A qualitative exploration ofdoctors and nurses experienceson the management of tubercu-losis and HIV co-infection in atuberculosis-HIV high burdencommunity in northernKwaZulu-Natal, South Africa

South Africa is faced with a huge challenge of addressing the high burden of tuberculosis-human immune virus (TBHIV) co-infection, and this challenge is more pronounced in the province of KwaZulu-Natal which has one of the highest burdens of TB-HIV co-infection in the world. The study explored the experiences of doctors and nurses with regard to the management of tuberculosis and HIV coinfection in a TB-HIV high burden community in northern KwaZulu-Natal, South Africa. The particular focus was to provide insight and to inform policy and programme development for effective management of TB-HIV co-infection in the TB-HIV high burden community of northern KwaZulu- Natal. An interpretivist exploratory qualitative approach was employed through individual semi-structured interviews of 16 participants comprising eight doctors and eight nurses, with a total interview time of 8.95 hours. Purposive sampling was used to select the doctors and nurses from the public and private sector of the TB-HIV high burden community of northern KwaZulu- Natal. Thematic analysis was used to analyse the data. Five key themes emerged from this study and these themes were discussed together with the sub-themes based on the various participant responses. The five key themes were practical experience about the management of TB-HIV co-infection; access to information and training on the management of TB-HIV co-infection; challenges and concerns about the management of TB-HIV co-infection; perception about local beliefs; and knowledge of policies and guidelines. Overall, this study highlights barriers that hamper the effective management of TB-HIV co-infection in northern KwaZulu-Natal. Recommendations of this study point towards an urgent need to scale up the management of TB-HIV co-infection through effective policies, improved capacity and infrastructure, stronger partnerships of all stakeholders, and further research

Not enough traction: Barriers that aspiring researchers from low- and middle-income countries face in global health research

There is a growing concern of low representation of researchers from low-middle-income countries (LMICs) in the publication of global health research in high-impact peer-reviewed journals. Nobody denies that researchers from the developing world generally face several obstacles to publishing their research. In this viewpoint, we share some of the barriers we have observed from our experience working in both academia and global health practice in low and middle-income countries such as limited opportunities for research funding, gender disparities, and language barriers. Beyond presenting the barriers, we also provide some pragmatic solutions to addressing these barriers through increased research financing, capacity building, gender equity and inclusion, and editorial support. Most importantly, we call for setting a new level of ambition in redressing the imbalances and actualizing the leadership and emergence of a veritable critical mass of LMICs researchers

Experiences of intimate partner violence and the health needs of women living in urban slums in Kampala, Uganda

Text in EnglishIntimate Partner Violence (IPV) is a major problem among women of child-bearing age in Uganda. This study explored the IPV experiences of women living in urban slums and their health needs in order to assist in developing strategies to prevent and respond to IPV. This was a cross-sectional explanatory study using a mixed methods approach among women aged 20-45 years in Kabalagala slums, Kampala, Uganda. The quantitative survey data was collected using a structured questionnaire while qualitative data was collected using in-depth interviews. Quantitative data were collected from a random sample of 372 women and qualitative data from a purposive sample of 48 women with IPV experiences. The quantitative data was analysed using STATA (version 11), and the qualitative data was coded and analysed manually into thematic content. The study revealed a high overall lifetime prevalence of IPV. The different IPV forms prevalent in the study population included psychological (99.7%), economic (93%), physical (92%) and sexual (88%). Physical violence in the last one year was 91%. The qualitative findings revealed the manifestations of IPV in this context. Furthermore, the physical and psychological health impacts of IPV included but were not limited to injuries; chronic pain and complications; HIV infection; low self-esteem; stress and fear of death, and loss of relationships. The researcher proposed three strategies to prevent and respond to IPV, namely implementing economic empowerment and poverty reduction programmes for women; strengthening the legal and justice system to respond appropriately to the problem of IPV, and improving the social and institutional support including training of health workers to prevent and respond to IPV. The proposed regulation of substance and alcohol use would also contribute to reducing IPV prevalence and scaling-up the response.Health StudiesD. Litt. et Phil. (Health Studies

“My condition is my secret”: perspectives of HIV positive female sex workers on differentiated service delivery models in Kampala Uganda

Background: Diferentiated service delivery (DSD) models for female sex workers (FSWs) continue to be scaled up with the goal of expanding access to HIV services and treatment continuity. However, little is known about FSWs’ perspectives on their preferences, facilitators, and barriers to the efective utilization of various DSD models. Methods: We conducted 24 in-depth interviews among FSWs on antiretroviral therapy for at least one year in two drop-in centres and two public health facilities in Kampala, Uganda in January 2021. Results: The facility-based individual management model was most preferred, due to a wide array of comprehensive health services, privacy, and professional health workers. Community DSD models were physically accessible, but least preferred due to stigmatization and discrimination, lack of privacy and confdentiality, and limited health services ofered. Conclusion: Targeted strategies to reduce stigma and discrimination and the provision of high-quality services have potential to optimise FSWs’ access to HIV services

Community Health Volunteers’ experiences of implementing COVID-19 vaccine education and promotion in Kenya: a qualitative descriptive study

Background: Vaccination was a key measure in the COVID-19 pandemic response, though much work was needed to promote vaccine uptake and acceptance. In Kenya, Community Health Volunteers (CHVs) played a key role in vaccine education and promotion. We conducted this study to explore CHVs’ experiences of implementing COVID-19 vaccine education and promotion during the pandemic to increase COVID-19 vaccine uptake in two areas of Kenya. Methods: In a qualitative descriptive study, we conducted 30 structured in-depth interviews with 20 CHVs and 10 Community Health Assistants from rural Kilifi County and Kangemi, an urban informal settlement of Nairobi County in Kenya between April 2022 and July 2022. Findings: Thematic analysis generated five key themes in relation to CHVs’ experiences of implementing COVID-19 vaccine education and promotion: Five key themes emerged regarding CHVs’ experiences of implementing COVID-19 vaccine education and promotion: (1) vaccine preferences influenced acceptance, (2) the fear of side effects was a barrier, (3) misinformation was widespread (4) lack of trust in government and politicization of vaccines was a barrier, and (5) CHVs’ efforts were a facilitator to increased uptake. Conclusion: Extensive community outreach from CHVs contributed to the high uptake of primary vaccines and boosters during the COVID-19 pandemic. CHVs acting as role models by receiving vaccinations first was particularly important in influencing communities to accept vaccinations. Findings provide evidence for prioritizing CHVs in the planning and implementation of future vaccination initiatives in Kenya and other countries

A systematic review of epidemiological patterns and proposed interventions to address pediatric burns in Nigeria

Background: Unintentional injuries from burns comprise a significant proportion of public health morbidity in Nigeria. In order to understand the type and impact of burns on youth in Low-and-Middle-Income countries, the epidemiology of burns must be adequately assessed. Methods: This review describes the epidemiological patterns of burn occurrences in the pediatric populations and proposes interventions using the Haddon Matrix to address injuries in specific populations in Nigeria. A literature search was conducted using the Proquest, CINAHL, and PubMed databases at the Johns Hopkins University library (January 1, 1990 to August 14, 2018), on burns or thermal injury among pediatric populations in Nigeria. The review focused on the forms of injury, risk factors and potential interventions. Results: Ten studies were identified and the main risk factors for burns were socioeconomic status, overcrowding, and involving young girls in traditional cooking roles. The main types of injuries include scald injuries (50%) and fire burns (45%) affecting mainly children aged 14 and below with significant regional epidemiological variations. We created a novel intervention to develop countermeasures and reduce the number of pediatric burns based on biological, physical and sociocultural environment.. Conclusion: Interventions such as improved supervision of children, improved emergency infrastructure and culturally sensitive first aid education and treatment can help ensure a reduction in morbidity and mortality resulting from burns. Epidemiological studies can provide an accurate depiction of the burden of burn injuries in different regions of Nigeria

Maternal and newborn care during the COVID-19 pandemic in Kenya: re-contextualising the community midwifery model

Peripartum deaths remain significantly high in low- and middle-income countries, including Kenya. The COVID-19 pandemic has disrupted essential services, which could lead to an increase in maternal and neonatal mortality and morbidity. Furthermore, the lockdowns, curfews, and increased risk for contracting COVID-19 may affect how women access health facilities. SARS-CoV-2 is a novel coronavirus that requires a community-centred response, not just hospital-based interventions. In this prolonged health crisis, pregnant women deserve a safe and humanised birth that prioritises the physical and emotional safety of the mother and the baby. There is an urgent need for innovative strategies to prevent the deterioration of maternal and child outcomes in an already strained health system. We propose strengthening community-based midwifery to avoid unnecessary movements, decrease the burden on hospitals, and minimise the risk of COVID-19 infection among women and their newborns

Effect of community-based interventions targeting female sex workers along the HIV care cascade in sub-Saharan Africa: a systematic review and meta-analysis

Background: Female sex workers are extremely vulnerable and highly susceptible to being infected with human immunodeficiency virus. As a result, community-based targeted interventions have been recommended as one of the models of care to improve access to HIV services and continued engagement in care. We conducted a systematic review to (1) assess the effect of FSW-targeted community interventions on the improvement of HIV services access along the treatment cascade and (2) describe community-based interventions that positively affect continuation in HIV care across the HIV treatment cascade for FSWs in sub-Saharan Africa. Methods: We defined the 5 steps that make up the HIV care cascade and categorized them as outcomes, namely, HIV testing and diagnosis, linkage to care, receipt of ART, and achievement of viral suppression. We conducted a systematic search of randomized controlled trials, cohort, and cross-sectional studies done in sub-Saharan African countries and published from 2004 to 2020. The period was selected based on the time span within which ART was scaled up through widespread roll-out of comprehensive HIV programs in sub-Saharan Africa. We reviewed studies with data on the implementation of community interventions for any of the HIV care cascade stage. The data were analyzed using random effects meta-analysis where possible, and for the rest of the studies, data were synthesized using summary statistics. Results: The significant impact of the community interventions was observed on HIV testing, HIV diagnosis, and ART use. However, for HIV testing and ART use, the improvement was not sustained for the entire period of implementation. There were minimal interventions that had impact on HIV diagnosis, with only one community service delivery model showing significance. Generally, the interventions that had reasonable impact are those that implemented targeted and comprehensive package of HIV services provided at one location, and with unique strategies specific to each cascade stage. Conclusions: The evidence brought forward from this review shows that the effect of community-based interventions varies across the different stages of HIV care cascade. A broad package of interventions including a combination of behavioral, biomedical, and structural, designed with specific strategies, unique to each cascade stage appears to be more effective, although information on long-term treatment outcomes and the extent to which FSWs remain engaged in care is sparse. There is need to conduct a further research to deepen the assessment of the effectiveness of community-based interventions on HIV care cascade for FSWs. This will enhance identification of evidence-based optimal interventions that will guide effective allocation of scarce resources for strategies that would have a significant impact on HIV service delivery

Interventions for Prevention of Non-Communicable Diseases among Adolescents Living with HIV: A Systematic Review

While the uptake of antiretroviral drugs has rapidly expanded among adolescents and adults living with HIV, research evidence suggests that people living with HIV have a higher risk of non-communicable diseases (NCDs). With more than 35% of the global burden of NCDs stemming from adolescence, there is a need to comprehend the existing evidence on early prevention, detection, and disease management, especially among the at-risk population. In line with the WHO Global Action Plan, 2013–2020 and “Best Buys”, recommendations on practical interventions for NCDs prevention, this systematic review seeks to synthesise evidence on the current interventions for preventing NCDs among adolescents living with HIV (ALHIV) and assessing the efectiveness of interventions targeted at preventing cardiovascular diseases, diabetes, and cancer among ALHIV. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The bibliographic database search yielded 2588 articles, though only four (4) studies met the inclusion criteria after screening for eligibility. While sub-Saharan Africa (SSA) sufers the brunt of HIV and NCDs, only one study was conducted in SSA, and three in high-income countries (Brazil and the USA). Physical activity and aerobic exercises (lifestyle interventions) indicated potential benefcial health efects in reducing cardiovascular conditions and improving quality of life among ALHIV. Hospital-based training and a home-based exercise program efectively improved ftness strengths and changes in body composition. Despite the disproportionate global burden of the HIV and NCDs comorbidities, limited adolescent-specifc evidence exists on the interventions for the prevention of NCDs among ALHIV. Thus, there is a need for health policy experts and researchers to steer research on interventions focused on the various NCDs among the ALHI

Barriers and facilitators to anti-retroviral therapy adherence among adolescents aged 10 to 19 years living with HIV in sub-Saharan Africa: A mixed-methods systematic review and meta-analysis

Background: Human Immunodeficiency Virus (HIV) significantly affects adolescents globally, with the sub-Saharan Africa (SSA) reporting a high burden of the disease. HIV testing, treatment, and retention to care are low among adolescents. We conducted a mixed-method systematic review to assess anti-retroviral therapy (ART) adherence; barriers and facilitators to ART adherence and ART outcomes among adolescents living with HIV and on ART in sub-Saharan Africa. Methods: We conducted searches in four scientific databases for studies conducted between 2010 and March 2022 to identify relevant primary studies. Studies were screened against inclusion criteria and assessed for quality, and data was extracted. Meta-analysis of rates and odd ratios was used to plot the quantitative studies and meta-synthesis summarized the evidence from qualitative studies. Results: A total of 10 431 studies were identified and screened against the inclusion/ exclusion criteria. Sixty-six studies met the inclusion criteria (41 quantitative, 16 qualitative, and 9 mixed-methods study designs). Fifty-three thousand two hundred and seventeen (53 217) adolescents (52 319 in quantitative studies and 899 in qualitative studies) were included in the review. Thirteen support focused interventions for improved ART adherence were identified from quantitative studies. The plotted results from the meta-analysis found an ART adherence rate of 65% (95%CI 56–74), viral load suppression was 55% (95%CI 46–64), un-suppressed viral load rate of 41% (95%CI 32–50), and loss to follow up of 17% (95%CI 10–24) among adolescents. Meta-synthesis found six themes of barriers to ART (social, patient-based, economic, health system-based, therapy-based, and cultural barriers) in both the qualitative and quantitative studies, and three themes of facilitators to ART were also identified (social support, counselling, and ART education and secrecy or confidentiality) from qualitative studies. Conclusion: ART adherence remains low among adolescents in SSA despite multiple interventions implemented to improve ART adherence. The low adherence rate may hinder the attainment of the UNAIDS 2030 targets. Additionally, various barriers to ART adherence due to lack of support have been reported among this age group. However, interventions aimed at improving social support, educating, and counselling adolescents may improve and sustain ART adherence