RESUMO
BACKGROUND: Hypertension (HTN) is highly prevalent among people living with HIV (PLHIV), but there is limited access to standardized HTN management strategies in public primary healthcare facilities in Nigeria. The shortage of trained healthcare providers in Nigeria is an important contributor to the increased unmet need for HTN management among PLHIV. Evidence-based TAsk-Strengthening Strategies for HTN control (TASSH) have shown promise to address this gap in other resource-constrained settings. However, little is known regarding primary health care facilities' capacity to implement this strategy. The objective of this study was to determine primary healthcare facilities' readiness to implement TASSH among PLHIV in Nigeria. METHODS: This study was conducted with purposively selected healthcare providers at fifty-nine primary healthcare facilities in Akwa-Ibom State, Nigeria. Healthcare facility readiness data were measured using the Organizational Readiness to Change Assessment (ORCA) tool. ORCA is based on the Promoting Action on Research Implementation in Health Services (PARIHS) framework that identifies evidence, context, and facilitation as the key factors for effective knowledge translation. Quantitative data were analyzed using descriptive statistics (including mean ORCA subscales). We focused on the ORCA context domain, and responses were scored on a 5-point Likert scale, with 1 corresponding to disagree strongly. FINDINGS: Fifty-nine healthcare providers (mean age 45; standard deviation [SD]: 7.4, 88% female, 68% with technical training, 56% nurses, 56% with 1-5 years providing HIV care) participated in the study. Most healthcare providers provide care to 11-30 patients living with HIV per month in their health facility, with about 42% of providers reporting that they see between 1 and 10 patients with HTN each month. Overall, staff culture (mean 4.9 [0.4]), leadership support (mean 4.9 [0.4]), and measurement/evidence-assessment (mean 4.6 [0.5]) were the topped-scored ORCA subscales, while scores on facility resources (mean 3.6 [0.8]) were the lowest. CONCLUSION: Findings show organizational support for innovation and the health providers at the participating health facilities. However, a concerted effort is needed to promote training capabilities and resources to deliver services within these primary healthcare facilities. These results are invaluable in developing future strategies to improve the integration, adoption, and sustainability of TASSH in primary healthcare facilities in Nigeria. TRIAL REGISTRATION: NCT05031819.
RESUMO
INTRODUCTION AND IMPORTANCE: The commonest method of elective CSF diversion remains ventriculo-peritoneal shunt (VP shunt). But in some circumstances, VP shunts fail repeatedly or becomes unattractive to the neurosurgeon and this calls for exploration of alternatives. For the index case, Ventriculo-atrial (VA) shunt was favoured and the objective in this report is to share experience gathered there from. Learning points serve to highlight the use of VA shunts as a resort in the drainage of cerebrospinal fluid in the case of repeated failures of peritoneal diversion of CSF and to explain our explain our experience with this index case. CASE PRESENTATION: A 54 years old obese woman with previous history of total abdominal hysterectomy was reported. She underwent repeated (three times) revisions of failed peritoneal end of her VP shunt on a background of obstructive hydrocephalus secondary to a posterior fossa tumour (previously excised). Following repeated failure of peritoneal catheter function, she underwent VA shunt and did well. CLINICAL DISCUSSION: The decision to place a VA shunt was made after careful deliberations. We discuss the peculiarities in placing a VA shunt. Following placement of a VA shunt, improvement was noted in her clinical condition at one week post op and has been sustained at multiple follow up clinic visits. CONCLUSION: VA shunts become an option for cerebrospinal fluid drainage when it becomes unequivocally clear in a multidisciplinary setting that the peritoneal catheter is unlikely to work in view of the unfavourable circumstances of the peritoneal cavity.
