Changes in disclosure, adherence and healthcare interactions after the introduction of immediate ART initiation: an analysis of patient experiences in Swaziland.

INTRODUCTION: There are concerns that immediate ART initiation (regardless of CD4 count) negatively affects HIV status disclosure, ART adherence and healthcare interactions. We assessed changes in these factors after the 'Early access to ART for all' intervention, a universal test-and-treat study in Swaziland. METHODS: We recruited two samples of participants between 2014 and 2017. The first group was interviewed before the intervention (control); the second group at the implementation and 6 months thereafter (intervention). RESULTS: High levels of disclosure to partners (controls and intervention: 94%) and family members (controls: 78%, intervention: 79%) were reported, and high levels of adherence (85% did not miss a dose among the controls, 84% in the intervention group). There were no changes in patients reporting feeling pressured to initiate ART (controls: 10%, intervention: 11%). The quality of interaction with healthcare workers improved after the intervention; healthcare workers explained more often the choice of ART initiation (controls: 88%, intervention: 93%) and the meaning of both CD4 and viral load test results (controls: 15%, intervention: 47%). More patients in the intervention group reported receiving test results (controls: 13%, intervention: 46%). We observed no changes in disclosure, adherence or patient experiences 6 months into the intervention compared to its start. CONCLUSION: Our results suggest that both reported adherence and disclosure levels remain high after the introduction of immediate ART in Swaziland. We observed an improvement in the healthcare interactions, possibly due to training at participating facilities, which will be an important element for a successful roll-out of immediate ART

Challenges faced by mental health nurses working with people living with mental illness in Eswatini: A qualitative study

Background: Research on the challenges faced by mental health nurses working in poorly resourced settings, especially in Eswatini, is limited. As a result, we conducted this study to explore and describe the challenges faced by mental health nurses working with people living with mental illness in Eswatini. Methods: The study employed a qualitative approach, using an exploratory-descriptive design and the data were collected from nine (9) purposively selected mental health nurses at the National Psychiatric Referral Hospital (NPRH). A majority (n = 7) of the participants had bachelors’ degrees and were female (n = 5), with a mean of 6 years working experience in a mental health setting. The data were collected using an unstructured interview guide through audio-recorded individual in-depth-interviews, and were analysed manually using Colaizzi’s method of phenomenological analysis. Results: Five themes emerged from the data: i) physical violence; ii) sexual harassment iii) emotional distress due to verbal abuse; iv) stigma and discrimination; and v) administrative challenges (drug stock-outs, staff shortage, overcrowding, and inadequate infrastructure and medical equipment). Conclusion: The mental health nurses shared several challenges they encounter on their day-to-day job, including physical, psychological and administrative challenges. There is a need for the Ministry of Health working with the Wellness Centre for health workers to design staff wellness programs aimed at mitigating work-related stress and challenges faced by mental health nurses. The Ministry of Health and the NPRH administration should put in place safety measures at the NPRH and should devise a management strategy to tackle the administrative challenges raised by the nurses in this study

Examining mediators of associations of food insecurity and being bullied with suicide among in-school adolescents in Eswatini: a cross-sectional study

Abstract We examined the potential mediating roles of anxiety and loneliness on the association of concurrent food insecurity (FI) and being bullied (BB) with suicidal behavior (SB) in Eswatini, a lower-middle-income country. We used data from the Global School-based Student Health Survey (GSHS; N = 3264), which employed a two-stage cluster sampling: first, 25 schools were selected based on the proportionate probability of enrollment; second, classes were randomly selected. A self-reported 84-item GSHS questionnaire was used to collect data for students aged 13–17 years. FI was measured by requesting students to recall how often they went hungry because of a lack of food at home in the 30 days before the study. Multiple logistic regressions and binary mediation function was applied to examine mediating factors of SB. The prevalence of SB, FI, and BB among adolescents was 27.5%, 7.7%, and 30.2%, respectively. Moreover, the relationship between FI and BB with SB was partly (approximately 24%) mediated by anxiety and loneliness. Our results highlight the mediating roles of anxiety and loneliness in suicidal adolescents who experience FI and BB. In conclusion, interventions for alleviating SB in high-risk adolescents experiencing FI and BB should also be aimed at ameliorating anxiety and loneliness