV transmission among discordant couples.Methods
A cross-sectional survey of 114 HIV discordant couples in Kampala, and in-depth interviews with 15 purposively selected couples. Quantitative data were analysed using STATA. Multivariate logistic regression analysis done to identify factors associated with consistent condom use. Thematic content analysis of qualitative data was done using NVIVO 2.Results
Participants wanting children and those with multiple sexual partners were less likely to use condoms (Adj OR 0.51, and 0.36 respectively). Three of the five types of sexual practices used by couples do not allow pregnancy to occur. Main reasons for wanting a child included: ensuring lineage continuity and posterity, securing relationships and pressure from relatives to reproduce. Challenges included: risk of HIV transmission to partner and child, lack of negotiating power for safer sex, failure of health systems to offer safe methods of reproductionConclusions
HIV sero-discordant couples with strong desire for childbearing have a dilemma of risking HIV infection or infecting their spouse. Some risk transmission of HIV infection to reproduce. We need to address gender issues, risky behaviour and reproductive health services for HIV sero-discordant couples. 相似文献13.
Simon Glew Alex Pollard Leila Hughes Carrie Llewellyn 《The British journal of general practice》2014,64(619):e60-e66
Background
The rate of new HIV infections in the UK continues to rise, with one-quarter of cases undiagnosed. Opt-out HIV testing — in which tests are routinely offered to all patients, with the offer to decline — have proved effective in antenatal care. Pilot studies of HIV opt-out testing at GP registration and acute medical admission to hospital have described service-level issues and the clinician’s perspective, but not the views of the general public.Aim
To further understand the public’s perspective on opt-out testing for HIV in England.Design and setting
Focus groups (n = 9) with a total of 54 participants in Brighton, England, where HIV prevalence is high.Method
Quota sampling on sexual orientation, age, sex, and testing experience was applied to groups with high and low HIV prevalences, and analysed using framework analysis.Results
Opt-out testing for HIV was acceptable. Testing on GP registration was regarded as a more appropriate setting than acute medical admission. Participants from groups in which HIV has a higher prevalence felt HIV testing required consideration that may not be possible during acute hospital admission. However, there was concern that screening would still be targeted at groups in which HIV prevalence is higher, based on clinicians’ judgement of patients’ behaviours, sexuality, or ethnicity.Conclusion
The opt-out method of testing for HIV must be routinely offered to all who are eligible, to increase test uptake and to prevent communities feeling targeted. Any pressure to test is likely to be poorly received. Inaccurate concerns about medical records being shared with financial services are a disincentive to test. Primary care should be an active setting for opt-out HIV testing. 相似文献14.
Background
There is growing evidence that emotional distress expressed in terms of anxiety and depression is very high among tuberculosis (TB) patients.Objectives
This study aims to determine levels of anxiety, depression and emotional distress in patients with several types of TB and to determine the association between social-demographic and economical factors, clinical variables and anxiety, depression and emotional distress.Methods
A cross-sectional study was performed in a sample of 81 TB patients. A social-demographic and economical questionnaire was used, followed by the hospital anxiety and depression scale.Results
38.3% and 49.4% of our sample presented significant levels of anxiety and depression. 44.4% of patients had significant levels of emotional distress.Married subjects, a diagnosis of extra-pulmonary TB and multidrug resistant TB were related to higher risk for anxiety. Gender, extra-pulmonary and multidrug resistant TB were associated to depression. Female gender and cases of extra-pulmonary TB presented a 1.5 times risk for emotional distress.Conclusions
Our study found high rates of anxiety, depression and emotional distress among TB patients. Marital status, gender, type and treatment of TB were related to higher levels of emotional disorder. Mental health services should be an integral part of programs against tuberculosis. 相似文献15.
Eligibility for HIV/AIDS treatment among adults in a medical emergency setting at an urban hospital in Uganda 总被引:1,自引:1,他引:0
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Nakanjako D Kyabayinze DJ Mayanja-Kizza H Katabira E Kamya MR 《African health sciences》2007,7(3):124-128
Background
Despite global effort to scale up access to antiretroviral therapy (ART), many people in need of HIV/AIDS care in Uganda have not been reached. HIV testing and ART are not widely offered as routine medical services and data on HIV/AIDS in emergency settings in Sub-Saharan Africa is limited.We determined the HIV prevalence and eligibility for ART in a medical emergency unit at Mulago hospital.Methods
In a cross-sectional study, we interviewed 223 patients who were systematically selected from the patients'' register from October through December 2004. HIV testing was offered routinely and results were delivered within 30 minutes. We evaluated HIV infected patients for WHO clinical stage of disease and referred them for HIV/AIDS care.Results
Out of 223 patients, 111 (50%) had HIV infection of whom 78 (70%) had WHO clinical stage 3 and 4 of disease thereby requiring ART. Overall, 84 out of 111 (76%) HIV positive patients had not received any specific HIV/AIDS care.Conclusion
The burden of HIV infection in the medical emergency unit is high and majority of the patients who required ART had no prior HIV/AIDS care. We recommend scale up of HIV/AIDS care in acute care settings in order to increase access to ART. 相似文献16.
17.
Background
About 75% of people living with HIV/AIDS (PHAs) who need antiretroviral therapy have no access to these drugs in low-income countries.Objective
To investigate the barriers to use of ART in Rakai district of UgandaMethods
We interviewed 38 key informants and 384 PHAs. Data was collected on: education/mobilization for ART, sources of information for ART, beliefs regarding ART, social support, use of alternative medicine, stigma/discrimination towards PHAs, distance to ART centres, transport costs to ART centres, waiting time, and on suggestions as how to improve the use of ART.Results
The major barriers mentioned regarding use of ART included: inadequate mobilization, long waiting time at ART treatment centres, high cost of transport to reach ART centres, stigma/discrimination towards PHAs and inadequate number of health workers to attend to PHAs.Conclusions
Access to antiretroviral therapy could be ameliorated by: improving community education using innovative approaches such as through music, dance and videos, increasing the number of providers who are able to provide ART as through engagement of non health professionals in ART care, bringing ART nearer to where people live and instituting measures aimed at reducing stigma/discrimination such as through involvement of PHAs in demystisfying HIV/AIDS. 相似文献18.
Iman Mortagy Karina Kielmann Stephanie E Baldeweg Jo Modder Mary B Pierce 《The British journal of general practice》2010,60(580):815-821
Background
National guidelines emphasise the need to deliver preconception care to women of childbearing age. However, uptake of the services among women with diabetes in the UK is low. Questions arising include how best to deliver preconception care and what the respective roles of primary versus secondary caregivers might be.Aim
To explore the perspective of GPs and secondary care health professionals on the role of GPs in delivering preconception care to women with diabetes.Design of study
Qualitative, cross-sectional study.Setting
A London teaching hospital and GP practices in the hospital catchment area.Method
Semi-structured interviews with GPs and members of the preconception care team in secondary care. Thematic analysis using the framework approach.Results
GPs and secondary care professionals differ in their perception of the number of women with diabetes requiring preconception care and the extent to which preconception care should be integrated into GPs'' roles. Health professionals agreed that GPs have a significant role to play and that delivery of preconception care is best shared between primary and secondary care. However, the lack of clear guidelines and shared protocols detailing the GP''s role presents a challenge to implementing ‘shared’ preconception care.Conclusion
GPs should be more effectively involved in providing preconception care to women with diabetes. Organisational and policy developments are required to support GPs in playing a role in preconception care. This study''s findings stress the importance of providing an integrated approach to ensure continuity of care and optimal pregnancy preparation for women with diabetes. 相似文献19.
Background
Mobile technologies have emerged as important tools that health care personnel can use to gain easy access to client data anywhere. This is particularly useful for nurses and care workers in home health care as they provide services to clients in many different settings. Although a growing body of evidence supports the use of mobile technologies, the diverse implications of mobile health have yet to be fully documented.Objective
Our objective was to examine a large-scale government-sponsored mobile health implementation program in the Danish home care sector and to understand how the technology was used differently across home care agencies.Methods
We chose to perform a longitudinal case study with embedded units of analysis. We included multiple data sources, such as written materials, a survey to managers across all 98 Danish municipalities, and semistructured interviews with managers, care workers, and nurses in three selected home care agencies. We used process models of change to help analyze the overall implementation process from a longitudinal perspective and to identify antecedent conditions, key events, and practical outcomes.Results
Strong collaboration between major stakeholders in the Danish home care sector (government bodies, vendors, consultants, interest organizations, and managers) helped initiate and energize the change process, and government funding supported quick and widespread technology adoption. However, although supported by the same government-sponsored program, mobile technology proved to have considerable interpretive flexibility with variation in perceived nature of technology, technology strategy, and technology use between agencies. What was first seen as a very promising innovation across the Danish home care sector subsequently became the topic of debate as technology use arrangements ran counter to existing norms and values in individual agencies.Conclusions
Government-sponsored programs can have both positive and negative results, and managers need to be aware of this and the interpretive flexibility of mobile technology. Mobile technology implementation is a complex process that is best studied by combining organization-level analysis with features of the wider sociopolitical and interorganizational environment. 相似文献20.
Jennifer N Egbunike Chris Shaw Alison Porter Lori A Button Paul Kinnersley Kerry Hood Sue Bowden Sue Bale Helen Snooks Adrian Edwards 《The British journal of general practice》2010,60(572):e83-e97