End-user centeredness in antiretroviral therapy services in Nigerian public health facilities

OBJECTIVE: To describe the perception of end users with regard to end-user centeredness in antiretroviral therapy (ART) service provision in Nigerian public health facilities. DESIGN: A qualitative design was followed. SUBJECTS: and setting: Unstructured focus group discussions were conducted with end users (n = 64) in six locations across the six different geopolitical zones of Nigeria. OUTCOME MEASURES: Data were analysed using the framework approach and Weft QDA® version 1.0.1. qualitative data analysis software. RESULTS: The results focused on end users’ participation in their care, ranging from understanding their diagnosis, choosing from available treatment options and places, and caring for their colleagues and themselves. CONCLUSION: End-user focused ART service provision positions end users to play key roles in decision-making with regard to their care. The findings of this study will be useful for nurses and other healthcare workers when promoting end-user centeredness in ART service provision.Department of HE and Training approved lis

Acceptance and uptake of voluntary HIV testing among healthcare workers in a South African public hospital

Background: Healthcare workers are seen as being at the centre of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) management. They are also at risk of HIV infection from occupational exposure to blood-borne pathogens during their daily work activities. Although many studies on HIV/AIDS and its management have been carried out globally, only a few address HIV counselling and testing among healthcare workers. The aim of this study is to determine factors associated with the acceptance and uptake of voluntary HIV testing among healthcare workers in a public hospital in KwaZulu-Natal. Method: A cross-sectional quantitative descriptive survey was conducted among healthcare workers in a public hospital, by means of self-administered questionnaires. Written informed consent was obtained from each participant prior to participation in the study. Results: A response rate of 239 (59.4%) was achieved from a targeted population of 402 healthcare workers. Of the 239 participants, 208 (87.0%) indicated that they would accept having an HIV test, while 217 (90.7%) reported having had HIV counselling and testing. There were positive associations between participants’ having had HIV counselling and testing and having a close relative living with HIV/AIDS (p-value = 0.032), previous accidental exposure to blood-borne pathogens (p-value = 0.003) and the number of years of their work experience (p-value = 0.0006). No significant associations were noted between participants who reported having undergone HIV counselling and testing in the previous year, and their demographic variables, such as age (0.766), gender (0.876), marital status (0.715), and knowledge of hospital policy on post-exposure prophylaxis (0.5669). Conclusion: The findings of this study showed high levels of acceptance (208, 87.0%) and uptake (217, 90.7%) of HIV counselling and testing among healthcare workers in the designated public hospital. Several factors influenced this.Health Studie

Factors influencing HIV-positive mothers to choose to use the flash-heat process of heating breast milk in South Africa

The objective of this cross-sectional study was to establish factors influencing HIV-positive mothers to choose to use the Flash-heat (FH) method to feed milk to new-born babies in South Africa. A total of 70 HIV-positive mothers were selected using purposive sampling methods. Backward stepwise binary logistic regression analysis was carried out to establish their willingness to use the FH feeding method. More than half (54.3%) the mothers were not breastfeeding their infant and among them a third (31.6%) mentioned that breastfeeding was difficult and this was given as the reason for not breastfeeding. Most of the mothers (74.3%) reported that they would use the FH method at home as a feeding method for their infants, and most (83%) of the mothers reported that they were willing to heattreat their expressed breast milk (EBM) in a pot on a Primus stove until the water boils-as required by the FH guideline. The results showed that mothers who reported that they were willing to heat EBM at home were 24 times more likely to adopt FH compared to those who were not willing to heat EBM at home (OR=24.23, p=0.001). Also, those mothers who reported that they were willing to express milk for 4 months had 22 times more chance of adopting FH than mothers who reported that they were not willing to express for 4 months (OR=21.60, p=0.016). The findings suggest that HIV-positive mothers in a public-health facility would adopt flash-heating as an alternative infant-feeding method at home.www.biomedres.infoam2017School of Health Systems and Public Health (SHSPH

Access to safe drining water and availability of environmental sanitation facilities among Dukem town households in Ethiopia

The objective of this study was to assess the accessibility of water and environmental sanitation amongst households of Dukem town in Ethiopia. This was a cross-sectional study conducted among 391 households. Almost all the households had access to improved sources of drinking water. Majority of the households had access to water within a distance of up to 200 metres or less and had access to water within a time of 30 minutes or less. More than two-thirds of households had improved toilets (flush/pour-flush toilet, ventilated improved pit (VIP) latrine and traditional pit latrine). It is important to make water available by supplying with private or yard tap connections for underserved population and improved basic sanitation by promoting Total Sanitation Approach which aims to achieve universal access and use of toilets and the elimination of open defecation in the communities.NoneHealth Studie

Utilisation of the National Antiretroviral Therapy Guidelines among health care professionals working in Abuja treatment centres, Nigeria

Background: Access to and utilisations of the National Antiretroviral Treatment Guidelines (NATG) are valuable factors for effective programme implementation. The objective of this study was to investigate the accessibility of the NATG and their utilisation by health care professionals from five treatment centres in Abuja, Nigeria. Method: A quantitative cross-sectional descriptive survey was conducted in 2007 using purposively sampled health care professionals. Questionnaires were self-administered to participants who consented in writing to participate in the survey. Results: 97 health care professionals participated in this study with about equal numbers of men and women: 48 (49.5%) women and 49 (50.5%) men. Of these, 21.6% were unaware of the existence of the NATG in their treatment centres. More than half (51.5%) reported that they did not have access to the NATG as opposed to those (48.5%) who had access to the guidelines. Furthermore, 16.5% of the participants confirmed that they had access to an institutional copy of the NATG while 14.4% indicated that they had individual copies and only 3.1% stated that they had individual copies and access to the hospital copy as well. Regarding utilisation of the NATG, 41.2% rarely used them, 32.9% never used them and only 25.7% often used them. The most frequent use of the NATG was among pharmacists (38.1%) compared to the least frequent use among nurses (20.0%). Conclusion: Poor accessibility of the NATG may have a negative impact on guidelines utilisation among health care professionals in Nigeria

Epidemiology of multimorbidity among people living with HIV in sub-Saharan Africa : a systematic review protocol

CITATION: Oladimeji, Kelechi Elizabeth et al. 2020. Epidemiology of multimorbidity among people living with HIV in sub-Saharan Africa : a systematic review protocol. BMJ Open, 10(12):e036988, doi:10.1136/bmjopen-2020-036988.The original publication is avaialble at: https://bmjopen.bmj.comIntroduction Sub-Saharan Africa remains the epicentre of the HIV pandemic, yet enormous knowledge gaps still exist to elicit a comprehensive portrait of multimorbidity and HIV linkage. This study aims to conduct a systematic meta-analysis of peer-reviewed literature to investigate the current status of multimorbidity epidemiology among people living with HIV (PLHIV) in sub-Saharan Africa. Methods and analysis Our review will assess observational studies (ie, cohort, case–control and cross-sectional) on multimorbidity associated with HIV/AIDS between 1 January 2005 and 31 October 2020 from sub-Saharan Africa. Databases to be searched include PubMed/MEDLINE, Scopus, Web of Science, Cochrane library, African Index Medicus and African Journals Online. We will also search the WHO clinical trial registry and databases for systematic reviews. The search strategy will involve the use of medical subject headings and key terms to obtain studies on the phenomena of HIV and multimorbidity at high precision. Quality assessment of eligible studies will be ascertained using a validated quality assessment tool for observational studies and risk of bias through sensitivity analysis to identify publication bias. Further, data on characteristics of the study population, multimorbid conditions, epidemiological rates and spatial distribution of multimorbid conditions in PLHIV will be extracted. Heterogeneity of individual studies will be evaluated using the I2 statistic from combined effect size estimates. The statistical analysis will be performed using STATA statistical software V.15 and results will be graphically represented on a forest plot.Publisher's versio

Using Geographic Information Systems and Spatial Analysis Methods to Assess Household Water Access and Sanitation Coverage in the SHINE Trial

Access to water and sanitation are important determinants of behavioral responses to hygiene and sanitation interventions. We estimated cluster-specific water access and sanitation coverage to inform a constrained randomization technique in the SHINE trial. Technicians and engineers inspected all public access water sources to ascertain seasonality, function, and geospatial coordinates. Households and water sources were mapped using open-source geospatial software. The distance from each household to the nearest perennial, functional, protected water source was calculated, and for each cluster, the median distance and the proportion of households within 1500 m of such a water source. Cluster-specific sanitation coverage was ascertained using a random sample of 13 households per cluster. These parameters were included as covariates in randomization to optimize balance in water and sanitation access across treatment arms at the start of the trial. The observed high variability between clusters in both parameters suggests that constraining on these factors was needed to reduce risk of bia

Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: a cluster-randomised trial.

BACKGROUND: Child stunting reduces survival and impairs neurodevelopment. We tested the independent and combined effects of improved water, sanitation, and hygiene (WASH), and improved infant and young child feeding (IYCF) on stunting and anaemia in in Zimbabwe. METHODS: We did a cluster-randomised, community-based, 2 × 2 factorial trial in two rural districts in Zimbabwe. Clusters were defined as the catchment area of between one and four village health workers employed by the Zimbabwe Ministry of Health and Child Care. Women were eligible for inclusion if they permanently lived in clusters and were confirmed pregnant. Clusters were randomly assigned (1:1:1:1) to standard of care (52 clusters), IYCF (20 g of a small-quantity lipid-based nutrient supplement per day from age 6 to 18 months plus complementary feeding counselling; 53 clusters), WASH (construction of a ventilated improved pit latrine, provision of two handwashing stations, liquid soap, chlorine, and play space plus hygiene counselling; 53 clusters), or IYCF plus WASH (53 clusters). A constrained randomisation technique was used to achieve balance across the groups for 14 variables related to geography, demography, water access, and community-level sanitation coverage. Masking of participants and fieldworkers was not possible. The primary outcomes were infant length-for-age Z score and haemoglobin concentrations at 18 months of age among children born to mothers who were HIV negative during pregnancy. These outcomes were analysed in the intention-to-treat population. We estimated the effects of the interventions by comparing the two IYCF groups with the two non-IYCF groups and the two WASH groups with the two non-WASH groups, except for outcomes that had an important statistical interaction between the interventions. This trial is registered with ClinicalTrials.gov, number NCT01824940. FINDINGS: Between Nov 22, 2012, and March 27, 2015, 5280 pregnant women were enrolled from 211 clusters. 3686 children born to HIV-negative mothers were assessed at age 18 months (884 in the standard of care group from 52 clusters, 893 in the IYCF group from 53 clusters, 918 in the WASH group from 53 clusters, and 991 in the IYCF plus WASH group from 51 clusters). In the IYCF intervention groups, the mean length-for-age Z score was 0·16 (95% CI 0·08-0·23) higher and the mean haemoglobin concentration was 2·03 g/L (1·28-2·79) higher than those in the non-IYCF intervention groups. The IYCF intervention reduced the number of stunted children from 620 (35%) of 1792 to 514 (27%) of 1879, and the number of children with anaemia from 245 (13·9%) of 1759 to 193 (10·5%) of 1845. The WASH intervention had no effect on either primary outcome. Neither intervention reduced the prevalence of diarrhoea at 12 or 18 months. No trial-related serious adverse events, and only three trial-related adverse events, were reported. INTERPRETATION: Household-level elementary WASH interventions implemented in rural areas in low-income countries are unlikely to reduce stunting or anaemia and might not reduce diarrhoea. Implementation of these WASH interventions in combination with IYCF interventions is unlikely to reduce stunting or anaemia more than implementation of IYCF alone. FUNDING: Bill & Melinda Gates Foundation, UK Department for International Development, Wellcome Trust, Swiss Development Cooperation, UNICEF, and US National Institutes of Health.The SHINE trial is funded by the Bill & Melinda Gates Foundation (OPP1021542 and OPP113707); UK Department for International Development; Wellcome Trust, UK (093768/Z/10/Z, 108065/Z/15/Z and 203905/Z/16/Z); Swiss Agency for Development and Cooperation; US National Institutes of Health (2R01HD060338-06); and UNICEF (PCA-2017-0002)

Quality of antiretroviral therapy in public health facilities in Nigeria and perceptions of end users

AIM: This paper describes perceptions of the end users on quality of antiretroviral therapy (ART) in public health facilities in Nigeria. BACKGROUND: Health care services in Nigeria face challenges of meeting end users’ requirements and expectations for quality ART service provision. METHOD: A qualitative design was followed. Unstructured focus group discussions were conducted with end users (n = 64) in six locations across the six geopolitical zones of Nigeria. RESULTS: The findings indicate that end users were satisfied with uninterrupted antiretroviral drug supplies, courtesy treatment, volunteerism of support group members and quality counselling services. CONCLUSION: End users expect effective collaboration between healthcare providers and support group members, to enhance the quality of life of people living with HIV. IMPLICATIONS FOR NURSING MANAGEMENT: A best practice guideline for the provision of end user focused ART service provision was developed for nurse managers.Web of Scienc

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