Mapping evidence of mobile health technologies for disease diagnosis and treatment support by health workers in sub-Saharan Africa: a scoping review.

BACKGROUND: The rapid growth of mobile technology has given rise to the development of mobile health (mHealth) applications aimed at treating and preventing a wide range of health conditions. However, evidence on the use of mHealth in high disease burdened settings such as sub-Sharan Africa is not clear. Given this, we systematically mapped evidence on mHealth for disease diagnosis and treatment support by health workers in sub-Saharan Africa. METHODS: We conducted a scoping review study guided by the Arksey and O'Malley's framework, Levac et al. recommendations, and Joanna Briggs Institute guidelines. We thoroughly searched the following databases: MEDLINE and CINAHL with full text via EBSCOhost; PubMed; Science Direct and Google Scholar for relevant articles from the inception of mHealth technology to April 2020. Two reviewers independently screened abstracts and full-text articles using the eligibility criteria as reference. This study employed the mixed methods appraisal tool version 2018 to assess the methodological quality of the included studies. RESULTS: Out of the 798 articles identified, only 12 published articles presented evidence on the availability and use of mHealth for disease diagnosis and treatment support by health workers in SSA since 2010. Of the 12 studies, four studies were conducted in Kenya; two in Malawi; two in Nigeria; one in South Africa; one in Zimbabwe; one in Mozambique, and one in Lesotho. Out of the 12 studies, one reported the use of mHealth for diseases diagnosis; three reported the use of mHealth to manage HIV; two on the management of HIV/TB; two on the treatment of malaria; one each on the management of hypertension; cervical cancer; and three were not specific on any disease condition. All the 12 included studies underwent methodological quality appraisal with a scored between 70 and 100%. CONCLUSIONS: The study shows that there is limited research on the availability and use of mHealth by health workers for disease diagnosis and treatment support in sub-Saharan Africa. We, therefore, recommend primary studies focusing on the use of mHealth by health workers for disease diagnosis and treatment support in sub-Saharan Africa.

A treatment-support intervention evaluated in South African paediatric populations with HIV infection or tuberculous meningitis.

OBJECTIVES: To evaluate a paediatric treatment-support intervention for home-based treatment of HIV infection or tuberculous meningitis (TBM). METHODS: A randomised-controlled study comparing local standard care (controls) with standard care plus intervention (combining adherence education, reinforcement and monitoring) in children aged 0-14 years. We recorded adherence measures (self-report, pill-count, drug-assays for isoniazid and rifampicin in urine and pyrazinamide in saliva), difficulties administering medication and PedsQL™questionnaires for health-related quality-of-life (HRQoL) and family impact. RESULTS: In the HIV group (6-months follow-up, n = 195), more children had above-median HRQoL-scores in the intervention group than in the control group (P = 0.009). Problems reported administering medication declined between baseline and follow-up for controls (P = 0.043). Disclosure of HIV status to the child increased between baseline and follow-up in both groups (intervention P < 0.001; control P = 0.031). In the TBM group (3-months follow-up, n = 43), all adherence measures remained high for both intervention and controls, except for rifampicin which declined between baseline and follow-up in the intervention group (P = 0.031). The intervention group maintained above median HRQoL-scores between baseline and follow-up, when the number of children with above-median HRQoL-scores decreased in the controls (P = 0.063). More children in the intervention group had above-median family impact-scores than controls (P = 0.040). CONCLUSIONS: The low-cost, culturally friendly treatment-support intervention had beneficial effects on health-related quality of life, family impact, caregiver disclosure of HIV status to the child, increased caregiver reporting of medication non-adherence and caregiver reporting of difficulties administering medication. Treatment adherence was not significantly affected in either HIV or TBM group.

Community-Based Accompaniment with Supervised Antiretrovirals for HIV-Positive Adults in Peru: A Cluster-Randomized Trial.

We conducted a cluster-randomized trial to estimate effects of directly observed combination antiretroviral therapy (DOT-cART) on retention with viral suppression among HIV-positive adults in Peru. We randomly allocated facilities to receive the 12-month intervention plus the standard of care, including adherence support provided through accompaniment. In the intervention arm, health workers supervised doses, twice daily, and accompanied patients to appointments. Among 356 patients, intention-to-treat analyses showed no statistically significant benefit of DOT, relative to no-DOT, at 12 or 24 months (adjusted probability of primary outcome: 0.81 vs. 0.73 and 0.76 vs. 0.68, respectively). A statistically significant benefit of DOT was found in per-protocol and as-treated analyses at 12 months (0.83 for DOT vs. 0.73 for no DOT, p value: 0.02 per-protocol, 0.01 as-treated), but not 24 months. Rates of retention with viral suppression were high in both arms. Among adults receiving robust adherence support, the added effect of time-limited DOT, if any, is small-to-moderate.

Psychometric properties of the Dutch version of the Treatment Support Measure (TSM) parent and youth form.

The Treatment Support Measure (TSM) Parent and Youth were created to help clinicians with actionable feedback when youths are not making sufficient progress in treatment. This study examined the psychometric properties of the Dutch TSM Parent and TSM Youth. Parents (n = 172) and youth (n = 122) were recruited at 2 outpatient mental health care institutions. Children of participating parents (50.6% boys) had a mean age of 11.9 years (SD = 3.46; range 4-18). Participating youth (30.3% boys) had a mean age of 15.68 years (SD = 1.75; range 12-18). Participants were asked to complete the TSM and questionnaires measuring related constructs once during treatment. Responses to the TSM Parent items were explained by 9 instead of 5 subscales, and responses to the TSM Youth items were explained by 8 instead of 4 subscales. The internal consistency reliability of both the TSM Parent and the TSM Youth scales was generally good. The convergent validity of the TSM Parent and the TSM Youth was also good, although the divergent validity was less convincing. The criterion validity was inconclusive; the TSM Parent was not able to differentiate between problematic and nonproblematic treatments, but multiple scales of the TSM Youth were able to differentiate between these groups. The TSM Parent and TSM Youth have potential to be helpful tools in clinical practice. They could signal potential barriers to youth progress and direct the conversation between the clinician and youth and parents about adaptation of treatment. KEY PRACTITIONER MESSAGE: This is the first study to investigate the psychometric properties of the Treatment Support Measure (TSM) Parent and Youth versions, which are created to help clinicians with actionable feedback when youths are not making sufficient progress in treatment. The Dutch TSM Parent and TSM Youth have moderate to good psychometric properties. The Dutch TSM Parent and TSM Youth might be helpful tools for use in clinical practice: they contain variables that are related to youth outcome, can signal potential barriers to youth progress, and can direct the conversation between the clinician and the youth and parents about adaptation of treatment. The Dutch TSM Parent and TSM Youth could be added to the regular ROM to facilitate both routine monitoring of outcome and direct and concrete aid to the here-and-now relational processes in treatment.

Experiences of schizophrenia patients with treatment buddy support during the COVID-19 pandemic.

Background: Schizophrenia is a major psychiatric disorder affecting physical, psychosocial, and cognitive functioning. Treatment includes pharmacological and psychotherapeutic interventions. Adherence to prescribed medication is critical but reportedly low, because of side effects, failure to understand instructions, a lack of insight about the condition, cognitive deficits, and financial difficulties. Interventions to promote adherence to medication are required. This study introduced a treatment buddy to provide the patient with virtual support in adherence to medication. Aim: The aim of this study was to explore the participants' lived experiences of a treatment buddy support. Setting: A specialised psychiatric clinic in a resource-constrained district of KwaZulu-Natal, South Africa. Methods: A qualitative study design, using semi-structured one-on-one interviews, was used to collect in-depth data from 24 participants, suffering from schizophrenia and who had been offered virtual treatment buddy support for 6 months. Data were analysed using thematic analysis. Results: The intervention improved adherence to medication. Participants indicated that the text messages served as reminders to take their medication daily. An alleviation of associated problems such as sleeping difficulties was observed. Participants were willing to encourage other patients suffering from schizophrenia to join 'treatment buddy services'. Conclusion: The virtual treatment buddy support increased awareness of the importance to adhere to antipsychotic medications among patients suffering from schizophrenia and helped to resolve other schizophrenia-related problems experienced by the participants. Contribution: The study has provided a supportive intervention that can be utilised by mental health institutions to address poor adherence to medication by patients suffering from schizophrenia.

Tuberculosis preventive practices among treatment supporters in Lagos, Nigeria.

Context: Tuberculosis (TB) treatment support is one of the recommended strategies to enhance treatment adherence and outcomes. Treatment supporters are at risk of contracting TB and adequate knowledge of TB and good preventive practices are required for their protection. Aims: This study aimed at assessing the knowledge and preventive practices of TB treatment supporters at Directly Observed Treatment Short-course (DOTS) centers in Lagos Mainland Local Government Area of Lagos state, Nigeria. Settings and Design: This cross-sectional study was conducted among 196 TB treatment supporters selected from five DOTS centers in Lagos. Methods: Data were obtained using an adapted pretested questionnaire. Statistical Analysis Used: Bivariate and multivariate analyses were performed to determine the factors associated with self-protection practices. A P < 0.05 was considered statistically significant. Results: The mean age of the participants was 37.3 ± 12.1 years. More than half of the respondents were females (59.2%) and immediate family members (61.3%). Overall, 22.5% had good knowledge of TB, while 53.0% had positive attitudes toward TB. Only 26.0% adequately protected themselves from infection. The caregiver's level of education (P = 0.001) and their relationship to the patient (P = 0.001) were significantly associated with good preventive practices in bivariate analysis. Not being related to the patient was a predictor of adequate TB prevention practices (adjusted odds ratio = 2.852; P = 0.006; 95% confidence interval = 1.360-5.984). Conclusions: This study revealed low levels of TB knowledge and fair preventive practices, especially among caregivers who are relatives. There is, therefore, a need to improve population literacy about TB and its prevention and a more focused orientation of relatives who volunteer as treatment supporters, through health education, with periodic monitoring during clinic visits, of how they prevent TB.

Résumé Contexte: Le soutien au traitement de la tuberculose (TB) est l'une des stratégies recommandées pour améliorer l'observance du traitement et les résultats. Traitement les supporters courent le risque de contracter la tuberculose et une connaissance adéquate de la tuberculose et de bonnes pratiques préventives sont nécessaires pour leur protection. Objectifs: Cette étude visait à évaluer les connaissances et les pratiques préventives des accompagnants du traitement de la tuberculose au traitement directement observé Centres de formation courte (DOTS) dans la zone de gouvernement local de Lagos Mainland, dans l'État de Lagos, au Nigéria. Réglages et conception : Cette section transversale L'étude a été menée auprès de 196 agents de soutien au traitement de la tuberculose sélectionnés dans cinq centres DOTS à Lagos. Méthodes: Les données ont été obtenues à l'aide de un questionnaire prétesté adapté. Analyse statistique utilisée : Des analyses bivariées et multivariées ont été effectuées pour déterminer les facteurs associés aux pratiques d'autoprotection. Un P < 0.05 était considéré comme statistiquement significatif. Résultats: L'âge moyen des participants était 37.3 ± 12.1 ans. Plus de la moitié des répondants étaient des femmes (59.2 %) et des membres de la famille immédiate (61.3 %). Dans l'ensemble, 22.5 % avaient bonne connaissance de la tuberculose, tandis que 53.0 % avaient des attitudes positives à l'égard de la tuberculose. Seuls 26.0% se sont protégés de manière adéquate contre l'infection. Les le niveau d'instruction de l'aidant (P = 0.001) et sa relation avec le patient (P = 0.001) étaient significativement associés à une bonne prévention. pratiques en analyse bivariée. Ne pas être apparenté au patient était un facteur prédictif de pratiques adéquates de prévention de la tuberculose (rapport de cotes ajusté = 2.852 ; P = 0.006 ; Intervalle de confiance à 95 % = 1.360­5.984). Conclusions: Cette étude a révélé de faibles niveaux de connaissances sur la tuberculose et des pratiques préventives équitables, surtout chez les soignants qui sont des proches. Il est donc nécessaire d'améliorer les connaissances de la population sur la tuberculose et sa prévention et de une orientation plus ciblée des proches qui se portent volontaires pour soutenir le traitement, par le biais d'une éducation à la santé, avec un suivi périodique pendant la cliniquevisites, de la façon dont ils préviennent la tuberculose. Mots-clés: Lagos, Nigéria, soutien au traitement, tuberculose.

Preoperative anxiety and associated factors among adult surgical patients in public hospitals, eastern Ethiopia.

Objective: This study aimed to assess the prevalence of preoperative anxiety and associated factors among adult surgical patients in public hospitals of eastern Ethiopia from 25 April to 26 May 2022. Methods: An institutional-based cross-sectional study was undertaken using a systematic sampling technique among 423 participants from patients eligible for elective surgery. The prevalence of preoperative anxiety was assessed using the state and trait anxiety inventory measurement scale. Data were analyzed using SPSS version 26. Descriptive and summary statistics were computed. Binary and multivariable logistic regression were computed. The strength of the association was presented using an adjusted odds ratio with a 95% confidence interval and statistical significance was declared at a p-value < 0.05. Results: The prevalence of preoperative anxiety among patients scheduled for elective surgery was 51.2%. Being 31-45 aged adult (AOR = 0.36; 95% CI = 0.17, 0.78), having moderate (AOR = 0.46; 95% CI = 0.22, 0.96) and strong social support (AOR = 0.04; 95% CI = 0.02, 0.08), being single (AOR = 0.19; 95% CI = 0.04, 0.89), listening to music (AOR = 0.37; 95% CI = 0.18, 0.74) and finding social and religious support (AOR = 0.15; 95% CI = 0.07, 0.33), and orthopedic surgery (AOR = 0.21; 95% CI = 0.10, 0.43) were significantly associated with lower odds of preoperative anxiety, whereas having fear of death (AOR = 1.16; 95% CI = 0.64, 2.09) was significantly associated with increased odds of preoperative anxiety. Conclusion: In the current study, the magnitude of preoperative anxiety was high. Being an older adult and having social and treatment support was associated with lower odds of preoperative anxiety. In contrast, lower psychological readiness (fear of death) was associated with increased odds of preoperative anxiety. Patients should be routinely assessed for anxiety during the preoperative appointment, and the proper coping mechanisms and anxiety-reduction approaches should be used. It is also advisable that appropriate policies and procedures for reducing preoperative anxiety should be devised.

Insights from participant engagement with the tuberculosis treatment support tools intervention: Thematic analysis of interactive messages to guide refinement to better meet end user needs.

BACKGROUND: Tuberculosis (TB) is a largely curable disease, yet it remains one of the top ten causes of death globally. In response to known challenges to completing the long course of TB treatment, our study team developed the TB treatment support tools (TB-TSTs). The mobile application (app) is comprised of the following main components: 1) tracks treatment progress, 2) provides disease tailored information, 3) interactive communication between patients and treatment supporters, and 4) is linked with a direct adherence drug metabolite test. OBJECTIVE: The objective of this study was to analyze the interactive communication between the patients and the treatment supporter during the TB-TSTs pilot testing to identify issues and guide intervention refinement. METHODS: We used mixed methods to analyze the interactive communication data. The study was conducted at a pulmonary disease specialized hospital in Argentina. Of the 42 study participants enrolled in the pilot study, 21 were randomly assigned to use the TB-TSTs for 6-months during their TB treatment. The treatment supporter was a registered nurse from the regional level of the National TB program. We conducted thematic and content analysis of the messages in their original language, Spanish. We assessed the themes over time and by whom initiated the messages. RESULTS: There were 2561 individual messages sent between the participants and treatment supporter. We identified 19 main themes: 7 were participant and 12 were treatment supporter initiated. Participant themes included missed report rationale, arranging in-person meeting, intervention support, TB treatment progress, disease/treatment questions, side effects and additional support. Treatment supporter themes included missed report inquiry, arranging in-person meeting, introduction and instructions, check-in's, positive reinforcement, treatment progress inquiry, test-strip issues, intervention orientation, initial side-effect check in, follow-up on side effects and photo quality issues. Messages and themes decreased over time with most occurring within the first 2 months of treatment. CONCLUSIONS: Although there was a decrease in the number of messages and the theme types over the 6-month study participation, treatment adherence support remained needed throughout. Potential solutions are suggested for the main issues and recommendations are being used to guide refinement.

Availability and Use of Mobile Health Technology for Disease Diagnosis and Treatment Support by Health Workers in the Ashanti Region of Ghana: A Cross-Sectional Survey.

Mobile health (mHealth) technologies have been identified as promising strategies for improving access to healthcare delivery and patient outcomes. However, the extent of availability and use of mHealth among healthcare professionals in Ghana is not known. The study's main objective was to examine the availability and use of mHealth for disease diagnosis and treatment support by healthcare professionals in the Ashanti Region of Ghana. A cross-sectional survey was carried out among 285 healthcare professionals across 100 primary healthcare clinics in the Ashanti Region with an adopted survey tool. We obtained data on the participants' background, available health infrastructure, healthcare workforce competency, ownership of a mobile wireless device, usefulness of mHealth, ease of use of mHealth, user satisfaction, and behavioural intention to use mHealth. Descriptive statistics were conducted to characterise healthcare professionals' demographics and clinical features. Multivariate logistic regression analysis was performed to explore the influence of the demographic factors on the availability and use of mHealth for disease diagnosis and treatment support. STATA version 15 was used to complete all the statistical analyses. Out of the 285 healthcare professionals, 64.91% indicated that mHealth is available to them, while 35.08% have no access to mHealth. Of the 185 healthcare professionals who have access to mHealth, 98.4% are currently using mHealth to support healthcare delivery. Logistic regression model analysis significantly (p < 0.05) identified that factors such as the availability of mobile wireless devices, phone calls, text messages, and mobile apps are associated with HIV, TB, medication adherence, clinic appointments, and others. There is a significant association between the availability of mobile wireless devices, text messages, phone calls, mobile apps, and their use for disease diagnosis and treatment compliance from the chi-square test analysis. The findings demonstrate a low level of mHealth use for disease diagnosis and treatment support by healthcare professionals at rural clinics. We encourage policymakers to promote the implementation of mHealth in rural clinics.

Mobile health applications for disease screening and treatment support in low-and middle-income countries: A narrative review.

The advances in mobile technologies and applications are driving the transformation in health services delivery globally. Mobile phone penetration is increasing exponentially in low-and middle-income countries, hence using mobile phones for healthcare services could reach more people in resource-limited settings than the traditional forms of healthcare provision. The review presents recent literature on facilitators and barriers of implementing mHealth for disease screening and treatment support in low-and middle-income countries. We searched for relevant literature from the following electronic databases: MEDLINE; CINAHL with full text via EBSCOhost; Science Direct; PubMed; Google Scholar and Web of Science using the keywords for relevant studies. We searched for published studies from 2015 to August 2020 with no language limitations. A total of 721 articles identified, 125 articles met the inclusion criteria and were included in the qualitative synthesis. The review demonstrates relevant facilitators for the implementation of mHealth, which includes knowledge, attitudes, and perceptions of stakeholders on the use of mHealth and the performance of mHealth for disease diagnosis in low and-middle-income countries. Barriers and challenges hindering the implementation of mHealth applications were also identified. We proposed a framework for improving the implementation of mHealth for disease screening and treatment support in low-and middle-income countries.

Experiences of schizophrenia patients with treatment buddy support during the COVID-19 pandemic

Background: Schizophrenia is a major psychiatric disorder affecting physical, psychosocial, and cognitive functioning. Treatment includes pharmacological and psychotherapeutic interventions. Adherence to prescribed medication is critical but reportedly low, because of side effects, failure to understand instructions, a lack of insight about the condition, cognitive deficits, and financial difficulties. Interventions to promote adherence to medication are required. This study introduced a treatment buddy to provide the patient with virtual support in adherence to medication. Aim: The aim of this study was to explore the participants' lived experiences of a treatment buddy support. Setting: A specialised psychiatric clinic in a resource-constrained district of KwaZulu-Natal, South Africa. Methods: A qualitative study design, using semi-structured one-on-one interviews, was used to collect in-depth data from 24 participants, suffering from schizophrenia and who had been offered virtual treatment buddy support for 6 months. Data were analysed using thematic analysis. Results: The intervention improved adherence to medication. Participants indicated that the text messages served as reminders to take their medication daily. An alleviation of associated problems such as sleeping difficulties was observed. Participants were willing to encourage other patients suffering from schizophrenia to join 'treatment buddy services'. Conclusion: The virtual treatment buddy support increased awareness of the importance to adhere to antipsychotic medications among patients suffering from schizophrenia and helped to resolve other schizophrenia-related problems experienced by the participants. Contribution: The study has provided a supportive intervention that can be utilised by mental health institutions to address poor adherence to medication by patients suffering from schizophrenia.

Tuberculosis preventive practices among treatment supporters in Lagos, Nigeria

Context: Tuberculosis (TB) treatment support is one of the recommended strategies to enhance treatment adherence and outcomes. Treatment supporters are at risk of contracting TB and adequate knowledge of TB and good preventive practices are required for their protection. Aims: This study aimed at assessing the knowledge and preventive practices of TB treatment supporters at Directly Observed Treatment Short-course (DOTS) centers in Lagos Mainland Local Government Area of Lagos state, Nigeria. Settings and design: This cross-sectional study was conducted among 196 TB treatment supporters selected from five DOTS centers in Lagos. Methods: Data were obtained using an adapted pretested questionnaire. Statistical analysis used: Bivariate and multivariate analyses were performed to determine the factors associated with self-protection practices. A P < 0.05 was considered statistically significant. Results: The mean age of the participants was 37.3 ± 12.1 years. More than half of the respondents were females (59.2%) and immediate family members (61.3%). Overall, 22.5% had good knowledge of TB, while 53.0% had positive attitudes toward TB. Only 26.0% adequately protected themselves from infection. The caregiver's level of education (P = 0.001) and their relationship to the patient (P = 0.001) were significantly associated with good preventive practices in bivariate analysis. Not being related to the patient was a predictor of adequate TB prevention practices (adjusted odds ratio = 2.852; P = 0.006; 95% confidence interval = 1.360-5.984). Conclusions: This study revealed low levels of TB knowledge and fair preventive practices, especially among caregivers who are relatives. There is, therefore, a need to improve population literacy about TB and its prevention and a more focused orientation of relatives who volunteer as treatment supporters, through health education, with periodic monitoring during clinic visits, of how they prevent TB.

Effect of treatment support on preventing local recurrence of hepatocellular carcinoma directly adjacent to the diaphragm.

Treatment support is anticipated to improve the results of radiofrequency ablation (RFA) treatment in cases in which visualization of tumors using the conventional B-mode is unclear. In the present study, the effectiveness of treatment support for RFA reducing the local recurrence rate of hepatocellular carcinoma (HCC) that are located directly adjacent to the diaphragm, and which are difficult to visualize with B-mode ultrasound imaging, was investigated. A total of 103 HCC tumors measuring <5 cm, which were located abutting the diaphragm, and which were difficult to visualize using the B-mode, were treated using RFA. Thirty-three of those HCC tumors were treated using RFA without treatment support, whereas the remaining 70 HCC tumors were treated using RFA with treatment support, including artificial pleural effusion, contrast-enhanced ultrasonography (CEUS) with the contrasting agent, Sonazoid™, and fusion imaging, either alone or in combination to improve the visualization of the tumors. The rate of local recurrence, and factors affecting local recurrence, were analyzed. Local recurrences were confirmed in 17 of the 103 nodules (16.50%). The overall rate of local recurrence was 13.1% at 6 months, and 20.2% at 12 months. The rate of local recurrence using RFA with artificial pleural effusion was significantly lower compared with those cases of HCC tumors treated without artificial pleural effusion (P=0.008). Similarly, the rate of local recurrence for CEUS RFA with Sonazoid™ was significantly lower compared with those cases of HCC tumors treated without Sonazoid™ (P=0.00081). In a multivariate analysis, CEUS RFA with Sonazoid™ and artificial pleural effusion contributed to the decrease in the rate of local recurrence (hazard ratios, 0.075 and 0.143, respectively). Based on these results, it is possible to conclude that CEUS with Sonazoid™ as a treatment support was the most effective method for reducing the rate of local recurrences abutting the diaphragm that are difficult to visualize using B-mode ultrasonography.

[The nurse in an addiction treatment, support and prevention centre]. / L'infirmière en centre de soins, d'accompagnement et de prévention en addictologie.

The nurse in an addiction treatment, support and prevention centre works within a multidisciplinary team. She is available to listen to the addicts and support them. Thanks to her specific skills and training, she plays a key role in the follow-up.

Social inclusion: An effort to end loss-to-treatment follow-up in tuberculosis.

SITUATION ANALYSIS: Pathanamthitta district is implementing Revised National Tuberculosis Control Program as a pilot district since 1993. The district programme was reporting approximately 5% of their diagnosed smear positive patients as never put on treatment (Initial lost to follow up - ILFU) and 5% of the new smear positive [NSP] Pulmonary TB patients as lost to follow up [LFU] during treatment. Attempts based on reengineering of DOTS were not largely successful in bringing down these proportions. INTERVENTION: A treatment support group [TSG] is a non-statutory body of socially responsible citizens and volunteers to provide social support to each needy TB patient safeguarding his dignity and confidentiality by ensuring access to information, free and quality services and social welfare programs, empowering the patient for making decision to complete treatment successfully. It is a complete fulfilment of social inclusion standards enumerated by Standards for TB Care in India. Pathanamthitta district started implementing this strategy since 2013. OUTCOMES: After intervention, proportion of LFU among NSPTB cases dropped markedly and no LFU were reported among the latest treatment cohorts. Proportion of ILFU keeps similar trend and none were reported among the latest diagnostic cohorts. LESSONS: Social support for TB care is feasible under routine program conditions. Addition of standards for social inclusion in STCI is meaningful. Its meaning is translated well by a society empowered with literacy and political sense.

S-PC: an e-treatment application for management of smoke-quitting patients.

The main objective of this paper is to present a new program that facilitates the management of people who want to quit smoking, implemented through an e-treatment software called S-PC (Smoker Patient Control). S-PC is a web-based application that manages groups of patients, provides a bidirectional communication through mobile text messages and e-mails between patients and clinicians and offers advice and control to keep track of the patients and their status. A total of 229 patients were enrolled in the study, randomly divided into two groups, although some variables were tested to ensure that there were no significant differences between the groups that could have an impact on the outcome of the treatment. There were no significant differences between the two groups regarding the ratio/number of males/females, tobacco dependence, co-oximetry, average cigarette consumption, current age and age when smoking started. The first group was made up of 104 patients (45.4% of the total) and followed a treatment that incorporated the S-PC tool, while the second one had 125 patients without the S-PC tool. S-PC was evaluated for its effectiveness at assisting the patients to give up smoking, and its effect on clinician time management. 74% of the S-PC group completed the treatment without relapses and remained abstinent three months after the completion of the treatment, understanding abstinence as being continuous (with no relapses allowed and co-oximetry below 1 ppm) from the day of stopping. In contrast only 45.6% of the No S-PC group completed the treatment without relapses and remained abstinent three months after completion of the treatment. The rate of admittance to the program has doubled in one year and patients went from having to wait for 3 months to be immediately admitted into the program. This therapeutic e-health program aims at maximizing the number of patients that a professional can effectively help to quit smoking. In addition, the system also detects patients who are not progressing appropriately, allowing the professional to improve their treatment parameters dynamically.

How disclosure and antiretroviral therapy help HIV-infected adolescents in sub-Saharan Africa cope with stigma.

HIV-related stigma has a major impact on the health and psychosocial wellbeing of HIV-infected children and youths. While there is some debate about the extent to which improved access to antiretroviral therapy (ART) contributes to a reduction in HIV stigma, we know little about how adolescents who know their HIV status and who are enrolled in ART experience and cope with stigma. The aim of the research was to understand and identify the pathways between HIV-status disclosure, ART, and children's psychosocial wellbeing, including from the perspective of adolescents themselves. Two qualitative studies were carried out, in Botswana and Tanzania, in 2011: 16 adolescents and three healthcare workers were enrolled in Botswana, and 12 adolescents and two healthcare workers were enrolled in Tanzania. The data were collected through individual and group interviews as well as participant observation. The recorded interviews were transcribed and analysed using thematic network analysis. The findings indicate that HIV-status disclosure enabled adolescents to engage effectively with their ART treatment and support groups, which in turn provided them with a sense of confidence and control over their lives. Although the adolescents in the two studies were still experiencing stigma from peers and community members, most did not internalise these experiences in a negative way, but retained hope for the future and felt pity for those untested and uninformed of their own HIV status. We conclude that disclosure and good HIV-related services provide an important platform for HIV-infected adolescents to resist and cope with HIV stigma.

Estudio de Costos Promedios de Servicios en el Hospital Nacional. Años 2.009/10 / Average Cost Study Services in the National Hospital. 2009/10 Year

RESUMEN Objetivo:El presente trabajo busca definir los costos promedios de los servicios brindados por el Hospital Nacional y proveer de información económica puntual a los Departamentos Médicos y Administrativos. Material y Métodos:Es un estudio descriptivo, que utilizando los archivos del Hospital Nacional, define servicios brindados y asigna costos promedios luego de agrupar los gastos correspondientes a cada área, siendo el costo promedio de cada servicio el cociente entre los gastos y el total de servicios brindados por esa área en un año. Resultados:Los resultados son los costos promedios de 28 servicios que brinda el Hospital Nacional. Conclusión:El método utilizado permite obtener datos precisos y útiles para la planificación.

ABSTRACT Objetive:This paper seeks to define the average costs of services provided by the National Hospital and provide accurate financial information to the Medical and Administrative Departments. Material and Methods:It is a descriptive study using the National Hospital files, define services provided and costs allocated to group averages after expenses for each area, with the average cost of each service by dividing the total costs and services provided by that area in a year. Results:The results are the average costs of 28 services provided by the National Hospital. Conclusion: The method allows for accurate and useful data for planning.