Adapted motivational interviewing to improve the uptake of treatment for glaucoma in Nigeria: study protocol for a randomized controlled trial.

BACKGROUND: Glaucoma is a chronic eye disease associated with irreversible visual loss. In Africa, glaucoma patients often present late, with very advanced disease. One-off procedures, such as laser or surgery, are recommended in Africa because of lack of or poor adherence to medical treatment. However, acceptance of surgery is usually extremely low. To prevent blindness, adherence to treatment needs to improve, using acceptable, replicable and cost-effective interventions. After reviewing the literature and interviewing patients in Bauchi (Nigeria) motivational interviewing (MI) was selected as the intervention for this trial, with adaptation for glaucoma (MIG). MI is designed to strengthen personal motivation for, and commitment to a specific goal by eliciting and exploring a person's reasons for change within an atmosphere of acceptance and compassion. The aim of this study is to assess whether MIG increases the uptake of laser or surgery amongst glaucoma patients where this is the recommended treatment. The hypothesis is that MIG increases the uptake of treatment. This will be the first trial of MI in Africa. METHODS: This is a hospital based, single centre, randomized controlled trial of MIG plus an information sheet on glaucoma and its treatment (the latter being "standard care") compared with standard care alone for glaucoma patients where the treatment recommended is surgery or laser.Those eligible for the trial are adults aged 17 years and above who live within 200 km of Bauchi with advanced glaucoma where the examining ophthalmologist recommends surgery or laser. After obtaining written informed consent, participants will be randomly allocated to MIG plus standard care, or standard care alone. Motivational interviewing will be delivered in Hausa or English by one of two MIG trained personnel. One hundred and fifty participants will be recruited to each arm. The primary outcome is the proportion of participants undergoing laser or surgery within two months of the date given to re attend for the procedure. MIG quality will be assessed using the validated MI treatment integrity scale. DISCUSSION: Motivational interviewing may be an important tool to increase the acceptance of treatment for glaucoma. The approach is potentially scalable and may be useful for other chronic conditions in Africa. TRIAL REGISTRATION: ISRCTN79330571 (Controlled-Trials.com)

The Demographic and Clinical Presentation of Ulcerative Keratitis in HIV and non-HIV Infected Patients at Muhimbili National Hospital

Background: Ulcerative keratitis and subsequent corneal scarring is at present the leading cause of ocular morbidity and unilateral blindness in developing countries. In developed countries, HIV infection has been associated with severe ulcerative keratitis. The demographic and clinical presentation of Ulcerative keratitis among HIV and non HIV infected patients are largely undetermined in Dar-es-Salaam. Objective: To compare the demographic and clinical presentation of ulcerative keratitis in HIV and Non-HIV infected patients at Muhimbili National Hospital (MNH), Dar-es-Salaam. Methodology: A comparative, hospital based cross sectional study was conducted from June 2008 - May 2009 at MNH eye department. Patients with ulcerative keratitis consecutively underwent ocular history, examination, corneal scrapping and HIV screening. Treatment was initiated based on clinical appearance of the ulcer and was changed accordingly after laboratory results. Patients were followed up until complete healing occurred. The demographic data from patients and the clinical presentation of ulcerative keratitis among HIV and non-HIV infected patients were compared. Data were analyzed using EPI Info 6 software. Results: One hundred and eighty six patients were enrolled during the study period. Of these 60% (111/186) had HIV infection (p=0.004). Compared to Non HIV -infected patients, HIV infected patients were likely to be males (p=0.0002) cohabiting or single (p=0.0001) and petty traders (P=0.0004). The leading cause of ulcerative keratitis among HIV and non-HIV infected patients were fungal and bacterial infections respectively. Compared to ulcers among non-HIV infected patients, ulcers among HIV infected patients presented with severe clinical signs and complications (p=0.47) and patients were more likely to be blind on presentation (p=0.001) and on discharge from hospital (p=0.001). Conclusion and recommendation: About 60% of patients presenting to MNH with ulcerative keratitis are infected with HIV. Compared to that in Non-HIV infected patients, ulcerative keratitis in HIV infected patients were due to fungus, presented with severe clinical signs and ended up with permanent visual loss. Efforts to screen all patients presenting with ulcerative keratitis at MNH should be instituted alongside awareness creation among health workers and the general public on the importance of seeking early treatment for ulcerative keratitis