Community-Based Accompaniment and the Impact of Distance for HIV Patients Newly Initiated on Antiretroviral Therapy: Early Outcomes and Clinic Visit Adherence in Rural Rwanda

Munyaneza, Fabien; Ntaganira, Joseph; Nyirazinyoye, Laetitia; Birru, Ermyas; Nisingizwe, Marie Paul; Gupta, Neil; Amoroso, Cheryl; Neza, Guillaine; Hirschhorn, Lisa R.; Hedt‐Gauthier, Bethany

doi:10.1007/s10461-016-1658-5

Cited by 21 publications

(31 citation statements)

References 31 publications

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“…Studies in high income countries provide accurate estimates of geographical access to services due to the wider availability of electronic health information systems and GIS data, as well as good transport infrastructure [63,[67][68][69][70]. In contrast, studies in developing countries typically use either Euclidean distances to obtain a basic measure of distance, or road networks in combination with friction surfaces to obtain estimates of travel time to PHC because the real network of footpaths is rarely available [21,27,41]. Given that most travel in rural areas is done by foot, inaccuracies from such models can be quite important [22,71].…”

Section: Discussionmentioning

confidence: 99%

“…Community health strategies are underway in most rural areas of Sub-Saharan Africa, where health infrastructure is sparse and the majority of travel is on foot [10]. Distance and travel time to primary health centers (PHC) in these areas are known drivers of care utilization, showing consistent negative impacts on the use of prenatal, perinatal and obstetric care for women [4,[11][12][13][14][15]; child vaccination coverage and pediatric health utilization [16][17][18][19]; voluntary enrolment in health insurances [2]; and rates of diagnosis or treatment for tuberculosis, malaria, and HIV [20][21][22][23][24]. In fact, the use of primary care tends to fall exponentially as distance from health facilities rises, a phenomenon known as "distance decay" [16,23,[25][26][27].…”

Section: Introductionmentioning

confidence: 99%

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Improving geographical accessibility modeling for operational use by local health actors

Ihantamalala

Herbreteau²,

Révillion

et al. 2020

Int J Health Geogr

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Background: Geographical accessibility to health facilities remains one of the main barriers to access care in rural areas of the developing world. Although methods and tools exist to model geographic accessibility, the lack of basic geographic information prevents their widespread use at the local level for targeted program implementation. The aim of this study was to develop very precise, context-specific estimates of geographic accessibility to care in a rural district of Madagascar to help with the design and implementation of interventions that improve access for remote populations. Methods: We used a participatory approach to map all the paths, residential areas, buildings and rice fields on Open-StreetMap (OSM). We estimated shortest routes from every household in the District to the nearest primary health care center (PHC) and community health site (CHS) with the Open Source Routing Machine (OSMR) tool. Then, we used remote sensing methods to obtain a high resolution land cover map, a digital elevation model and rainfall data to model travel speed. Travel speed models were calibrated with field data obtained by GPS tracking in a sample of 168 walking routes. Model results were used to predict travel time to seek care at PHCs and CHSs for all the shortest routes estimated earlier. Finally, we integrated geographical accessibility results into an e-health platform developed with R Shiny. Results: We mapped over 100,000 buildings, 23,000 km of footpaths, and 4925 residential areas throughout Ifanadiana district; these data are freely available on OSM. We found that over three quarters of the population lived more than one hour away from a PHC, and 10-15% lived more than 1 h away from a CHS. Moreover, we identified areas in the North and East of the district where the nearest PHC was further than 5 h away, and vulnerable populations across the district with poor geographical access (> 1 h) to both PHCs and CHSs. Conclusion: Our study demonstrates how to improve geographical accessibility modeling so that results can be context-specific and operationally actionable by local health actors. The importance of such approaches is paramount for achieving universal health coverage (UHC) in rural areas throughout the world.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Improving geographical accessibility modeling for operational use by local health actors

Ihantamalala

Herbreteau²,

Révillion

et al. 2020

Int J Health Geogr

View full text Add to dashboard Cite

show abstract

“…distance, or road networks in combination with friction surfaces to obtain estimates of travel time to PHC because the real network of footpaths is rarely available [21,27,42]. Given that most travel in rural areas is done by foot, inaccuracies from such models can be quite important [22,71].…”

Section: Discussionmentioning

confidence: 99%

“…Community health strategies are underway in most rural areas of Sub-Saharan Africa, where health infrastructure is sparse and the majority of travel is on foot [10]. Distance and travel time to primary health centers (PHC) in these areas are known drivers of care utilization, showing consistent negative impacts on the use of prenatal, perinatal and obstetric care for women [4,[11][12][13][14][15]; child vaccination coverage and pediatric health utilization [16][17][18][19]; voluntary enrolment in health insurances [2]; and rates of diagnosis or treatment for tuberculosis, malaria, and HIV [20][21][22][23][24]. In fact, the use of primary care tends to fall exponentially as distance from facility rises, a phenomenon known as "distance decay" [16,23,[25][26][27].…”

Section: Introductionmentioning

confidence: 99%

Improving geographical accessibility modeling for operational use by local health actors

Ihantamalala¹,

Herbreteau

Révillion³

et al. 2020

Preprint

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Background Geographical accessibility to health facilities remains one of the main barriers to access care in rural areas of the developing world. Although methods and tools exist to model geographic accessibility, the lack of basic geographic information prevents their widespread use at the local level for targeted program implementation. The aim of this study was to develop very precise, context-specific estimates of geographic accessibility to care in a rural district of Madagascar to help with the design and implementation of interventions that improve access for remote populations. Methods We used a participatory approach to map all the paths, residential areas, buildings and rice fields on OpenStreetMap (OSM). We estimated shortest route from every household in the District to the nearest primary health care center (PHC) and community health site (CHS) with the Open Source Routing Machine (OSMR) tool. Then, we used remote sensing methods to obtain a high resolution land cover map, a digital elevation model and rainfall data to model travel speed. Travel speed models were calibrated with field data obtained by GPS tracking in a sample of 168 walking routes. Model results were used to predict travel time to seek care at PHCs and CHSs for all the shortest route estimated earlier. Finally, we integrated geographical accessibility results into an e-health platform developed with R Shiny. Results We mapped over 100,000 buildings, 23,000 km of footpaths, and 4,925 residential areas throughout Ifanadiana district; this data is freely available on OSM. We found that over three quarters of the population lived more than one hour away from a PHC, and 10-15% lived more than one hour away from a CHS. Moreover, we identified areas in the North and East of the district where the nearest PHC was further than 5 hours away, and vulnerable populations across the district with poor geographical access (>1 hour) to both PHCs and CHSs. Conclusion Our study demonstrates how to improve geographical accessibility modeling so that results can be context-specific and operationally actionable by local health actors. The importance of such approaches is paramount for achieving universal health coverage in rural areas throughout world.

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“…While some clinic-based strategies such as early initiation of ART have improved retention in care (Brown et al., 2016 ), other clinic-based strategies such as peer support or innovative counselling programmes have lacked anti-stigma or health outcome benefits, respectively (Rao et al., 2018 ; Uusküla et al., 2018 ). Some HIV-infected persons who take ART face barriers to care and require accompaniment in the community for various reasons, ranging from a weak health system, stigma, social ostracisation, alcohol abuse, as well as competing demands on time and money in the context of widespread abject poverty (Fatti, Meintjes, Shea, Eley, & Grimwood, 2012 ; Munyaneza et al., 2018 ; Pokhrel, Gaulee Pokhrel, Neupane, & Sharma, 2018 ; Vogt et al., 2017 ). Younger age groups are particularly in need of community-based ART (Fatti et al., 2018 ; Grimwood et al., 2012 ).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a community-based ART programme after tapering home visits in rural Sierra Leone: a 24-month retrospective study

Kelly

Frankfurter²,

Lurton

et al. 2018

SAHARA-J: Journal of Social Aspects of HIV/AIDS

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Evaluations of community-based antiretroviral therapy (ART) programmes have demonstrated positive outcomes, but little is known about the impact of tapering community-based ART. The objective of this study was to assess 24-month HIV retention outcomes of a community-based ART programme and its tapered visit frequency in Koidu City, Sierra Leone. This retrospective, quasi-experimental study compared outcomes of 52 HIV-infected persons initiated on community-based ART against 91 HIV-infected persons receiving the standard of care from November 2009 to February 2013. The community-based ART pilot programme was designed to strengthen the standard of care through a comprehensive, patient-centred case management strategy. The strategy included medical, educational, psychological, social, and economic support. Starting in October 2011, the frequency of home visits was tapered from twice daily every day per week to once daily three days per week. Outcomes were retention in care at 12 and 24 months and adherence to ART over a three-month time period. Participants who received community-based ART had significantly higher retention than those receiving standard of care. At 12 months, retention rates for community-based ART and standard of care were 61.5% and 31.9%, respectively (p < .01). At 24 months, retention rates for community-based ART and standard of care were 73.1% and 44.0%, respectively (p < .01). Significant differences in levels of adherence were observed when comparing community-based ART against persons receiving standard of care (p < .05). No differences in adherence levels were observed between groups of people receiving various frequencies of home visits. Our pilot programme in Koidu City provides new evidence that community-based ART has the potential to improve retention and adherence outcomes for HIV-infected persons, regardless of the frequency of home visits. Overcoming the barriers to HIV care requires a comprehensive, patient-centred approach that may include clinic-based and community-based interventions.

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Community-Based Accompaniment and the Impact of Distance for HIV Patients Newly Initiated on Antiretroviral Therapy: Early Outcomes and Clinic Visit Adherence in Rural Rwanda

Cited by 21 publications

References 31 publications

Improving geographical accessibility modeling for operational use by local health actors

Improving geographical accessibility modeling for operational use by local health actors

Improving geographical accessibility modeling for operational use by local health actors

Evaluation of a community-based ART programme after tapering home visits in rural Sierra Leone: a 24-month retrospective study

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