The importance of self-management for better treatment outcomes for HIV patients in a low-income setting: perspectives of HIV experts and service providers.

BACKGROUND: Self-management is the most important strategy to improve quality of life in patients with a chronic disease. Despite the increasing number of people living with HIV (PLWH) in low-income countries, very little research on self-management is conducted in this setting. The aim of this research is to understand the perspectives of service providers and experts on the importance of self-management for PLWH. METHODS: A systematizing expert interview type of qualitative methodology was used to gain the perspectives of experts and service providers. The study participants had experience in researching, managing, or providing HIV service in east and southern African (ESA) countries. All the interviews were audio recorded, transcribed, and translated to English. The quality of the transcripts was ensured by randomly checking the texts against the audio record. A thematic analysis approach supported by Atlas TI version 9 software. RESULT: PLWH face a variety of multi-dimensional problems thematized under contextual and process dimensions. The problems identified under the contextual dimension include disease-specific, facility-related, and social environment-related. Problems with individual origin, such as ignorance, outweighing beliefs over scientific issues, low self-esteem, and a lack of social support, were mostly highlighted under the process dimensions. Those problems have a deleterious impact on self-management, treatment outcomes, and the quality of life of PLWH. Low self-management is also a result of professional-centered service delivery in healthcare facilities and health service providers' incapacity to comprehend a patient's need beyond the medical concerns. Participants in the study asserted that patients have a significant stake in enhancing treatment results and quality of life through enhancing self-management. CONCLUSION AND RECOMMENDATION: HIV patients face multifaceted problems beyond their medical issues. The success of medical treatment for HIV is strongly contingent upon patients' self-management practices and the supportive roles of their family, society, and health service providers. The development and integration of self-management practices into clinical care will benefit patients, their families, and the health system.

A case study of HIV/AIDS services from community-based organizations during COVID-19 lockdown in China.

INTRODUCTION: People living with HIV (PLHIV) relied on community-based organizations (CBOs) in accessing HIV care and support during the COVID-19 pandemic in China. However, little is known about the impact of, and challenges faced by Chinese CBOs supporting PLHIV during lockdowns. METHODS: A survey and interview study was conducted among 29 CBOs serving PLHIV in China between November 10 and November 23, 2020. Participants were asked to complete a 20-minute online survey on their routine operations, organizational capacity building, service provided, and challenges during the pandemic. A focus group interview was conducted with CBOs after the survey to gather CBOs' policy recommendations. Survey data analysis was conducted using STATA 17.0 while qualitative data was examined using thematic analysis. RESULTS: HIV-focused CBOs in China serve diverse clients including PLHIV, HIV high-risk groups, and the public. The scope of services provided is broad, ranging from HIV testing to peer support. All CBOs surveyed maintained their services during the pandemic, many by switching to online or hybrid mode. Many CBOs reported adding new clients and services, such as mailing medications. The top challenges faced by CBOs included service reduction due to staff shortage, lack of PPE for staff, and lack of operational funding during COVID-19 lockdowns in 2020. CBOs considered the ability to better network with other CBOs and other sectors (e.g., clinics, governments), a standard emergency response guideline, and ready strategies to help PLHIV build resilience to be critical for future emergency preparation. CONCLUSION: Chinese CBOs serving vulnerable populations affected by HIV/AIDS are instrumental in building resilience in their communities during the COVID-19 pandemic, and they can play significant roles in providing uninterrupted services during emergencies by mobilizing resources, creating new services and operation methods, and utilizing existing networks. Chinese CBOs' experiences, challenges, and their policy recommendations can inform policy makers on how to support future CBO capacity building to bridge service gaps during crises and reduce health inequalities in China and globally.

Clinician Use of HIV-Related Infographics During Clinic Visits in the Dominican Republic is Associated with Lower Viral Load and Other Improvements in Health Outcomes.

We designed an infographic intervention to help clinicians provide health information to persons living with HIV. In this study, we assessed the extent to which our intervention may improve objectively and subjectively measured health outcomes (CD4 count, viral load, and engagement with clinician among others) when integrated into routine visits in the Dominican Republic. In this pretest-posttest study, we followed participants for 9 months at 3-month intervals. Physicians administered the intervention during participants' first 3 visits. Outcome measures, selected using a conceptual model, were assessed at 4 time points. We assessed changes in outcomes over time with general linear regressions and Wilcoxon Signed-Rank tests. Participants (N = 50) were mostly female (56%) and had been living with HIV for a mean of 6.3 years (SD = 6.1). All outcomes, except CD4 count, demonstrated statistically significant improvements by study end. This provides preliminary evidence our intervention may improve outcomes, but further testing is needed.

RESUMEN: Diseñamos una intervención infográfica para ayudar a los médicos brindar información médica a personas viviendo con el VIH. En este estudio, evaluamos en qué medida nuestra intervención puede mejorar los resultados de salud (conteo de CD4, carga viral, y compromiso con el médico entre otros), medidos de una manera objetiva y subjetiva, cuando se incorpora en las visitas médicas de rutina en la República Dominicana. En este estudio de prueba previo y posterior, seguimos los participantes durante 9 meses a intervalos de 3 meses. Los médicos administraron la intervención durante las primeras 3 visitas de los participantes. Seleccionamos las medidas de resultado utilizando un marco conceptual y las evaluamos en los 4 puntos de tiempo. Evaluamos cambios a lo largo del tiempo usando regresiones lineales generales y pruebas de asociación de Wilcoxon Signed-Rank. Los participantes (N = 50) fueron mayormente mujeres (56%) y habían estado viviendo con el VIH durante una media de 6,3 años (DE = 6,1). Todos los resultados, aparte del conteo de CD4, demostraron mejoras estadísticamente significativas al final del estudio. Esto proporciona evidencia preliminar de que nuestra intervención puede mejorar los resultados de la salud, pero se justifican pruebas adicionales.

HIV/AIDS late presentation and its associated factors in China from 2010 to 2020: a systematic review and meta-analysis.

BACKGROUND: Late presentation to HIV/AIDS care presents serious health concerns, like increased transmission and high healthcare costs, increased mortality, early development of opportunistic infection, increased risk of antiretroviral therapy drug resistance. Despite the effort to contain the HIV/AIDS epidemic, LP has remained an impediment to individual immune reconstitution and public health. OBJECTIVE: This review aimed to estimate the prevalence and determine the factors associated with late presentation to HIV/AIDS care. METHODS: We searched PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Wanfang, and Weipu database for articles published from 2010 to 2020. We utilized I2 statistics and Q-test to estimate heterogeneity between studies. Random-effects meta-analysis models were used to calculate the aggregate odds ratio of late presentation to HIV/AIDS care. RESULTS: Of 9563 titles and abstracts retrieved, 189 were identified as potentially eligible and 39 fulfilled the inclusion criteria. The pooled prevalence of late presentation to HIV/AIDS care was 43.26%. The major risk factors were patients ≥ 50 years old (OR = 2.19, 95% CI: 1.85-2.58; I2 = 97.44%), married (OR = 1.50, 95% CI: 1.35-1.68; I2 = 96.58%), with heterosexual contact as risk factor for infection (OR = 1.91, 95% CI: 1.73-2.11; I2 = 90.74%) and diagnosed in medical institutions (OR = 2.35,95% CI: 2.11-2.62; I2 = 96.05%). In middle or low HIV prevalence areas, patients ≥ 50 years old (P = 0.01), married (P < 0.01) and diagnosed in medical institutions (P = 0.01) were more likely to be presented late than in high prevalence areas. From 2016-2020, the OR of patients who were married and diagnosed in medical facilities were significantly lower than before (P < 0.01). CONCLUSION: Patients ≥ 50 years old, married, with heterosexual contact as risk factor for infection, and diagnosed in medical institutions were risk factors of LP. Gender had no significant relationship with LP. In middle or low prevalence areas, patients who were ≥ 50 years old, married, and diagnosed in medical institutions were more likely to be presented late than in other areas. Married patients and those diagnosed in medical institutions after 2015 have a lower risk of LP than before.

"Part of getting to where we are is because we have been open to change" integrating community health workers on care teams at ten Ryan White HIV/AIDS program recipient sites.

BACKGROUND: Community Health Workers (CHWs) have long been integrated in the delivery of HIV care in middle- and low-income countries. However, less is known about CHW integration into HIV care teams in the United States (US). To date, US-based CHW integration studies have studies explored integration in the context of primary care and patient-centered medical homes. There is a need for research related to strategies that promote the successful integration of CHWs into HIV care delivery systems. In 2016, the Health Resources and Services Administration HIV/AIDS Bureau launched a three-year initiative to provide training, technical assistance and evaluation for Ryan White HIV/AIDS Program (RWHAP) recipient sites to integrate CHWs into their multidisciplinary care teams, and in turn strengthen their capacity to reach communities of color and reduce HIV inequities. METHODS: Ten RWHAP sites were selected from across eight states. The multi-site program evaluation included a process evaluation guided by RE-AIM to understand how the organizations integrated CHWs into their care teams. Site team members participated in group interviews to walk-the-process during early implementation and following the program period. Directed content analysis was employed to examine program implementation. Codes developed using implementation strategies outlined in the Expert Recommendations for Implementing Change project were applied to group interviews (n = 20). FINDINGS: Implementation strategies most frequently described by sites were associated with organizational-level adaptations in order to integrate the CHW into the HIV care team. These included revising, defining, and differentiating professional roles and changing organizational policies. Strategies used for implementation, such as network weaving, supervision, and promoting adaptability, were second most commonly cited strategies, followed by training and Technical Assistance strategies. CONCLUSIONS: Wrapped up in the implementation experience of the sites there were some underlying issues that pose challenges for healthcare organizations. Organizational policies and the ability to adapt proved significant in facilitating CHW program implementation. The integration of the CHWs in the delivery of HIV care requires clearly distinguishing their role from the roles of other members of the healthcare delivery team.

Reliability, validity and measurement invariance of the Simplified Medication Adherence Questionnaire (SMAQ) among HIV-positive women in Ethiopia: a quasi-experimental study.

BACKGROUND: Adherence to antiretroviral therapy is critical to the achievement of the third target of the UNAIDS Fast-Track Initiative goals of 2020-2030. Reliable, valid and accurate measurement of adherence are important for correct assessment of adherence and in predicting the efficacy of ART. The Simplified Medication Adherence Questionnaire is a six-item scale which assesses the perception of persons living with HIV about their adherence to ART. Despite recent widespread use, its measurement properties have yet to be carefully documented beyond the original study in Spain. The objective of this paper was to conduct internal consistency reliability, concurrent validity and measurement invariance tests for the SMAQ. METHODS: HIV-positive women who were receiving ART services from 51 service providers in two sub-cities of Addis Ababa, Ethiopia completed the SMAQ in a HIV treatment referral network study between 2011 and 2012. Two cross-sections of 402 and 524 female patients of reproductive age, respectively, from the two sub-cities were randomly selected and interviewed at baseline and follow-up. We used Cronbach's coefficient alpha (α) to assess internal consistency reliability, Pearson product-moment correlation (r) to assess concurrent validity and multiple-group confirmatory factor analysis to analyze factorial structure and measurement invariance of the SMAQ. RESULTS: All participants were female with a mean age of 33; median: 34 years; range 18-45 years. Cronbach's alphas for the six items of the SMAQ were 0.66, 0.68, 0.75 and 0.75 for T1 control, T1 intervention, T2 control, and T2 intervention groups, respectively. Pearson correlation coefficients were 0.78, 0.49, 0.52, 0.48, 0.76 and 0.80 for items 1 to 6, respectively, between T1 compared to T2. We found invariance for factor loadings, observed item intercepts and factor variances, also known as strong measurement invariance, when we compared latent adherence levels between and across patient-groups. CONCLUSIONS: Our results show that the six-item SMAQ scale has adequate reliability and validity indices for this sample, in addition to being invariant across comparison groups. The findings of this study strengthen the evidence in support of the increasing use of SMAQ by interventionists and researchers to examine, pool and compare adherence scores across groups and time periods.

Late presentation of HIV positive adults and its predictors to HIV/AIDS care in Ethiopia: a systematic review and meta-analysis.

INTRODUCTION: Late presentation to HIV/AIDS care which is attended by problems like, poor treatment outcomes, early development of opportunistic infections, increased healthcare costs, and mortality is a major problem in Ethiopia. Although evidences are available on the prevalence and associated factors of late presentation to HIV/AIDS care, discrepancies among findings are appreciated. Thus, the country has faced difficulties of having a single estimated data. OBJECTIVE: This study aimed to estimate the pooled prevalence of late presentation of HIV positive adults to HIV/AIDS care and its predictors in Ethiopia. METHOD: We searched all available articles through Google Scholar, PubMed, Web of Sciences, and EMBASE databases. Additionally, we accessed articles from the Ethiopian institutional online research repositories and reference lists of included studies. We included cohort, case- control, and cross-sectional studies in our review. Besides, we utilized the weighted inverse variance random-effects model. The total percentage of variation among studies due to heterogeneity was determined by I2 statistic. Searching was limited to studies conducted in Ethiopia and published in the English language. Publication bias was checked by Egger's regression test. RESULTS: A total of 8 studies with 7, 568 participants were included. The pooled prevalence of late presentation to HIV/AIDS care was 52.89% (95%CI: 35.37, 70.40). The odds of late presentation to HIV/AIDS care of frequent alcohol users [3.67(95% CI = 1.52-5.83)], high fear of stigma [3.90 (95% CI = 1.51-6.28)], chronic illness [3.34(95% CI = 1.52-5.16)], and the presence of symptoms at the time of HIV diagnosis [3.06 (95% CL = 1.18-4.94)] were higher compared to participants who did not experience the preceding. CONCLUSION: The prevalence of late presentation of HIV positive adults to HIV/AIDS care was high in Ethiopia. Frequent alcohol use, high fear of stigma, chronic illness, and the presence of symptoms at the time of HIV diagnosis were associated with high odds of late presentation to HIV/AIDS care. TRIAL REGISTRATION: Registered in PROSPERO databases with the registration number of CRD42018081840 .

[Applying the Modified Delphi Technique to Develop the Role of HIV Case Managers and Essential Nursing Competencies in HIV Care].

BACKGROUND: Since 2005, the Taiwan Centers for Disease Control (Taiwan CDC) initiated an HIV case management program in AIDS-designated hospitals to provide integrative services and risk-reduction counseling for HIV-infected individuals. In light of the increasingly complex and highly specialized nature of clinical care, expanding and improving competency-based professional education is important to enhance the quality of HIV/AIDS care. PURPOSE: The aim of this study was to develop the essential competency framework for HIV care for HIV case managers in Taiwan. METHODS: We reviewed essential competencies of HIV care from Canada, the United Kingdom, and several African countries and devised descriptions of the roles of case managers and of the associated core competencies for HIV care in Taiwan. The modified Delphi technique was used to evaluate the draft framework of these roles and core competencies. A total of 15 HIV care experts were invited to join the expert panel to review and rank the draft framework. RESULTS: The final framework consisted of 7 roles and 27 competencies for HIV case managers. In Round 1, only 3 items did not receive consensus approval from the experts. After modification based on opinions of the experts, 7 roles and 27 competencies received 97.06% consensus approval in Round 2 and were organized into the final framework for HIV case managers. These roles and associated core competencies were: HIV Care Expert (9 competencies), Communicator (1 competency), Collaborator (4 competencies), Navigator (2 competencies), Manager (4 competencies), Advocate (2 competencies), and Professional (5 competencies). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The authors developed an essential competency framework for HIV care using the consensus of a multidisciplinary expert panel. Curriculum developers and advanced nurses and practitioners may use this framework to support developments and to ensure a high quality of HIV care.

Lower PrEP Retention among Young and Black Clients Accessing PrEP at a Cluster of Safety Net Clinics for Gay and Bisexual Men.

Young men of color who have sex with men are vulnerable to HIV and experience poor PrEP uptake and retention. We conducted a secondary data analysis and calculated adjusted Prevalence Odds Ratios (aPORs) for PrEP retention along with 95% CIs at 90, 180, and 360 days at an organization running safety net clinics in Texas for gay and bisexual men. We found statistically significant association with age, race, in-clinic versus telehealth appointments, and having healthcare insurance. White clients had an aPOR of 1.29 [1.00, 1.67] as compared to Black clients at 90 days. Age group of 18-24 had a lower aPOR than all other age groups except 55 or older at all three time periods. Clients who met providers in person had an aPOR of 2.6 [2.14, 3.19] at 90, 2.6 [2.2, 3.30] at 180 days and 2.84 [2.27, 3.54] at 360 days. Our findings highlight the need for population-specific targeted interventions.

Lower PrEP retention for black and young MSM in TexasOur study findings suggest that of all clients who start PrEP, Black clients and younger clients had a higher chance of not continuing PrEP as compared to White clients and older clients respectively. This analysis was done for a clinic that pre-dominantly offers services to gay and bisexual men. We also found that those who were attending clinic in person had higher chances of continuing. Further those who are insured also had higher chances of continuing.

Predictors of Late Presentation for HIV/AIDS in West Arsi Zone Public Health Institutions, South Ethiopia: Unmatched Case-Control Study.

BACKGROUND: Late presentation for HIV/AIDS care is defined as individuals newly presenting for HIV/AIDS care with a CD4 count below 350 cells/µl or presenting for care with WHO clinical staging of stage III or IV. Globally, around 21.7 million people living with HIV/AIDS were receiving ART in 2017, with an increase of 2.3 million since 2016. Despite this progress, most people start ART late in their disease progression. OBJECTIVE: This study aims to identify predictors of late presentation for HIV/AIDS among people living with HIV and attending ART clinics in West Arsi Zone public health institutions, South Ethiopia, 2019. METHODOLOGY: A facility-based unmatched case-control study was conducted among people living with HIV attending ART clinics in West Arsi Zone public health institutions, with a total sample size of 500 (167 cases and 333 controls). The sample size was calculated using Epi info version 7 and participants were selected using the case-based control selection sampling technique. Descriptive statistics were carried out to summarize the data. Bi-variate binary logistic regression analysis was carried for selecting candidate variables for multivariate binary logistic regression. A p-value of <0.05 was taken to declare the presence of a statistical association between outcomes and explanatory variables. RESULTS: Rural residence (AOR=7.74 95% CI (3.4-17.6)), being single (AOR=0.18 95% CI (0.06-0.49)) symptom(s) at first HIV diagnosis (AOR=7.69 95% CI (4.09-14.4)), no private house (AOR=5.09 95% CI (2.47-10.45)), fear of losing job (AOR=4.12 95% CI (2.04-8.31)), alcohol consumption (AOR=4.35 95% CI (2.18-8.69), and having chronic medical illness (AOR=5.04 95% CI (2.48-10.24)) were identified as having significant associations with late presentation of HIV/AIDS care. CONCLUSION: Rural residence, fear of losing a job, and chronic medical illness were potential risk factors for late presentation of HIV/AIDS care. Being single is the only protective factor for the late presentation of HIV/AIDS care.

The economic impact of pharmacist care for people living with HIV/AIDS: A systematic review.

Background and objective: There is an increase in the global prevalence of the human immunodeficiency virus (HIV). While it has been proven that pharmacist interventions improve the health outcomes of people living with HIV/AIDS (PLWHA), the economic impact of these initiatives is uncertain. Consequently, we aim to systematically review and synthesize the evidence surrounding the economic impact of pharmacist care in PLWHA. Methods: PubMed, EMBASE, Scopus, IPA via ProQuest, the Cochrane Library, and the CINAHL Plus databases were systematically searched. Original studies evaluating the economic effect of pharmacist-managed services for PLWHA were included in the review. The quality of the economic studies was assessed using the Consolidated Health Economic Evaluation Reporting Standard (CHEERS) checklist. Results: A search of databases yielded 4206 citations, four of which met the eligibility criteria. Three studies were conducted in a hospital-based outpatient facility, while one study was conducted in a community pharmacy setting. The types of "pharmacist-managed services" included targeted motivational education, pharmaceutical care, health screening for opportunistic infections, and referral to specialists. Two of the four economic evaluation studies had complete economic analyses and were rated as moderate in quality. In comparison with usual care, pharmacist services led to cost savings of (51.29 to 165.74 in 2021 USD$) per person per year, saving 18.5 h per patient per year, and a lower cost of generating 12 years of quality-adjusted life years. In addition, the benefit-to-cost ratio of the pharmacist service was 2.51:1. Conclusions: The pharmacist-managed services demonstrated the benefits of improving overall PLWHA health outcomes in economic viability. However, future real world controlled, high-quality economic studies are required to determine the long-term cost-effectiveness of these services, given the pharmacist's growing role in the health care team managing PLWHA.

Sustaining hope: A narrative inquiry into the experiences of hope for nurses who work alongside people living with HIV in Ghana.

Aim: In this research, we explored how nurses working in HIV care in Ghana live and work with hope. Background: Nurses who work with people living with HIV have concerns about their well-being and quality of life. They also complain of stress-related workload due to high nurse-patient ratio. The study sought to examine the experiences of nurses in Ghana and the ways that hope is intertwined with their experiences in working with people living with HIV. Design: This study was a narrative inquiry study. Narrative inquiry is a collaborative way to inquire into participants' experiences in the three-dimensional spaces of temporality, sociality and place. Methods: We engaged with five nurses who work in an acute care setting where their primary focus is to provide care to people living with HIV. We engaged in six to eight conversations with each participant over several months. We asked participants to describe memories of significant experiences in their past and present lives, and share experiences that they would describe hopeful in their HIV nursing practice. Results: In this narrative inquiry study, four resonant threads emerged and included: (a) becoming a nurse for people living with HIV took time; (b) experiences of practising with hope were important; (c) faith in God, allowed them to gain strength, which was connected to hope; and (d) learning to live with hope was shaped by childhood experiences.

Qualidade do acesso percebida por usuários de serviços especializados em HIV/AIDS da Bahia, Brasil / Quality of access perceived by users of HIV/AIDS specialized services in Bahia, Brazil / Calidad de acceso percibida por los usuarios de servicios especializados en VIH/SIDA en Bahía, Brasil

Este artigo descreve o acesso e a percepção do acesso de usuários a serviços especializados no tratamento do vírus da imunodeficiência humana e da Síndrome da Imunodeficiência Humana (HIV/AIDS) em municípios baianos por meio de um recorte epidemiológico descritivo-analítico, com abordagem quantitativa de dados primários de estudo realizado em cinco serviços localizados na capital e oito no interior do estado da Bahia, Brasil. Participaram deste estudo 475 usuários, de 21 municípios baianos, predominantemente do sexo feminino, com faixa etária entre 25 e 44 anos, negros, cristãos, desempregados, com escolaridade compreendendo o ensino fundamental, renda de até três salários mínimos, heterossexual e cisgênero. O acesso à testagem para HIV e outras Infecções Sexualmente Transmissíveis (IST), profilaxias de pós-exposição e pré-exposição e outros insumos de prevenção não constituíram motivação de inserção no serviço. O tratamento específico e a assistência médica para HIV e outras IST foi motivação para que a maioria dos participantes se direcionassem ao serviço especializado. O deslocamento até o serviço de referência é realizado principalmente por transportes coletivos, e o trajeto casa-serviço tem duração de pelo menos uma hora. O horário de funcionamento da unidade atende às necessidades da maior parte dos participantes, mas parcela dos usuários mencionaram o desejo de funcionamento em horários alternativos. A marcação de consultas é realizada principalmente de forma presencial e por telefone, com possibilidade de agendamento diário, assim a maioria dos usuários avaliaram a organização do serviço para marcação de consultas como boa ou muito boa. O tempo de espera, entre marcação e consulta, mais comum é de uma semana a um mês.

This article describes user access and perception of access to specialized HIV/AIDS services in Bahia municipalities by applying a qualitative epidemiological, descriptive-analytical approach to primary data from research conducted in five services located in the capital and eight in the countryside. A total of 475 users from 21 municipalities in Bahia participated in this study. Most were female, between 25 and 44 years old, Black, Christian, unemployed, with complete primary education, income of up to 3 minimum wages, heterosexual and cisgender. Access to HIV testing and other STIs, post-exposure and pre-exposure prophylaxis and other prevention inputs did not constitute motivation for procuring the service. Specific treatment and medical care for HIV and other STIs motivated most participants to turn to specialized services. Commuting to the reference service is made mainly by public transport and the home-service journey takes at least one hour. The unit's opening hours meet the needs of most participants, but some mentioned the desire for alternative operating times. Appointments are booked mainly in person and over the phone, with the possibility of daily scheduling, so most users rated the service organization for scheduling appointments as good or very good. The most common waiting time between booking and consultation is one week to one month.

Este artículo describe el acceso y la percepción de acceso de los usuarios a servicios especializados en el tratamiento del virus de inmunodeficiencia humana y síndrome de inmunodeficiencia humana (VIH/sida) en municipios de Bahía (Brasil) mediante un enfoque epidemiológico, descriptivo-analítico, y un enfoque cuantitativo de datos primarios de un estudio realizado en cinco servicios ubicados en la capital y ocho en el interior del estado de Bahía. Participaron en este estudio 475 usuarios, de 21 municipios de Bahía, con mayor predominio femenino, con edades de entre 25 y 44 años, negros, cristianos, desempleados, con educación primaria, ingresos de hasta tres salarios mínimos, heterosexuales y cisgénero. El acceso a pruebas de VIH y otras infecciones de transmisión sexual (ITS), profilaxis posexposición y preexposición, y otros insumos de prevención no constituyeron una motivación para ingresar al servicio. El tratamiento específico y la asistencia médica para el VIH y otras ITS fueron la razón para que la mayoría de los participantes buscaran servicios especializados. El desplazamiento al servicio de referencia se realiza principalmente en transporte público, y el trayecto desde el domicilio al servicio tiene una duración mínima de una hora. El horario de atención de la unidad satisface las necesidades de la mayoría de los participantes, pero algunos usuarios mencionaron el deseo de que operase en horarios alternativos. Las citas se realizan principalmente de forma presencial y telefónica, con posibilidad de concertación diaria, por lo que la mayoría de los usuarios valoran como buena o muy buena la organización del servicio de citas. El tiempo de espera más habitual entre la reserva y la consulta es de una semana a un mes.

Perceived behavioural predictors of late initiation to HIV/AIDS care in Gurage zone public health facilities: a cohort study using health belief model.

OBJECTIVE: The study was aimed to measure incidence density rate and identify perceived behavioural believes of late initiation to HIV/AIDS care in Gurage zone public health facilities from September 2015 to November 2016. RESULTS: The incidence density rates of late initiation to HIV/AIDS care were 2.21 per 100 person-months of observation. HIV positive individuals who did not perceived susceptibility were 8.46 times more likely delay to start HIV/AIDS care than their counter parts [OR = 8.46 (95% CI 3.92, 18.26)]. HIV infected individuals who did not perceived severity of delayed ART initiation were 6.13 time more likely to delay than HIV infected individuals who perceived its severity [OR = 6.13 (95% CI 2.95, 12.73)]. HIV positive individuals who didn't have self-efficacy were 2.35 times more likely delay to start HIV/AIDS care than HIV positive individuals who have self-efficacy [OR = 2.35 (95% CI 1.09, 5.05)]. CONCLUSIONS: The study revealed that high incidence density rates of delayed initiation for HIV care and variations were explained by poor wealth, and perceived threat and benefit. Therefore, interventions should be designed to initiate care at their diagnosis time.

Associations between healthcare worker participation in workplace wellness activities and job satisfaction, occupational stress and burnout: a cross-sectional study in Botswana.

OBJECTIVES: Healthcare workers (HWs) are prone to high levels of stress and burnout, particularly when caring for people with HIV/AIDS. This study assessed whether participation in Botswana's Workplace Wellness Programme (WWP) for HWs was associated with job satisfaction, occupational stress, well-being and burnout. METHODS: Using multistage sampling, a paper-based questionnaire was distributed to 1856 randomly selected HWs at 135 public facilities across Botswana. Well-validated scales assessed key outcomes. Analysis of covariance models were built for psychosocial factors associated with WWP participation, controlling for associated demographics. RESULTS: Response rate was 73% (n=1348). The majority of respondents were female (62%), not married (65%) and had children (84%). Mean age was 40.0 years (SD±9.9). Respondents were roughly split between participation in no WWP activities (29.4%), 1-6 WWP activities (38.9%) and seven or more WWP activities (31.7%) in the past year. High participation was associated with older age, being a doctor or other professional, working at hospitals or District Health Management Teams, working longer in health services or working longer at a facility. In unadjusted analyses, high participation was significantly associated (P<0.05) with higher satisfaction with overall job, work, supervision, promotion, pay and professional efficacy and lower stress, exhaustion and cynicism. All associations remained significant in controlled analyses except cynicism. CONCLUSIONS: Results from this study suggest that participation in workplace wellness activities is associated with higher satisfaction with multiple job facets and lower stress, exhaustion and cynicism. Introduction of these activities may help ameliorate high occupational stress levels among HWs.

Development, use, and integration of a nationally-distributed HIV/AIDS electronic health information system.

BACKGROUND: The management of HIV infection requires extensive, longitudinal information record-keeping and coordination to ensure optimal monitoring and outcomes of care and treatment. OBJECTIVE: Agencies funded by The Ryan White HIV/AIDS Treatment Modernization Act are increasingly required to monitor the quality of their HIV care and generate reports for funding agencies. To assist in their data collection and reporting capacity, the HIV/AIDS Bureau in the Health Resources and Services Administration released its first version of a software application called CAREWare in 2000. METHODS: This report describes the development of the application, the agencies that use it, how it is used, and overall satisfaction. The role of CAREWare in the larger health information technology landscape affecting HIV primary care providers is also discussed. RESULTS AND CONCLUSION: CAREWare has evolved significantly in functionality and use, including the capacity to run in a real-time network connecting multiple service providers, generate performance measures, and import data in multiple formats. The application is the source of over half of the Bureau s data, is used regularly by most providers and is installed in nearly every state. Ongoing enhancements will be essential to ensure that CAREWare stays current in a rapidly-changing environment of health information technology and data exchange.

Retention in care and factors affecting it among people living with HIV/AIDS in Changsha City, China.

The aim of this study was to describe the retention in care and examine the factors affecting it among people living with HIV and AIDS (PLWHA) in Changsha City, China. Data on treatment, care, and their retention of all registered 822 PLWHA in Changsha Center for Disease Control and Prevention were analyzed. The retention rate had shown 58.1% among this sample. With logistic regression analysis, retention in care was significantly related to education level (senior high school vs university: odds ratio [OR] = 0.471, 95% confidence interval [CI] = 0.237-0.937), CD4 count (<50cells/mm(3) vs >500cells/mm(3): OR = 2.659, 95% CI = 1.816-28.760), and initiation of antiretroviral therapy (No vs Yes: OR = 0.362, 95% CI = 0.180-0.550). In conclusion, the intervention to improve retention in care for PLWHA in Changsha is warranted, especially for those who have lower education level, for those who have higher baseline CD4 count, and for those who have not initiated antiretroviral therapy.

Ongoing impact of HIV infection on mortality among people who inject drugs despite free antiretroviral therapy.

AIMS: To determine the impact of HIV infection on mortality over time among people who inject drugs (PWID) in settings with free HIV/AIDS care. DESIGN AND SETTING: Prospective cohort study of PWID in Vancouver, Canada, recruited between May 1996 and December 2011. We ascertained morality rates and causes of death through a confidential linkage with the provincial vital statistics registry. PARTICIPANTS: A total of 2283 individuals were followed for a median of 60.9 months (interquartile range: 34.4-113.1), among whom 622 (27.2%) individuals were HIV-positive at baseline, and 179 (7.8%) seroconverted during follow-up. MEASUREMENTS: The primary and secondary outcomes of interests were all-cause mortality and cause of death, respectively. The main independent variable of interest was HIV serostatus (positive versus negative). We used Cox proportional hazards regression to determine factors associated with mortality, including socio-demographic variables, drug use behaviors and other risk behaviors. FINDINGS: During the study period, 491 (21.5%) individuals died. In multivariate analyses, HIV infection remained associated independently with all-cause mortality (adjusted hazard ratio = 3.15; 95% CI: 2.59-3.82). While all-cause mortality rates declined markedly during the study period (P < 0.001), the independent effect of HIV infection on mortality remained unchanged over time (P = 0.640). Among HIV-positive individuals, significant changes in causes of death from infectious and AIDS-related causes to non-AIDS-related etiologies were observed. CONCLUSIONS: HIV infection continues to have a persistent impact on mortality rates among people who inject drugs in settings with free HIV/AIDS care, although causes of death have shifted markedly from infectious and AIDS-related causes to non-AIDS-related etiologies.

Access to antiretroviral therapy among HIV/AIDS patients in Chiang Mai province, Thailand.

The objective of this study is to investigate the access to antiretroviral treatment among human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients in Chiang Mai province, Thailand. Access to antiretroviral treatment is defined in terms of availability, affordability, and acceptability. The data for the study were collected during the period of April 1, 2012-May 31, 2012 from a sample of 380 HIV/AIDS patients in eight hospitals who had received antiretroviral treatment for more than 6 months at the time of data collection. The results of the study show that for most patients, the average traveling time to access health care was acceptable, but the nearly half day waiting time caused them to be absent from their work. In particular, it took longer for patients in the rural and lower income groups to access the treatment than the other groups. Their travel times and food costs relating to the treatment were found to be relatively high and therefore these patients had a higher tendency to borrow or seek financial assistance from their relatives. However, due to improvements in the access to treatment, most patients were satisfied with the services they received. The results imply that policy should be implemented to raise the potential of subdistrict hospitals where access to antiretroviral treatment is available, with participating HIV/AIDS patients acting as volunteers in providing services and other forms of health promotion to new patients. Privacy issues could be reduced if the antiretroviral treatment was isolated from other health services. Additionally, efforts to educate HIV/AIDS patients and society at large should be made.

Perceptions and activities of religious leaders on the prevention of HIV/AIDS and care of people living with the HIV infection in Ibadan, Nigeria.

INTRODUCTION: The epidemic of human immunodeficiency virus (HIV) continues in Nigeria despite efforts to control it. Meaningful efforts aimed at combating this disease must be multisectoral. However, despite the major influence religious leaders have in this society, their role has not been well studied. The aim of the study was to assess the perceptions and activities of religious leaders on prevention of HIV/acquired immunodeficiency syndrome (AIDS) and care of people living with the virus in Ibadan, Nigeria. MATERIALS AND METHODS: In a cross-sectional study, 336 leaders from eight religious denominations in Ibadan were surveyed utilizing a self-administered, semi-structured questionnaire. Respondents were selected by cluster sampling technique. Data was analyzed using the Statistical Package for Social Sciences software version 15. RESULTS: The mean age of respondents was 37.9 (± 13.5) years. The majority (97.6%) were aware of the HIV/AIDS scourge, and most had good knowledge of routes of transmission and modes of prevention (85.7%). Attitudes to people living with HIV/AIDS were positive in 84.2% respondents, and many practiced preventive measures (94.9%). One hundred and ninety (56.5%) respondents had ever preached about HIV/AIDS transmission and treatment to their congregations, while 257 (76.5%) used their position as a medium of educating their congregation about the dangers of HIV/AIDS and how to prevent it. Further analysis showed that respondents who were Christians (P = 0.026), had ever been married (P = 0.004), and were males (P = 0.002) were more likely to have ever preached about health issues to their congregations (individual role). CONCLUSION: The study concluded that the religious leaders are well informed about HIV/AIDS and have adequate knowledge and positive attitudes towards people living with AIDS. However, they need encouragement and training to enable them to more effectively harness their position for HIV prevention and to control programs and activities among their congregation to thereby play a crucial role in the war against HIV/AIDS in Nigeria.