Experiences of patients living with HIV and AIDS on antiretroviral therapy in Accra, Ghana.

BACKGROUND:  The human immunodeficiency virus and acquired immunodeficiency syndrome (HIV and AIDS) pandemic has greatly affected Africa, particularly Ghana. The pandemic remains a public health concern, particularly in terms of accessing essential medication and improving quality of life for people living with the disease. OBJECTIVES:  This study aimed to explore and describe the experiences of persons diagnosed and living with HIV who are on antiretroviral therapy. METHOD:  A qualitative, exploratory, descriptive, and contextual design was used. The research population included persons diagnosed with HIV who were receiving antiretroviral therapy at three public hospitals in Ghana. Data saturation was achieved after conducting 15 semi-structured interviews. Creswell's six steps of data analysis were used to analyse the data, which resulted in the emergence of one main theme and six sub-themes. RESULTS:  The main theme identified by the researchers highlighted the participants' diverse experiences of being diagnosed and living with HIV. It was found that the study participants expressed shock, disbelief, surprise, and fear of death after being diagnosed with HIV. The participants also experienced stigmatisation, discrimination, and rejection. CONCLUSION:  There is a need for further research on the extent of discrimination and stigmatisation and the effect on optimal adherence to antiretroviral therapy. Continuous public education on HIV is required to limit the extent of discrimination and stigmatisation.Contribution: The study has highlighted the various emotions related to stigma and discrimination expressed by persons living with HIV (PLHIV). The findings will guide policy on eliminating discrimination and stigmatisation for people living with HIV.

Provision of antiretroviral therapy for children in Nelson Mandela Bay: Health care professionals' challenges.

BACKGROUND:  The human immunodeficiency virus and/or acquired immune deficiency syndrome (HIV/AIDS) pandemic continues to increase in prevalence worldwide, particularly in South Africa, and includes the often overlooked paediatric population. The provision of paediatric antiretroviral treatment (ART) is as essential for children as for adults, and has numerous obstacles, not least of which is lack of decentralisation of facilities to provide essential treatment. Optimising ART, care and support for HIV-positive children, and their caregivers, at public sector primary health care (PHC) clinics is crucial to improve morbidity and mortality rates in children. AIM:  To explore the experiences of health care professionals regarding the provision of ART for children at PHC clinics. SETTING:  The study was conducted in six PHC clinics in Nelson Mandela Bay Health District, Eastern Cape, South Africa. METHODOLOGY:  The researchers used a qualitative, explorative, descriptive and contextual research design with in-depth interviews. We used non-probability purposive sampling. Data collected were thematically analysed using Creswell's data analysis spiral. We used Lincoln and Guba's model to ensure trustworthiness. Ethical standards were applied. RESULTS:  Health care professionals experienced numerous challenges, such as lack of resources, need for training, mentoring and debriefing, all related to providing decentralised ART for HIV-positive children at the PHC level. CONCLUSION:  Capacitation of the health care system, integration of services, competent management and visionary leadership to invoke a collaborative interdisciplinary team approach is required to ensure that HIV is treated as a chronic disease at the PHC clinic level.

An Integrative Literature Review of the Factors That Contribute to Professional Nurses and Midwives Making Sound Clinical Decisions.

PURPOSE: To identify available literature concerning the factors that contribute to nurses and midwives making sound clinical decisions. METHOD: This is an integrative literature review. FINDINGS: Thirty-eight articles revealed four main domains that influence nurses' and midwives' clinical decision making-nurses and midwives' personal characteristics (n = 30), e.g., clinical experience; organizational factors (n = 26), e.g., colleagues; patient characteristics (n = 26), e.g., physical and clinical status; and environmental factors (n = 9), e.g., time. These four domains of factors combined influence sound clinical decision making in the context of nursing and midwifery. CONCLUSIONS: Understanding the role of the factors influencing clinical decision making will help to improve patient and health outcomes. PRACTICE IMPLICATIONS: Further understanding about the extent of the impact some factors have on clinical decision making is needed.

The experiences of dentists in the management planning of oral health services in Lesotho, Africa.

INTRODUCTION: Health sector reforms motivated by the need for efficiency, effectiveness and equity in the delivery of services have interested authorities in the planning competencies of managers, because planning sets the stage for the effective management of health systems. The huge public and private cost of oral health makes planning an important dimension for health authorities when considering the allocation of funds. Productivity in the oral health service sector is not often reported on, despite the cost involved in rendering oral health services. This study explores and describes the management planning experiences of oral health managers in the public sector in Lesotho, Africa, which consists of clinics in 10 districts serving hundreds of rural and remote mountainous communities. METHODS: The study used a qualitative research design. Of the purposive sample of 14 public sector dentists then available, seven dentists (2 female and 5 male) met the criteria for participation (> or = 1 year of experience in district oral health planning), and consented to and were available for participation. Data were collected by in-depth, one-on-one interviews with 6 participants, and textual data were collected from the seventh. Interviews were audiotaped and transcribed verbatim. Data were organised and analysed using the Tesch method, with themed topics coded and categorised by a researcher and an independent coder for analysis. RESULTS: One major theme emerged (the management planning of oral health services were experienced as inefficient) and four sub-themes: (1) the need to plan carefully to provide efficient clinical services; (2) constraints to promoting expansion of community based dental services; (3) a breakdown in communication hampered service delivery; and (4) internal and external stakeholder issues impacted strongly on management planning. CONCLUSION: The inefficiency (failure of the community to derive maximum curative, preventive and rehabilitative benefits from public expenditure on oral health in Lesotho), as described by participants, arose from factors that impair careful planning; constrained the expansion of community based oral health services; caused a breakdown in communication between dentists and their authorities leading to poor services delivery; and was impacted strongly by internal and external stakeholder issues.