Introduction Worldwide, over two-thirds of people living with HIV are on antiretroviral therapy (ART). Despite increased ART access, high virological suppression prevalence remains out of reach. Few ...studies consider the quality of ART services and their impact on recipients' viral suppression. We assessed the association between ART service readiness and HIV viral load suppression among pregnant and breastfeeding women living with HIV (WLH) receiving ART in maternal and child health (MCH) clinics in Kinshasa, Democratic Republic of Congo. Methods We performed a cross-sectional analysis leveraging data from a continuous quality improvement intervention on WLH's long-term ART outcomes. From November 2016 to May 2020, we enrolled WLH from the three largest clinics in each of Kinshasa'Łs 35 health zones. We measured clinic's readiness using three WHO-identified ART care quality indicators: relevant guidelines in ART service area, stocks of essential ART medicines, and relevant staff training in ≥24 months, scoring clinics 0-3 based on observed indicators. We defined viral load suppression as ≤1,000 cp/ml. Multilevel mixed-effect logistic models were used to estimate prevalence odds ratios (ORs) measuring the strength of the association between ART service readiness and viral suppression. Results Of 2,295 WLH, only 1.9% received care from a clinic with a score of 3, 24.1% received care from a 0-scoring clinic, and overall, 66.5% achieved virologically suppression. Suppression increased from 65% among WLH receiving care in 0-scoring clinics to 66.9% in 1-scoring clinics, 65.8% in 2-scoring clinics, and 76.1% in 3-scoring clinics. We did not observe a statistically significant association between ART service readiness score and increased viral suppression prevalence, however we did find associations between other factors, such as the location of the health center and pharmacist availability with suppressed viral load. Discussion A lack of comprehensive ART care underscores the need for enhanced structural and organizational support to improve virological suppression and overall health outcomes for women living with HIV..
A mixed design approach was performed to assess the CD4 count levels over time and their associated factors among 362 HIV patients on ART from clinics with HIV testing and counseling (ART-HTC) ...services and those with general healthcare (ART-GH) services. Longitudinal CD4 count data were retrospectively collected from medical records. Sociodemographic, clinical, alcohol use and smoking characteristics were obtained via face-to-face interviews. Multivariate mixed effect linear regression was utilized to determine the association. We found that HIV patients at ART-GH clinics were more likely to achieve higher CD4 counts over time compared to patients at ART-HTC clinics. Additionally, having an increase in CD4 counts was found to be associated with having longer duration of ART and higher baseline CD4 levels. Cigarette smoking and hazardous alcohol use, however, were not associated with CD4 count improvement. Our findings suggest that combining HTC and GH services might provide a synergistic benefit in ART treatment outcomes through an improved access to comprehensive HIV healthcare services for HIV patients on therapy.
Objectives To describe initial registration characteristics of adult and paediatric TB patients at a large, public, integrated TB and HIV clinic in Lilongwe, Malawi, between January 2008 and ...December 2010.
Methods Routine data on patient with TB category and TB type, stratified by HIV and ART status, were used to explore differences in proportions among TB only, TB/HIV co‐infected patients not on ART and TB/HIV co‐infected patients on ART using chi‐square tests. Trends over time illustrate strengths and weaknesses of integrated service provision.
Results Among 10 143 adults, HIV ascertainment and ART uptake were high and increased over time. The proportion of relapse was highest among those on ART (5%). The proportion of smear‐positive pulmonary TB (PTB) was highest among HIV‐negative patients with TB (34.9%); extra‐pulmonary TB (EPTB) was lowest among TB only (16.2%). Among 338 children <15 years, EPTB and smear‐positive PTB were more common among TB‐only patients. Time trends showed significant increases in the proportion of adults with smear‐positive PTB and the proportion of adults already on ART before starting TB treatment. However, some co‐infected patients still delay ART initiation.
Conclusions HIV ascertainment and ART uptake among co‐infected patients are successful and improving over time. However, delays in ART initiation indicate some weakness linking TB/HIV patients into ART during TB follow‐up care. Improved TB diagnostics and screening efforts, especially for paediatric patients, may help improve quality care for co‐infected patients. These results may aid efforts to prioritise TB and HIV prevention, education and treatment campaigns for specific populations.
Objectifs: Décrire les caractéristiques initiales à l’inscription des patients adultes et pédiatriques atteints de tuberculose (TB) dans une vaste clinique publique de soins intégrés TB et VIH à Lilongwe, au Malawi, entre janvier 2008 et décembre 2010.
Méthodes: Les données de routine sur les catégories de patients TB et le type de TB, stratifiées par le statut VIH et ART, ont été utilisées pour explorer les différences dans les proportions chez les patients avec TB seule, les patients coinfectés TB/VIH qui ne sont pas sous ART et les patients coinfectés TB/VIH sous ART, en utilisant le test du Chi carré. Les tendances au fil du temps illustrent les points forts et les faiblesses de la prestation de services intégrés.
Résultats: Parmi 10.143 adultes, la confirmation du VIH et l’adoption de l’ART étaient élevées et ont augmenté au fil du temps. La proportion des rechutes était plus élevée chez ceux sous traitement antirétroviral (5%). La proportion des frottis positifs de TB pulmonaire (TBP) était plus élevée chez les patients TB VIH‐négatifs (34,9%); la TB extra‐pulmonaire (TBEP) était la moins fréquente chez les patients avec une TB seule (16,2%). Parmi 338 enfants de moins de 15 ans, la TBEP et la TBP à frottis positif étaient plus fréquentes chez les patients avec une TB seule. Les tendances temporelles ont montré des augmentations significatives de la proportion d’adultes avec une TBP à frottis positif et de la proportion d’adultes déjà sous ART avant le commencement du traitement antituberculeux. Cependant, certains patients coinfectés retardent encore l’initiation de l’ART.
Conclusions: La confirmation du VIH et l’adoption de l’ART chez les patients coinfectés s’effectuent avec succès et s’améliorent au fil du temps. Toutefois, les retards dans l’initiation de l’ART indiquent une certaine faiblesse dans la liaison entre patients TB/VIH et l’ART pendant les soins de suivi TB. L’amélioration du diagnostic de la TB et des efforts de dépistage, en particulier chez les patients pédiatriques, pourrait aider à améliorer la qualité des soins pour les patients coinfectés. Ces résultats pourraient contribuer aux efforts à donner la prioritéà la prévention, l’éducation et les campagnes de traitement de la TB et du VIH pour les populations spécifiques.
Objetivos: Describir las características de pacientes adultos y pediátricos con TB en el momento de registrarse en una gran clínica pública, con tratamiento integrado para la TB y el VIH en Lilongwe, Malawi, entre Enero 2008 y Diciembre 2010.
Métodos: Se utilizaron datos rutinarios de las categorías “pacientes con TB” y “tipo de TB”, estratificados por estatus de VIH y TAR, para explorar – utilizando pruebas de Chi‐cuadrado ‐ las diferencias en proporciones entre pacientes con solo TB, con coinfección TB/VIH sin TAR y pacientes coinfectados con TB/VIH recibiendo TAR. Las tendencias a lo largo del tiempo ilustran las fortalezas y las debilidades de un servicio integrado.
Resultados: Entre 10,143 adultos, la constatación de seropositividad para VIH y la toma del TAR eran altos y aumentaban a lo largo del tiempo. La proporción de recaídas era mayor entre aquellos recibiendo TAR (5%). La proporción de TB con TB pulmonar con frotis positivo (TBP) era mayor entre los pacientes con TB, negativos para VIH (34.9%); la TB extra‐pulmonar (TBEP) era menor entre pacientes con solo TB (16.2%). Entre 338 niños <15 años, la TBEP y la TBP con frotis positivo eran más comunes entre pacientes con solo TB. La tendencia en el tiempo mostraba un aumento significativo en la proporción de adultos con TBP con frotis positivo y la proporción de adultos que ya estaban en TAR antes de comenzar el tratamiento para la TB. Sin embargo, algunos pacientes co‐infectados siguen retrasando la iniciación del TAR.
Conclusiones: La constatación de la seropositividad para el VIH y la toma del TAR de pacientes co‐infectados es un éxito y mejora con el tiempo. Sin embargo, los retrasos en la iniciación del TAR indican una debilidad en el enlace de pacientes con TB/VIH al TAR durante el seguimiento para la TB. Una mejora del diagnóstico y la revisión de la TB, especialmente entre los pacientes pediátricos, podría ser de ayuda a la hora de aumentar la calidad de los cuidados ofrecidos a pacientes co‐infectados. Estos resultados pueden ser de utilidad a la hora de determinar las prioridades de las campañas de prevención, educación y tratamiento de la TB y el VIH.
Zambia is one of the HIV high burden countries in Sub Saharan Africa. Government of Zambia has been expanding Antiretroviral Therapy (ART) service nationwide at district level. However, it is still ...hard to access to ART service for PLHIVs who live in rural. In terms of accessibility, the service must be expanded to rural health centre level, but there are many challenges to expand the quality services into such resource limited setting, especially in the shortage of health providers. JICA's “Integrated HIV and AIDS Care Implementation Project at District Level” launched at April 2006 to improve the quality and accessibility of HIV and AIDS care services in rural Zambia. Two districts in rural area, namely Mumbwa and Chongwe, were selected as project sites. The Project introduced the “mobile ART service” at rural health centre level using the existing health system. Mobile ART services enable a rural health centre that cannot offer ART by itself to provide ART services through the human resource and technical support/assistance of the District Hospital. Mumbwa and Chongwe District Health Management Team (DHMT) started mobile ART services in the first Quarter of 2007, therefore access to ART service in districts has been improved and contributed to increase of ART clients and reduce the defaulter rate within first 6 months of treatment. The project also tried to introduce the community involvement to overcome the shortage of human resources. We found that Mobile ART services involving the community are beneficial and effective, and help ART services expansion to rural health facilities where resources are limited, and as close as possible to places where clients live. The strategies we experienced were cited in “the National Mobile HIV Services Guidelines” published by the MoH and will be able to be duplicated in other resource-limited areas of not only Zambia but also other developing countries.
Background- COVID-19 pandemic has had a huge impact on the collateral health system. It made access to essential health services difficult. Such an essential service is a service provided to HIV ...patients. This study was planned to assess the effect of the current COVID-19 pandemic on Anti-Retroviral therapy (ART) center services. Methods -Pre-recorded epidemiological data from an ART center of a teaching hospital was used to answer the research question. Data was collected for retrieving 4 parameters i.e. number of registrations, number of HIV-positive patients kept on ART, number of deaths, and loss to follow up of the COVID-19 year and non-COVID-19 year then comparison was made between both. Data analysis was done with the help of SPSS. Independent t-test, one-way ANOVA test, and multiple comparison Tuckey’s test were applied. Results- Statistically significant difference was noted in the total number of registrations, the number of patients kept on ART, death, and loss to follow-up in non- COVID-19 & COVID-19 years. After appling above mentioned statistical test the p-value came out to be <0.05. Conclusion-COVID-19 pandemic has adversely affected the auxiliary non-COVID-19 health services and health programs. The current study gives evidence that ART functioning is negatively affected by the COVID-19 pandemic.
ABSTRACT
The coronavirus disease 2019 (COVID-19) pandemic created a significant impact on medically assisted reproduction (MAR) services. ESHRE decided to mobilize resources in order to collect, ...analyse, monitor, prepare and disseminate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) knowledge specifically related to ART and early pregnancy. This article presents the impact of the SARS-CoV-2 pandemic focusing on reproductive healthcare. It details the rationale behind the guidance prepared to support MAR services in organizing and managing the re-start of treatments or in case of any future wave of COVID-19 disease. The guidance includes information on patient selection and informed consent, staff and patient triage and testing, adaptation of ART services, treatment planning and code of conduct. The initiatives detailed in this article are not necessarily COVID-specific and such action plans could be applied effectively to manage similar emergency situations in different areas of medicine, in the future.
•Organizational intermediation has social and economic impacts in the arts sector.•Social engagement is the process of working collaboratively towards social change.•Arts-service organizations play ...an integral role in sustaining and promoting the arts.•Arts-service organizations can meaningfully develop social engagement in Canada.•Fostering diversity and inclusion in the arts is important intermediation work.
Research on cultural intermediaries has frequently highlighted their roles that shape, regulate, organize, and govern processes of value formation and legitimization in creative economies. Here we move beyond a focus on individual brokers in cultural intermediary occupations to examine cultural intermediary work performed by organizations, focusing on strategies of organizational intermediary work which aim to foster social engagement. Our research study examines the arts-service organization (ASO) sector—member-directed representative professional bodies that serve the interests of their members as well as their artistic discipline and the public—through a quantitative survey mapping the sector in Canada and through semi-structured interviews. In this article, we highlight organizational intermediation strategies in the ASO sector, including fostering diverse representation; reflexivity and learning; and collaboration, discussing challenges and opportunities in these areas. We position the varied strategies of organizational intermediation as one way to communicate the work and worth of developing social engagement, which is often otherwise intangible and challenging to communicate and highlight.
Background: Arts-service organizations (ASOs) are member-directed representative professional bodies, meant to serve the interests of their members as well as their artistic discipline and the ...public. Despite this broad, mixed role, there is a dearth of academic research about ASOs and the role they play in Canada’s cultural ecosystem.
Analysis: Working in partnership with cultural research organization Mass Culture, the Arts-Service Organizations as Cultural Research Conduits research project sought to develop more knowledge about this sector.
Conclusion and implications: Using a cultural mapping methodology, quantitative and qualitative data were collected about the scale, scope, and role of the sector, particularly with regard to research conducted internally and externally by the ASO sector.
Investigations conducted among healthcare providers to assess their knowledge and perceptions towards the integration of anti-retroviral therapy (ART) related services in Sub-Saharan Africa are ...limited. This study explored the knowledge and perceptions of primary healthcare providers towards the integration of ART management services at departmental levels in health facilities in Lira district.
We conducted a descriptive cross-sectional survey that employed qualitative methods of data collection in four selected health facilities in Lira district between January and February 2022. The study involved in-depth interviews with key informants and focus group discussions. The study population consisted exclusively of primary healthcare providers; however, those who were not full-time employees of the participating health facilities were excluded. We used thematic content analysis.
A significant proportion of staff (especially those who are not directly involved in ART) still lack full knowledge of ART services integration. There was generally a positive perception, with some suggesting ART integration can minimize stigma and discrimination. The potential barriers to integration included limited knowledge and skills for providing comprehensive ART services, insufficient staffing and space, funding gaps, and inadequate drug supplies, coupled with increased workload due to enlarged clientele.
Whereas healthcare workers are generally knowledgeable about ART integration, but their knowledge was limited to partial integration. The participants had a basic understanding of ART services being provided by different health facilities. Furthermore, participants viewed integration as critical, but it should be implemented in conjunction with ART management training. Given that respondents reported a lack of infrastructure, increased workload, and understaffing, additional investments in staff recruitment, motivation through training and incentives, and other means are needed if ART integration is to be implemented.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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