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1.
Afr J AIDS Res ; 19(2): 135-146, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32780677

RESUMO

Since 2012, PMTCT Option B+ has been recommended by the World Health Organization to reduce vertical transmission but numerous adherence challenges remain. We conducted a qualitative study at baseline using six focus group discussions and 14 in-depth interviews to explore knowledge, beliefs, attitudes and challenges towards the Option B+ strategy for PMTCT among HIV-infected pregnant and post-partum women and health workers engaged in Uganda's national Option B+ PMTCT programme. Data were analysed using a thematic approach to capture latent and manifest content with the social ecological model as a theoretic foundation in order to make contextual sense of key stakeholders' needs for an effective Option B+ intervention. Overall, among all study participants, we found multi-level barriers to adhering to Option B+ cutting across all levels of the social ecological model. In line with the model, our study revealed barriers at personal, relational, organizational and societal levels. Some personal beliefs such as that the baby's health is more important that the mother's, organizational (negative attitudes and behaviour of health workers), structural such as poverty, work conflicts, fear and lack of disclosure related to community stigma were all critical obstacles to women adhering to the Option B+ programme. We found that both health workers and participants in the programme have a relatively clear understanding of the benefits of adhering to their treatment; though a more nuanced understanding and thus emphasis in counselling on side effects, is critical to helping patients adhere.


Assuntos
Infecções por HIV/tratamento farmacológico , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Complicações Infecciosas na Gravidez/tratamento farmacológico , Cooperação e Adesão ao Tratamento/psicologia , Adulto , Feminino , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Humanos , Masculino , Mães , Gravidez , Pesquisa Qualitativa , População Rural , Participação dos Interessados , Uganda/epidemiologia , População Urbana
2.
Int Breastfeed J ; 15(1): 43, 2020 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-32414404

RESUMO

BACKGROUND: Early initiation and exclusive breastfeeding for 6 months reduces infant morbidity and mortality and can positively impact on cognitive function. In Uganda, exclusive breastfeeding for 6 months is recommended but many women introduce alternative feeds early. Interventions to scale-up peer support provision for exclusive breastfeeding are limited. We explored the barriers, facilitators and solutions to scaling-up of peer counselling support for exclusive breastfeeding in Uganda. METHODS: A qualitative study was conducted in Mbale District and Kampala City between April and July 2014. Data were collected through 15 key informant interviews with health workers and managers of organizations involved in child and maternal health as well as seven focus group discussions with peer counsellors who took part in the PROMISE EBF Trial (2006-2008), VHT members, mothers and fathers of children aged 1 year and below. Data were analysed using the content thematic approach. RESULTS: The need for peer support for exclusive breastfeeding, especially for young and first-time mothers, was highlighted by most study participants. While mothers, mothers-in-law, friends and husbands were mentioned as major stakeholders regarding infant feeding, they were perceived to lack adequate information on breastfeeding. Health workers were mentioned as a key source of support, but their constraints of heavy workloads and lack of education materials on breastfeeding were highlighted. High community expectations of peer counsellors, the perceived inadequacy of breast milk, general acceptability of complimentary feeding, household food insecurity, heavy workload for women and unsupportive 'work-places' were key barriers to scaling-up of peer counselling support for breastfeeding. The peer counsellors who were part of the PROMISE EBF trial in Mbale, the village health team programme, health facilities, community groups, the media and professional associations emerged as potential facilitators that can aid the scaling-up of peer counselling support for breastfeeding. CONCLUSIONS: Peer support for breastfeeding is highly valued in this setting. The health system and health workers are regarded as the main facilitators to scaling-up of peer support for exclusive breastfeeding. Partnerships with village health teams (VHTs), community groups, role models, professional associations and the media are other potential facilitators to this scaling-up.

3.
BMC Health Serv Res ; 20(1): 222, 2020 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-32183796

RESUMO

BACKGROUND: Although Differentiated Service Delivery (DSD) for anti-retroviral therapy (ART) has been rolled-out nationally in several countries since World Health Organization (WHO)'s landmark 2016 guidelines, there is little research evaluating post-implementation outcomes. The objective of this study was to explore patients' and HIV service managers' perspectives on barriers to implementation of Differentiated ART service delivery in Uganda. METHODS: We employed a qualitative descriptive design involving 124 participants. Between April and June 2019 we conducted 76 qualitative interviews with national-level HIV program managers (n = 18), District Health Team leaders (n = 24), representatives of PEPFAR implementing organizations (11), ART clinic in-charges (23) in six purposively selected Uganda districts with a high HIV burden (Kampala, Luwero, Wakiso, Mbale, Budadiri, Bulambuli). Six focus group discussions (48 participants) were held with patients enrolled in DSD models in case-study districts. Data were analyzed by thematic approach as guided by a multi-level analytical framework: Individual-level factors; Health-system factors; Community factors; and Context. RESULTS: Our data shows that multiple barriers have been encountered in DSD implementation. Individual-level: Individualized stigma and a fear of detachment from health facilities by stable patients enrolled in community-based models were reported as bottlenecks. Socio-economic status was reported to have an influence on patient selection of DSD models. Health-system: Insufficient training of health workers in DSD delivery and supply chain barriers to multi-month ART dispensing were identified as constraints. Patients perceived current selection of DSD models to be provider-intensive and not sufficiently patient-centred. Community: Community-level stigma and insufficient funding to providers to fully operationalize community drug pick-up points were identified as limitations. CONTEXT: Frequent changes in physical addresses among urban clients were reported to impede the running of patient groups of rotating ART refill pick-ups. CONCLUSION: This is one of the first multi-stakeholder evaluations of national DSD implementation in Uganda since initial roll-out in 2017. Multi-level interventions are needed to accelerate further DSD implementation in Uganda from demand-side (addressing HIV-related stigma, community engagement) and supply-side dimensions (strengthening ART supply chain capacities, increasing funding for community models and further DSD program design to improve patient-centeredness).


Assuntos
Antirretrovirais/uso terapêutico , Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Assistência à Saúde , Infecções por HIV/tratamento farmacológico , Pessoal de Saúde , Assistência Centrada no Paciente , Instituições de Assistência Ambulatorial , Assistência à Saúde/métodos , Grupos Focais , Programas Governamentais , Pesquisas sobre Serviços de Saúde , Humanos , Entrevistas como Assunto , Competência Profissional , Pesquisa Qualitativa , Estigma Social , Uganda
4.
Pediatr Blood Cancer ; 67(2): e27830, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31135090

RESUMO

INTRODUCTION: Understanding factors that affect the decisions of caregivers of African children to enroll their children in clinical trials would lead to more fully informed consent. METHODS: During the NOHARM study (NCT01976416), a placebo-controlled clinical trial of hydroxyurea for Ugandan children with sickle cell anemia (SCA), 206 caregivers were given a semistructured questionnaire about factors that influenced participation in the study and their perceptions of study benefits and risks. Factors were further assessed with focus group discussions. RESULTS: Caregivers identified education provided during the recruitment process (44%), the child's current poor state of health (35%), and the possibility of improvement in the child's health (16%) as their primary initial reasons for deciding to participate in the NOHARM trial. Concerns regarding the drug or participation in a research study, including the stated concern of death by several caregivers, were outweighed by the possibility of improvement in the child's health. During the study, 72% of caregivers cited improved health as an advantage of study participation, while disadvantages cited included the potential side effects of hydroxyurea, most of which did not occur during the trial. DISCUSSION: Our study findings highlight the generally poor state of health of Ugandan children with SCA, the desperation by caregivers for anything that could improve the child's health, and the inevitable improvements in care that result from strict adherence to a study protocol, even a protocol based on local guidelines. Studies in this vulnerable population must be careful not to portray improved care as a primary incentive for participation.


Assuntos
Anemia Falciforme/tratamento farmacológico , Cuidadores/psicologia , Tomada de Decisões , Conhecimentos, Atitudes e Prática em Saúde , Consentimento dos Pais/estatística & dados numéricos , Participação do Paciente/psicologia , Medição de Risco/métodos , Anemia Falciforme/patologia , Antidrepanocíticos/uso terapêutico , Criança , Ensaios Clínicos Fase III como Assunto , Humanos , Hidroxiureia/uso terapêutico , Participação do Paciente/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto , Inquéritos e Questionários
5.
PLoS One ; 14(9): e0221902, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31490987

RESUMO

BACKGROUND: Preterm infants are at increased risk of infections including vaccine preventable diseases. Therefore, timely vaccination is crucial to ensure adequate disease protection. Information on whether preterm infants are vaccinated according to chronological age as recommended is limited in low-income countries. OBJECTIVES: We evaluated the timeliness of vaccination and associated factors among preterm infants at Mulago hospital, Uganda. METHODS: We conducted a mixed methods study between July 2016 and April 2017. Vaccination dates of preterm infants aged 6-24 months were obtained from child health cards. Additional data were collected using a questionnaire. Five key informant interviews with health workers and two focus group discussions with caregivers were conducted. Cox regression analysis was used to identify factors associated with vaccination timeliness. Qualitative data was transcribed and analysed manually using content thematic approach. RESULTS: We enrolled 350 preterm infants, with a median age of 8.4 months (IQR 6.8-10.8). Less than half, 149/350 (42.6%) of infants received all vaccines within the recommended time range. Timely vaccination was highest for BCG (92%) and lowest for OPV (45.4%). Untimely vaccination was highest for vaccines administered at 6 weeks (DPT 1, PCV 1 and OPV 1) compared to other vaccines in the EPI schedule. Delivering from home or private clinics and vaccine stock-out were significantly associated with untimely BCG and OPV 0 vaccination. Low maternal education level and being very preterm were associated with untimely DPT 1 and DPT 3 receipt. Admission and long stay in the neonatal unit were associated with untimely DPT 1 receipt while extreme low birth weight was associated with untimely DPT 3 vaccination. Increasing parity was associated with untimely measles vaccination. Qualitative findings revealed that lack of knowledge and poor attitudes of health workers and caregivers, gaps in documentation of vaccination status and inadequate communication by health workers hindered timely vaccination. CONCLUSION: More than half of preterm infants attending a specialised clinic at Mulago National Referral hospital in Uganda did not receive vaccines within the recommended time range. Specific strategies to improve vaccination timeliness in preterm infants are needed especially among the extremely low birth weight, very preterm and those with prolonged hospitalisation.


Assuntos
Esquemas de Imunização , Recém-Nascido Prematuro/imunologia , Centros de Atenção Terciária/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Demografia/estatística & dados numéricos , Feminino , Grupos Focais , Humanos , Lactente , Masculino , Uganda
6.
PLoS Negl Trop Dis ; 13(6): e0007344, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31220081

RESUMO

BACKGROUND: Nodding Syndrome was first reported from Tanzania in the 1960s but appeared as an epidemic in Northern Uganda in the 1990s during the LRA civil war. It is characterized by repetitive head nodding, often followed by other types of seizures, developmental retardation and growth faltering with onset occurring in children aged 5-15 years. More than 50 years after the first reports, the aetiology remains unknown and there is still no cure. The recent hypothesis that Nodding Syndrome is caused by onchocerciasis also increases the relevance of onchocerciasis control. Northern Uganda, with its unique socio-political history, adds challenges to the prevention and treatment for Nodding Syndrome. This article aims to show how and why Nodding Syndrome has been politicised in Uganda; how this politicisation has affected health interventions including research and dissemination; and, the possible implications this can have for disease prevention and treatment. METHODOLOGY: Ethnographic research methods were used triangulating in-depth interviews, focus group discussions, informal conversations and participant observation, for an understanding of the various stakeholders' perceptions of Nodding Syndrome and how these perceptions impact future interventions for prevention, treatment and disease control. PRINCIPAL FINDINGS: Distrust towards the government was a sentiment that had developed in Northern Uganda over several decades of war and was particularly linked to the political control and ethnic divisions between the north and south. This coincided with the sudden appearance of Nodding Syndrome, an unknown epidemic disease of which the cause could not be clearly identified and optimal treatment had not clearly been established. Additionally, the dissemination of the inconclusive results of research conducted in the area lacked sufficient community involvement which further fueled this political distrust. Disease perceptions revolved around rumours that the entire Acholi ethnic group of the north would be annihilated, or that international researchers were making money by stealing study samples. This discouraged some community members from participating in research or from accepting the mass drug administration of ivermectin for prevention and treatment of onchocerciasis. Such rumour and distrust led to suspicions concerning the integrity of the disseminated results, which may negatively impact future disease management and control interventions. CONCLUSIONS AND RECOMMENDATIONS: Trust must be built up gradually through transparency and by de-politicising interventions. This can be done by engaging the community at regular intervals during research and data collection and the dissemination of results in addition to involvement during service delivery for prevention and treatment. Maintaining a regular feedback loop with the community will help control rumours, build trust, and improve the preparations for adequate dissemination.


Assuntos
Pesquisa Biomédica/organização & administração , Política de Saúde , Síndrome do Cabeceio/epidemiologia , Síndrome do Cabeceio/etiologia , Adolescente , Animais , Criança , Pré-Escolar , Feminino , Comunicação em Saúde , Humanos , Masculino , Síndrome do Cabeceio/diagnóstico , Síndrome do Cabeceio/terapia , Relações Profissional-Paciente , Uganda/epidemiologia
7.
J Trop Med ; 2019: 6496240, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31223313

RESUMO

Background: While studies have focused on HIV prevalence and incidence among fishing communities, there has been inadequate attention paid to the construction and perception of HIV risk among fisher folk. There has been limited research with respect to communities along Lake Albert on the border between Uganda and the Democratic Republic of Congo (DRC). Methods: We conducted a qualitative study on three landing sites of Butiaba, Bugoigo, and Wanseko on the shores of Lake Albert along the border of Uganda and the Democratic Republic of Congo. Data were collected using 12 Focus Group Discussions and 15 key informant interviews. Analysis was done manually using content and thematic approaches. Results: Lakeshore livelihoods split families between men, women, and children with varying degrees of exposure to HIV infection risk. Sustaining a thriving fish trade was dependent on taking high risks. For instance, profits were high when the lake was stormy. Landing sites were characterized by widespread prostitution, alcohol consumption, drug abuse, and child labour. Such behaviors negatively affected minors and in many ways predisposed them to HIV infection. The lake shore-border heterogeneity resulted in a population with varying HIV knowledge, attitudes, behavior, and competencies to risk perception and adaptation amidst negative masculinities and negative resilience. Conclusion: The susceptibility of lakeshore communities to HIV is attributable to a complex combination of geo-socio, the available (health) services, economic, and cultural factors which converged around the fishing livelihood. This study reveals that HIV risk assessment is an interplay of plural rationalities within the circumstances and constraints that impinge on the daily lives by different actors. A lack of cohesion in a multiethnic setting with large numbers of outsiders and a large transient population made the available HIV interventions less effective.

8.
BMC Hematol ; 19: 9, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31114692

RESUMO

Background: Sickle cell disease (SCD) is a chronic hematologic disease associated with increased morbidity and mortality. Hemoglobinopathies are the most prevalent genetic disease globally, and SCD is estimated to affect 0.7% of Ugandan. The disease may adversely impact on the quality of life of sickle cell patients. This study aimed to evaluate the health related quality of life (HRoL) of adolescents with SCD. Methods: This was a mixed-methods study of adolescents with sickle cell disease and their caretakers living in Kampala city, Uganda. All children aged 8-17 years with homozygous sickle cell disease attending the sickle cell clinic at Mulago Hospital during the study period were included in this study. Participants completed the PedsQL™ generic core scales parent-proxy and child self-report questionnaire during a routine clinic visit. HRQoL was the primary outcome measured. Socio-demographics and disease related data were obtained through personal interview with caretakers and reviewing patients' medical records. Mean scores were used for HRQoL and linear regression for associated factors. Results: Of the 140 adolescents with SCD included in the study, 40% were male. A total of 95 adolescents (68%) were between the age of 8-12 years with a mean age of 14.25 years. The physical function was assessed slightly higher by adolescents with a mean score of57.5 ± 20.3 compare to caretakers with 52.8 ± 22.1(p < 0.001). As assessed by caretakers, physical HRQoL scores were negatively associated with pain about-10.02 CI [- 19.22, - 0.81](p = 0.033), whereas it was positively associated with Pneumococcal vaccine with the score of 28.43 CI [16.78,40.09](p < 0.001) as assessed by adolescents and 31.37CI [22.22,40.51](p < 0.001) by caretakers. Pneumococcal vaccination impacted positively the psychosocial functioning with a score of 8.67CI [1.51,15.84] (p = 0.018) as assessed by children and 15.94 CI [5.50,26.38](p = 0.003) as assessed by the caretakers. Conclusions: This study highlighted that pain was negatively associated with both physical and psychosocial functioning; whereas getting Pneumococcal vaccine was positively associated with both physical and psychosocial functioning as reported by children and caretakers.

9.
BMC Pregnancy Childbirth ; 18(1): 476, 2018 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-30514237

RESUMO

BACKGROUND: Cleansing the umbilical cord with chlorhexidine reduces neonatal morbidity and mortality, particularly in communities where newborn deaths and home births are common. As a result, the World Health Organization and national authorities are advocating the scale up of this intervention. In order for such a scale up to be effective, it has to be acceptable to the targeted population. With the overall aim to clarify conditions for scale-up, this study explored the acceptability of single dose chlorhexidine solution for umbilical cord care among health workers and infant care providers in the districts of Kampala and Mukono in Central Uganda. METHODS: This was a qualitative study that involved mothers of neonates enrolled in a chlorhexidine trial, nurses implementing the trial, key community members and opinion leaders in childcare. We conducted 30 in depth interviews (IDIs) with mothers (18), health workers (8), traditional birth attendants (2), a father (1) and a grandmother (1) and 4 focus group discussions (FGDs), 3 with mothers and 1 with health workers. We used qualitative content analysis to analyze our findings and borrow upon Sekhon's model when presenting our findings. RESULTS: Cognitive and emotional responses to chlorhexidine use included ease of use, and a perception that chlorhexidine reduced smell and abdominal colic. We also found that wider social and cultural factors were important to chlorhexidine use. These included cultural value put on quick separation of the umbilical cord as well as the practice of bathing the baby in a herbal mixture called kyogero. We also found that older relatives were key decision makers in umbilical cord care for newborns, but were seldom present during health workers' counseling of mothers about hygienic care of the cord. CONCLUSIONS: The application of chlorhexidine on the umbilical cord stump at birth was acceptable as an addition rather than a total replacement of traditional substances. The scale up of chlorhexidine should consider how to accommodate local beliefs and practices in a way that does not compromise the effect of the intervention; encouraging mothers to delay the bathing of babies in kyogero could be one way of doing this.


Assuntos
Anti-Infecciosos Locais/uso terapêutico , Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Clorexidina/uso terapêutico , Doenças do Recém-Nascido/prevenção & controle , Mães , Aceitação pelo Paciente de Cuidados de Saúde , Assistência Perinatal/métodos , Cordão Umbilical , Adulto , Agentes Comunitários de Saúde , Feminino , Grupos Focais , Humanos , Ciência da Implementação , Recém-Nascido , Infecções , Tocologia , Enfermeiras e Enfermeiros , Pesquisa Qualitativa , Autoeficácia , Uganda
10.
BMC Infect Dis ; 18(1): 566, 2018 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-30428835

RESUMO

BACKGROUND: Prevention of mother to child transmission (PMTCT) has lowered the incidence of paediatric HIV globally. The risk of mother-to-child transmission of HIV (MTCT) remains high in Africa, where there is a high prevalence of pregnancy and poor health-seeking behaviour among young girls and women. METHODS: In this cross-sectional, mixed-methods study, we evaluated the utilization of PMTCT services and associated factors among adolescent and young postpartum mothers aged 15 to 24 years at a public urban referral hospital in Uganda. Both HIV-positive and HIV-negative participants were recruited. Utilization of PMTCT services was defined as use of the PMTCT cascade of services including ever testing for HIV, receiving HIV test results; If tested negative, subsequent retesting up to 14 weeks; If tested positive, Antiretroviral drugs (ARVs) for the mother, ARVs and septrin prophylaxis for infant, safe delivery, safer infant feeding, early infant diagnosis within 6 weeks, and linkage to treatment and care. Optimal utilization of PMTCT was defined as being up to date with utilization of PMTCT services for reported HIV status at the time of being interviewed. The overall proportion of participants who optimally utilized PMTCT services was determined using descriptive statistics. Qualitative data was analyzed manually using the content thematic approach. RESULTS: Of the 418 participants, 65 (15.5%) were HIV positive. Overall, only 126 of 418 participants (30.1%) had optimally utilized PMTCT services. However, utilization of PMTCT services was better among HIV positive mothers, with 83% (54/65) having utilized the services optimally, compared to only 20% (72/353) of the HIV negative mothers (OR 18.2 (95% CI; 9.0-36.7)). The benefits of knowing ones HIV status, health of the unborn child, and counseling and support from health workers and peers, were the major factors motivating adolescent and young mothers to utilize PMTCT services, while stigma, financial constraints, non-disclosure, and lack of partner and family support were key demotivating factors. CONCLUSION: Utilization of PMTCT services by these adolescent and young mothers was suboptimal. Special consideration should be given to adolescents and young women in the design of elimination of mother to child transmission (EMTCT) programs, to improve the utilization of PMTCT services.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Complicações Infecciosas na Gravidez/tratamento farmacológico , Adolescente , Adulto , Aconselhamento , Estudos Transversais , Feminino , HIV , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Humanos , Lactente , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Mães , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Gravidez na Adolescência/estatística & dados numéricos , Prevalência , Estigma Social , Uganda/epidemiologia , Adulto Jovem
11.
Glob Health Action ; 11(1): 1523302, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30295159

RESUMO

BACKGROUND: In the context of declining international assistance for ART scale-up in Sub-Saharan Africa, the institutionalization of ART programs through integrating them in the organizational routines of health facilities is gaining importance as a program sustainability strategy. OBJECTIVE: The aims of this study were; (i) to compare the level of institutionalization of ART programs in health facilities in Uganda and (ii) to explore reasons for variations in the degree of program institutionalization. METHODS: In Phase One, we utilized Level of Institutionalization Scales developed by Goodman (1993) to measure the degree of institutionalization of ART interventions in 195 health facilities across Uganda. The 45-item questionnaire measured institutionalization based on four sub-systems (production, maintenance, supportive, managerial) theorized to make up an organization assessed against two levels of institutionalization; routines (lowest) niche saturation (highest). In Phase Two, four health facilities were purposively selected (2 with the highest and 2 with the lowest institutionalization scores) for a multiple case-study involving semi-structured interviews with ART clinic managers(n = 32), on-site observations and document review. RESULTS: The two highest scoring health facilities had a longer HIV intervention implementation history of between 8 and 11 years. The highest scoring cases associated intervention institutionalization with sustained workforce trainings in ART management, the retention of ART-trained personnel and generating in-house ART manuals. The turnover of ART-proficient staff was identified as a barrier to intervention institutionalization in the lowest-ranked cases. Significant differences in organizational contexts were identified. The two highest-ranked health facilities were well-established, higher-tier hospitals while the lowest scoring health facilities were lower-level health facilities. CONCLUSIONS: The level of institutionalization of ART interventions appeared to be differentiated by level of care in the Ugandan health system. Interventions aimed at strengthening program institutionalization in lower-level health centers at the level of human resources for health could enhance ART scale-up sustainability.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Antirretrovirais/uso terapêutico , Programas Governamentais/organização & administração , Infecções por HIV/tratamento farmacológico , Institucionalização/organização & administração , Adulto , África ao Sul do Saara , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários , Uganda
12.
BMC Health Serv Res ; 18(1): 690, 2018 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-30185191

RESUMO

BACKGROUND: Although there is mounting evidence and policy guidance urging the integration of HIV services into general health systems in countries with a high HIV burden, vertical (stand-alone) HIV clinics are still common in Uganda. We sought to describe the specific contexts underpinning the endurance of vertical HIV clinics in Uganda. METHODS: A qualitative research design was adopted. Semi-structured interviews were conducted with the heads of HIV clinics, clinicians and facility in-charges (n = 78), coupled with eight focus group discussions (64 participants) with patients from 16 health facilities purposively selected, from a nationally-representative sample of 195 health facilities across Uganda, because they run stand-alone HIV clinics. Data were analyzed by thematic approach as guided by the theory proposed by Shediac-Rizkallah & Bone (1998) which identifies; Intervention characteristics, organizational context, and broader environment factors as potentially influential on health programme sustainability. RESULTS: Intervention characteristics: Provider stigma was reported to have been widespread in the integrated care experience of participating health facilities which necessitated the establishment of stand-alone HIV clinics. HIV disease management was described as highly specialized which necessitated a dedicated workforce and vertical HIV infrastructure such as counselling rooms. Organizational context: Participating health facilities reported health-system capacity constraints in implementing integrated systems of care due to a shortage of ART-proficient personnel and physical space, a lack of laboratory capacity to concurrently conduct HIV and non-HIV tests and increased workloads associated with implementing integrated care. Broader environment factors: Escalating HIV client loads and external HIV funding architectures were perceived to have perpetuated verticalized HIV programming over the past decade. CONCLUSION: Our study offers in-depth, contextualized insights into the factors contributing to the endurance of vertical HIV clinics in Uganda. Our analysis suggests that there is a complex interaction in supply-side constraints (shortage of ART-proficient personnel, increased workloads, laboratory capacity deficiencies) and demand-side factors (escalating demand for HIV services, psychosocial barriers to HIV care) as well as the specialized nature of HIV disease management which pose challenges to the integrated-health services agenda.


Assuntos
Infecções por HIV , Instalações de Saúde , Pessoal de Saúde/psicologia , Pacientes/psicologia , Avaliação de Programas e Projetos de Saúde , Adulto , Assistência à Saúde , Feminino , Grupos Focais , Programas Governamentais , Infecções por HIV/economia , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Especialização , Uganda , Adulto Jovem
14.
Clin Infect Dis ; 63(suppl 5): S312-S321, 2016 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-27941110

RESUMO

BACKGROUND: If malaria patients who cannot be treated orally are several hours from facilities for injections, rectal artesunate prior to hospital referral can prevent death and disability. The goal is to reduce death from malaria by having rectal artesunate treatment available and used. How best to do this remains unknown. METHODS: Villages remote from a health facility were randomized to different community-based treatment providers trained to provide rectal artesunate in Ghana, Guinea-Bissau, Tanzania, and Uganda. Prereferral rectal artesunate treatment was provided in 272 villages: 109 through community-based health workers (CHWs), 112 via trained mothers (MUMs), 25 via trained traditional healers (THs), and 26 through trained community-chosen personnel (COMs); episodes eligible for rectal artesunate were established through regular household surveys of febrile illnesses recording symptoms eligible for prereferral treatment. Differences in treatment coverage with rectal artesunate in children aged <5 years in MUM vs CHW (standard-of-care) villages were assessed using the odds ratio (OR); the predictive probability of treatment was derived from a logistic regression analysis, adjusting for heterogeneity between clusters (villages) using random effects. RESULTS: Over 19 months, 54 013 children had 102 504 febrile episodes, of which 32% (31 817 episodes) had symptoms eligible for prereferral therapy; 14% (4460) children received treatment. Episodes with altered consciousness, coma, or convulsions constituted 36.6% of all episodes in treated children. The overall OR of treatment between MUM vs CHW villages, adjusting for country, was 1.84 (95% confidence interval [CI], 1.20-2.83; P = .005). Adjusting for heterogeneity, this translated into a 1.67 higher average probability of a child being treated in MUM vs CHW villages. Referral compliance was 81% and significantly higher with CHWs vs MUMs: 87% vs 82% (risk ratio [RR], 1.1 [95% CI, 1.0-1.1]; P < .0001). There were more deaths in the TH cluster than elsewhere (RR, 2.7 [95% CI, 1.4-5.6]; P = .0040). CONCLUSIONS: Prereferral episodes were almost one-third of all febrile episodes. More than one-third of patients treated had convulsions, altered consciousness, or coma. Mothers were effective in treating patients, and achieved higher coverage than other providers. Treatment access was low. CLINICAL TRIALS REGISTRATION: ISRCTN58046240.


Assuntos
Antimaláricos/administração & dosagem , Antimaláricos/uso terapêutico , Malária/tratamento farmacológico , Administração Retal , Artemisininas/administração & dosagem , Artemisininas/uso terapêutico , Artesunato , Pré-Escolar , Agentes Comunitários de Saúde , Feminino , Gana/epidemiologia , Guiné-Bissau/epidemiologia , Humanos , Lactente , Malária/epidemiologia , Masculino , Encaminhamento e Consulta , Tanzânia/epidemiologia , Uganda/epidemiologia
15.
Vulnerable Child Youth Stud ; 11(3): 281-285, 2016 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-27695510

RESUMO

Inequities in access to HIV prevention and treatment for children remain a global challenge and a black spot to effective HIV prevention and response especially in many HIV endemic countries like Uganda. In Uganda while about 51% of the adults living with HIV are on antiretrovirals, only 39% of the children aged 0-14 years accessed the needed HIV care in 2014. In this article, it is argued that much focus on health system interventions with little regard to bridging the gap between health facilities, where much of the care is provided, and the communities, where children are conceived, born and cared for, contributes to and sustains this inequality. Investments need to be made in building and implementing models that create and enhance linkages between communities and health care facilities. Success factors from the Towards an AIDS Free Generation in Uganda project model in creating these linkages are bringing all actors together in one approach, building on existing community structures and enabling community health workers to be the linking pin between communities and facilities. Only with models like this, full elimination of mother-to-child transmission and paediatric HIV care coverage (0-14 years) can be reached in Uganda and other HIV endemic countries.

16.
Reprod Health ; 13: 41, 2016 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-27091158

RESUMO

BACKGROUND: Integration of sexual and reproductive health (SRH), HIV/AIDS and maternal health (MH) services is a critical strategy to confront the HIV/AIDS epidemic, high maternal mortality and the unmet need for contraception. In 2011 the AIDS Information Centre (AIC) in partnership with the Ministry of Health implemented SRH, HIV/AIDS and MH integration services in the districts of Katakwi and Mubende in Uganda. This paper documents challenges encountered in providing these integrated services in the two districts. METHODS: This was a cross-sectional qualitative study conducted in Mubende and Katakwi districts in Uganda. Data were collected using 10 focus group discussions with 89 women attending ANC and postnatal care and 21 key informant interviews with district managers and health workers who were involved in the integrated service delivery. Content thematic approach was used for data analysis. RESULTS: The study findings indicate that various challenges were encountered in integrating HIV, ANC and PNC services. Major challenges included inadequate staff, gaps in knowledge of service providers especially with regard to provision of long-term family planning, limited space, shortage of critical supplies such as HIV test kits, drugs and gloves. CONCLUSION: These findings indicate that the delivery of integrated HIV, SRH and MH services is hampered greatly by health system challenges and depict the need for additional staffing in health facilities, capacity building of health workers and health managers as well as ensuring sufficient supplies to health facilities for smooth implementation of integrated SRH, HIV and MH services.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Prestação Integrada de Cuidados de Saúde , Infecções por HIV/tratamento farmacológico , Cuidado Pós-Natal , Complicações Infecciosas na Gravidez/tratamento farmacológico , Cuidado Pré-Natal , Saúde da População Rural , Adolescente , Adulto , Fármacos Anti-HIV/provisão & distribução , Fortalecimento Institucional , Estudos Transversais , Prestação Integrada de Cuidados de Saúde/tendências , Feminino , Grupos Focais , Luvas Protetoras/provisão & distribução , Infecções por HIV/diagnóstico , Infecções por HIV/transmissão , Mão de Obra em Saúde , Humanos , Estudos de Casos Organizacionais , Cuidado Pós-Natal/tendências , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Cuidado Pré-Natal/tendências , Pesquisa Qualitativa , Kit de Reagentes para Diagnóstico/provisão & distribução , Saúde da População Rural/etnologia , Uganda , Adulto Jovem
17.
BMJ Open ; 6(3): e009991, 2016 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-26966059

RESUMO

OBJECTIVE: To examine the relationship between pregnancy history and the use of contraception among women of reproductive age (15-49 years) in East Africa. METHODS: Demographic and Health Surveys data from Burundi (2010), Kenya (2008-2009), Rwanda (2010), Tanzania (2010) and Uganda (2011) were used in the analysis. Logistic regression was used to determine the effects of women's pregnancy history on their use of contraception. SETTING: Burundi, Kenya, Rwanda, Tanzania and Uganda. PARTICIPANTS: 3226, 2377, 4396, 3250 and 2596 women of reproductive age (15-49 years) from Burundi, Kenya, Rwanda, Tanzania and Uganda, respectively, were included in the analysis. RESULTS: Women who had experienced a mistimed pregnancy were more likely to use a modern contraceptive method during their most recent sexual encounter in Kenya, Rwanda, Burundi and Uganda. Other significant correlates of women's contraceptive use were: desire for more children, parity, household wealth, maternal education and access information through radio. In-country regional differences on use of modern contraceptive methods were noted across five East African countries. CONCLUSIONS: Women's birth histories were significantly associated with their decision to adopt a modern contraceptive method. This highlights the importance of considering women's birth histories, especially women with mistimed births, in the promotion of contraceptive use in East Africa. Variations as a result of place of residency, educational attainment, access to family planning information and products, and wealth ought to be addressed in efforts to increase use of modern contraceptive methods in the East African region.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/métodos , Serviços de Planejamento Familiar/estatística & dados numéricos , Fertilidade , História Reprodutiva , Adolescente , Adulto , África Oriental , Demografia , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Gravidez , Fatores Socioeconômicos , Adulto Jovem
18.
BMC Health Serv Res ; 13: 189, 2013 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-23705793

RESUMO

BACKGROUND: Routine HIV counselling and testing as part of antenatal care has been institutionalized in Uganda as an entry point for pregnant women into the prevention of mother-to-child transmission of HIV (PMTCT) programme. Understanding how women experience this mode of HIV testing is important to generate ideas on how to strengthen the PMTCT programme. We explored pregnant HIV positive and negative women's experiences of routine counselling and testing in Mbale District, Eastern Uganda and formulated suggestions for improving service delivery. METHODS: This was a qualitative study conducted at Mbale Regional Referral Hospital in Eastern Uganda between January and May 2010. Data were collected using in-depth interviews with 30 pregnant women (15 HIV positive and 15 HIV negative) attending an antenatal clinic, six key informant interviews with health workers providing antenatal care and observations. Data were analyzed using a content thematic approach. RESULTS: Prior to attending their current ANC visit, most women knew that the hospital provided HIV counselling and testing services as part of antenatal care (ANC). HIV testing was perceived as compulsory for all women attending ANC at the hospital but beneficial, for mothers, especially those who test HIV positive and their unborn babies. Most HIV positive women were satisfied with the immediate counselling they received from health workers, but identified the need to provide follow up counselling and support after the test, as areas for improvement. However, most HIV negative women mentioned that they were given inadequate attention during post-test counselling. This left them with unanswered questions and, for some, doubts about the negative test results. CONCLUSIONS: In this setting, routine HIV counselling and testing services are known and acceptable to mothers. There is need to strengthen post-test and follow up counselling for both HIV positive and negative women in order to maximize opportunities for primary and post exposure HIV prevention. Partnerships and linkages with people living with HIV, especially those in existing support groups such as those at The AIDS Support Organization (TASO), may help to strengthen counselling and support for pregnant women. For effective HIV prevention, women who test HIV negative should be supported to remain negative.


Assuntos
Aconselhamento , Infecções por HIV/diagnóstico , Conhecimentos, Atitudes e Prática em Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Complicações Infecciosas na Gravidez/diagnóstico , Gestantes/psicologia , Adolescente , Adulto , Área Programática de Saúde , Feminino , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Soropositividade para HIV/psicologia , Humanos , Entrevistas como Assunto , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Cuidado Pré-Natal/psicologia , Pesquisa Qualitativa , Programas Médicos Regionais , População Rural , Classe Social , Uganda , Adulto Jovem
19.
J Int AIDS Soc ; 15(2): 17429, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22905360

RESUMO

INTRODUCTION: Disclosure of HIV serostatus by women to their sexual partners is critical for the success of the prevention of mother-to-child transmission of HIV (PMTCT) programme as an integrated service in antenatal care. We explored pregnant HIV-positive and HIV-negative women's partner disclosure experiences and support needs in eastern Uganda. METHODS: This was a qualitative study conducted at Mbale Regional Referral Hospital in eastern Uganda between January and May 2010. Data collection was through in-depth interviews with 15 HIV-positive and 15 HIV-negative pregnant women attending a follow up antenatal clinic (ANC) at Mbale Hospital, and six key informant interviews with health workers at the clinic.Data management was done using NVivo version 9, and a content thematic approach was used for analysis. RESULTS: All HIV-negative women had disclosed their HIV status to their sexual partners but expressed need for support to convince their partners to also undergo HIV testing.Women reported that their partners often assumed that they were equally HIV-negative and generally perceived HIV testing in the ANC as a preserve for women. Most of the HIV-positive women had not disclosed their HIV status to sexual partners for fear of abandonment, violence and accusation of bringing HIV infection into the family. Most HIV-positive women deferred disclosure and requested health workers' support in disclosure. Those who disclosed their positive status generally experienced positive responses from their partners. CONCLUSIONS: Within the context of routine HIV testing as part of the PMTCT programme, most women who test HIV-positive find disclosure of their status to partners extremely difficult. Their fear of disclosure was influenced by the intersection of gender norms, economic dependency, women's roles as mothers and young age. Pregnant HIV-negative women and their unborn babies remained at risk of HIV infection owing to the resistance of their partners to go for HIV testing. These findings depict a glaring need to strengthen support for both HIV-positive and HIV-negative women to maximize opportunities for HIV prevention.


Assuntos
Infecções por HIV/psicologia , Relações Interpessoais , Complicações Infecciosas na Gravidez/psicologia , Cônjuges/psicologia , Revelação da Verdade , Adolescente , Adulto , Feminino , Humanos , Entrevistas como Assunto , Gravidez , Gestantes , Parceiros Sexuais/psicologia , Uganda , Adulto Jovem
20.
BMC Health Serv Res ; 12: 3, 2012 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-22222064

RESUMO

BACKGROUND: The implementation and utilization of programmes for the prevention of mother-to-child transmission (PMTCT) of HIV in most low income countries has been described as sub-optimal. As planners and service providers, the views of health workers are important in generating priorities to improve the effectiveness of the PMTCT programme in Uganda. We explored the lessons learnt by health workers involved in the provision of PMTCT services in eastern Uganda to better understand what more needs to be done to strengthen the PMTCT programme. METHODS: A qualitative study was conducted at Mbale Regional Referral Hospital, The AIDS Support Organisation (TASO) Mbale and at eight neighbouring health centres in eastern Uganda, between January and May 2010. Data were collected through 24 individual interviews with the health workers involved in the PMTCT programme and four key informants (2 district officials and 2 officials from TASO). Data were analyzed using the content thematic approach. Study themes and sub-themes were identified following multiple reading of interview transcripts. Relevant quotations have been used in the presentation of study findings. RESULTS: The key lessons for programme improvement were: ensuring constant availability of critical PMTCT supplies, such as HIV testing kits, antiretroviral drugs (ARVs) for mothers and their babies, regular in-service training of health workers to keep them abreast with the rapidly changing knowledge and guidelines for PMTCT, ensuring that lower level health centres provide maternity services and ARVs for women in the PMTCT programme and provision of adequate facilities for effective follow-up and support for mothers. CONCLUSIONS: The voices of health workers in this study revealed that it is imperative for government, civil society organizations and donors that the PMTCT programme addresses the challenges of shortage of critical PMTCT supplies, continuous health worker training and follow-up and support for mothers as urgent needs to strengthen the PMTCT programme.


Assuntos
Atitude do Pessoal de Saúde , Infecções por HIV/transmissão , Pessoal de Saúde/psicologia , Promoção da Saúde/organização & administração , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Complicações Infecciosas na Gravidez , Desenvolvimento de Programas/métodos , Estudos Transversais , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Gravidez , Pesquisa Qualitativa , Uganda
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