"It is kind of like a responsibility thing": transitional challenges in asthma medication adherence among adolescents and young adults.

OBJECTIVE: Nonadherence to asthma medications is prevalent among adolescents and young adults (AYAs) with asthma, leading to worsened control of asthma symptoms and more frequent exacerbations. AYAs have unique developmental transitional challenges that may alter medication adherence. We aimed to use a socio-ecological framework to explore the effect of transitional challenges from adolescence to young adulthood on asthma controller medication adherence and to identify possible strategies to promote medication adherence. METHODS: We conducted qualitative semi-structured interviews by phone with 7 adolescents (14 to 17 years), their respective caregivers, and 7 young adults (18 to 30 years). Participants were recruited from a respiratory clinical trial network and pulmonary clinics in 4 states at 6 different sites through convenience sampling. Interviews were audio recorded, transcribed and coded using thematic analyses. RESULTS: Participants identified personal challenges affecting adherence to asthma medications during the transition from adolescence to young adulthood including responsibility for asthma self-management, understanding of asthma condition and severity, embarrassment, and life demands. Health systems factors including medication cost, challenges with insurance, difficulties obtaining refills, and difficulty with access to medications at school also impacted asthma medication adherence. Participants recommended adherence strategies including improved access to inhalers, incorporating asthma medications into daily routines, and using reminders. CONCLUSIONS: Focusing on the transitional challenges of AYAs during the time period from adolescence to young adulthood is necessary for supporting their asthma medication adherence and creating future interventions. Socio-ecological and systems factors should also be targeted for improved asthma medication adherence.Supplemental data for this article can be accessed online at https://doi.org/10.1080/02770903.2021.1897836.

Health system barriers to the implementation of the national action plan to combat antimicrobial resistance in Vietnam: a scoping review.

BACKGROUND: Vietnam is among 11 countries in the Western Pacific region that has developed a National Action Plan for Antimicrobial Resistance (NAPCA). METHODS: This scoping review characterises health system barriers to the implementation of the Vietnam NAPCA, with reference to the WHO Health Systems Framework. RESULTS: Over 7 years, between 2013 and 2020, the Ministry of Health (MOH) of Vietnam has been implementing activities to achieve the six NAPCA objectives. They include revision of regulations needed for antimicrobial resistance (AMR) prevention programs; formation and operation of national management bodies; improvement of antimicrobial stewardship (AMS) in hospitals; maintenance of surveillance systems for AMR; provision of trainings on AMR and antibiotics use to doctors and pharmacists; and organization of nation-wide educational campaigns. Limited cooperation between MOH management bodies, shortages of human resource at all health system levels, a low degree of agreement between national and hospital guidelines on antibiotic use, low capability in the domestic supply of standardised drugs, and unequal training opportunities for lower-level health professionals present ongoing challenges. Actions suggested for the next period of the NAPCA include a final review of what has been achieved by the plan so far and evaluating the effectiveness of the different components of the plan. Different options on how to improve coordination across sectors in the development of a new NAPCA should be put forward. CONCLUSIONS: The 6-year implementation of the Vietnam NAPCA has yielded valuable lessons for AMS in Vietnam, guiding the development of future national plans, with a central focus on scaling up AMS in hospitals and promoting community AMS programs to combat AMR.

Integration of family planning into HIV services: a systematic review.

BACKGROUND: The unmet need for safe and effective contraception still remains high. In 2017, about 25% of women of childbearing age who wanted to avoid pregnancy in the developing world were not using a modern contraceptive method. The biggest proportion (21%) of these women live in Sub-Saharan Africa. Little attention has been paid to the health systems factors impacting the integration of family planning into HIV services. This systematic review intends to document health systems factors constraining or facilitating the integration of family planning into HIV services. METHODS: A search of electronic databases such as PubMed and Google Scholar was conducted using keywords. We considered peer-reviewed articles which were published in English between 1st January 2010 and 31st December 2020. The peer-reviewed articles which were considered focussed on identifying barriers and facilitators at the levels of the health system which influence the success or failure of integrated family planning and HIV programs, availability of integrated family planning services in HIV care, the evidence on the feasibility, effectiveness and cost-effectiveness of integrating family planning and HIV services and investigating the outcomes of programs aimed at strengthening family planning integration in HIV counselling, testing and care. Twenty-seven articles that identify factors affecting integration of family planning into HIV services met the inclusion criteria and were thematically analysed. RESULTS: Health systems factors constraining integration of family planning and HIV services were human resource turnover and shortages, lack of policy guidance on integrated care, poor oversight, unclear service delivery guidelines, inadequate infrastructure and insufficient monitoring systems. Facilitators to the successful integration of family planning into HIV services were identified as training in family planning for service providers, the creation of a supportive policy environment to accommodate service integration, supportive supervision and a positive attitude by service providers towards service integration. CONCLUSION: Increase in the health workforce to support integrated service delivery, skills enhancement for service providers and improvement in family planning commodity stock levels play a key role in facilitating the integration of family planning into HIV services.

PLAIN ENGLISH SUMMARYThe findings of this systematic review support integration of family planning into HIV services. The results indicate that it is both possible to integrate family planning into HIV services as well as to implement an integrated model to health care service delivery. Further, the review indicates that there are a number of health systems factors that facilitate as well as constrain the integration of the two services.Integrating family planning into HIV services addresses a number of Sexual and Reproductive Health challenges being faced by women of childbearing age. Integrated family planning and HIV services reduce high rates of unintended pregnancies among HIV-positive women, reduce high pregnancy-related maternal mortality rates and increase the chance of meeting international and national development goals and targets, particularly Sustainable Development Goal number 3. Integration also helps women receive several services during a single visit to a health facility.Integrated family planning and HIV services ought to support the provision of comprehensive family planning and HIV services in a country. This is critical to encourage especially women living with HIV infection to access a full range of contraceptive methods. The provision of comprehensive family planning and HIV services allows HIV negative as well as HIV positive couples and individuals to meet their sexual and reproductive health needs.The review produced sufficient knowledge on the health systems factors which facilitate and constrain the integration of family planning into HIV services.The systematic review demonstrated the need to deal with health systems barriers in order to ensure success in integrating family planning and HIV services. The review also demonstrated the need for health systems strengthening in order to provide quality integrated family planning and HIV services.Key MessagesIntegration of family planning into HIV services is more and more being used as an approach for meeting the contraceptive needs of HIV-positive women of the childbearing age group.Training for service providers, supportive supervision, a supportive policy environment and a positive attitude by service providers towards integration were identified as health systems factors facilitating to the integration of family planning and HIV services.Staff turnover and shortage, inadequate infrastructure, stock-outs of family planning commodities, lack of coordinated leadership for integration, lack of integrated national policies and operational frameworks and separate funding for family planning and HIV services were identified as health systems barriers to integration of family planning and HIV services.