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1.
BMC Infect Dis ; 19(1): 1076, 2019 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-31864297

RESUMO

BACKGROUND: HIV voluntary counseling and testing (VCT) is a crucial gateway to all strategies related to care, prevention and treatment of human immunodeficiency virus (HIV) infection. Nevertheless, utilization of voluntary counselling and testing (VCT) service among adults is very low in Ethiopia. The objective of this study is to identify determinants associated with VCT utilization among adult women aged 15-49 in Ethiopia. METHODS: A cross-sectional study was conducted based on data taken from the Ethiopian Demographic Health Survey (EDHS) 2016. Using cluster sampling, 14,369 women aged 15-49 years were selected from all the nine administrative regions and two city administrations. Logistic regression was used to analyze factors associated with HIV VCT utilization. RESULTS: Overall prevalence of ever tested for HIV was 53% (95% CI, 52, 54). Aged 20-44, ever married, being at higher socio economic position (SEP) and having risky sexual behavior were factors which are positively associated with VCT utilization. Being Muslims in urban and protestants in rural were factors significantly and negatively associated with VCT utilization. Those who had stigmatizing attitude both in urban and rural and who had comprehensive knowledge in rural were less likely to utilize VCT service. CONCLUSION: VCT utilization among women in Ethiopia is demonstrating better improvement in recent years. However, stigmatizing attitude continued to be among the major factors, which are negatively affecting VCT uptake among women in Ethiopia. Concerted efforts should be made by all stakeholders to mitigate stigma, improve socio economic inequities and increase awareness on the benefit of VCT in controlling HIV in the society. In this aspect, the role of religious leader, schools, health extension workers and community leaders should not be undermined.


Assuntos
Aconselhamento/estatística & dados numéricos , Infecções por HIV/diagnóstico , Programas de Rastreamento/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adolescente , Adulto , Estudos Transversais , Etiópia/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos , Humanos , Programas de Rastreamento/psicologia , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Estigma Social , Fatores Socioeconômicos , Adulto Jovem
2.
Afr J AIDS Res ; 18(4): 332-340, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31779576

RESUMO

HIV testing rates remain stubbornly low among men - a crucial target population for reaching the ambitious global and regional goals of the HIV programme. In an era of declining donor funding, identifying cost-effective strategies to increase testing rates amongst men remains paramount. Antenatal care is an effective entry-point for the delivery of HIV testing services for women, and partner testing presents an important opportunity to reach their male partners. We present the results of a discrete choice experiment in Uganda, examining preferences among 824 pregnant women and 896 male partners regarding service delivery characteristics of HIV testing. Both men and women preferred nurse administered testing to self-testing (OR = 0.835; p < 0.001), oral testing over a finger-prick test (OR = 1.176; p < 0.001) and testing with a partner over testing alone (OR = 1.230; p < 0.001). Men had a preference for testing at home compared to testing at a clinic (OR = 1.099; p = 0.024), but women were indifferent regarding the testing location. The cost of testing had the biggest effect on preferences. Free testing was preferred over a cost of US$2.90 (OR = 0.781; p < 0.001) or US$2.00 (OR = 0.670; p < 0.001). Offering an incentive of US$3.40 increased men's preferences compared to a free test (OR = 1.168; p < 0.001), although this did not affect women's preferences. Partner testing linked to antenatal care is a potential strategy to increase testing coverage among men, particularly given the preference for partner testing - provided costs to clients remain low. Future cost-effectiveness evaluations should investigate the economic impact of reaching men using these strategies.


Assuntos
Infecções por HIV/diagnóstico , Programas de Rastreamento/psicologia , Preferência do Paciente/estatística & dados numéricos , Gestantes/psicologia , Cuidado Pré-Natal/estatística & dados numéricos , Parceiros Sexuais/psicologia , Adulto , Instituições de Assistência Ambulatorial , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Humanos , Masculino , Gravidez , Cuidado Pré-Natal/psicologia , Uganda/epidemiologia
3.
Artigo em Inglês | MEDLINE | ID: mdl-31614513

RESUMO

To determine whether Seoul's dementia screening program increased the rate of diagnosis and the appropriate use of healthcare services for people with dementia, a retrospective data analysis was conducted based on administrative data from the Health Insurance Review and Assessment Service. Two cohorts were constructed to represent the year before Seoul's dementia screening program began (2007) (control group) and the year after the implementation of the program (2009) (treatment group). A difference-in-difference analysis was used to compare the diagnosis rates, number of clinic visits, and dementia-related drug prescription rates for 4 districts that implemented dementia screening programs between 2007 and 2009 and 14 areas that did not. After the introduction of the program, there was a 55.4% increase in physician-diagnosed dementia. The "average drug cost per patient" increased by 52.2% (Exp(ß) = 1.522, p = 0.0264), the "average outpatient visits per patient" tended to increase by 13.5% (Exp(ß) = 1.135, p = 0.1852), and the "average outpatient treatment fees per visit per patient" tended to increase by 24.4% (Exp(ß) = 1.244, p = 0.0821). The implementation of dementia screening programs led to an increase in healthcare service utilization. Therefore, this program was found to be an effective strategy for reducing undiagnosed dementia cases and encouraging patients to use adequate healthcare services.


Assuntos
Demência/diagnóstico , Demência/terapia , Programas de Rastreamento/psicologia , Programas de Rastreamento/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Estudos Retrospectivos
4.
Patient Educ Couns ; 102(12): 2335-2343, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31561933

RESUMO

OBJECTIVE: To construct and validate a computer-based and performance-based instrument to assess health literacy skills for informed decision making in colorectal cancer screening among screening invitees. METHODS: An instrument was constructed based on a conceptual framework of health literacy skills in colorectal cancer screening and findings from an expert survey. The instrument was field-tested among individuals with low health literacy (n = 28). Its validity and reliability was assessed using classical test theory and item response theory approaches in an online panel of colorectal cancer screening invitees (n = 696). RESULTS: Confirmatory factor analysis confirmed four separate factors: Comprehension, Application, Numeracy and Communication. A fifth domain (Appraisal) demonstrated poor reliability and validity and was omitted in further analyses. Internal consistency (Cronbach's alpha > 0.6 for the four scales) was acceptable and test-retest reliability was moderate. The four factors were measurement invariant for age, sex and educational level. CONCLUSION: The computer-based measures were acceptable for self-administration. The constructed multidimensional health literacy instrument showed acceptable measurement properties. PRACTICE IMPLICATIONS: Our findings imply that the computer-based instrument can be used for the development of interventions to support informed decision making about colorectal cancer screening among individuals with varying health literacy levels. Further research is needed for optimizing performance-based measurement of the Appraisal and Communication domains.


Assuntos
Neoplasias Colorretais/diagnóstico , Tomada de Decisões , Alfabetização em Saúde/normas , Consentimento Livre e Esclarecido/normas , Programas de Rastreamento/psicologia , Educação de Pacientes como Assunto/métodos , Inquéritos e Questionários/normas , Neoplasias Colorretais/prevenção & controle , Neoplasias Colorretais/psicologia , Feminino , Alfabetização em Saúde/métodos , Humanos , Consentimento Livre e Esclarecido/psicologia , Masculino , Programas de Rastreamento/métodos , Reprodutibilidade dos Testes
5.
Health Psychol ; 38(12): 1083-1095, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31556658

RESUMO

OBJECTIVE: This prospective study aimed to identify predictors of intention and subsequent attendance of flexible sigmoidoscopy screening using constructs derived from the Health Belief Model (HBM). METHOD: A total of 4,330 people aged 54 years and registered at 1 of 83 participating English general practices were sent a preinvitation questionnaire to assess sociodemographics, HBM variables including perceived benefits, barriers, seriousness, health motivation, and external cues to action as well a range of other constructs and personal characteristics known to relate to cancer screening. RESULTS: Of the 1,578 respondents (36.4%), 1,555 (98.5%) answered the intention question: 52.9% stated definitely yes, 38.1% probably yes, 6.8% probably not, and 2.2% definitely not. Intentions were positively associated with a higher score on a scale of benefits (odds ratio [OR] = 4.62; 95% confidence intervals [CI; 3.24, 6.59]) and health motivation, that is, interest in other ways of preventing colorectal cancer (OR = 2.61; 95% CI [1.62, 4.22]), while a higher score on perceived barriers (OR = 0.19; 95% CI [0.12, 0.31]) and currently following recommended healthy lifestyle behaviors (OR = 0.31; 95% CI [0.16, 0.59]) were negatively associated. Attendance was verified for 922 intenders (65.2%) of whom 737 (79.9%) attended. Attendance was predicted by health motivation (OR = 1.75; 95% CI [1.07, 2.86]), perceived benefits (OR = 1.82; 95% CI [1.37, 2.43]), perceived barriers (OR = 0.47; 95% CI [0.32, 0.69]), individual-level deprivation (OR = 0.26; 95% CI [0.14, 0.50]), and having diabetes (OR = 0.48; 95% CI [0.25, 0.94]). CONCLUSION: This study supported the usefulness of the HBM in predicting cancer screening and was further enhanced by adding non-HBM variables such as individual socioeconomic deprivation and comorbidities. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Neoplasias Colorretais/psicologia , Detecção Precoce de Câncer/psicologia , Sigmoidoscopia/métodos , Feminino , Humanos , Intenção , Masculino , Programas de Rastreamento/psicologia , Pessoa de Meia-Idade , Estudos Prospectivos
6.
Bull Soc Pathol Exot ; 112(2): 90-95, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31478618

RESUMO

Schools are considered as one of the most effective vectors for education on sexually transmitted diseases among young people. We report here the results of a study of HIV infection as presented in school textbooks in Ivory Coast, conducted in June 2018 as part of the development of a communication strategy to increase demand for HIV infection testing, especially among young people. Surprisingly, even though the textbooks studied were published between 2007 and 2017, almost all of them stated that HIV infection leads to death, with no mention of the existence of treatments that make it possible to live in good health. Some textbooks even stated that no treatment is available. These findings highlight one cause - perhaps major - for the reluctance of young people to get tested. The misrepresentation of HIV infection, reinforced by education, hampers incentive campaigns for HIV testing, for which the best argument is that awareness of a positive HIV status makes it possible to benefit from treatment. The present study included textbooks from the French educational program, used throughout French-speaking Africa, and from the Ivory Coast program. It would be interesting to conduct a similar study in other French-speaking and English-speaking African countries. Adapting the presentation of HIV in school textbooks to reflect the current situation in the fight against HIV infection should be a priority.


Assuntos
Comunicação , Infecções por HIV , Serviços de Saúde Escolar , Livros de Texto como Assunto , Síndrome de Imunodeficiência Adquirida/diagnóstico , Síndrome de Imunodeficiência Adquirida/prevenção & controle , Síndrome de Imunodeficiência Adquirida/transmissão , Atitude Frente a Saúde , Costa do Marfim/epidemiologia , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , HIV-1/fisiologia , HIV-2/fisiologia , Promoção da Saúde/métodos , Promoção da Saúde/normas , Humanos , Conhecimento , Linguagem , Programas de Rastreamento/psicologia , Serviços de Saúde Escolar/normas , Serviços de Saúde Escolar/estatística & dados numéricos , Educação Sexual/normas , Educação Sexual/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/prevenção & controle , Doenças Sexualmente Transmissíveis/transmissão , Livros de Texto como Assunto/normas
8.
J Clin Nurs ; 28(23-24): 4471-4477, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31410923

RESUMO

AIMS AND OBJECTIVES: To determine the effect of the knowledge and health beliefs of individuals about colorectal cancer on their screening behaviour. BACKGROUND: Colorectal cancer ranks third among the most common cancers both worldwide and in Turkey. Colorectal cancer plays an important role in cancer mortality but can be prevented by promoting healthy behaviour and participation in early screening programmes. DESIGN: This descriptive study was completed with 114 women and 121 men. METHODS: The study data were collected using the 'Data collection form' and 'Health Belief Model Scale for Protection from Colorectal Cancer'. Potential risk factors were investigated using logistic regression analyses. The AGREE checklist was completed. RESULTS: The colorectal cancer screening tests were known by 23.0% of the subjects and 17% had undergone one of these tests. The score medians obtained from the confidence-benefit subscale of Health Belief Model Scale for Protection from Colorectal Cancer were found to be significantly higher in those who had undergone colorectal cancer screening. Logistic regression analysis revealed that having knowledge of the relevant tests was associated with undergoing colorectal cancer screening. CONCLUSIONS: Having knowledge on colorectal cancer screening tests increases the relevant confidence-benefit perception regarding the tests and the behaviour of participating in screening programmes. Regular training on colorectal cancer and early diagnosis should therefore be provided by healthcare professionals to both women and men aged 50-70 years to increase the rate of undergoing early screening tests. RELEVANCE TO CLINICAL PRACTICE: Increasing the rate of early screening is among the responsibilities of health workers working in primary health centres. Therefore, problems that prevent individuals from participating in these programmes need to be identified. In this way, health workers will develop suggestions and initiatives that change the individual's health beliefs and increase motivation.


Assuntos
Neoplasias Colorretais/prevenção & controle , Detecção Precoce de Câncer/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Programas de Rastreamento/psicologia , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Fatores de Risco , Turquia
9.
BMC Public Health ; 19(1): 1136, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31426776

RESUMO

BACKGROUND: Worldwide, HIV remains a major public health challenge, especially in Sub-Saharan Africa. Literature indicates that men's involvement in HIV testing, care, and treatment services is lower compared to women, therefore novel approaches are required to engage men in the cascade of HIV care. This study aimed to explore men's perception on the provision of HIV testing services in venues where English Premier League football games are televised. METHODS: An exploratory qualitative study was conducted between February and May 2018. Six focus group discussions were conducted with 50 conveniently selected men aged 18 years and older using a pre-tested discussion guide. All focus group discussions were audio recorded, transcribed verbatim, and analyzed thematically. RESULTS: Overall, HIV testing at venues telecasting English Premier League football games was acceptable to men. There was a very strong preference for health workers providing testing and counseling services be external or unknown in the local community. Possible motivators for testing services provided in these settings include subsidizing or eliminating entrance fee to venues telecasting games, integrating testing and counseling with health promotion or screening for other diseases, use of local football games as mobilization tools and use of expert clients as role models. CONCLUSIONS: This study suggests that HIV testing services at venues where EPL football games are televised is generally acceptable to men. In implementing such services, consideration should be given to preferences for external or unknown health workers and the motivating factors contributing to the use of these services. Given that HIV testing is currently not conducted in these settings, further research should be conducted to evaluate the feasibility of this approach as a means of enhancing HIV testing among Ugandan men.


Assuntos
Infecções por HIV/prevenção & controle , Promoção da Saúde/métodos , Programas de Rastreamento/psicologia , Homens/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Futebol , Adulto , Idoso , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Uganda , Adulto Jovem
10.
Afr J AIDS Res ; 18(3): 192-197, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31469045

RESUMO

Background: Sub-Saharan Africa accounts for 71% of the global burden of HIV infection. For the general population of Botswana, the estimated HIV prevalence is 18.5%; for female sex workers it is 61.9%. This study explored and documented female sex workers' perceptions and attitudes towards the acceptability of HIV self-testing in Selibe Phikwe, north-eastern Botswana. Methods: Purposive convenience sampling and snowballing approaches were used to recruit 17 participants into the study which was carried out in collaboration with a community-based organisation, the Silence Kills Support Group. Two focus group discussions and five in-depth interviews were conducted. Information was collected on female sex workers' awareness of HIV self-testing, their willingness to use it, their preferred distribution model, and their preferred test kit. Themes and subthemes that emerged were interpreted based on the Integrated Behavioural Model. Results: HIV self-testing (HIVST) was not known to most participants. Participants expressed negative attitude towards HIVST due to a lack of knowledge and confidence to carry out self-testing independently. Participants preferred facility-based services and a blood test over HIVST. Inadequate post-test counselling and lack of assisted HIVST were among their major concerns. Raising community awareness of HIVST through education was suggested. Conclusion: Improving the uptake of HIVST will require community sensitization, the availability of counselling services, close follow-ups, and the introduction of assisted HIVST approaches.


Assuntos
Infecções por HIV/diagnóstico , Conhecimentos, Atitudes e Prática em Saúde , Programas de Rastreamento/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Profissionais do Sexo/psicologia , Adulto , Botsuana , Aconselhamento , Feminino , Grupos Focais , HIV , Infecções por HIV/epidemiologia , Humanos , Masculino , Adulto Jovem
12.
Afr J AIDS Res ; 18(2): 115-122, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31282305

RESUMO

HIV status awareness is a rate limiting step in HIV treatment and prevention initiatives aimed at addressing the global HIV epidemic. Uptake of HIV testing remains suboptimal despite global campaigns aimed at improving uptake. HIV self-testing (HIVST) displays the potential to increase uptake of HIV testing in public health care facilities, which are the main access points for HIV testing, but evidence to support this notion is limited. Therefore, this study determined the factors that influence the feasibility of introducing HIVST into public facilities in KwaZulu-Natal, South Africa, through a mixed method crossover study design, implemented among 40 consenting adults who were either regular HIV testers or HIV testing naïve. Qualitative assessments were conducted using a topic guide centred on the feasibility of HIVST. Usability of HIVST was quantitatively assessed by means of a HIVST usability assessment checklist. Technical, environmental and economic factors were found to influence HIVST feasibility. The majority of participants were able to conduct unsupervised HIVST but training may be required for those unable to follow instructions. Accessibility of HIVST was associated with affordability and convenience. Environmental factors such as storage and location to perform the test and a disposal kit require further consideration in limited resource settings due to lack of privacy and confidentiality. While we demonstrated that HIVST is feasible, and identified factors that may influence its feasibility, these factors require further consideration in primary health care facilities in resource limited settings prior to scale-up.


Assuntos
Infecções por HIV/diagnóstico , Programas de Rastreamento/psicologia , Adolescente , Adulto , Estudos de Coortes , Estudos de Viabilidade , Feminino , HIV/isolamento & purificação , Infecções por HIV/psicologia , Humanos , Masculino , Programas de Rastreamento/métodos , Distribuição Aleatória , População Rural/estatística & dados numéricos , África do Sul , População Urbana/estatística & dados numéricos , Adulto Jovem
13.
Public Health Genomics ; 22(1-2): 25-35, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31330524

RESUMO

BACKGROUND/AIMS: Familial hypercholesterolaemia (FH) is a common genetic disorder that, if untreated, predisposes individuals to premature coronary heart disease. As most individuals with FH remain undiagnosed, new approaches to detection are needed and should be considered a priority in public health genomics. Universal screening of children for FH has been proposed, and this study explores public perspectives on the acceptability of this approach. METHODS: A one-day deliberative public forum was held in Perth, WA, Australia. Thirty randomly selected individuals were recruited, with self-reported sociodemographic characteristics used to obtain discursive representation. Participants were presented with information from a variety of perspectives and asked to discuss the information provided to identify points of consensus and disagreement. The data collected were analysed using thematic analysis. RESULTS: Of the 17 participants at the forum, 16 deemed universal screening of children for FH to be acceptable. Fifteen of these 16 believed this was best performed at the time of an immunisation. Participants proposed a number of conditions that should be met to reduce the likelihood of unintended harm resulting from the screening process. DISCUSSION/CONCLUSION: The outcomes of the forum suggest that establishing a universal screening programme for FH in childhood is acceptable to the general public in WA.


Assuntos
Comportamento do Consumidor , Doença das Coronárias/prevenção & controle , Hiperlipoproteinemia Tipo I , Programas de Rastreamento , Percepção Social , Adulto , Austrália , Criança , Feminino , Humanos , Hiperlipoproteinemia Tipo I/diagnóstico , Hiperlipoproteinemia Tipo I/epidemiologia , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/psicologia , Prevenção Primária/métodos , Opinião Pública
14.
BMC Public Health ; 19(1): 992, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340797

RESUMO

BACKGROUND: Chlamydia trachomatis (C. trachomatis) is the most common bacterial sexually transmitted infection in the UK. Recent studies suggest that in addition to the genital tract, C. trachomatis is found in the throat and rectum, suggesting the number of infections is under-reported. There is an urgent need to study the impact of extending diagnosis to include extra-genital samples; however, there is a lack of evidence on the acceptability of asking young women to provide these samples. METHOD: A mixed methods single group feasibility study explored the acceptability of combined genital and extra-genital testing in young women aged 16-25 years consecutively attending a sexual health centre in Edinburgh, Scotland. Young women were asked to complete a self- administered anonymous questionnaire whether they would be willing to give self-taken throat and ano-rectal samples. Interviews with women (n = 20) willing to self-sample were conducted before and after self-sampling, and these explored the underlying reasons behind their decision, and feelings about the tests. RESULTS: Of 500 women recruited to the study, 422 (84.4%) women provided sufficient data for analysis. From completed questionnaires, 86.3% of respondents reported willingness to self-sample from the throat. Willingness of ano-rectal self-sampling was lower (59.1%), particularly in women under 20 (< 20 years: 44.4%; ≥20 years, 68.2%). Willingness of ano-rectal self-sampling was higher in women who had more sexual partners in the last 6 months (0 partners, 48.3%, n = 14, 3 or more partners, 67.4%, n = 60) and in those who have previous experience of a positive test for a sexually transmitted infection (STI) (positive: 64.5%; negative: 57%). Interviewed women suggested that a lack of knowledge of STIs, embarrassment and lack of confidence in the ability to carry out the sampling were barriers towards acceptability. CONCLUSIONS: In this study, self-sampling of throat samples is largely acceptable; however, the acceptability of taking an ano-rectal sample for C. trachomatis testing in young women was lower in younger women. The study suggests further research to investigate the acceptability of extra-genital testing as an addition to routine C. trachomatis testing, and whether this increases detection and prevents infective sequelae for women.


Assuntos
Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Programas de Rastreamento/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adolescente , Adulto , Chlamydia trachomatis , Estudos de Viabilidade , Feminino , Humanos , Programas de Rastreamento/métodos , Escócia , Comportamento Sexual/psicologia , Parceiros Sexuais/psicologia , Doenças Sexualmente Transmissíveis/psicologia , Inquéritos e Questionários , Adulto Jovem
15.
Behav Med ; 45(2): 134-142, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31343966

RESUMO

Black Americans are greatly affected by HIV disparities and exhibit high levels of medical mistrust, including HIV conspiracy beliefs, a form of mistrust around HIV's origin and treatment. A 2002-2003 national survey of Black Americans found that 48% believed that "HIV is a manmade virus." However, the extent to which such beliefs remain widespread is unknown. Moreover, HIV conspiracy beliefs have been associated with greater HIV risk, but have also been associated with a higher testing likelihood-and no research to date has attempted to explain these seemingly contradictory findings. We obtained updated data on prevalence and correlates of HIV conspiracy beliefs from the US National Survey on HIV in the Black Community, a nationally representative e-mail survey of 868 Black individuals aged 18-50 years (February-April 2016). Substantial percentages agreed that HIV is man-made (31%) and that the government is withholding a cure for HIV (40%). HIV conspiracy beliefs and HIV risk were both significantly associated with a higher HIV testing likelihood. The association between HIV conspiracy beliefs and HIV testing was significantly mediated by individual-level HIV risk (73% of total effect), but not by area-level socioeconomic position (an ecological determinant of higher HIV prevalence). Mistrust remains high among Black Americans, but the association of mistrust with prevention behaviors is complex. People who do not trust the public health system may also be at greater risk-and thus, more likely to get tested, potentially due to greater access to community-based testing venues that engage higher risk populations.


Assuntos
Afro-Americanos/psicologia , Infecções por HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Programas de Rastreamento/psicologia , Confiança/psicologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Classe Social , Adulto Jovem
16.
BMC Public Health ; 19(1): 898, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286953

RESUMO

BACKGROUND: HIV diagnosis is a critical step in linking HIV-infected individuals to care and treatment and linking HIV-uninfected persons to prevention services. However, the uptake of HIV testing remains low in many countries. HIV self-screening (HIVSS) is acceptable to adults, but there is limited data on HIVSS feasibility in community programmes. This study aimed to evaluate the feasibility of HIVSS in South Africa. METHODS: We conducted a prospective study that enrolled participants through mobile site, homebased, workplace and sex worker programmes in two townships from May to November 2017. Following an information session on HIVSS, interested participants were offered one of three methods of HIVSS testing: supervised, semi-supervised, and unsupervised. Participants who opted for unsupervised testing and those who tested HIV positive after semi- or supervised HIVSS were followed up telephonically or with a home visit one week after receipt of the test kit to confirm results and linkages to care. Follow-up visits were concluded when the participant indicated that they had used the kit or had accessed a confirmatory HIV test. RESULTS: Of the 2061 people approached, 88.2% (1818/2061) received HIV testing information. Of this group, 89% (1618/1818) were enrolled in the study and 70.0% (1133/1618) were tested for HIV with the kit. The median age was 28 (IQR:23-33) years with an even gender distribution. Of those enrolled, 43.0% (696/1618) were identified through homebased outreach, 42.5% (687/1618) through mobile sites, 7.3% (118/1618) at their workplace and 7.2% (117/1618) from sex worker programmes. A total of 68.7% (1110/1616) selected unsupervised HIVSS, whereas 6.3% (101/1616) opted for semi-supervised and 25.0% ((405/1616) chose supervised HIVSS. Overall, the HIV prevalence using the HIVSS test was 8.2% (93/1129). Of those newly diagnosed with HIV, 16% (12/75) were initiated on ART. Almost half (48.0%; 543/1131) of those tested were linked to a primary HIV test as follows: supervised (85.2%; 336/394); semi-supervised (93.8%; 91/97) and unsupervised (18.1%; 116/640). CONCLUSION: Unsupervised HIVSS was by far the most selected and utilised HIVSS method. Linkages to primary and confirmatory testing for the unsupervised HIVSS and further care were low, despite home visits and telephonic reminders.


Assuntos
Infecções por HIV/diagnóstico , Programas de Rastreamento/métodos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Autocuidado/métodos , Testes Sorológicos/métodos , Adulto , Estudos de Viabilidade , Feminino , HIV , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Humanos , Masculino , Programas de Rastreamento/psicologia , Prevalência , Estudos Prospectivos , Autocuidado/psicologia , Testes Sorológicos/psicologia , Profissionais do Sexo , África do Sul/epidemiologia , Adulto Jovem
17.
Diabetes Metab Syndr ; 13(3): 1739-1744, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31235087

RESUMO

BACKGROUND: Diabetes mellitus is a public health burden requiring a multi-sectorial approach including adequate population awareness to tackle this epidemic. The study was aimed to determine the level of diabetes awareness among a high-risk dysglycaemic population in relation to socio-demographic, lifestyle and family history of diabetes as well as to body mass index (BMI) and blood pressure measurements. Furthermore, the authors strived to explore any relationships between diabetes awareness and an oral glucose tolerance test dysglycaemia diagnosis. METHOD: Participants obtaining impaired fasting blood glucose in a representative health examination survey were invited to undergo an oral glucose tolerance test (OGTT). During the OGTT session, participants were invited to take part in a diabetes awareness questionnaire as well as have their weight, height and blood pressure measured. Association between awareness scores and different parameters (age, gender, education, residential district, smoking, alcohol habit, family history, BMI and blood pressure) were explored. RESULTS: Being a female, ageing, non-smoker and having a family history of diabetes had a positive association with adequate diabetes awareness. Even though generally good awareness was present, the majority of the participants were obese, with an elevated blood pressure and obtained a dysglycaemic status post OGTT. CONCLUSION: Diabetes awareness solely does not appear to engage individuals in preventive initiatives. Behavioural changes are required but these are only established after the motivational action gap has been overcome. Empowering community diabetes mellitus screening programs targeting the environment, social gradients and cultural norms while engaging in preventive interventions are recommended.


Assuntos
Biomarcadores/análise , Diabetes Mellitus Tipo 2/prevenção & controle , Diabetes Mellitus Tipo 2/psicologia , Educação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Programas de Rastreamento/psicologia , Estado Pré-Diabético/psicologia , Adolescente , Adulto , Idoso , Glicemia/análise , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Seguimentos , Teste de Tolerância a Glucose , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/prevenção & controle , Prognóstico , Fatores de Risco , Adulto Jovem
18.
Diabetes Metab Syndr ; 13(3): 1827-1831, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31235101

RESUMO

BACKGROUND: Gestational diabetes mellitus (GDM) complicates the health of mother and child not only in the short term but also in the long term basis. Addressing GDM through early detection and proper management is vital to improve maternal and child health. Identifying existing barriers for detection and management is important for policy improvement. This study aims to explore barriers for detection and management of GDM in Wolaita Zone, Southern Ethiopia. METHODS: A qualitative study was conducted. Health professionals working in antenatal clinic, delivery, and other maternal health services were selected purposively. A total of 18 in-depth interviews were done. The transcripts were imported into NVIVO version 12 software packages. A qualitative thematic analysis approach was used to analyze the data. RESULTS: Screening of women for GDM was done based on the risk factor assessment within 24-28 weeks of gestational age. The participants mentioned that they made diagnosis of GDM based on the World Health organization criteria. Barriers for detection and management of GDM include; lack of standard guidelines and protocols, lack of awareness among mid-level health care providers on GDM, inadequate trained health care providers, shortage of supplies and equipment and late antenatal care visits. CONCLUSIONS: Policy makers and health care leadership need to address challenges by availing standard guidelines and protocols, providing on job training for health care providers, fulfilling supplies and consumables and working on early antenatal visits of pregnant mothers.


Assuntos
Competência Clínica , Diabetes Gestacional/diagnóstico , Programas de Rastreamento/psicologia , Cooperação do Paciente , Guias de Prática Clínica como Assunto/normas , Adulto , Comportamento Cooperativo , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/psicologia , Diabetes Gestacional/terapia , Gerenciamento Clínico , Etiópia/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Gravidez , Prognóstico , Pesquisa Qualitativa , Inquéritos e Questionários
19.
PLoS One ; 14(6): e0213920, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31246969

RESUMO

BACKGROUND: Women engaging in compensated dating is one of the at risk group of HIV infection due to multiple sexual partnerships and risky sexual practices. The present study examined the prevalence of HIV testing behavior and intention, and identified factors associated with HIV testing intention among women engaging in compensated dating in Hong Kong. Factors from the Theory of Planned Behaviors and the role of various types of barriers to HIV testing were also explored. METHODS: An anonymous, cross-sectional survey was conducted online. Target participants were women who have engaged in compensated dating and provided sex services to clients. Participants were recruited via three sources, including i) online outreaching, ii) referral made by NGOs, and iii) referral made by participants. A total of 183 participants completed the study. RESULTS: Respectively 29.7% and 18.6% have taken up HIV testing and showed intention to take up HIV testing in the future year. Results from the multiple hierarchical regression model showed that having ever received HIV testing (ß = 0.44, p < .001), attitudes towards HIV testing (ß = 0.22, p < .01), subjective norm (ß = 0.18, p < .05), perceived behavioral control (ß = 0.18, p < .01) and perceived discrimination from health care workers (ß = -0.24, p < .05) significantly predicted intention to take up HIV testing. CONCLUSION: The present study demonstrates the applicability of extended TPB in HIV testing intention among women engaging in compensated dating. Interventions to promote HIV testing among this group are greatly warranted.


Assuntos
Infecções por HIV/diagnóstico , Programas de Rastreamento/psicologia , Profissionais do Sexo , Estudos Transversais , Feminino , Infecções por HIV/psicologia , Hong Kong , Humanos , Intenção , Profissionais do Sexo/psicologia , Inquéritos e Questionários , Adulto Jovem
20.
BMC Med Educ ; 19(1): 196, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31185978

RESUMO

BACKGROUND: Routine IPV screening is a controversial topic and there is no evidence to suggest that it improves the health outcomes of women. Consequently, understanding the socio-cultural dimensions, becomes essential to ensure that victims receive appropriate and local support. This study was conducted to gather the perceptions of victims of IPV on the relevance of raising the topic at health care facilities and to determine specific categories of women to target for screening by medical personnel. It also explored how the information gathered could support victims and whether medical students should be trained on issues relating to IPV. METHODS: Thirty-three key informant interviews were conducted among women attending clinics from three teaching hospitals in the Lagos, Oyo and Osun States of South West Nigeria. The hospitals offer antenatal, emergency, primary care and community outreach clinics which are well-attended by women. A six-item questionnaire assessed eligibility for participation in the study and participants were then purposively sampled. Interviews were conducted using a semi-structured guide. Ethical approval and gatekeepers' permissions were obtained, and each participant signed informed consent. Data was collected between June and November 2017. The data was entered into Excel and analysed deductively to answer each objective. RESULTS: Most (n = 24) participants stated that medical practitioners should ask all women who present to health care facilities, about their experiences of IPV. Physically, medically and socially vulnerable women, including those in relationships with men in risky occupations, were identified as needing special attention and possible follow-up. They supported the use of the information within and outside of the health care facility, depending on the need of the woman. The majority (n = 24) indicated a need to train medical students about IPV and 19 participants suggested for the topic to be curriculated. Most victims favoured the inclusion of a multidisciplinary team in teaching medical students about IPV. CONCLUSIONS: Victims of IPV were in support of initiatives to discuss the topic among some groups of female patients in health care settings. They thought it would enhance the quality of care (medical, psychological, legal and social) to victims. They identified an inter-professional team of stakeholders to include when training medical students about IPV.


Assuntos
Vítimas de Crime/psicologia , Educação Médica/métodos , Violência por Parceiro Íntimo , Programas de Rastreamento , Adulto , Feminino , Humanos , Entrevistas como Assunto , Violência por Parceiro Íntimo/psicologia , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/psicologia , Nigéria , Inquéritos e Questionários
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