The leadership of communities in HIV service delivery

Barr, David; Odetoyinbo, Morolake; Mworeko, Lillian; Greenberg, Julia

doi:10.1097/qad.0000000000000717

Cited by 15 publications

(14 citation statements)

References 3 publications

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“…Programs such as community based ART distribution[9, 50], improving adherence via medication diary for care givers[51], home based nursing interventions[52] and adherence clubs[53] could increase linkage to and retention in care and further reduce discontinuation. People living with HIV should also meaningfully be involved in the continuum of care to improve retention programs[54].…”

Section: Discussionmentioning

confidence: 99%

Prevalence, trend and risk factors for antiretroviral therapy discontinuation among HIV-infected adults in Ethiopia in 2003-2015

et al. 2017

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BackgroundIt is well acknowledged that antiretroviral therapy (ART) discontinuation hampers the progress towards achieving the UNAIDS treatment targets that aim to treat 90% of HIV diagnosed patients and achieve viral suppression for 90% of those on treatment. Nevertheless, the magnitude, trend and risk factors for ART discontinuation have not been explored extensively. We carried out a retrospective data analysis to assess prevalence, trend and risk factors for ART discontinuation among adults in Southwest Ethiopia.Methods12 years retrospective cohort analysis was performed with 4900 HIV-infected adult patients between 21 June 2003 and 15 March 2015 registered at the ART clinic at Jimma University Teaching Hospital. ART discontinuation could be loss to follow-up, defaulting and/or stopping medication while remaining in care. Because data for 2003 and 2015 were incomplete, the 10 years data were used to describe trends for ART discontinuation using a line graph. We used binary logistic regression to identify factors that were correlated with ART discontinuation. To handle missing data, we applied multiple imputations assuming missing at random pattern.ResultsIn total, 4900 adult patients enrolled on ART, of whom 1090 (22.3%) had discontinued, 954 (19.5%) had transferred out, 300 (6.1%) had died, 2517 (51.4%) were alive and on ART, and the remaining 39 (0.8%) had unknown outcome status. The trend of ART discontinuation showed an upward direction in the recent times and reached a peak, accounting for a magnitude of 10%, in 2004 and 2005. Being a female (AOR = 2.1, 95%CI: 1.7–2.8), having an immunological failure (AOR = 2.3, 1.9–8.2), having tuberculosis/HIV co-infection (AOR = 1.5, 1.1–2.1) and no previous history of HIV testing (AOR = 1.8, 1.4–2.9) were the risk factors for ART discontinuation.ConclusionsOne out of five adults had discontinued from ART, and the trend of ART discontinuation increased recently. Discontinued adults were more likely to be females, tuberculosis/HIV co-infected, with immunological failure and no history of HIV testing. Therefore, it is vital to implement effective programs such as community ART distribution and linkage-case-management to enhance ART linkage and retention.

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Section: Discussionmentioning

confidence: 99%

Prevalence, trend and risk factors for antiretroviral therapy discontinuation among HIV-infected adults in Ethiopia in 2003-2015

et al. 2017

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“…There is an increasing expectation that CHWs will participate in disease surveillance and data collection activities, as well as play an active role in the diagnosis and referral for care, and in efforts to roll out anti-retroviral treatment (ART) coverage [3]. CHW programs have been suggested to play a “transformative” role in scaling up HIV services for achieving the 90-90-90 treatment goals—including through community-level “test-and-treat” initiatives [4–9], differentiated care models [10], and there have been calls to dramatically increase the number of CHWs in HIV endemic settings [11–13]. …”

Section: Introductionmentioning

confidence: 99%

Harmonizing community-based health worker programs for HIV: a narrative review and analytic framework

et al. 2017

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BackgroundMany countries have created community-based health worker (CHW) programs for HIV. In most of these countries, several national and non-governmental initiatives have been implemented raising questions of how well these different approaches address the health problems and use health resources in a compatible way. While these questions have led to a general policy initiative to promote harmonization across programs, there is a need for countries to develop a more coherent and organized approach to CHW programs and to generate evidence about the most efficient and effective strategies to ensure their optimal, sustained performance.MethodsWe conducted a narrative review of the existing published and gray literature on the harmonization of CHW programs. We searched for and noted evidence on definitions, models, and/or frameworks of harmonization; theoretical arguments or hypotheses about the effects of CHW program fragmentation; and empirical evidence. Based on this evidence, we defined harmonization, introduced three priority areas for harmonization, and identified a conceptual framework for analyzing harmonization of CHW programs that can be used to support their expanding role in HIV service delivery. We identified and described the major issues and relationships surrounding the harmonization of CHW programs, including key characteristics, facilitators, and barriers for each of the priority areas of harmonization, and used our analytic framework to map overarching findings. We apply this approach of CHW programs supporting HIV services across four countries in Southern Africa in a separate article.ResultsThere is a large number and immense diversity of CHW programs for HIV. This includes integration of HIV components into countries’ existing national programs along with the development of multiple, stand-alone CHW programs. We defined (i) coordination among stakeholders, (ii) integration into the broader health system, and (iii) assurance of a CHW program’s sustainability to be priority areas of harmonization. While harmonization is likely a complex political process, with in many cases incremental steps toward improvement, a wide range of facilitators are available to decision-makers. These can be categorized using an analytic framework assessing the (i) health issue, (ii) intervention itself, (iii) stakeholders, (iv) health system, and (v) broad context.ConclusionsThere is a need to address fragmentation of CHW programs to advance and sustain CHW roles and responsibilities for HIV. This study provides a narrative review and analytic framework to understand the process by which harmonization of CHW programs might be achieved and to test the assumption that harmonization is needed to improve CHW performance.Electronic supplementary materialThe online version of this article (doi:10.1186/s12960-017-0219-y) contains supplementary material, which is available to authorized users.

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“…Though our findings revealed a higher preference for peer-led services than for public health sector services, the proportion of key population members that accessed HIV prevention services from peerled services was not higher than that of public sector facilities. This difference may be because peerled services are few in Nigeria and are far apart [41,42], making distance to services a significant limiting factor for service access, as highlighted in this study.The higher preference for peer-led services is intuitively expected, as they are likely to give a higher level of connectedness and empathy.…”

Section: Discussionmentioning

confidence: 90%

Satisfaction With Use of Public Health and Peer Led Facilities for Hiv Prevention Services by Key Populations in Nigeria

Ochonye

Foláyan

Fatusi

et al. 2019

Preprint

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Background: The aim of the study was to identify the proportion of female sex workers, men who have sex with men, and people who inject drugs who had accessed HIV prevention services at public health facilities and peer-led facilities, their level of satisfaction with these services, and perceived barriers and challenges to accessing HIV services from public and peer-led HIV prevention service providers. Methods: A mixed-method approach was used to collect data from key populations in the four states in Nigeria. Quantitative data collected included level of satisfaction with and barriers to use of public and peer-led facilities. In-depth interviews and focus-group discussions were conducted to explore reasons for satisfaction with and barriers to use of services. Descriptive and bivariate analyses were was conducted for quantitative data. Qualitative data were summaried, emerging themes identified, described and quotes reflecting the themes corresponding to interview questions highlighted Results : Nine hundred sixty-seven persons responded to questions on the use of public health or/and peer-led facilities. Two hundred thirty-eight (49.4%) respondents had received HIV and sexual and reproductive health services through public health facilities, and 236 (48.7%) had received the services through peer-led facilities. Significantly more respondents were satisfied with the quality of services provided by peer-led organisations than with public health facilities with respect to service providers listening to respondent’s problems and concerns (p=0.007),privacy and confidentiality (p=0.04) and respect of rights of service recipients (p=0.04). Significantly more respondents using peer-led organisations than those using public health facilities identified no barriers to service access (p=0.003). More respondents using public health facilities than peer-led facilities identified cost of services (p=0.01), confidentiality (p=0.002), waiting time (p<0.01) and staff attitude (p=0.001) as barriers to service access. Thee was no difference in the proportion of respondents willing to discontinue their use of either facilities (p=0.08). Qualitative data revealed that concerns with access of services at the public health facility were due mainly to stigma and the effects of the same-sex prohibition law. Conclusion: Key populations were more satisfied receiving HIV prevention services at peer-led organisations than at public health facilities.

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The leadership of communities in HIV service delivery

Cited by 15 publications

References 3 publications

Prevalence, trend and risk factors for antiretroviral therapy discontinuation among HIV-infected adults in Ethiopia in 2003-2015

Prevalence, trend and risk factors for antiretroviral therapy discontinuation among HIV-infected adults in Ethiopia in 2003-2015

Harmonizing community-based health worker programs for HIV: a narrative review and analytic framework

Satisfaction With Use of Public Health and Peer Led Facilities for Hiv Prevention Services by Key Populations in Nigeria

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