43 research outputs found
Associations between national viral hepatitis policies/programmes and country-level socioeconomic factors: a sub-analysis of data from the 2013 WHO viral hepatitis policy report
BACKGROUND: As more countries worldwide develop national viral
hepatitis strategies, it is important to ask whether
context-specific factors affect their decision-making. This
study aimed to determine whether country-level socioeconomic
factors are associated with viral hepatitis programmes and
policy responses across WHO Member States (MS). METHODS: WHO MS
focal points completed a questionnaire on national viral
hepatitis policies. This secondary analysis of data reported in
the 2013 Global Policy Report on the Prevention and Control of
Viral Hepatitis in WHO Member States used logistic regression to
examine associations between four survey questions and four
socioeconomic factors: country income level, Human Development
Index (HDI), health expenditure and physician density. RESULTS:
This analysis included 119 MS. MS were more likely to have
routine viral hepatitis surveillance and to have a national
strategy and/or policy/guidelines for preventing infection in
healthcare settings if they were in the higher binary categories
for income level, HDI, health expenditure and physician density.
In multivariable analyses, the only significant finding was a
positive association between having routine surveillance and
being in the higher binary HDI category (adjusted odds ratio 26;
95% confidence interval 2.0-340). CONCLUSION: Countries with
differing socioeconomic status indicators did not appear to
differ greatly regarding the existence of key national policies
and programmes. A more nuanced understanding of the multifaceted
interactions of socioeconomic factors, health policy, service
delivery and health outcomes is needed to support country-level
efforts to eliminate viral hepatitis
Assessing quality of life in people with HIV in Spain: psychometric testing of the Spanish version of WHOQOL-HIV-BREF
BACKGROUND: The assessment of health-related quality of life (HRQoL) in people living with HIV (PLHIV) has become crucial to evidence-based practice. The goals of this study are to analyze the psychometric properties and evidence of the validity of the Spanish version of WHOQOL-HIV-BREF in a sample of PLHIV in Spain and to examine the more impaired HRQoL facets and dimensions and identify the PLHIV who show the most vulnerable profile. METHODS: A total of 1462 PLHIV participated in an observational cross-sectional ex-post-facto study. Data were collected at 33 Spanish sites through an online survey. In addition to measuring HRQoL, the study used other tools to measure treatment adherence (CEAT-VIH 2.0 version), psychological well-being (GHQ-12) and HIV-related stigma (HSSS). Cronbach's alpha, first- and second-order confirmatory factor analysis (CFA), the Pearson coefficient and one-way ANOVA were used to evaluate reliability, construct validity and concurrent and known-group validity, respectively. Differences according to the socio-demographic and epidemiological profiles of participants were analyzed. RESULTS: First- and second-order CFAs confirmed a six-domain first-order structure of the Spanish version of WHOQOL-HIV-BREF and one second-order factor related to overall HRQoL with an acceptable fit to the data, although some minor changes would improve it. The six-domain structure showed an acceptable internal consistency (Cronbach's alpha ranged from .61 to .81). Significant moderate to large correlations between domains and overall HRQoL, adherence, psychological well-being and negative self-image were found. Significant differences were found according to participants' self-reported CD4+ cell count in several HRQoL facets and domains. Being female, heterosexual, having low socio-economic and educational statuses, having acquired HIV through an unsafe injection and living more years with HIV were related to poorer HRQoL. PLHIV older than 50 presented lower scores in 19 HRQoL facets. CONCLUSIONS: This study demonstrates that the Spanish version of the WHOQOL-HIV-BREF is a valid instrument. It also presents the most recent data about HRQoL in PLHIV in Spain with the largest sample to date.This study was funded by ViiV Healthcare (www.viivhealthcare.com). Study Number: SEISIDA 001/2016. ViiV Healthcare was involved in the study design and preparation of the manuscript, without influencing the data collection and analysis or the decision to publish. All listed authors meet the criteria for authorship set forth by the International Committee of Medical Journal Editors. All authors had full access to the data and are responsible for the veracity and completeness of the reported data.S
Hepatitis C services at harm reduction centres in the European Union: a 28-country survey
Background: In the context of the WHO’s 2016 Viral Hepatitis Strategy and the introduction of treatment that
can cure more than 95% of cases with hepatitis C virus (HCV) infection, the European Joint Action on HIV
and Co-infection Prevention and Harm Reduction (HA-REACT) undertook a study in the member states of the
European Union (EU). It aimed to determine service providers’ understanding of the current services in their
respective countries and the barriers experienced by PWID in accessing HCV testing, care and treatment
services in their country.
Methods: In 2017, 38 purposively selected harm reduction service providers completed a 26-item Englishlanguage online survey addressing the availability, accessibility and funding of HCV services at harm reduction
centres. HCV-related data and reported findings were extracted by country or by responding organization.
Results: Responses were received from all EU member states. Respondents from 23 countries reported that
HCV tests are offered by harm reduction services in their countries, and eight countries reported that
addiction specialists in their countries are able to prescribe HCV therapy. Almost half of the respondents
(45%) said that their respective organizations had established referral systems with centres providing HCV
treatment.
Conclusions: Not all EU member states have harm reduction services that provide HCV tests, and many do
not have established referral systems with treatment providers. Moreover, the inability of addiction specialists
to prescribe HCV treatment points to missed opportunities to make treatment more accessible. Further,
discrepancies were noted between the available HCV services and stakeholders’ knowledge about their
availability
Health Outcomes for Clients of Needle and Syringe Programs in Prisons
High levels of drug dependence have been observed in the
prison population globally, and the sharing of injecting drug
equipment in prisons has contributed to higher prevalence of
bloodborne diseases in prisoners than in the general population.
Few prison needle and syringe programs (PNSPs) exist. We
conducted a systematic review to assess evidence regarding
health outcomes of PNSPs. We searched peer-reviewed databases
for data relating to needle and syringe programs in prisons. The
search methodology was conducted in accordance with accepted
guidelines. Five studies met review inclusion criteria, and all
presented evidence associating PNSPs with one or more health
benefits, but the strength of the evidence was low. The outcomes
for which the studies collectively demonstrated the strongest
evidence were prevention of human immunodeficiency virus and
viral hepatitis. Few negative consequences from PNSPs were
observed, consistent with previous evidence assessments. More
research is needed on PNSP effectiveness, and innovative study
designs are needed to overcome methodological limitations of
previous research. Until stronger evidence becomes available,
policymakers are urged to recognize that not implementing PNSPs
has the potential to cause considerable harm, in light of what
is currently known about the risks and benefits of needle and
syringe programs and PNSPs and about the high prevalence of
human immunodeficiency virus and viral hepatitis in prisons
Ability to Monitor National Responses to the HIV Epidemic "Beyond Viral Suppression": Findings From Six European Countries.
With more people living with HIV (PLHIV) ageing into their 50s and beyond in settings where antiretroviral therapy is widely available, non-AIDS comorbidities and health-related quality of life (HRQoL) are becoming major challenges. Information is needed about whether national HIV monitoring programmes have evolved to reflect the changing focus of HIV care. " - " We created a 56-item English-language survey to assess whether health systems report on common health-related issues for people with HIV including physical and mental health comorbidities, HRQoL, psychosocial needs, and fertility desires. One expert was identified via purposive sampling in each of six countries (Estonia, Italy, the Netherlands, Slovenia, Sweden, and Turkey) and was asked to participate in the survey. " - " Three respondents reported that the current monitoring systems in their countries do not monitor any of four specified aspects of 10 comorbidities including bone loss, cardiovascular disease, and neurocognitive disorders. Two respondents stated that their countries potentially can report on leading causes of hospital admission among PLHIV, and five on leading cases of death. In three countries, respondents reported that there was the ability to report on the HRQoL of PLHIV. In two countries, respondents provided data on the percentage of PLHIV denied health services because of HIV status in the past 12 months. " - " This study identified areas for potential HIV monitoring improvements in six European countries in relation to comorbidities, HRQoL, discrimination within health systems, and other issues associated with the changing nature of the HIV epidemic. It also indicated that some countries either currently monitor or have the ability to monitor some of these issues. There are opportunities for health information systems in European countries to expand the scope of their HIV monitoring in order to support decision-making about how the long-term health-related needs of PLHIV can best be met
Beyond viral suppression of HIV - the new quality of life frontier
BACKGROUND: In 2016, the World Health Organization (WHO) adopted
a new Global Health Sector Strategy on HIV for 2016-2021. It
establishes 15 ambitious targets, including the '90-90-90'
target calling on health systems to reduce under-diagnosis of
HIV, treat a greater number of those diagnosed, and ensure that
those being treated achieve viral suppression. DISCUSSION: The
WHO strategy calls for person-centered chronic care for people
living with HIV (PLHIV), implicitly acknowledging that viral
suppression is not the ultimate goal of treatment. However, it
stops short of providing an explicit target for health-related
quality of life. It thus fails to take into account the needs of
PLHIV who have achieved viral suppression but still must contend
with other intense challenges such as serious non-communicable
diseases, depression, anxiety, financial stress, and experiences
of or apprehension about HIV-related discrimination. We propose
adding a 'fourth 90' to the testing and treatment target: ensure
that 90 % of people with viral load suppression have good
health-related quality of life. The new target would expand the
continuum-of-services paradigm beyond the existing endpoint of
viral suppression. Good health-related quality of life for PLHIV
entails attention to two domains: comorbidities and
self-perceived quality of life. CONCLUSIONS: Health systems
everywhere need to become more integrated and more
people-centered to successfully meet the needs of virally
suppressed PLHIV. By doing so, these systems can better meet the
needs of all of their constituents - regardless of HIV status -
in an era when many populations worldwide are living much longer
with multiple comorbidities
The Micro-Elimination Approach to Eliminating Hepatitis C:Strategic and Operational Considerations
The introduction of efficacious new hepatitis C virus (HCV) treatments galvanized the World Health Organization to define ambitious targets for eliminating HCV as a public health threat by 2030. Formidable obstacles to reaching this goal can best be overcome through a micro-elimination approach, which entails pursuing elimination goals in discrete populations through multi-stakeholder initiatives that tailor interventions to the needs of these populations. Micro-elimination is less daunting, less complex, and less costly than full-scale, country-level initiatives to eliminate HCV, and it can build momentum by producing small victories that inspire more ambitious efforts. The micro-elimination approach encourages stakeholders who are most knowledgeable about specific populations to engage with each other and also promotes the uptake of new models of care. Examples of micro-elimination target populations include medical patients, people who inject drugs, migrants, and prisoners, although candidate populations can be expected to vary greatly in different countries and subnational areas
The Consensus Hepatitis C Cascade of Care:standardized reporting to monitor progress toward elimination
Cascade-of-care (CoC) monitoring is an important component of the response to the global hepatitis C virus (HCV) epidemic. CoC metrics can be used to communicate, in simple terms, the extent to which national and subnational governments are advancing on key targets, and CoC findings can inform strategic decision-making regarding how to maximize the progression of individuals with HCV to diagnosis, treatment, and cure. The value of reporting would be enhanced if a standardized approach were used for generating CoCs. We have described the Consensus HCV CoC that we developed to address this need and have presented findings from Denmark, Norway, and Sweden, where it was piloted. We encourage the uptake of the Consensus HCV CoC as a global instrument for facilitating clear and consistent reporting via the World Health Organization (WHO) viral hepatitis monitoring platform and for ensuring accurate monitoring of progress toward WHO's 2030 hepatitis C elimination targets.</p
Development of a Clinic Screening Tool to Identify Burdensome Health-Related Issues Affecting People Living With HIV in Spain
BackgroundNumerous health-related issues continue to undermine the health and health-related quality of life (HRQoL) of people living with HIV (PLHIV). We developed a clinic screening tool (CST-HIV) for the purpose of identifying these issues in routine specialist clinical care in Spain.MethodsWe used the following established instrument development procedures: (1) a literature review; (2) four focus group discussions (FGDs), two that convened 16 expert HIV care providers, and two that convened 15 PLHIV; (3) prioritisation, selection and definition of constructs (health-related issues) to include in the CST-HIV and drafting of initial item pool; and (4) a pilot study to analyse psychometric properties and validity of items and to determine which to retain in the final CST-HIV. The FGD interview scripts incorporated an exercise to prioritise the health-related issues perceived to have the greatest negative effect on HRQoL. The online questionnaire used for the pilot study included the pool of CST-HIV items and validated measures of each construct.ResultsWe identified 68 articles that reported on factors associated with the HRQoL of PLHIV. The most burdensome health-related issues identified in the FGDs related to stigma, socioeconomic vulnerability, sleep/fatigue, pain, body changes, emotional distress, and sexuality. Based on the literature review and FGD findings, we selected and defined the following constructs to include in the initial CST-HIV: anticipated stigma, emotional distress, sexuality, social support, material deprivation, sleep/fatigue, cognitive problems, and physical symptoms. Two researchers wrote six to eight items for each construct. Next, 18 experts rated 47 items based on their clarity, relevance, and representativeness. Pilot testing was carried out with 226 PLHIV in Spain. We retained 24 items based on empirical criteria that showed adequate psychometric properties. Confirmatory factor analysis confirmed the eight-factor structure with a good fit to the data (RMSEA = 0.035, AGFI = 0.97, CFI = 0.99). We found strong positive correlations between the instrument’s eight dimensions and validated measures of the same constructs. Likewise, we found negative associations between the dimensions of the CST-HIV and HRQoL.ConclusionThe CST-HIV is a promising tool for use in routine clinical care to efficiently identify and address health-related issues undermining the HRQoL of PLHIV