C. Cohen

E. Bukusi

G. Gray

K. Owuor

M.A. Onono

T. Abuya

Annals of Global Health

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Anna l s o f G l o b a l He a l t h 199Structure/Method/Design: This is a mixed methods study that willinvolve data collection through social media, specifically pictures and2-minute video clips, a short demographic survey and photo narrativefrom youth aged 18 to 30 in Nigeria.Results (Scientific Abstract)/Collaborative Partners (Program-matic Abstract): Results from initial study on the impact of global-ization on youth in Nigeria by the author has shown that globalizationprocesses affect youth positively and negatively. Findings from thisstudy will provide further illustration and context of this impact.Summary/Conclusion: This mixed-methods, mixed-media, andmulti-disciplinary study will provide results from one of the initialstudies on the impact of globalization on youth in Nigeria using socialmedia.Factors influencing compliance to prevention of mother-to-child transmission guidelines in Western KenyaM.A. Onono1, T. Abuya2, K. Owuor1, E. Bukusi1, G. Gray3, C. Cohen4;1Kenya Medical Research Institute, Center for Microbiology Research,Kisumu/KE, 2Population Council, Nairobi/KE, 3Perinatal HIVResearch Unit, Soweto/ZA, 4University of California, San Francisco, SanFrancisco, CA/USBackground: Prevention of mother-to-child transmission (PMTCT)guidelines in Kenya requires all pregnant HIV-infected women beprovided with highly active antiretroviral therapy (HAART) or ARVprophylaxis unless they opt out. We assessed the level of complianceto PMTCT guidelines and factors influencing compliance by healthcare providersStructure/Method/Design: Compliance was measured using chartaudits of 200 HIV-infected pregnant and postpartum women betweenNovember 2012 and June 2013. Factors associated with compliancewere explored through 32 in-depth interviews with staff directlyinvolved in PMTCT across 22 government facilities in westernKenya.Results (Scientific Abstract)/Collaborative Partners (Program-matic Abstract): Although providers were knowledgeable aboutPMTCT and had high levels of professional confidence, complianceto guidelines was suboptimal and resulted in increased odds ofMTCT. Chart audits showed that where MTCT occurred, providerswere more likely to have failed to follow guidelines for prescription ofART for mothers [OR, 8.61; 95% CI, 2.8-26.2] and infants [OR,3.92; 95% CI, 1.1-13.6], HIV counseling [OR, 3.94; 95% CI, 1.27-12.20], and timely provision of ARVs [OR, 2.97; 95% CI, 1.38-6.31].Providers did not comply due to perception that 1) clients were inearly gestation period (<28 weeks), 2) known HIV-infected womenhad less MTCT risk, 3) newly diagnosed women were more likely toopt out of PMTCT interventions. Providers attributed MTCT toclient behavior citing reasons such as spousal influences, non-adherence to prescribed interventions, transport cost to health facil-ities, and stigma and disclosure dynamics. As a response to the clientbehavior, providers felt they lacked skills to convince women to takeARVs, felt demoralized, delayed providing PMTCT interventions, orsimply did nothing. Systemic factors such as lack of privacy due towork-space challenges, language barriers during counseling, andincreased workload linked to low staff numbers were cited ashampering guideline compliance. Fear of team alienation and stronggroup pressure was a key motivation to manage HIV-infected womenwell so as to avoid the ripple effect of discrimination at facility andpersonal level.Summary/Conclusion: Client and provider behavior interact withhealth-system factors in a complex way to influence MTCT. Toaddress the problem of suboptimal guideline compliance, particularly,at the roll out of Option B+, it is important to understand uniquecontextual factors and how they affect the performance of providersimplementing PMTCT.Quality of life of HIV patients 2 years into treatment in acommunity-based antiretroviral therapy program inwestern UgandaC. Paulsen1, A. Alibhai1, W. Kipp1, D. Saunders1, J. Konde-Lule2,G. Jhangri1, T. Rubaale3; 1University of Alberta, Edmonton, AB/CA,2Makerere University, School of Public Health, Kampala/UG, 3KabaroleHealth Department, Fort Portal/UGBackground: Objectives:The aim of this study was to examine changes in the health-related quality of life (HRQOL) outcomes of patients in a community-based antiretroviral therapy (CBART) program in western Uganda, 2years after the initiation of treatment.Structure/Method/Design: A culturally adapted version of theMOS-HIV survey was administered to patients in the CBART pro-gram at baseline, after 1 year and after 2 years of treatment. Com-plementary clinical data was also collected at these times.Changes in physical health (PHS) and mental health (MHS)summary scores were assessed and their associations with patientcharacteristics were examined.Results (Scientific Abstract)/Collaborative Partners (Program-matic Abstract): Preliminary analysis suggests that the gains in PHSand MHS made during the first year of treatment have been main-tained between throughout the second year of treatment as well.Further subgroup analysis is being carried out to examine associationsbetween key demographic characteristics and changes in HRQOL.The influence of clinical factors, such as viral suppression, are alsobeing examined.While PHS and MHS both increased significantly overall duringthe first year of treatment, there was a proportion of patients whoexperienced either no change or a decrease in HRQOL during thefirst year of treatment. Associations between magnitude and directionof changes during the first and second year of treatment are also beingexamined.Summary/Conclusion: The improvements in HRQOL show thatCBART programs in rural Uganda can both provide positive treatmentoutcomes, and maintain them over time. However, improvements werenot universal, and some patients continued to struggle despite improvedclinical improvements. HRQOL surveys can be useful in identifyingthese patients, who may require additional support. Understanding theongoing challenges of CBART patients is important for program plan-ning, in order to better meet local needs.Relationship among dietary patterns, apolipoproteins, C-reactive protein, and other lipids in adult populations infour cities of the Southern Cone of Latin AmericaR. Poggio, N. Elorriaga, L. Guitierrez, V. Irazola, A. Rubinstein; IECS,Buenos Aires, PLEASE SELECT/ARBackground: In the last decades, there has been a nutrition tran-sition in Latin America to diets with higher total caloric intake andlower consumption of vegetables, cereals, and fruits. An unhealthydietary pattern affects plasma levels of apolipoprotein (Apo) AI, ApoB, and C-reactive protein (CRP), which are independently associatedwith the incidence of coronary heart disease and stroke. There is no

Factors influencing compliance to prevention of mother-to-child transmission guidelines in Western Kenya

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Factors influencing compliance to prevention of mother-to-child transmission guidelines in Western Kenya

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