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1.
AIDS Behav ; 28(5): 1782-1794, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38416275

RESUMO

Peer-to-peer chain recruitment has been used for descriptive studies, but few intervention studies have employed it. We used this method to enroll sexually active women ages 18 to 25 into an online Pre-Exposure Prophylaxis (PrEP) information and motivation intervention pilot in eThekwini (Durban), South Africa. Seeds (N = 16) were recruited by study staff and randomized to Masibambane, Ladies Chat, a Gender-Enhanced group-based WhatsApp Workshop (GE), or Individual-Access (IA), a control condition that provided participants with online information/motivation materials only. Each seed could recruit up to three women to participate in the same study condition, with an incentive for each enrolled woman; participants in subsequent waves could choose to recruit or not. We evaluated if peer-to-peer recruitment was self-sustaining and resulted in enrolling women who, in subsequent waves, had less contact with the health care system and less knowledge about PrEP than the initial seeds. Over three recruitment waves beyond the seeds, 84 women were recruited. Almost 90% of women became recruiters, with each recruiting on average 1.90 women and 1.26 eligible enrolled women. The approach was successful at reaching women with less education but not women with less health system contact and PrEP knowledge across waves. IA participants had a slightly higher, though non-significantly different, percentage of individuals who became Peer Health Advocates (PHAs) than GE participants and, on average, they recruited slightly more women who enrolled. Our findings demonstrated that peer-to-peer recruitment is a feasible and self-sustaining way to recruit SA young women into a PrEP intervention study.


Assuntos
Infecções por HIV , Seleção de Pacientes , Grupo Associado , Profilaxia Pré-Exposição , Humanos , Feminino , Profilaxia Pré-Exposição/métodos , África do Sul , Infecções por HIV/prevenção & controle , Adulto , Adulto Jovem , Adolescente , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/uso terapêutico , Motivação , Conhecimentos, Atitudes e Prática em Saúde , Projetos Piloto
2.
AIDS Behav ; 26(10): 3386-3399, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35429310

RESUMO

This scoping review assessed how the term 'self-management' (SM) is used in peer-reviewed literature describing HIV populations in low- and middle-income countries (LMIC). This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. OVID Medline, Embase, CAB Abstracts, and EBSCO CINAHL, Scopus, and Cochrane Library were searched up to September 2021 for articles with SM in titles, key words, or abstracts. Two team members independently screened the titles and abstracts, followed by the full-text. A data extraction tool assisted with collecting findings. A total of 103 articles were included. Since 2015, there has been a 74% increase in articles that use SM in relation to HIV in LMIC. Fifty-three articles used the term in the context of chronic disease management and described it as a complex process involving active participation from patients alongside providers. Many of the remaining 50 articles used SM as a strategy for handling one's care by oneself, with or without the help of community or family members. This demonstrates the varied conceptualizations and uses of the term in LMIC, with implications for the management of HIV in these settings. Future research should examine the applicability of SM frameworks developed in high-income settings for LMIC.


Assuntos
Países em Desenvolvimento , Infecções por HIV , Doença Crônica , Atenção à Saúde , Infecções por HIV/tratamento farmacológico , Humanos , Renda
3.
BMC Public Health ; 22(1): 705, 2022 04 10.
Artigo em Inglês | MEDLINE | ID: mdl-35399064

RESUMO

BACKGROUND: Gender-transformative work in the Global South often focuses on transforming 'toxic masculinities' to prevent intimate partner violence (IPV), but there has been little research on whether and how constructions of masculinities by men with disabilities shape their experiences and perpetration of violence. METHODS: We used repeated in-depth interviews and content analysis to understand whether and how physical disability intersects with the construction of masculinities and experience/perpetration of violence among 15 adult men with physical disabilities participating in interventions to prevent IPV in Ghana, Rwanda, and South Africa. RESULTS: Societal expectations and participants' aspirations around masculinity impacted their vulnerability to violence mainly by men without disabilities. Participants reported experiences of disrespect and social exclusion in their communities and felt incapable of protecting themselves when being violated. Most participants felt they were not providing for their families and perceived themselves as having lost decision-making and positions of power in their homes. They expressed their disappointment with having reduced stamina, virility, and sexual prowess in intimate partnerships as a result of their disability. While participants reported that they could not attain key markers of idealized masculinity, placed upon and often internalized by themselves, they longed to achieve these markers to facilitate their inclusion and acceptance in their communities. CONCLUSIONS: Programmers addressing violence need to engage with men with physical disabilities and consider the intersectionality of masculinities and disability, how these reinforce patriarchal norms and how men with disabilities can be included and enabled to overcome their conflict between disability and masculinities.


Assuntos
Pessoas com Deficiência , Violência por Parceiro Íntimo , Adulto , Humanos , Violência por Parceiro Íntimo/prevenção & controle , Masculino , Masculinidade , África do Sul , Violência
4.
AIDS Care ; 32(4): 471-479, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31426663

RESUMO

The care offered to children living with HIV (CLHIV) experiencing HIV-related disability is often challenged by caregiver illness, poverty and poor support structures in and around communities. Since caregiver needs directly influences the care offered to CLHIV this paper aimed to explore the experiences of the caregivers of CLHIV in order to inform an appropriate rehabilitation model in South Africa. A qualitative enquiry using in-depth interviews with 14 caregivers (one male and thirteen females) of CLHIV experiencing disability in a peri-urban setting was conducted. Data were analysed using thematic analysis. Four themes emerged from the interviews: understanding of HIV-related disability and rehabilitation, challengers to care and well-being, enablers to care; and perceived needs of caregivers. The study revealed that caregiver burden is influenced by the availability of resources and social support services. Financial constraints, poor access to rehabilitation and reduced support networks challenged the care offered to CLHIV. The perceived needs of the caregivers in this study included appeals for improved social security, housing, accessible rehabilitation and education. Changes in government policy guiding social support, employment, education and rehabilitation interventions are needed to improve the availability of resources, education, health and well-being of CLHIV and their caregiver's in South Africa.


Assuntos
Cuidadores/psicologia , Pessoas com Deficiência/reabilitação , Pessoas com Deficiência/estatística & dados numéricos , Infecções por HIV/complicações , Infecções por HIV/reabilitação , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Rede Social , Adulto , Criança , Feminino , Infecções por HIV/psicologia , Recursos em Saúde , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Fatores Socioeconômicos , África do Sul
5.
AIDS Care ; 32(5): 623-629, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31416343

RESUMO

Anti-retroviral treatment (ART) has improved the survival of people living with HIV in Africa. Living with chronic HIV comes with new health and functional challenges and the need to manage ART adherence. The Sepo Study applied disability frameworks to better understand living with chronic HIV while using ART. The study followed 35 people (18 women, 17 men) living with HIV and on ART 6 months or longer in private and public health facilities in Lusaka, Zambia over 18-months (2012-2015). A total of 99 in-depth interviews were conducted. Conventional content analysis and NVIVOv10 were applied to analyse the data. Participants were adhering to ART at the times of the interviews and therefore less likely to report major challenges with adherence. Three main themes emerged from the data related to adherence. Firstly, ART was regarded as "giving life", which underscored adherence. Secondly, all participants described strategies for to managehealth and functional limitations, which they attributed as side-effects or chronicity. Thirdly, participants described experiences of uncertainty, including the efficacy of new regimens, potential loss of functioning, risk of new health problems, and death. Long-term ART managment in Africa needs to integrate rehabilitation approaches to address functional limitations, uncertainties, strengthen and support for adherence.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Adulto , Terapia Antirretroviral de Alta Atividade , Pessoas com Deficiência/psicologia , Feminino , Infecções por HIV/psicologia , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Zâmbia
6.
Afr J AIDS Res ; 19(3): 263-268, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33119455

RESUMO

Background: Health care workers play an integral role in the rehabilitation and care of people living with HIV who face multiple impairments and often disabilities. The aim of the article was to understand the perceptions and attitudes of health care workers towards caring for people living with HIV, and experiencing disability. Methods: Fifteen health care workers offering care to people living with HIV were interviewed using a semi-structured guide. These health care workers included doctors, a social worker, a pharmacist, a dietician, an occupational therapist, a physiotherapist, and nurses and HIV couPnsellors who were employed at a public health care facility in KwaZulu-Natal. Data from the interviews were transcribed and analysed using conventional content analysis. Results: Four themes emerged from semi-structured interviews with the health care workers: a holistic disability framework, a multidisciplinary team dynamic, organisational barriers and recommendations by health care workers. Conclusion: Health care workers perceived a shift from a biomedical perspective of disability to a bio-psychosocial interpretation that is influenced by contextual and environmental barriers imposed by communities on people living with HIV. Barriers included stigmatisation that leads to attitudinal barriers and social exclusion of people living with HIV and experiencing disabilities within communities. Lack of resources, including of equipment, and a shortage of health care staff also posed barriers to the care offered to people living with HIV and experiencing disabilities. Participants agreed that improved communication in the multidisciplinary health care team, as well as continuing education and training, would enable health care workers to offer improved, integrated care to people living with HIV who experience disabilities.


Assuntos
Pessoas com Deficiência/reabilitação , Infecções por HIV/fisiopatologia , Infecções por HIV/reabilitação , Pessoal de Saúde/psicologia , Prestação Integrada de Cuidados de Saúde , Feminino , Infecções por HIV/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/educação , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Pesquisa Qualitativa , África do Sul/epidemiologia
7.
Women Health ; 59(10): 1212-1226, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31043146

RESUMO

Depressive symptoms occur frequently among people living with HIV, especially women. These symptoms are associated with human, social, financial, and physical/natural capabilities and life stressors that differ between women and men. However, the link between depressive symptoms and functional limitations/disability is seldom discussed in the context of HIV, especially for gender-specific relationships. A cross-sectional survey of 1042 people living with HIV and using long-term antiretroviral therapy (ART) in South Africa was conducted from June to August 2014 to investigate the associations of disability, human, social, physical/natural, and financial capabilities, health, and adherence to ART, including possible gender-specific factors. Socio-demographic information, capabilities, health indicators, functional limitations/disability, and depressive symptoms (CES-D 10) were measured. We applied descriptive and bivariate statistics and multiple regression. Overall, 26% of people presented with depressive symptoms. Greater functional limitations and health symptoms and lower food security were strongly associated with depressive symptoms, while associations with financial capital and body mass index were gender-specific. The results call for the improvement of comprehensive care, including gender-sensitive mental health interventions. The results further indicate that functional limitations/disability needs to be considered, along with linking rehabilitation and livelihood programs with comprehensive HIV-care, in particular for those who experience depressive symptoms.


Assuntos
Antirretrovirais/uso terapêutico , Depressão/psicologia , Pessoas com Deficiência/psicologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Assistência de Longa Duração/psicologia , Atividades Cotidianas , Adulto , Terapia Antirretroviral de Alta Atividade/métodos , Estudos Transversais , Feminino , Humanos , Masculino , Adesão à Medicação/psicologia , Saúde Mental , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , África do Sul
8.
AIDS Care ; 30(3): 312-317, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28826230

RESUMO

Previous research has demonstrated increased comorbidities related to the chronic effects of HIV. Rehabilitation science offers a useful approach for studying chronic illness. This longitudinal qualitative study used a rehabilitation science approach to explore the experiences over time of women and men living with HIV and on antiretroviral therapy (ART) in the high HIV-prevalence setting of Lusaka, Zambia. Thirty-five participants participated in a total of 99 in-depth interviews from 2012 to 2015. The central pattern that emerged across the participants' narratives was the paradoxical experience of profound optimism alongside significant new challenges. Participants' stories of hopefulness in the face of ongoing struggles played out in three interconnected themes: (1) impacts on my body and life; (2) interventions I am grateful to have and new interventions I need; and (3) stigma reduced and created by ART. Results reflected the ups and downs of life with HIV as a chronic illness. Participants, whilst committed to and healthier on ART, typically experienced multiple physical, psychological and sensory impairments that varied in type, severity and trajectory. Participants valued improved relationships enabled by ART, but yearned for support for living long-term with HIV. Frequently participants reflected that their needs were overlooked related to managing side-effects, exercise, family planning and healthy sexuality. ART strengthened acceptance by self and others through improved health and productivity and through becoming a source of support for others. However, being on ART also led to stigma, driven by persistent associations with sickness, death, lack of productivity and uncertainty. This study points to shortcomings in the current focus of HIV care in Zambia and the region, which centres on initiating and adhering to ART. Findings call for evolution of the HIV care continuum to embrace a more holistic and long-term approach to living with HIV as a chronic and episodic condition.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Otimismo , Estigma Social , Adulto , Estudos de Coortes , Feminino , Infecções por HIV/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Modalidades de Fisioterapia , Preconceito/psicologia , Pesquisa Qualitativa , Zâmbia/epidemiologia
9.
AIDS Care ; 29(1): 32-39, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27350256

RESUMO

We have only just begun to understand the long-term impact of living with chronic HIV on health and livelihood after a decade of widespread access to treatment in southern Africa. This paper explores health and well-being, disability, and livelihood dynamics among people living with HIV (PLHIV) in a public healthcare setting in South Africa. We undertook a cross-sectional survey among a cohort of 1042 people on ART and explored associations between socio-demographic characteristics, treatment adherence, measures of disability (functional and activity limitations), livelihood resources (capitals) and outcomes, including food security, and exposure to livelihood shocks. A range of dynamic relationships relevant for decision-makers is evident. Age, gender, and marital status all had significant associations with levels of livelihood capitals and outcomes. Those who had been on ART for longer periods of time also had significantly higher aggregate livelihood capital. This was particularly driven by social and financial capital. Livelihoods are built within specific social and health contexts. Of particular importance is that the resources drawn on to build a livelihood differ significantly between men and women, and that different forms of disability also have gender-specific pathways in influencing livelihood and livelihood outcomes. Our results support the need for a gender-sensitive approach to supporting the well-being and livelihoods of PLHIV. Of equal importance is an approach that considers more comprehensively the new experiences of comorbidities and disabilities that may occur with a long life on ART.


Assuntos
Infecções por HIV/economia , Infecções por HIV/psicologia , Adolescente , Adulto , Fatores Etários , Fármacos Anti-HIV/uso terapêutico , Estudos Transversais , Avaliação da Deficiência , Feminino , Abastecimento de Alimentos , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Resiliência Psicológica , Fatores Sexuais , Fatores Socioeconômicos , África do Sul , Adulto Jovem
10.
AIDS Care ; 29(10): 1260-1264, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28278572

RESUMO

People living with HIV (PLHIV) are living longer lives on antiretroviral therapy and are prone to a wide range of disabilities. Innovative strategies are required to meet the rehabilitation needs of PLHIV, particularly in resource-poor communities where HIV is endemic and access to institution-based rehabilitation is limited. Home-based rehabilitation (HBR) is one such approach, but there is a paucity of research related to HBR programmes for PLHIV or the experiences of community care workers (CCWs) involved in these programmes. Following a four month randomised controlled trial of a HBR intervention designed specifically for PLHIV in KwaZulu-Natal, South Africa; four CCWs were interviewed. This study employed a qualitative research design, using semi-structured interviews to explore these workers' experiences of being involved in carrying out this intervention. Participants reported how their personal development, improvement in their own health and increased feelings of self-worth enabled them to successfully implement the intervention. Participants also described a number of inhibitors, including stigma and environmental challenges related to the distances between patients' homes, the steep terrain and the hot climate. Despite this, the participants felt empowered by acquiring knowledge and skills that enabled them to shift roles beyond rehabilitation provision. The findings of this study should be considered when employing a task shifting approach in the development and implementation of HBR interventions for PLHIV. By employing a less specialised cadre of community workers to conduct basic HBR interventions, both the relative lack of qualified rehabilitation professionals and the high levels of disability in HIV-epidemic communities can be simultaneously addressed.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Agentes Comunitários de Saúde/psicologia , Infecções por HIV/reabilitação , Pacientes Domiciliares/reabilitação , Modalidades de Fisioterapia , Relações Profissional-Paciente , Adulto , Pessoas com Deficiência/reabilitação , Emoções , Infecções por HIV/psicologia , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Ensaios Clínicos Controlados Aleatórios como Assunto , África do Sul
11.
AIDS Care ; 28 Suppl 1: 132-9, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27002771

RESUMO

In the era of widespread access to antiretroviral therapy, people living with HIV survive; however, this comes with new experiences of comorbidities and HIV-related disability posing new challenges to rehabilitation professionals and an already fragile health system in Southern Africa. Public health approaches to HIV need to include not only prevention, treatment and support but also rehabilitation. While some well-resourced countries have developed rehabilitation approaches for HIV, resource-poor settings of Southern Africa lack a model of care that includes rehabilitation approaches providing accessible and comprehensive care for people living with HIV. In this study, a learning in action approach was used to conceptualize a comprehensive model of care that addresses HIV-related disability and a feasible rehabilitation framework for resource-poor settings. The study used qualitative methods in the form of a focus group discussion with thirty participants including people living with HIV, the multidisciplinary healthcare team and community outreach partners at a semi-rural health facility in South Africa. The discussion focused on barriers and enablers of access to rehabilitation. Participants identified barriers at various levels, including transport, physical access, financial constraints and poor multi-stakeholder team interaction. The results of the group discussions informed the design of an inclusive model of HIV care. This model was further informed by established integrated rehabilitation models. Participants emphasized that objectives need to respond to policy, improve access to patient-centered care and maintain a multidisciplinary team approach. They proposed that guiding principles should include efficient communication, collaboration of all stakeholders and leadership in teams to enable staff to implement the model. Training of professional staff and lay personnel within task-shifting approaches was seen as an essential enabler to implementation. The health facility as well as outreach services such as intermediate clinics, home-based care, outreach and community-based rehabilitation was identified as important structures for potential rehabilitation interventions.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Pessoas com Deficiência/reabilitação , Infecções por HIV/reabilitação , Acessibilidade aos Serviços de Saúde , Equipe de Assistência ao Paciente , Assistência Centrada no Paciente , Doença Crônica , Grupos Focais , Infecções por HIV/psicologia , Serviços de Assistência Domiciliar , Humanos , Pessoa de Meia-Idade , Pesquisa Qualitativa , Serviços de Saúde Rural/organização & administração , População Rural , África do Sul
12.
Afr J AIDS Res ; 15(1): 77-88, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27002360

RESUMO

Home-based rehabilitation (HBR) has been shown to improve the lives of people living with a wide range of chronic diseases in resource-rich settings. This may also be a particularly effective strategy in resource-poor settings, where access to institution-based rehabilitation is limited. This review aimed to summarise and discuss the evidence related to the effectiveness of home-based rehabilitation (HBR) interventions designed specifically for adults living with HIV. A scoping review methodology was employed, involving systematic search techniques and appraisal of appropriate evidence. English-language journal articles that assessed the quality of life or functional ability outcomes of HBR interventions for adults living with HIV were considered for this review. Out of an initial 1 135 publications retrieved from the search of databases, six articles met this review's inclusion criteria. While this review highlights the scarcity of empirical evidence related to HBR interventions for adults living with HIV, the findings of these six articles are that HBR is a safe management option that may confer a number of physical and psychological benefits for this population. Future research on HBR interventions should include a wider range of assessment measures, including cost-benefit analyses and specific tools designed to assess the functional ability and participation in activities of daily living of participants involved in these programmes. In particular, more research on HBR is required in resource-poor environments, such as sub-Saharan Africa where HIV is endemic, to assess whether this is a feasible strategy that is both effective and practical in the areas that may need it most.


Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/reabilitação , Serviços de Assistência Domiciliar , Qualidade de Vida , Exercício Físico , Feminino , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Modalidades de Fisioterapia
13.
Afr J AIDS Res ; 14(3): 285-94, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26439603

RESUMO

BACKGROUND: Healthcare workers have been at the forefront of dealing with the impact of HIV and AIDS at all stages of the pandemic. This brings new challenges to include disability into HIV care. However, the implications for healthcare workers in an already fragile health system along with HIV-related disabilities in persons living with HIV are little understood. This study examined the healthcare workers' perspective on disability in HIV care. METHOD: This article describes a qualitative study using in-depth interviews with 10 healthcare workers in a semi-urban hospital setting in KwaZulu-Natal, South Africa. The study aimed to understand healthcare workers' experiences with disability in the context of HIV. The International Classification of Functioning Disability and Health (ICF) was used as a guiding framework to understand disability. RESULTS: Healthcare workers described HIV-related disabilities on all three levels of disability, namely impairments/ body function, activity limitations and participation restrictions, as affecting the livelihood of their patients and household members. Issues also arose from disability and stigma that were perceived as affecting adherence to antiretroviral treatment. In addition, healthcare workers encounter challenges in dealing with the increased needs of care and support for those people living with HIV who experience HIV-related disabilities. They indicated a limited ability to cope and respond to these needs. Primarily they arrange additional referrals to manage complex or episodic disabilities. Participants also identified issues such as excessive work load, lack of resources and training and emotional challenges in dealing with disability. CONCLUSION: Healthcare workers need support to respond to the increased needs of people living with HIV who have HIV-related disabilities. Responses need to reflect: 1) increase in rehabilitative staff including in community outreach programmes; 2) skills training in HIV-related disability; and 3) psychosocial support for healthcare workers.


Assuntos
Pessoas com Deficiência/psicologia , Infecções por HIV/psicologia , Pessoal de Saúde/psicologia , Síndrome da Imunodeficiência Adquirida/psicologia , Adaptação Psicológica , Adulto , Idoso , Idoso de 80 Anos ou mais , Emoções , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Apoio Social , África do Sul , Adulto Jovem
14.
Health Res Policy Syst ; 12: 66, 2014 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-25466570

RESUMO

BACKGROUND: Health technology assessment (HTA) is mostly used in the context of high- and middle-income countries. Many "resource-poor" settings, which have the greatest need for critical assessment of health technology, have a limited basis for making evidence-based choices. This can lead to inappropriate use of technologies, a problem that could be addressed by HTA that enables the efficient use of resources, which is especially crucial in such settings. There is a lack of clarity about which HTA tools should be used in these settings. This research aims to provide an overview of proposed HTA tools for "resource-poor" settings with a specific focus on sub-Saharan Africa (SSA). METHODOLOGY: A systematic review was conducted using basic steps from the PRISMA guidelines. Studies that described HTA tools applicable for "resource-limited" settings were identified and critically appraised. Only papers published between 2003 and 2013 were included. The identified tools were assessed according to a checklist with methodological criteria. RESULTS: Six appropriate tools that are applicable in the SSA setting and cover methodological robustness and ease of use were included in the review. Several tools fulfil these criteria, such as the KNOW ESSENTIALS tool, Mini-HTA tool, and Multi-Criteria Decision Analysis but their application in the SSA context remains limited. The WHO CHOICE method is a standardized decision making tool for choosing interventions but is limited to their cost-effectiveness. Most evaluation of health technology in SSA focuses on priority setting. There is a lack of HTA tools that can be used for the systematic assessment of technology in the SSA context. CONCLUSIONS: An appropriate HTA tool for "resource-constrained" settings, and especially SSA, should address all important criteria of decision making. By combining the two most promising tools, KNOW ESSENTIALS and Multi-Criteria Decision Analysis, appropriate analysis of evidence with a robust and flexible methodology could be applied for the SSA setting.


Assuntos
Técnicas de Apoio para a Decisão , Política de Saúde , Avaliação da Tecnologia Biomédica/métodos , África Subsaariana , Análise Custo-Benefício , Medicina Baseada em Evidências , Necessidades e Demandas de Serviços de Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Pobreza , Alocação de Recursos
15.
Afr J AIDS Res ; 13(3): 229-35, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25388977

RESUMO

There have been countless youth programmes throughout Africa resulting in increased knowledge of HIV, but all too often there is a discrepancy between knowledge and behaviour change. According to available literature, successful projects need to consider the context in which young people live, be consistent with community values, and be family inclusive and youth centred. This, however, requires active involvement of communities, families and youth, which in turn implies a more local response to the epidemic in small projects. This paper presents results from a survey in a rural community of South Africa which investigated the contextual factors associated with HIV knowledge, attitudes and practice in such a setting. The community was of particular interest as it had developed a local youth literacy and family support programme which included HIV-prevention messages. All school aged children of the two settlements were approached (N = 100), some of whom regularly participated in the literacy classes. The survey investigated the association between contextual factors such as caregivers, peers and exposure to the literacy classes in regards to HIV-knowledge, attitudes and practice. The results suggest that contextual factors have an impact on sexual behaviour and self-efficacy as well as on attitudes towards condom use. This indicates that peers and caregivers influence the perceived agency to practise safe sex and the likelihood that adolescents practise 'deviant' behaviour such as drinking, getting involved in drugs or becoming sexually active. However, the results suggest that exposure to community projects such as literacy classes have the potential to positively influence reading scores, attitudes towards condom use and delay of sexual debut while it has little effect on HIV knowledge.


Assuntos
Transmissão de Doença Infecciosa/prevenção & controle , Infecções por HIV/prevenção & controle , Educação em Saúde/métodos , Conhecimentos, Atitudes e Prática em Saúde , Adolescente , Criança , Feminino , Humanos , Masculino , População Rural , Comportamento Sexual , África do Sul
16.
J Int AIDS Soc ; 27(4): e26239, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38566480

RESUMO

INTRODUCTION: Disability and HIV are intricately linked, as people with disabilities are at higher risk of contracting HIV, and living with HIV can lead to impairments and disability. Despite this well-established relationship, there remains limited internationally comparable evidence on HIV knowledge and access to testing for people with disabilities. METHODS: We used cross-sectional data from 37 Multiple Indicator Cluster Surveys. Surveys were from six UNICEF regions, including East Asia and Pacific (n = 6), East and Central Asia (n = 7), Latin America and the Caribbean (n = 6), Middle East and North Africa (n = 4), South Asia (n = 2) and sub-Saharan Africa (n = 12). A total of 513,252 people were eligible for inclusion, including 24,695 (4.8%) people with disabilities. We examined risk ratios and 95% confidence intervals for key indicators on HIV knowledge and access to testing for people with disabilities by sex and country. We also conducted a meta-analysis to get a pooled estimate for each sex and indicator. RESULTS: Men and women with disabilities were less likely to have comprehensive knowledge about HIV prevention (aRR: 0.74 [0.67, 0.81] and 0.75 [0.69, 0.83], respectively) and to know of a place to be tested for HIV (aRR: 0.95 [0.92, 0.99] and 0.94 [0.92, 0.97], respectively) compared to men and women without disabilities. Women with disabilities were also less likely to know how to prevent mother-to-child transmission (aRR: 0.87 [0.81, 0.93]) and ever have been tested for HIV (aRR: 0.90 [0.85, 0.94]). CONCLUSIONS: Men and women with disabilities have lower overall HIV knowledge and in particular women with disabilities also indicate lower testing rates. Governments must include people with disabilities in HIV programmes by improving disability-inclusion and accessibility to HIV-related information, education and healthcare services.


Assuntos
Pessoas com Deficiência , Infecções por HIV , Masculino , Humanos , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Países em Desenvolvimento , Estudos Transversais , Transmissão Vertical de Doenças Infecciosas
17.
Front Public Health ; 11: 1061339, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36992889

RESUMO

Background: As the global population ages and the HIV pandemic matures, a growing number of older persons aged ≥50 years are becoming increasingly vulnerable to acquiring HIV. Unfortunately, older persons are often neglected and left out of sexual health programs and services. This study explored the experiences of older persons living with and without HIV in accessing prevention and care services and how those experiences translate into the neglect and abuse of older persons. The study also explored older people's perspectives on community responses to HIV in older people. Methods: This qualitative analysis used data from 37 individuals who participated in focus group discussions conducted in 2017/2018 across two communities in Durban, South Africa. Using an interview guide and thematic content analysis, salient themes regarding attitudes to HIV in older persons and factors of access to HIV prevention and cares services for older persons were analyzed. Results: The study participant's mean age was 59.6 years. Major themes emerging from the data included factors impacting HIV prevention and transmission in older people; community responses to HIV contributing to the abuse of older people, and structural drivers of abuse in older people living with HIV (OPLHIV). Knowledge about HIV and how to protect themselves from HIV was limited among participants. Older persons were frightened to acquire HIV at an older age as they feared judgment and discrimination for getting HIV at that age. OPLHIV reported frequently experiencing community stigma and poor staff attitudes and practices at health facilities, such as a triage health delivery system that fueled community stigma. Participants also experienced neglect, verbal and emotional abuse at healthcare facilities. Conclusion: Although there were no reports of physical and sexual abuse of older persons in this study, this study shows that despite decades of HIV programs in the country, HIV-related stigma, discrimination, and disrespect of older persons remain pervasive in the community and at health facilities. As an increasing number of people age and live longer with HIV, the neglect and outright abuse of older persons need urgent policy and program interventions.


Assuntos
Infecções por HIV , Humanos , Idoso , Idoso de 80 Anos ou mais , Pessoa de Meia-Idade , Infecções por HIV/epidemiologia , África do Sul/epidemiologia , Estigma Social , Grupos Focais , Atitude do Pessoal de Saúde
18.
AIDS Educ Prev ; 35(1): 14-35, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36735226

RESUMO

This article describes the processes of transforming an in-person group-based intervention to promote uptake of PrEP among young woman in South Africa to an online interactive "workshop" during the COVID-19 pandemic. Beginning in person and continuing virtually, we used a step-by-step participatory approach with multiple stakeholder groups to develop nine activities to increase knowledge about, as well as motivation and intention to take PrEP, and to address gender-based barriers to PrEP. Activities were informed by our theoretical framework and formative work with young women ages 18-25. We demonstrate how we developed a gender-enhanced online PrEP workshop that was interactive, group-based, and in accordance with elements of established successful intervention design; why WhatsApp emerged as the most accessible application for the young women in our workshop; and how an intervention with a hybrid approach-alternating between chat box and live sessions-combined with verbal, written, and emoji-based communication enabled interaction among participants.


Assuntos
Fármacos Anti-HIV , COVID-19 , Infecções por HIV , Profilaxia Pré-Exposição , Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Infecções por HIV/prevenção & controle , África do Sul , Motivação , Fármacos Anti-HIV/uso terapêutico , Pandemias , COVID-19/prevenção & controle
19.
Disabil Health J ; 16(4): 101499, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37481353

RESUMO

The Washington Group short set (WG-SS) questions are increasingly integrated into national household surveys, censuses, and international survey programs. They enable the monitoring of disability rights and the production of internationally comparable statistics. Disability statistics on prevalence and inequalities can be estimated using different cut-offs on the degree of functional difficulties based on the WG-SS. This commentary discusses what cut-offs to adopt for the purpose of investigating and monitoring disability gaps. We recommend a three-way disaggregation comparing persons with (a) no difficulty, (b) some difficulty and (c) a lot of difficulty or unable to do. In cases where sample sizes are small for disaggregated analysis, we recommend comparing persons with no difficulty to persons with any level of difficulty (i.e. persons with any disability).


Assuntos
Pessoas com Deficiência , Humanos , Washington , Censos
20.
Disabil Rehabil ; 44(1): 114-123, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32406761

RESUMO

PURPOSE: To assess recent estimates of HIV prevalence and the inclusion of persons with disabilities in the HIV response in sub-Saharan Africa. METHODS: A systematic literature search was conducted of recent HIV prevalence studies among persons with disabilities in sub-Saharan Africa and National Strategic Plans from 18 countries in east and southern Africa were reviewed. Results were compared to a 2014 literature search and a 2009 National Strategic Plans review that used similar methods. RESULTS: Between 2013 and 2018, four published studies were identified with estimates of HIV prevalence among persons with disabilities in sub-Saharan Africa. In each study, HIV prevalence was higher among persons with disabilities than national population estimates. Fourteen of the 18 National Strategic Plans reviewed identified persons with disabilities as a vulnerable or marginalized population and thirteen National Strategic Plans proposed targeted programs for persons with disabilities. Among seven assessed disability inclusion indicators of National Strategic Plans, four showed some improvement, two showed no change, and one regressed compared to the 2009 analysis. CONCLUSIONS: Data on HIV prevalence among persons with disabilities is rare. In addition, inclusion of this population in National Strategic Plans in East and Southern African countries is often lacking specific detail.Implications for rehabilitationHIV prevalence studies in sub-Saharan Africa among persons with disabilities are rare and community studies do not disaggregate by type of disability.Estimates of HIV prevalence among persons with disabilities are greater than national averages.Government National HIV Strategic Plans often mention persons with disabilities as a vulnerable population but less often identify specific interventions or inclusive strategies for prevention or care.The integration of attention to disability in national HIV bio-behavioral surveys would allow increased understanding of HIV vulnerability and prevalence and could increase attention to persons with disabilities as a key population within National Strategic Plans.


Assuntos
Pessoas com Deficiência , Infecções por HIV , África Austral/epidemiologia , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Prevalência , Populações Vulneráveis
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