The economic burden of HIV/AIDS on individuals and households in Nepal: a quantitative study.

BACKGROUND: There have been only limited studies assessing the economic burden of HIV/AIDS in terms of direct costs, and there has been no published study related to productivity costs in Nepal. Therefore, this study explores in detail the economic burden of HIV/AIDS, including direct costs and productivity costs. This paper focuses on the direct costs of seeking treatment, productivity costs, and related factors affecting direct costs, and productivity costs. METHODS: This study was a cross-sectional, quantitative study. The primary data were collected through a structured face-to-face survey from 415 people living with HIV/AIDS (PLHIV). The study was conducted in six representative treatment centres of six districts of Nepal. The data analysis regarding the economic burden (direct costs and productivity costs) was performed from the household's perspective. Descriptive statistics have been used, and regression analyses were applied to examine the extent, nature and determinants of the burden of the disease, and its correlations. RESULTS: Average total costs due to HIV/AIDS (the sum of average total direct and average productivity costs before adjustment for coping strategies) were Nepalese Rupees (NRs) 2233 per month (US$30.2/month), which was 28.5$ 20.4), and average productivity costs (before adjustment for coping strategies) were NRs 721 (US$ 9.7). The average monthly productivity losses (before adjustment for coping strategies) were 5.05 days per person. The major determinants for the direct costs were household income, occupation, health status of respondents, respondents accompanied or not, and study district. Health status of respondents, ethnicity, sexual orientation and study district were important determinants for productivity costs. CONCLUSIONS: The study concluded that HIV/AIDS has caused a significant economic burden for PLHIV and their families in Nepal. The study has a number of policy implications for different stakeholders. Provision of social support and income generating programmes to HIV-affected individuals and their families, and decentralising treatment services in each district seem to be viable solutions to reduce the economic burden of HIV-affected individuals and households

Factors impacting antiretroviral therapy adherence among human immunodeficiency virus-positive adolescents in Sub-Saharan Africa: a systematic review

© 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.Objectives: Eighty-two percent of human immunodeficiency virus (HIV)–positive adolescents live in Sub-Saharan Africa (SSA). Despite the availability of antiretroviral therapy (ART), adherence levels are suboptimal, leading to poor outcomes. This systematic review investigated factors impacting ART adherence among adolescents in SSA, including religious beliefs and intimate relationships. Methods: A systematic review was conducted between June and August 2016 using eight electronic databases, including Cochrane and PubMed. Published, ongoing and unpublished research, conducted in SSA from 2004 to 2016, was identified and thematic analysis was used to summarise findings. Results: Eleven studies from eight SSA countries, published in English between 2011 and 2016, reported on factors impacting ART adherence among adolescents living with HIV (ALHIV). Forty-four barriers and 29 facilitators to adherence were identified, representing a complex web of factors. The main barriers were stigma, ART side-effects, lack of assistance and forgetfulness. Facilitators included caregiver support, peer support groups and knowledge of HIV status. Conclusions: Stigma reflects difficult relations between ALHIV and their HIV-negative peers and adults. Most interventions target only those with HIV, suggesting a policy shift towards the wider community could be beneficial. Recommendations include engaging religious leaders and schools to change negative societal attitudes. Limitations of the review include the urban settings and recruitment of predominantly vertically infected participants in most included studies. Therefore, the findings cannot be extrapolated to ALHIV residing in rural locations or horizontally infected ALHIV, highlighting the need for further research in those areas.Peer reviewedFinal Accepted Versio

Organizational practices across cultures: An exploration in six cultural contexts

This study examined organizational practices in a sample of 1239 employees from various organizations in Argentina, Brazil, Malaysia, New Zealand, Turkey, and the United States. Twenty-four items measuring employee-orientation, formalization, and innovation practices showed a clear factorial structure across all samples, along with good reliabilities. Significant organizational position differences were found for employee-orientation and innovation practices. Sector differences were found for formalization and innovation practices. Cultural differences were found for employee-orientation and innovation practices, which can be explained using macroeconomic indicators,tightness–looseness, and individualism. Our study demonstrates the importance of individual, organizational, economic, and cultural level for understanding perceptions of organizational practices across a wider range of societies

Mutual trust between leader and subordinate and employee outcomes

Stable and enduring cooperative relationships among people are primarily based on mutual trust. However, little evidence exists about the effects of mutual trust between supervisor and subordinate on work outcomes. To understand better the dynamics of trust in supervisor–subordinate relationships, we examined how mutual trust between supervisor and subordinate is associated with work outcomes. Based on a sample of 247 subordinate–supervisor pairs, multilevel analyses revealed a positive effect of perceived mutual trust on task performance and interpersonal facilitation after controlling for trust in leader and felt trust. In addition, task performance and interpersonal facilitation increased as trust in leader and felt trust or trust in subordinate both increased

The impact of sexual harassment on job satisfaction, turnover intentions, and absenteeism: findings from Pakistan compared to the United States

The purpose of this study was to compare and contrast how differences in perceptions of sexual harassment impact productive work environments for employees in Pakistan as compared to the US; in particular, how it affects job satisfaction, turnover, and/or absenteeism. This study analyzed employee responses in Pakistan (n = 146) and the United States (n = 102, 76) using questionnaire data. Significant results indicated that employees who were sexually harassed reported (a) a decrease in job satisfaction (b) greater turnover intentions and (c) a higher rate of absenteeism. Cross-cultural comparisons indicated that (a) Pakistani employees who were sexually harassed had greater job dissatisfaction and higher overall absenteeism than did their US counterparts and (b) Pakistani women were more likely to use indirect strategies to manage sexual harassment than were US targets

Characteristics of menopause in three socioeconomic urban groups in Karachi, Pakistan

To determine age, symptoms and treatment choices in Pakistani women with spontaneous menopause, three groups in Karachi were interviewed using a structured questionnaire. The groups consisted of 250 poor slum dwellers, 250 middle class clinic attenders and 150 wives of retired military officers. Interviews were carried out in 1989 and 1990 by members of a team from the Aga Khan University consisting of a gynaecologist, a community health physician and two senior medical students. All interviewees had natural menopause at least 12 months previously. The results showed a mean age of 47 years for menopause in all groups. One in five women were symptomatic in the poorest group but one in two were in the other groups. Treatment was sought by 6% in the poor group, 26% of the middle class group and 38% of the most privileged group. Age at menopause was 4 years earlier than in most reports and fewer women had menopausal symptoms. These urban women may not represent the situation across the country but, as life expectancy in Pakistan is rising (now 56.4 years for women), menopausal problems may increase

Quantitative and Qualitative Analysis of AgNORS in OSMF Leukoplakia and OSCC

Background: Oral cancer is one of the most significant reasons of death in India. The quantitative and qualitative assessment of AgNORs parameters has been used in oncology for both diagnostic and prognostic objectives. The number and distribution of AgNOR in the nucleus (configuration) were helpful in detecting and predicting the prognosis of various neoplasias. Aim: To assess the biologic aggressiveness of leukoplakia, oral submucous fibrosis and oral squamous cell carcinoma and quantitative and qualitative analysis of AGNORs in OSMF, Leukoplakia and OSCC. Materials and Methods: The study samples were distributed in four different groups:-Group- I: - Control group, 10 sample of normal mucosa. Group II: – 30 histopathologically proven samples of leukoplakia. Group III:-30 histopathologically proven samples of oral submucousfibrosis. Group IV: - 30 histopathologically proven samples of oral squamous cell carcinoma. The number of dots per nucleus was used to count AgNORs. Images were taken with a digital camera linked to a labomed572 Binocular Photo Microscope with an X100 oil immersion objective lens. The photos were categorised, copied, and saved to a computer