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4.
BMJ ; 368: l6925, 2020 01 22.
Artigo em Inglês | MEDLINE | ID: mdl-31969320

RESUMO

OBJECTIVE: To investigate pharmaceutical or medical device industry funding of patient groups. DESIGN: Systematic review with meta-analysis. DATA SOURCES: Ovid Medline, Embase, Web of Science, Scopus, and Google Scholar from inception to January 2018; reference lists of eligible studies and experts in the field. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Observational studies including cross sectional, cohort, case-control, interrupted time series, and before-after studies of patient groups reporting at least one of the following outcomes: prevalence of industry funding; proportion of industry funded patient groups that disclosed information about this funding; and association between industry funding and organisational positions on health and policy issues. Studies were included irrespective of language or publication type. REVIEW METHODS: Reviewers carried out duplicate independent data extraction and assessment of study quality. An amended version of the checklist for prevalence studies developed by the Joanna Briggs Institute was used to assess study quality. A DerSimonian-Laird estimate of single proportions with Freeman-Tukey arcsine transformation was used for meta-analyses of prevalence. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) was used to assess the quality of the evidence for each outcome. RESULTS: 26 cross sectional studies met the inclusion criteria. Of these, 15 studies estimated the prevalence of industry funding, which ranged from 20% (12/61) to 83% (86/104). Among patient organisations that received industry funding, 27% (175/642; 95% confidence interval 24% to 31%) disclosed this information on their websites. In submissions to consultations, two studies showed very different disclosure rates (0% and 91%), which appeared to reflect differences in the relevant government agency's disclosure requirements. Prevalence estimates of organisational policies that govern corporate sponsorship ranged from 2% (2/125) to 64% (175/274). Four studies analysed the relationship between industry funding and organisational positions on a range of highly controversial issues. Industry funded groups generally supported sponsors' interests. CONCLUSION: In general, industry funding of patient groups seems to be common, with prevalence estimates ranging from 20% to 83%. Few patient groups have policies that govern corporate sponsorship. Transparency about corporate funding is also inadequate. Among the few studies that examined associations between industry funding and organisational positions, industry funded groups tended to have positions favourable to the sponsor. Patient groups have an important role in advocacy, education, and research, therefore strategies are needed to prevent biases that could favour the interests of sponsors above those of the public. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017079265.


Assuntos
Associações de Consumidores/economia , Indústria Farmacêutica/economia , Administração Financeira/legislação & jurisprudência , Associações de Consumidores/ética , Associações de Consumidores/legislação & jurisprudência , Revelação/ética , Revelação/legislação & jurisprudência , Indústria Farmacêutica/ética , Administração Financeira/ética , Estudos Observacionais como Assunto , Política Organizacional
6.
Lancet ; 395(10221): 361-369, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31958402

RESUMO

BACKGROUND: Failure to report the results of a clinical trial can distort the evidence base for clinical practice, breaches researchers' ethical obligations to participants, and represents an important source of research waste. The Food and Drug Administration Amendments Act (FDAAA) of 2007 now requires sponsors of applicable trials to report their results directly onto ClinicalTrials.gov within 1 year of completion. The first trials covered by the Final Rule of this act became due to report results in January, 2018. In this cohort study, we set out to assess compliance. METHODS: We downloaded data for all registered trials on ClinicalTrials.gov each month from March, 2018, to September, 2019. All cross-sectional analyses in this manuscript were performed on data extracted from ClinicalTrials.gov on Sept 16, 2019; monthly trends analysis used archived data closest to the 15th day of each month from March, 2018, to September, 2019. Our study cohort included all applicable trials due to report results under FDAAA. We excluded all non-applicable trials, those not yet due to report, and those given a certificate allowing for delayed reporting. A trial was considered reported if results had been submitted and were either publicly available, or undergoing quality control review at ClinicalTrials.gov. A trial was considered compliant if these results were submitted within 1 year of the primary completion date, as required by the legislation. We described compliance with the FDAAA 2007 Final Rule, assessed trial characteristics associated with results reporting using logistic regression models, described sponsor-level reporting, examined trends in reporting, and described time-to-report using the Kaplan-Meier method. FINDINGS: 4209 trials were due to report results; 1722 (40·9%; 95% CI 39·4-42·2) did so within the 1-year deadline. 2686 (63·8%; 62·4-65·3) trials had results submitted at any time. Compliance has not improved since July, 2018. Industry sponsors were significantly more likely to be compliant than non-industry, non-US Government sponsors (odds ratio [OR] 3·08 [95% CI 2·52-3·77]), and sponsors running large numbers of trials were significantly more likely to be compliant than smaller sponsors (OR 11·84 [9·36-14·99]). The median delay from primary completion date to submission date was 424 days (95% CI 412-435), 59 days higher than the legal reporting requirement of 1 year. INTERPRETATION: Compliance with the FDAAA 2007 is poor, and not improving. To our knowledge, this is the first study to fully assess compliance with the Final Rule of the FDAAA 2007. Poor compliance is likely to reflect lack of enforcement by regulators. Effective enforcement and action from sponsors is needed; until then, open public audit of compliance for each individual sponsor may help. We will maintain updated compliance data for each individual sponsor and trial at fdaaa.trialstracker.net. FUNDING: Laura and John Arnold Foundation.


Assuntos
Ensaios Clínicos como Assunto/legislação & jurisprudência , Comportamento Cooperativo , Relatório de Pesquisa/legislação & jurisprudência , Pesquisa Biomédica/legislação & jurisprudência , Ensaios Clínicos como Assunto/normas , Ensaios Clínicos como Assunto/estatística & dados numéricos , Estudos de Coortes , Revelação/legislação & jurisprudência , Revelação/normas , Revelação/estatística & dados numéricos , Humanos , Sistema de Registros , Relatório de Pesquisa/normas , Estados Unidos , United States Food and Drug Administration
8.
J Homosex ; 67(2): 189-205, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30372375

RESUMO

Previous research has indicated that the sexual orientation of a sexual assault victim influences perceptions of blame. Although researchers have studied perceptions of blame toward straight and lesbian sexual assault victims, none have yet assessed perceptions of blame toward bisexual victims. The purpose of the current study is to examine perceptions of blame toward a female sexual assault victim and to determine whether the victim's sexual orientation impacts the level of attributed blame. Despite no previous research examining the impact of bisexuality on victim blaming, misconceptions that bisexual females are highly sexual, promiscuous, and untrustworthy make it likely that this population would be subject to greater levels of blame than either straight or lesbian victims. After random assignment to a vignette description of a sexual assault and completion of a victim-blaming questionnaire, results failed to support our hypotheses; participants did not blame the bisexual victim of sexual assault more than either the straight or lesbian victims. Further contrary to expected findings, males did not hold more blaming attitudes than females across conditions. Nonetheless, this study is important given the finding that attributions of blame influence whether sexual assault victims choose to disclose their assault, the failure of which can lead to negative mental health outcomes. Ultimately, the current study was a first step in understanding whether bisexual assault victims are evaluated differently than their straight and lesbian counterparts.


Assuntos
Vítimas de Crime/psicologia , Delitos Sexuais/psicologia , Comportamento Sexual/psicologia , Adulto , Atitude , Bissexualidade/psicologia , Revelação , Feminino , Homossexualidade Feminina/psicologia , Humanos , Percepção Social , Responsabilidade Social , Inquéritos e Questionários
9.
J Homosex ; 67(1): 104-126, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30307803

RESUMO

Malay-Muslim men who have sex with men (MSM) are marginalized and hidden in Malaysia, a predominantly Muslim country in southeast Asia. We explored the policy, network, community, and individual factors related to HIV infection among Malay-Muslim MSM through 26 in-depth interviews and one focus group discussion (n = 5) conducted in Kuala Lumpur and Kota Bharu between October 2013 and January 2014. As religion plays an important role in their lives, participants viewed homosexuality as a sin. Low risk perception and misconceptions about HIV/AIDS were common, and most participants expressed reluctance to consult a doctor unless they had symptoms. Additionally, buying condoms was embarrassing and anxiety-producing. Fear of discrimination by health care providers and community hindered participants from disclosing sexual behaviors and accessing health services. Homophobic comments and policies by the government and religious leaders were concerns of participants. A safe and enabling environment is needed to reduce HIV risks among Malay-Muslim MSM.


Assuntos
Revelação , Infecções por HIV/psicologia , Homofobia , Homossexualidade Masculina , Islamismo , Religião e Sexo , Minorias Sexuais e de Gênero/psicologia , Adulto , Redes Comunitárias , Preservativos , Grupos Focais , Pessoal de Saúde , Acesso aos Serviços de Saúde , Humanos , Malásia , Masculino , Fatores de Risco
10.
J Clin Nurs ; 29(1-2): 94-106, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31509294

RESUMO

AIMS AND OBJECTIVES: To describe the experiences and wishes of lesbian and bisexual women concerning health care in Finland. BACKGROUND: Sexual orientation is a personal aspect of identity and also an important aspect of holistic health care. Lesbian and bisexual women have unmet health needs. The way that healthcare personnel encounter lesbian and bisexual women affects whether they disclose their sexual orientation. DESIGN: Qualitative inductive survey. METHODS: The research data for this study were collected in spring 2018 using an electronic survey (n = 22). The data were analysed using inductive content analysis. The research report has been checked using COREQ checklist, see Appendix S1. RESULTS: The research data were divided into two main domains: experiences and wishes. Women described health care as being heteronormative. They had both good and bad experiences, and their own poor experiences and those of others had a negative impact on their utilisation of healthcare services. Women had apprehensions about encountering stereotyping in health care and did not always disclose their orientation, even though recognising it would be integral to the provision of holistic health care. Lesbian and bisexual women wished that health care would refrain from heteronormativity, acknowledge issues that were important to them and engage with them without any prejudgement. They also wished healthcare environments would be improved to reflect an open acceptance of sexual minorities and also co-operate with sexual minority organisations. CONCLUSIONS: Women had conflicting experiences. Heteronormativity was seen as an obstacle for holistic health care. Women hoped health care would collaborate with the third sector. RELEVANCE TO CLINICAL PRACTICE: Sexual diversity should be acknowledged and better communicated to patients. Women hoped personnel would have the understanding to treat them in the same professional way as any other patients, but with expertise specific to their needs, for example in sexual health guidance.


Assuntos
Revelação , Satisfação do Paciente , Relações Profissional-Paciente , Minorias Sexuais e de Gênero/psicologia , Adulto , Atitude do Pessoal de Saúde , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Qualidade da Assistência à Saúde , Comportamento Sexual/psicologia , Cônjuges , Inquéritos e Questionários
11.
BMJ ; 367: l6704, 2019 11 29.
Artigo em Inglês | MEDLINE | ID: mdl-31784486
12.
Mayo Clin Proc ; 94(12): 2467-2475, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31806100

RESUMO

OBJECTIVES: To characterize public perception of physicians' conflicts of interest (COIs) across medical and surgical specialties. PATIENTS AND METHODS: A cross-sectional 6-arm randomized survey of a nonprobability sample from Amazon's Mechanical Turk occurred on December 11 to 16, 2018. Survey respondents were randomly assigned to vignettes that varied the physician specialty with COI. The primary outcome was mean difference in Mayer Trust, and the secondary outcome included the proportion who desire to discontinue care. RESULTS: There were 1729 of 1920 respondents who completed the experiment (90.1% completion rate). Respondents were male (52.5%; n=907), white (71.4%; n=1234), and between the ages of 25 and 44 years (70.9%; n=1227). Mean ± SD Mayer Trust across the 6 specialties was 3.7±.60, with the only between-specialty differences observed for psychiatry compared with the other specialties (F=5.4; P<.001). The median dollar amount that would affect respondents' trust in a physician was $5000 (interquartile range, $100-$100,000). A total of 75.1% (n=1298) of respondents desired COI information, with 41.6% (n=720) discontinuing care. Age older than 34 years (adjusted odds ratio [aOR], 0.7; 95%, CI, 0.49-0.99; P=.047), nonwhite race (aOR, 1.3; 95% CI, 1.02-1.6; P=.03), educational attainment of 4 or more years of college (aOR, 1.31; 95% CI, 1.05-1.6; P=.016), and physician specialty as a psychiatrist (aOR, 1.5; 95% CI, 1.03-2.2; P=.034) were predictors for discontinuing care. CONCLUSION: Public COI disclosure is a common method for managing financial conflicts. Although survey respondents were more likely to discontinue care with a physician with COI, they will act on this knowledge of COI differently depending on the specialty of the physician. The finding that psychiatry is an outlier may be a chance finding that warrants further confirmation. Continued efforts to ensure best practices for disclosure are required.


Assuntos
Conflito de Interesses , Revelação , Medicina , Opinião Pública , Especialidades Cirúrgicas , Confiança , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Relações Médico-Paciente , Inquéritos e Questionários , Adulto Jovem
13.
Nihon Koshu Eisei Zasshi ; 66(12): 746-755, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31875625

RESUMO

Objectives Multinational R&D pharmaceutical companies operating in many countries and regions have deep ties with patient groups that are recipients of their corporate social responsibility (CSR). CSR activities are diverse and range from direct funding (including donations and sponsorships) to indirect funding (such as expenses associated with company-sponsored lectures); there are rewards for CSR requests for patient groups (writing, supervision, and surveys), and labor is provided by company employees. In developing pharmaceutical products, R&D companies can provide greater benefits to patients by listening to them. It is therefore important for all stakeholders to ensure transparency regarding the relationship between companies and patient groups. This study aimed to identify trends in information disclosure toward ensuring transparency of relations between CSR activities and patient groups based on industry groups regulations in Japan, the United States, and Europe.Methods The contents described in regulations by the European Federation of Pharmaceutical Industries and Associations (EFPIA), Pharmaceutical Research and Manufacturers of America (PhRMA), and the Japan Pharmaceutical Manufacturers Association (JPMA) concerning such transparency were qualitatively and inductively analyzed in terms of four concepts: transparency, equal partnership, mutual benefit, and independence.Results Most of the descriptions relate to transparency. The EFPIA regulation is the most detailed; it states that there should be no influence on patient groups' work or on events and activities organized by companies or patient groups. The rules of the three associations also impose the need to maintain records concerning the purpose and contents of financial support and activity items. However, information disclosure to secure transparency is not required in the PhRMA regulation. The JPMA regulation does not specify a clear update schedule; the EFPIA regulation requires disclosure information to be updated once a year. In terms of equal partnership, such terms as "mutual respect," "equal value," and "establishing a trust relationship" appeared in searches with all three regulations. None of the regulations referred to "mutual benefit." All the regulations either respected or validated the independence of patient groups.Conclusion Each pharmaceutical association set its own regulations and recommended voluntary information disclosure by member companies; however, the extent of such disclosure differed with each association. The regulations of industry associations form the basis for the policies of member companies; thus, it is desirable that the contents and regulations related to mutual information disclosure be established in great detail worldwide.


Assuntos
Revelação , Indústria Farmacêutica , Ética nos Negócios , Internacionalidade , Organizações , Pacientes , Responsabilidade Social , Indústria Farmacêutica/organização & administração , Europa (Continente) , Humanos , Japão , Estados Unidos
14.
J Law Med ; 27(1): 108-121, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31682345

RESUMO

Disclosure of genetic information without consent of the patient (proband) challenges the legal frameworks of privacy and confidentiality. Changes to privacy legislation enable and provide guidelines for undertaking disclosure, with the purpose of reducing the harm to genetic relatives who, armed with such information, may seek predictive testing themselves. Nevertheless, significant uncertainty remains for health care professionals in the application of the discretion to disclose genetic information to at-risk relatives. First, jurisdictional inconsistencies in privacy legislation present challenges for the provision of genetic services across the country. Second, the current guidelines provide insufficient clarity regarding the justification for disclosure of genetic information to reduce psychological harm to relatives. Third, the implications of a potential expansion of a legal duty of care to inform genetic relatives in some circumstances indicates that such a duty would be unduly burdensome for health care professionals, and suggests that revision of the threshold for use - rather than disclosure - of depersonalised genetic information may represent a pragmatic way forward.


Assuntos
Revelação , Privacidade Genética , Austrália , Confidencialidade , Testes Genéticos , Humanos , Consentimento Livre e Esclarecido
16.
Pan Afr Med J ; 33: 224, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692753

RESUMO

Introduction: Despite increasing efforts to address the reproductive health needs of persons living with Human Immuno-Deficiency Virus (HIV), a high unmet need for contraception exists among HIV+ women in sub-Saharan Africa. Currently, Ethiopia promotes integration of family planning (FP) services in to HIV chronic care. Yet the contraceptive prevalence rate among clients remains low. The objective of the study was to assess the role of socio-cultural factors on modern family planning use among HIV+ clients attending Anti-Retroviral Therapy clinics in Addis Ababa sub-cities. Methods: The study involved a facility based cross sectional survey. The ten sub cities were initially categorized/stratified into 5 based on direction (East, West, South, North and Central) and from each category one sub city was randomly selected. The total sample size was proportionally allocated to the selected health facilities according to previous monthly average client load per health center. Participants were selected using simple random sampling technique during their routine visit at the health centers. Data were collected through a semi-structured interviewer administered questionnaire. Both descriptive and inferential statistics were generated and results considered significant at 95% confidence level using STATA version 14.0. Results: Six hundred and thirty-six clients participated in the study. Majority of them were age between 30-39 years. Though majority, 607 (95.4%) participants approved the use of modern FP method, current use rate stood at 39%. Condom was the most (14.5%) commonly used single method. The odds of FP use by participants who disclosed their HIV status were almost twice that of their counterparts (AOR= 1.84; 95% CI: 1.14, 2.95). Participants who held discussion with their spouse/partners concerning FP, irrespective of the frequency had an odd of more than four when using FP than their counterparts (AO= 4.35; 95% CI: 2.69, 7.04). Conclusion: This study revealed that 6 out of every 10 HIV+ clients are not currently using FP methods. Disclosure of HIV status as well as open discussion with spouse/partner were positively associated with family planning use. These study findings call for comprehensive and client focus FP education and counseling in line with disclosure of HIV status and dialogue with spouse/partner in order to increase uptake and utilization of FP among clients. Partners have a great influence on the use and choice of FP methods, so their views are paramount.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Serviços de Planejamento Familiar/estatística & dados numéricos , Infecções por HIV/epidemiologia , Educação Sexual/estatística & dados numéricos , Síndrome de Imunodeficiência Adquirida/epidemiologia , Adulto , Preservativos/estatística & dados numéricos , Anticoncepção/métodos , Anticoncepção/estatística & dados numéricos , Estudos Transversais , Revelação/estatística & dados numéricos , Etiópia , Serviços de Planejamento Familiar/organização & administração , Feminino , Humanos , Masculino , Saúde Reprodutiva , Parceiros Sexuais/psicologia , Inquéritos e Questionários , Adulto Jovem
17.
BMJ ; 367: l5896, 2019 11 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694810

RESUMO

OBJECTIVE: To assess the effect of disclosing authors' conflict of interest declarations to peer reviewers at a medical journal. DESIGN: Randomized controlled trial. SETTING: Manuscript review process at the Annals of Emergency Medicine. PARTICIPANTS: Reviewers (n=838) who reviewed manuscripts submitted between 2 June 2014 and 23 January 2018 inclusive (n=1480 manuscripts). INTERVENTION: Reviewers were randomized to either receive (treatment) or not receive (control) authors' full International Committee of Medical Journal Editors format conflict of interest disclosures before reviewing manuscripts. Reviewers rated the manuscripts as usual on eight quality ratings and were then surveyed to obtain "counterfactual scores"-that is, the scores they believed they would have given had they been assigned to the opposite arm-as well as attitudes toward conflicts of interest. MAIN OUTCOME MEASURE: Overall quality score that reviewers assigned to the manuscript on submitting their review (1 to 5 scale). Secondary outcomes were scores the reviewers submitted for the seven more specific quality ratings and counterfactual scores elicited in the follow-up survey. RESULTS: Providing authors' conflict of interest disclosures did not affect reviewers' mean ratings of manuscript quality (Mcontrol=2.70 (SD 1.11) out of 5; Mtreatment=2.74 (1.13) out of 5; mean difference 0.04, 95% confidence interval -0.05 to 0.14), even for manuscripts with disclosed conflicts (Mcontrol= 2.85 (1.12) out of 5; Mtreatment=2.96 (1.16) out of 5; mean difference 0.11, -0.05 to 0.26). Similarly, no effect of the treatment was seen on any of the other seven quality ratings that the reviewers assigned. Reviewers acknowledged conflicts of interest as an important matter and believed that they could correct for them when they were disclosed. However, their counterfactual scores did not differ from actual scores (Mactual=2.69; Mcounterfactual=2.67; difference in means 0.02, 0.01 to 0.02). When conflicts were reported, a comparison of different source types (for example, government, for-profit corporation) found no difference in effect. CONCLUSIONS: Current ethical standards require disclosure of conflicts of interest for all scientific reports. As currently implemented, this practice had no effect on any quality ratings of real manuscripts being evaluated for publication by real peer reviewers.


Assuntos
Conflito de Interesses , Revelação/ética , Escrita Médica/normas , Revisão da Pesquisa por Pares/ética , Pesquisadores/ética , Adulto , Revelação/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Revisão da Pesquisa por Pares/normas , Controle de Qualidade , Pesquisadores/normas
18.
Medicine (Baltimore) ; 98(43): e17690, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651898

RESUMO

The accumulated healthcare performance data related to unwarranted practice variations are not necessarily disseminated to patients and citizens. To clarify the needs for public disclosure, we explored Japanese and Dutch citizens' preferences and values towards information disclosure and healthcare disparity.Online opt-in survey was conducted and we asked citizens their preference to know about the healthcare performance indicators of regions and hospitals, and their attitudes towards healthcare equity. After a descriptive statistical analysis, Chi-squared automatic interaction detection tree analysis was performed to explore the socio-demographic determinants which were associated with positive value for information disclosure and healthcare equity. Then, we compared the combination of attributes of the highest and the lowest subgroups of each country and compared within and between countries. Last, logistic regression analysis was performed to further evaluate the impact of each determinant.Significant differences were observed between the 2 countries (Japan [JPN] 1038; Netherlands [NL] 1040). The crucial attributes identified were age, sex, educational background, and living area (JPN), along with age and sex (NL). Japanese comprised multiple subgroups with heterogeneous values, showed relatively low interest in knowing the information, and seemed to accept healthcare inequality, especially among urban males aged 20 to 59 years. Contrarily, Dutch people mostly showed high interest in both items. Female and older respondents valued information disclosure highly across countries.To share healthcare performance knowledge and empowering the public, historical, cultural, and socio-demographic context including health literacy of citizens' subgroups should be considered in making comprehensive public reports.


Assuntos
Revelação , Disparidades em Assistência à Saúde , Indicadores de Qualidade em Assistência à Saúde , Humanos , Japão , Países Baixos , Inquéritos e Questionários
19.
BMC Public Health ; 19(1): 1382, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660947

RESUMO

BACKGROUND: Private health facilities are increasingly being recognized as the neglected partner in the provision of HIV services. The non-adherence rate in the study sites ranged from 19 to 22%. This study explored the factors associated with non-adherence from antiretroviral therapy (ART) among adult patients accessing ART services at two privately owned urban health facilities in Malawi. METHODS: We conducted a descriptive qualitative approach employing in-depth interviews among adults who either defaulted or were retained in HIV care in two privately owned facilities in Malawi from March to July 2017. We purposively selected participants and interviewed a total of 6 ART providers and 24 ART clients. Data were analyzed manually using a thematic approach. RESULTS: Overall, participants identified four facilitators for retention in care and four broad categories of barriers namely individual, psychological, drug related and human resource related factors. The factors that facilitated retention in care included follow up visits after missing a visit, adequate information education and counseling, and supportive relationships. CONCLUSION: The main reason for defaulting from antiretrovirals (ARVs) was fear of disclosing an HIV status to avert potential stigma and discrimination. In implementing ART clinics due consideration and strategies need to be adopted to ensure that privacy and confidentiality is preserved. Although adoption of all the key Malawi Implementing strategies like expert clients and a guardian may optimize retention in care, there is need for prior analysis of how those may lead to unintended disclosure which inadvertently affects adherence. Furthermore, private facilities should orient their clients to the public facilities within the catchment area so that clients have an option for alternative access to HIV care in the event of financial constraints.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Instalações Privadas/estatística & dados numéricos , Adulto , Revelação , Medo , Feminino , Infecções por HIV/psicologia , Humanos , Malaui , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Estigma Social , Adulto Jovem
20.
Med Clin North Am ; 103(6): 967-976, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582007

RESUMO

Historically, both pretest and posttest genetic counseling has been standard of care for genetic testing. This model should be adapted for primary care providers (PCPs) willing to learn critical information about the test and key concepts that patients need to make an informed testing decision. It is helpful for PCPs to discuss a few initial patients with a genetic counselor to prepare for the key concepts of pretest and posttest counseling. This article provides guidance about the recommended level of involvement of PCPs based on the test indication, test complexity, disorder management, and the potential for psychosocial sequela.


Assuntos
Revelação , Aconselhamento Genético , Atenção Primária à Saúde , Aconselhamento Genético/ética , Aconselhamento Genético/métodos , Aconselhamento Genético/psicologia , Humanos , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/normas
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