Background Biomedical technologies have the potential to be advantageous in remote communities. However, information about barriers faced by users of technology in general and in remote Indigenous communities is scarce. The purpose of this study was to characterize the leading challenges faced by researchers who have used biomedical technologies in the Peruvian Amazon. Methods This exploratory, qualitative study with a phenomenological approach depicts the lived experience of participants who were researchers with experience working with biomedical technologies in the Peruvian Amazon in the past five years. Analysis was based on three core themes: design, implementation, and acceptability. Sub-themes included environment, community, and culture. Of the 24 potential participants identified and contacted, 14 agreed to participate, and 13 met inclusion criteria and completed semi-structured interviews. Results were sent to each participant with the opportunity to provide feedback and partake in a 30-minute validation meeting. Five participants consented to a follow-up meeting to validate the results and provide further understanding. Results Participants recognized significant challenges, including technologies designed out-of-context, difficulty transporting the technologies through the Amazon, the impact of the physical environment (e.g., humidity, flooding), and limited existing infrastructure, such as electricity and appropriately trained health personnel. Participants also identified cultural factors, including the need to address past experiences with technology and health interventions, understand and appropriately communicate community benefits, and understand the effect of demographics (e.g., age, education) on the acceptance and uptake of technology. Complementary challenges, such as corruption in authority and waste disposal, and recommendations for technological and health interventions such as co-design were also identified. Conclusions This study proposes that technological and health interventions without efforts to respect local cultures and health priorities, or understand and anticipate contextual challenges, will not meet its goal of improving access to healthcare in remote Amazon communities. Furthermore, the implications of corruption on health services, and improper waste disposal on the environment may lead to more detrimental health inequities.
Introduction: Technological advances in public health have allowed the life expectancy of people to increase. However, new challenges appear in populations that age as the greatest number of chronic and oncological diseases requiring chronic and/or palliative care. In Peru, this is an area that has not developed. The use of Information and Communication Technologies (ICT) can optimize healthcare, and in the case of palliative care they could shorten the distances between the specialist, the caregiver and the patient. Objective: To know the needs of health professionals and caregivers of patients who are in palliative care, regarding the management of information, knowledge, attitudes and the use of ICT in palliative care. Materials and Methods: As part of the TeleJampiq project, a first phase of qualitative study is developed. A focus group was conducted with six caregivers. Family members' information was obtained through two field reports and two interviews. Finally, the exploration of the needs and suggestions of palliative care specialists was carried out by ten in-depth interviews (six physicians, one psychologist and three nurses). Through the data analysis we were able to identify three major themes in which the results were classified: Management of information on chronic diseases and terminal patients, knowledge and actions in palliative care and use of ICT for palliative care. Results: Management of information on chronic diseases and terminal patients. It is essential to draw a distinction between terminability and palliation. Managing these concepts could make a difference from the start of treatment. Knowledge and actions in palliative care. Nonfamily caregivers' knowledge of the meaning of palliative care is like that of specialists (doctors and nurses). Use of ICT for palliative care. The use of mobile devices among health personnel interviewed is overwhelming. Engaging in aspects of information management to other specialists such as nutritionists and psychologists would be beneficial. Conclusions: It is necessary to use ICT in the field of chronic and palliative care, being a fundamental aspect the communication between personnel working in the system and the use of scales, care protocols, among others.
Mother-to-child transmission of HIV (MTCT) accounts for a significant proportion of new HIV infections in Peru. The purpose of this case–control study was to examine maternal and infant factors associated with MTCT in Peru from 2015 to 2016. For each biologically confirmed case infant, we randomly selected four birth year- and birth hospital-matched controls from five hospitals in Lima-Callao. Maternal and infant information were gathered from medical records. Simple conditional logistic regression was utilized to examine possible maternal and infant characteristics associated with MTCT. The rate of MTCT was 6.9% in 2015 and 2.7% in 2016. A total of 63 matched controls were identified for 18 cases. Protective factors included higher number of prenatal visits (odds ratio [OR]: 0.72; 95% confidence interval [CI]: 0.55–0.94, p = 0.012) and having more children (OR: 0.10, 95% CI: 0.01–0.79, p = 0.029). Risk factors included later maternal diagnosis (OR: 1.19; 95% CI: 1.06–1.34; p = 0.001) and greater viral load at the time of maternal diagnosis (OR: 1.05; 95% CI: 1.01–1.10; p = 0.022). Our study highlights the importance of targeting early and continued prenatal care as specific areas to target to prevent gaps in the HIV treatment cascade for pregnant HIV-infected women. These strategies can ensure early screening and initiation of antiretroviral therapy to reduce MTCT rates.
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