Acceptability of HIV counselling and testing among tuberculosis patients in south Ethiopia

<p>Abstract</p> <p>Background</p> <p>To benefit from available care and treatment options, patients should first be counselled and tested for HIV. Our aim was to assess the acceptability of HIV testing among tuberculosis patients under routine care conditions in south Ethiopia.</p> <p>Methods</p> <p>We interviewed all adult tuberculosis patients who were treated at Arba Minch Hospital in Ethiopia between January and August 2005. After recording socio-demographic information and tuberculosis treatment history, we referred those patients who showed initial willingness to a counsellor for HIV counselling and testing. Rapid test methods were used following a pretest counselling session. The results were disclosed during a post-test counselling session. We used the logistic regression method to assess factors associated with willingness and acceptability.</p> <p>Results</p> <p>190 adult tuberculosis patients were treated at the hospital and all of them consented to take part in the study. Their median age was 30 years (range, 15–68) and 52% of them were males. 49 patients (26%) were previously tested including 29 (59%) HIV positive. Of 161 patients (excluding the 29 already positive), 118 (73%) were willing to be tested and 58% (68/118) of those willing accepted the test. The overall acceptability rate was 35% (56/161). Fourteen (20.6%) were HIV positive and women were more likely to be HIV infected (p = 0.029). Unemployment and self-perceived high risk of HIV infection were associated with initial willingness (OR [95%CI]:2.6 [1.3–5.5] vs. 5.0 [1.1–22.4], respectively). However, only being unemployed was associated with accepting the test (OR = 4.2; 95%CI = 1.9–9.3).</p> <p>Conclusion</p> <p>The low acceptability of HIV counselling and testing among tuberculosis patients poses a challenge to the scale-up of TB/HIV collaborative efforts. There is a need for alternative counselling and testing strategies.</p

"FIGHT AIDS TOGETHER" AN INTENSIVE DRIVE TO PREVENT AIDS

INTRODUCTIONIn September, 1990 the Department of AIDS Control (DAC), Ministry of Health of Ethiopia confronted a difficult predicament. The Department had long acknowledged that small as it was, it could not shoulder the responsibility of educating a nation of more than 50 million people. Nevertheless, it had been given the mandate of educating those millions to prevent the spread of AIDS. The dilemma was obvious

Lay beliefs of TB and TB/HIV co-infection in Addis Ababa, Ethiopia: a qualitative study

<p>Abstract</p> <p>Background</p> <p>Knowledge about lay beliefs of etiology, transmission and treatment of TB, and lay perceptions of the relationship between TB and HIV is important for understanding patients' health seeking behavior and adherence to treatment. We conducted a study to explore lay beliefs about TB and TB/HIV co-infection in Addis Ababa, Ethiopia.</p> <p>Findings</p> <p>We conducted a qualitative study using in-depth interviews with 15 TB/HIV co-infected patients and 9 health professionals and focus group discussions with 14 co-infected patients in Addis-Ababa, Ethiopia. We found that a predominant lay belief was that TB was caused by exposure to cold. Excessive sun exposure, exposure to mud, smoking, alcohol, khat and inadequate food intake were also reported as causes for TB. Such beliefs initially led to self-treatment. The majority of patients were aware of an association between TB and HIV. Some reported that TB could transform into HIV, while others said that the body could be weakened by HIV and become more susceptible to illnesses such as TB. Some patients classified TB as either HIV-related or non-HIV-related, and weight loss was a hallmark for HIV-related TB. The majority of patients believed that people in the community knew that there was an association between TB and HIV, and some feared that this would predispose them to HIV-related stigma.</p> <p>Conclusion</p> <p>There is a need for culturally sensitive information and educational efforts to address misperceptions about TB and HIV. Health professionals should provide information about causes and treatment of TB and HIV to co-infected patients.</p

Awareness of Breast Cancer and Its Early Detection Measures Among Female Students, Northern Ethiopia

Globally breast cancer is the most common of all cancers. Since risk reduction strategies cannot eliminate the majority of breast cancers, early detection remains the cornerstone of breast cancer control. This paper, therefore, attempts to assess the awareness of breast cancer and its early detection measures among female students in Mekelle University, Ethiopia. An institution based cross-sectional study was conducted on randomly selected female students. Multistage sampling technique was employed to select the participants. A pre-tested structured questionnaire was used. Data analysis was carried out using SPSS version 16. In this study, 760 students participated making a response rate of 96 percent. Respondents with good knowledge score for risk factors, early detections measures and warning signs of breast cancer were 1.4 percent, 3.6 percent and 22.1 percent respectively. The majority 477 (62.8 percent) of participants practiced self-breast examination. In conclusion the participants had poor knowledge of risk factors, early detection measures and early warning signs of breast cancer.Therefore, the Ministry of health of Ethiopia together with its stalk holders should strengthen providing IEC targeting women to increase their awareness about breast cancer and its early detection measure

Incidence of Opportunistic Infections Among Adult HIV Positive People Receiving Co-trimoxazole Prophylaxis

In Ethiopia, Co-trimoxazole prophylaxis therapy (CPT) used to prevent opportunistic infections among people living with HIV is the standard of practice; however incidence of opportunistic infection and their predictors are rarely documented in the country. This was a retrospective follow up study to describe the incidence and predictors of opportunistic infections among 244 adults receiving CPT. Participants were followed for a median time of 72 weeks. During a study period a total of 53opportunistic infections were recorded; making the overall incidence rate 23.9/100 person-years. High incidence of opportunistic infections is likely to occur if: the clients were married (adjusted hazard ratio (AHR) 1.965;(95% CI: 1.109, 3.451), had history of tuberculosis treatment (AHR: 2.34(95% CI:1.05, 5.24)), patients who are indicated for CPT because of both clinical and WHO clinical staging criteria(AHR 2.418 (95% CI:1.02, 5.72 ),and had poor adherence to CPT (AHR, 2.11 (95% CI: 1.19-3.72)). Eventhough adherence is non-substitutable strategy to prevent opportunistic infection, the cohort of HIV patients failed to adhere to CPT, which in turn resulthigh incidence of opportunistic infections among them, therefore improving adherence as guideline should be a priority to prevent OIs among people living with HIV in the study region

ATTEMPTS AT INTEGRATING THE TRAINING IN LEPROSY AND TUBERCULOSIS: EXPERIENCE, PROBLEMS AND PROSPECTS

EXPERIENCEFirst CourseAfter a year of preparation in cooperation with the International Union Against Tuberculosis (I.U.A.T .) the Ministry of Health of Ethiopia and staff of the medical Faculty of Addis Ababa University, the first course on Tuberculosis and tuberculosis Control was conducted at ALER T immediately after the Leprosy Doctors' Course of April 1983. The arrangement allowed for some of the participants working in combined leprosy /TB Control projects in Tanzania and Kenya to stay on to attend the TBC Course.Most of the participants, however, were doctors or health officers working in TB Control only and they arrived after the Leprosy Course was over. In this first course ALERT provided facilities as regards lecture rooms, laboratory space, board and lodging of the participants, production of some teaching material and transport to and from the TBC Centre, the TBC hospital and the airport of Addis Ababa

Revision of the Ethiopian Essential Health Service Package: An Explication of the Process and Methods Used

To make progress toward universal health coverage, countries should define the type and mix of health services that respond to their populations’ needs. Ethiopia revised its essential health services package (EHSP) in 2019. This paper describes the process, methodology and key features of the new EHSP. A total of 35 consultative workshops were convened with experts and the public to define the scope of the revision, develop a list of health interventions, agree on the prioritization criteria, gather evidence and compare health interventions. Seven prioritization criteria were employed: disease burden, cost effectiveness, equity, financial risk protection, budget impact, public acceptability and political acceptability. In the first phase, 1,749 interventions were identified, including existing and new interventions, which were regrouped and reorganized to identify 1,442 interventions as relevant. The second phase removed interventions that did not match the burden of disease or were not relevant in the Ethiopian setting, reducing the number of interventions to 1,018. These were evaluated further and ranked by the other criteria. Finally, 594 interventions were classified as high priority (58%), 213 as medium priorities (21%) and 211 as low priority interventions (21%). The current policy is to provide 570 interventions (56%) free of charge while guaranteeing the availability of the remaining services with cost-sharing (38%) and cost-recovery (6%) mechanisms in place. In conclusion, the revision of Ethiopia’s EHSP followed a participatory, inclusive and evidence-based prioritization process. The interventions included in the EHSP were comprehensive and were assigned to health care delivery platforms and linked to financing mechanisms.publishedVersio

Defining the Ethiopian Essential Health Service Package : Process, methods and cost-effectiveness evidence for the prioritisation of health interventions

Background: All countries have signed up to the United Nations (UN) Sustainable Development Goals (SDGs), including Target 3.8 on achieving universal health coverage (UHC). UHC is realised when everyone has access to quality essential health services with financial risk protection. Countries should, therefore, measure and track their progress towards UHC over time and take appropriate action. Defining an essential health service package (EHSP) is the first and crucial step towards UHC progress. In defining an EHSP, counties identify the type and mix of health services that respond to their populations’ needs. However, there are gaps in evidence regarding Ethiopia’s current UHC status, and it had been more than 15 years since the EHSP was defined in Ethiopia. Furthermore, there is relatively little national cost-effectiveness evidence available to redefine the EHSP in Ethiopia. Therefore, this study aimed to estimate Ethiopia’s UHC service coverage status, generate relevant cost-effectiveness evidence and synthesise and describe the methods, process and key features of the revised Ethiopian EHSP. Methods: This thesis consists of three studies. In Paper I, 16 individual tracer indicators that measure a health system’s performance in various domains were selected to measure UHC service coverage in Ethiopia. We grouped the tracer indicators into four major programme areas (i.e., reproductive maternal neonatal child health [RMNCH], infectious disease, noncommunicable disease [NCD] and capacity and access), and we constructed an overall UHC service coverage index using geometric means. We also estimated the subnational level of UHC service coverage. In this paper, various surveys and routinely collected administrative data were used. In Paper II, we employed a standardised WHO- CHOICE generalised cost-effectiveness analysis (GCEA) methodology. Average cost- effectiveness ratios (ACERs) for 159 health interventions were calculated. The health benefits of interventions were determined using healthy life years (HLYs) gained. The economic costs of interventions were estimated from the health system perspective. We used the OneHealth tool for data analysis. In the third paper (Paper III), we synthesised and described the methods, process and critical features of the 2019 EHSP. A total of 35consultative workshops were convened with experts and the public to define the revision’s scope, develop a list of health interventions, agree on the prioritisation criteria, gather evidence and compare health interventions. Seven prioritisation criteria were employed: disease burden, cost effectiveness, equity, financial risk protection, budget impact, public acceptability and political acceptability. Results: The overall UHC service coverage for Ethiopia in 2015 was 34.3%, ranging from the highest (52.2%) in Addis Ababa to the lowest (10%) in Afar. The programme area coverage varied from about 53% for infectious diseases to 20% for capacity and access (Paper I). In Paper II, we found ACERs ranging from less than US$1 per HLY gained for family planning intervention to about USD 48,000 for colorectal cancer treatment at stage 4. About 75% of all interventions evaluated had ACERs of less than USD 1,000 per HLY gained. The majority (95%) of RMNCH and infectious disease interventions had an ACER of less than USD 1,000 per HLY while around half of interventions (44%) targeting NCDs had an ACER of less than USD 1,000 per HLY. In Paper III (EHSP revision process), 1,749 interventions were identified in the first phase. These interventions were regrouped and reorganised, and 1,442 interventions were identified as possible candidates for the EHSP. In the second phase, we removed interventions that did not match the burden of disease or were not relevant in the Ethiopian setting, and, therefore, the number of EHSP intervention was reduced to 1,018. We then evaluated and ranked the interventions by the other six criteria. In the final EHSP, 594 (58%) interventions were classified as high priority, 213 (21%) as medium priority and 211 (21%) as low priority. The current policy is to provide 56% of interventions free of charge and to ensure 38% on cost-sharing and 6% on cost-recovery arrangements. Conclusions: In conclusion, the baseline (2015) UHC service coverage index for Ethiopia was low. Furthermore, several potential cost-effective interventions were available that could substantially reduce Ethiopia’s disease burden if scaled up. The revision of Ethiopia’s EHSP followed a comprehensive, participatory, inclusive and evidence-based process, and the EHSP interventions were linked to appropriate health care delivery platforms and financing mechanisms.Doktorgradsavhandlin