Patient perspectives on integrated healthcare for HIV, hypertension and type 2 diabetes: a scoping review

Introduction Antiretroviral therapy has reduced mortality and led to longer life expectancy in people living with HIV. These patients are now at an increased risk of non-communicable diseases (NCDs). Integration of care for HIV and NCDs has become a focus of research and policy. In this article, we aim to review patient perspectives on integration of healthcare for HIV, type 2 diabetes and hypertension. Methods The framework for scoping reviews developed by Arksey and O'Malley and updated by Peter et al was applied for this review. The databases PubMed, Web of Science and Cochrane library were searched. Broad search terms for HIV, NCDs (specifically type 2 diabetes and hypertension) and healthcare integration were used. As the review aimed to identify definitions of patient perspectives, they were not included as an independent term in the search strategy. References of included publications were searched for relevant articles. Titles and abstracts for these papers were screened by two independent reviewers. The full texts for all the publications appearing to meet the inclusion criteria were then read to make the final literature selection. Results Of 5502 studies initially identified, 13 articles were included in this review, of which 11 had a geographical origin in sub-Saharan Africa. Nine articles were primarily focused on HIV/diabetes healthcare integration while four articles were focused on HIV/hypertension integration. Patient’s experiences with integrated care were reduced HIV-related stigma, reduced travel and treatment costs and a more holistic person-centred care. Prominent concerns were long waiting times at clinics and a lack of continuity of care in some clinics due to a lack of healthcare workers. Non-integrated care was perceived as time-consuming and more expensive. Conclusion Patient perspectives and experiences on integrated care for HIV, diabetes and hypertension were mostly positive. Integrated services can save resources and allow for a more personalised approach to healthcare. There is a paucity of evidence and further longitudinal and interventional evidence from a more diverse range of healthcare systems are needed

Delayed diagnosis of tuberculosis in persons living with HIV in Eastern Europe: associated factors and effect on mortality-a multicentre prospective cohort study

Background: Early diagnosis of tuberculosis (TB) is important to reduce transmission, morbidity and mortality in people living with HIV (PLWH). Methods: PLWH with a diagnosis of TB were enrolled from HIV and TB clinics in Eastern Europe and followed until 24 months. Delayed diagnosis was defined as duration of TB symptoms (cough, weight-loss or fever) for ≥ 1 month before TB diagnosis. Risk factors for delayed TB diagnosis were assessed using multivariable logistic regression. The effect of delayed diagnosis on mortality was assessed using Kaplan-Meier estimates and Cox models. Findings: 480/740 patients (64.9%; 95% CI 61.3-68.3%) experienced a delayed diagnosis. Age ≥ 50 years (vs. < 50 years, aOR = 2.51; 1.18-5.32; p = 0.016), injecting drug use (IDU) (vs. non-IDU aOR = 1.66; 1.21-2.29; p = 0.002), being ART naïve (aOR = 1.77; 1.24-2.54; p = 0.002), disseminated TB (vs. pulmonary TB, aOR = 1.56, 1.10-2.19, p = 0.012), and presenting with weight loss (vs. no weight loss, aOR = 1.63; 1.18-2.24; p = 0.003) were associated with delayed diagnosis. PLWH with a delayed diagnosis were at 36% increased risk of death (hazard ratio = 1.36; 1.04-1.77; p = 0.023, adjusted hazard ratio 1.27; 0.95-1.70; p = 0.103). Conclusion: Nearly two thirds of PLWH with TB in Eastern Europe had a delayed TB diagnosis, in particular those of older age, people who inject drugs, ART naïve, with disseminated disease, and presenting with weight loss. Patients with delayed TB diagnosis were subsequently at higher risk of death in unadjusted analysis. There is a need for optimisation of the current TB diagnostic cascade and HIV care in PLWH in Eastern Europe

Essay: The Yi and the Internet: Promoting Ethnicity and Ethnic Identity in Chinese Virtuality

Since the turn of the century China has witnessed an unparalleled development of internet sites, blogs, chat forums, and corresponding virtual communities. These virtual platforms have become important nodes for information and networking, especially in light of economic and intellectual migration and the corresponding trans-local quality of relationships and networks, and contribute to a further diversification of China’s cultural landscape. China’s ethnic minorities, too, have been employing internet platforms as a means to promote, and to reflect on, their own culture. For some groups these platforms signify an extension of early, non-virtual ethnic networks and platforms in urban contexts, which provide a renewed incentive for the affirmation of ethnicity/ethnic identity by engaging netizens in an ongoing dialogue on ethnic cultural contents, which transcends physical space. The article introduces two major internet platforms of the so-called Yi minority, www.yizuren.com and http://yizucn.com, and probes into their potential for ethnic identity promotion, and into general parameters of the relationship between the Yi and the internet

Of Canons and Commodities: The Cultural Predicaments of Nuosu-Yi “Bimo Culture”

The Nuosu are a subgroup of the so-called Yi ethnic group. Today around two million Nuosu live in Liangshan Autonomous Prefecture in Sichuan Province and translocal urban contexts, such as Chengdu and Beijing. For many centuries, the Nuosu have cultivated a belief system composed of a combination of animism and ancestor worship. Since the resurrection of religious activity across China that began in the early 1980s, this faith – represented by the three types of religious practitioners known as bimo, sunyi, and monyi – has reportedly been experiencing a comprehensive revival at folk level. For the bimo, this revival has been paralleled and increasingly overlaid by a scholarly reappraisal of Nuosu religion under premises other than religious. Bimo practice and identity have thus become subsumed under the illustrious concept of “bimo culture”. In this article, I trace the genealogy of the concept of “bimo culture” as part of a cultural canon of and for the Yi which is intended to promote development at the local level but which is also contributing to a weakening of the status of the bimo and Nuosu ritual life in Liangshan today

Of Canons and Commodities: the Cultural Predicaments of Nuosu-Yi "Bimo Culture"

"The Nuosu are a subgroup of the so-called Yi ethnic group. Today around two million Nuosu live in Liangshan Autonomous Prefecture in Sichuan Province and translocal urban contexts, such as Chengdu and Beijing. For many centuries, the Nuosu have cultivated a belief system composed of a combination of animism and ancestor worship. Since the resurrection of religious activity across China that began in the early 1980s, this faith - represented by the three types of religious practitioners known as bimo, sunyi, and monyi - has reportedly been experiencing a comprehensive revival at folk level. For the bimo, this revival has been paralleled and increasingly overlaid by a scholarly reappraisal of Nuosu religion under premises other than religious. Bimo practice and identity have thus become subsumed under the illustrious concept of 'bimo culture'. In this article, I trace the genealogy of the concept of 'bimo culture' as part of a cultural canon of and for the Yi which is intended to promote development at the local level but which is also contributing to a weakening of the status of the bimo and Nuosu ritual life in Liangshan today" (author's abstract

Perspectives of Local Community Leaders, Health Care Workers, Volunteers, Policy Makers and Academia on Climate Change Related Health Risks in Mukuru Informal Settlement in Nairobi, Kenya&mdash;A Qualitative Study

Sub-Saharan Africa has been identified as one of the most vulnerable regions to climate change. The objective of this study was to explore knowledge and perspectives on climate change and health-related issues, with a particular focus on non-communicable diseases, in the informal settlement (urban slum) of Mukuru in Nairobi, Kenya. Three focus group discussions and five in-depth interviews were conducted with total of 28 participants representing local community leaders, health care workers, volunteers, policy makers and academia. Data were collected using semi-structured interview guides and analyzed using grounded theory. Seven main themes emerged: climate change related diseases, nutrition and access to clean water, environmental risk factors, urban planning and public infrastructure, economic risk factors, vulnerable groups, and adaptation strategies. All participants were conscious of a link between climate change and health. This is the first qualitative study on climate change and health in an informal settlement in Africa. The study provides important information on perceived health risks, risk factors and adaptation strategies related to climate change. This can inform policy making, urban planning and health care, and guide future research. One important strategy to adapt to climate change-associated health risks is to provide training of local communities, thus ensuring adaptation strategies and climate change advocacy

Climate change and health in urban informal settlements in low- and middle-income countries – a scoping review of health impacts and adaptation strategies

Background: Climate change affects human health with those with the least resources being most vulnerable. However, little is known about the impact of climate change on human health and effective adaptation methods in informal settlements in low- and middle-income countries. Objective: The objective of this scoping review was to identify, characterize, and summarize research evidence on the impact of climate change on human health in informal settlements and the available adaptation methods and interventions. Method: A scoping review was conducted using the Arksey and O’Malley framework. The four bibliographic databases PubMed, Web of Science, Embase, and the Cochrane library were searched. Eligibility criteria were all types of peer-reviewed publications reporting on climate change or related extreme weather events (as defined by the United Nations Framework Convention on Climate Change), informal settlements (as defined by UN-Habitat), low- and middle-income countries (as defined by the World Bank) and immediate human health impacts. Review selection and characterization were performed by two independent reviewers using a predefined form. Results: Out of 1197 studies initially identified, 15 articles were retained. We found nine original research articles, and six reviews, commentaries, and editorials. The articles were reporting on the exposures flooding, temperature changes and perceptions of climate change with health outcomes broadly categorized as mental health, communicable diseases, and non-communicable diseases. Six studies had a geographical focus on Asia, four on Africa, and one on South America, the remaining four articles had no geographical focus. One article investigated an adaptation method for heat exposure. Serval other adaptation methods were proposed, though they were not investigated by the articles in this review. Conclusion: There is a paucity of original research and solid study designs. Further studies are needed to improve the understanding of the impact, the most effective adaptation methods and to inform policy making