Background
Although Venezuela has a National Human Immunodeficiency Virus (HIV) Program offering free diagnosis and treatment, 41% of patients present for diagnosis at a later disease-stage, indicating that access to care may still be limited. Our study aimed to identify factors influencing delay in presenting for HIV-diagnosis using a case-case comparison. A cross-sectional survey was performed at the Regional HIV Reference Centre (CAI), Carabobo Region, Venezuela. Between May 2005 and October 2006 225 patients diagnosed with HIV at CAI were included and demographic, behavioural and medical characteristics collected from medical files. Socio-economic and behavioural factors were obtained from 129 eligible subjects through interviews. "Late presentation" at diagnosis was defined as patients classified with disease-stage B or C according to the 1993 Centers for Disease Control and Prevention (Atlanta, USA) classification, and "early presentation" defined as diagnosis in disease-stage A.
Results
Of 225 subjects, 91 (40%) were defined as late presenters. A similar proportion (51/129) was obtained in the interviewed sub-sample. Older age (>30 years), male heterosexuality, lower socio-economic status, perceiving ones partner to be faithful and living ≥ 25 km from the CAI were positively associated with late diagnosis in a multivariate model. Females were less likely to present late than heterosexual males (odds ratio = 0.23,
P
= 0.06). The main barriers to HIV testing were low knowledge of HIV/AIDS, lack of awareness of the free HIV program, lack of perceived risk of HIV-infection, fear for HIV-related stigma, fear for lack of confidentiality at testing site and logistic barriers.
Conclusion
Despite the free Venezuelan HIV Program, poverty and barriers related to lack of knowledge and awareness of both HIV and the Program itself were important determinants in late presentation at HIV diagnosis. This study also indicates that women; heterosexual, bisexual and homosexual men might have different pathways to testing and different factors related to late presentation in each subgroup. Efforts must be directed to i) increase awareness of HIV/AIDS and the Program and ii) the identification of specific factors associated with delay in HIV diagnosis per subgroup, to help develop targeted public health interventions improving early diagnosis and prognosis of people living with HIV/AIDS in Venezuela and elsewhere.
Predominance of a morality that views the Colombian SGSSS in terms of the market model generates conditions that go against the principles and values that are supposed to guide the health system as guarantor of the right to health and human dignity. Health decisions should take into account not only technical and scientific criteria but also the principles and values involved, and consideration should be given to safeguarding them.
Objective: To analyze the quality of the maternal health services in Medellín city, Colombia within the context of the Social Security System in Health from the perspective of the mothers, physicians and nurses involved in the provision of these services. Methodology: A qualitative study was carried out, during which 24 individual interviews were conducted to key doctors and nurses, who work in health institutions that providing maternal care. Also three focus groups with mothers were conducted. The data analysis was carried out using a systematic and carefully coding and categorization process. Findings: In spite of the fact that municipal policies have been put in place to improve maternity care, mother and pregnant women face problems with health services. Findings suggests that the strategies put in place by these health institutions to decrease labor costs, the administrative barriers, the low tariffs of the obstetric services paid by the health insurers within and competitive market, and the focus on getting financial profitability, are aspects that affecting quality of maternal care.
The DOTS-R is a promising cost-effective alternative for improved control of TB in endemic areas. It is recommended that the health authorities include home-based guardian monitoring of patients in their institutional management of the TB program, with the participation of health workers and the physical and financial resources that currently support this program.
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