1.  Title: A survey of mothers' comfort discussing contraception with infant providers at well-child visits. Author: Fagan EB; Rodman E; Sorensen EA; Landis S; Colvin GF Source: Southern Medical Journal. 2009 Mar;102(3):260-4. Abstract: OBJECTIVE: To determine whether mothers feel comfortable with their infants' providers discussing contraception with them at their infants' well-child checks. METHODS: A cross-sectional survey was conducted using a convenience sample of 114 mothers presenting at a community family medicine residency program for well-child visits among infants up to 17 months old. RESULTS: Almost all mothers (87%) felt comfortable talking with their infants' providers about contraception and were likely to accept the advice of their infants' providers to see their own doctors regarding contraception (83%) or to use a prescription from their infants' providers for contraception (75%). CONCLUSION: Many mothers miss or delay their postpartum visits but see their infants' doctor multiple times within the first year. Mothers are comfortable talking with infant providers about contraception. By discussing contraception with mothers at well-child visits, physicians may encourage mothers to use contraception and prevent unintended pregnancies. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | MOTHERS | INFANT | CLINICS | PHYSICIANS | CLINIC VISITS | CONTRACEPTION | POSTPARTUM | INFORMATION | PROVIDERS WITH CLIENTS | Developed Countries | North America | Americas | Research Methodology | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Health Facilities | Delivery of Health Care | Health | Health Personnel | Service Statistics | Program Activities | Programs | Organization and Administration | Family Planning | Puerperium | Reproduction | Health Services Document Number: 330896 |
| 2. Peer Reviewed Title: Local differences in human immunodeficiency virus prevalence: a comparison of social venue patrons, antenatal patients, and sexually transmitted infection patients in eastern kinshasa. Author: Mwandagalirwa K; Jackson EF; McClamroch K; Bollinger R; Ryder RW; Weir SS Source: Sexually Transmitted Diseases. 2009 Jul;36(7):406-12. Abstract: BACKGROUND: This study compares the sexual behavior and HIV prevalence of men and women at social venues where people meet new sexual partners in Eastern Kinshasa with that of sexually transmitted infection (STI) treatment and antenatal clinic (ANC) patients in the same area. METHODS: ANC patients, STI clinic patients, and social venue patrons were interviewed, asked to provide a blood sample on-site, and provided with information about obtaining test results. Every patron at identified social venues in the study area was invited to participate. RESULTS: One thousand one hundred sixteen pregnant women; 66 male and 229 female STI clinic patients; and 952 male and 247 female patrons of social venues were interviewed and tested for HIV. HIV prevalence differed by group: ANC patients (4%); female venue patrons (12%); female STI patients (16%); male venue patrons (2%); and male STI patients (23%). HIV prevalence among sex workers at social venues (29%) was higher than HIV prevalence among other female patrons with new or multiple partnerships in the past four weeks (19%) and higher than HIV prevalence among female patrons denying sex work (6%). However, the absolute number of infected women was higher among women reporting recent new or multiple partnerships than among the smaller group of sex workers (23 vs. 18). Two-thirds of the infected female STI patients (24/36) reported no more than one and no new sexual partner in the past year. CONCLUSION: Improving prevention programs in Kinshasa is essential. Prevention efforts should not neglect women at social venues who do not self-identify as sex workers but who have high rates of new sexual partnership formation. Language: English Keywords: DEMOCRATIC REPUBLIC OF THE CONGO | RESEARCH REPORT | COMPARATIVE STUDIES | CLIENTS | MULTIPLE PARTNERS | HIV INFECTIONS | PREVALENCE | ANTENATAL CARE | SEXUALLY TRANSMITTED DISEASES | CLINICS | VOLUNTARY COUNSELING AND TESTING | INTERVIEWS | CONDOM USE | Developing Countries | Africa, Central | Africa, Sub Saharan | Africa | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Sexual Partners | Sex Behavior | Behavior | Viral Diseases | Diseases | Measurement | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Reproductive Tract Infections | Infections | Health Facilities | HIV Testing | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Data Collection | Risk Reduction Behavior Document Number: 342831 |
| 3. Title: Awareness and attitude of health workers at a Nigerian HIV treatment clinic toward HIV/AIDS and HAART adherence. Author: Olowookere SA; Fatiregun AA; Osagbemi KG Source: Journal of the International Association of Physicians in AIDS Care. 2009 May-Jun;8(3):208-12. Abstract: OBJECTIVE: To assess the awareness and attitude of antiretroviral clinic workers to HIV/AIDS and highly active antiretroviral therapy (HAART). METHODS: A descriptive cross-sectional study design using a self-administered questionnaire was used. RESULTS: Of the 43 staff, 39 (92.5%) completed the questionnaire. Their mean age was 35.1 + 7.6 years. There were 19 (48.7%) males and 20 (51.7%) females. The majority (87.2%) had tertiary education. More than three fifths (61.5%) were married. There were 20 (51.3%) professional staff and 19 (48.7%) support staff. Only 28.2% of staff members had ever received on-the-job training in HIV/AIDS care. None of the adherence counselors had ever received any training in HIV/AIDS care and HAART adherence counseling. Despite this lack of training, this majority of the clinic staff had good knowledge about and a positive attitude to HIV/AIDS and HAART adherence. CONCLUSION: Adherence counselors and support staff required on-the-job training for optimum job performance. Language: English Keywords: NIGERIA | RESEARCH REPORT | HEALTH PERSONNEL | AIDS | HIV INFECTIONS | CLINICS | AWARENESS | ATTITUDES | KNOWLEDGE | ANTIRETROVIRAL THERAPY | USER COMPLIANCE | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Delivery of Health Care | Health | Viral Diseases | Diseases | Health Facilities | Sociocultural Factors | Psychological Factors | Behavior | HIV Document Number: 342455 |
| 4. Peer Reviewed Title: Urban female patients' perceptions of the family medicine clinic as a site for abortion care. Author: Rubin SE; Godfrey EM; Shapiro M; Gold M Source: Contraception. 2009 Aug;80(2):174-9. Abstract: BACKGROUND: Induced abortion is common in the US, yet there is a lack of providers. We surveyed female patients asking why they would or would not (a) accept early abortion offered by their family physician (FP) in their family medicine clinic (FMC) and (b) prefer to access abortion services in the FMC. STUDY DESIGN: An anonymous survey with open- and closed-ended questions was conducted at three FMCs. Results were analyzed using qualitative and quantitative methods. RESULTS: Four hundred forty-nine women completed the survey. Respondents supported offering medication (68.8%) and suction (43.1%) abortion in the FMC. Sixty-seven percent of the respondents who identified themselves as possibly having a future abortion (n=231) would prefer to have the abortion in their FMC. Comfort with either their provider or the FMC was the most frequently cited reason for preferring the FMC. Concern about preserving comfort at the FMC was mentioned by others as a reason for not choosing the FMC. "Expertise" was the most commonly cited reason by those who preferred a specialized abortion clinic. Anonymity or privacy was mentioned by different respondents as a benefit of care at both sites. CONCLUSION: In order to address patient preferences and concerns, early abortion services should be offered in the FMC as well as in specialty clinics. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | SURVEYS | WOMEN | URBAN POPULATION | ABORTION | PHYSICIAN'S OFFICE | CLINICS | PRIMARY HEALTH CARE | PERCEPTION | PRIVACY | Developed Countries | North America | Americas | Sampling Studies | Studies | Research Methodology | Demographic Factors | Population | Population Characteristics | Fertility Control, Postconception | Family Planning | Health Facilities | Delivery of Health Care | Health | Health Services | Psychological Factors | Behavior Document Number: 342390 Notification |
5.  Title: Reaching out to youth: Youth-friendly sexual and reproductive health services through schools, clinics, and communities. Author: Project HOPE Source: Millwood, Virginia, Project HOPE, 2008. 8 p. Abstract: Uzbekistan’s largely conservative social norms mean that matters of sexuality and reproduction are not openly discussed and certainly not with young, unmarried people. Yet, youth need straightforward answers and an atmosphere that encourages them to ask questions. The Government of Uzbekistan recognized this need and decreed that the subject be taught in secondary schools. This act alone was insufficient: not only was the decree or prikaz unaccompanied by funding for teacher training and educational materials but the decree in and of itself did not create an environment for teachers, students, parents, or health. By integrating family planning into it's child survival project (2003-2007), Project HOPE created two new youth-friendly clinics and three youth-friendly rooms within clinics in five pilot sub districts in the Navoi oblast with plans to expand these services to other districts in Uzbekistan. This case study highlights the success achieved in increasing access for 31,673 young adults to youth friendly services. (excerpt) Language: English Keywords: UZBEKISTAN | PROGRESS REPORT | EVALUATION | ADOLESCENTS | COMMUNITY | USAID | SEXUALLY TRANSMITTED DISEASE PREVENTION | REPRODUCTIVE HEALTH | SCHOOL-BASED SERVICES | COMMUNITY HEALTH SERVICES | CLINICS | INTEGRATED PROGRAMS | SEX EDUCATION | CHILD SURVIVAL | TRAINING PROGRAMS | Developing Countries | Asia, Central | Asia | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Residence Characteristics | Population Distribution | Geographic Factors | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Health | Programs | Organization and Administration | Primary Health Care | Health Services | Delivery of Health Care | Health Facilities | Education | Survivorship | Length of Life | Mortality | Population Dynamics Document Number: 328456 |
| 6. Title: The effects of religious contextual norms, structural constraints, and personal religiosity on abortion decisions. Author: Adamczyk A Source: Social Science Research. 2008 Jun;37(2):657-672. Abstract: Researchers have established that individual religiosity influences abortion attitudes, and that abortion attitudes, in turn, shape abortion restrictions and access. Less clear is whether religion and abortion structural constraints influence abortion decisions. This study examines the several individual, contextual, and structural factors that could shape the abortion decisions of women who conceive before marriage. Special attention is given to the importance of academic aspirations and structural constraints, in contrast to religious beliefs and county religious context, for making an abortion decision. Hierarchical modeling techniques and two waves of data from the National Longitudinal Study of Adolescent Health (Add Health) are employed. Neither generic religiosity nor conservative Protestant religious context appear to influence women's abortion decisions. Conversely, young women's abortion decisions are shaped by academic ambition, identification with a conservative Protestant denomination, proximity to an abortion clinic and the level of public abortion funding in their county of residence. (author's) Language: English Keywords: UNITED STATES OF AMERICA | NEW YORK | RESEARCH REPORT | LONGITUDINAL STUDIES | ADOLESCENTS, FEMALE | WOMEN | RELIGION | BELIEFS | ABORTION | CLINICS | FUNDS | UNIVERSITIES | EDUCATION | DECISION MAKING | Developed Countries | North America | Americas | Studies | Research Methodology | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Sociocultural Factors | Culture | Fertility Control, Postconception | Family Planning | Health Facilities | Delivery of Health Care | Health | Financial Activities | Economic Factors | Schools | Behavior Document Number: 326943 Notification |
| 7. Peer Reviewed Title: Characteristics and outcomes of adult patients lost to follow-up at an antiretroviral treatment clinic in Johannesburg, South Africa. Author: Dalal RP; MacPhail C; Mqhayi M; Wing J; Feldman C Source: JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2008 Jan 1;47(1):101-107. Abstract: A significant proportion of those initiating antiretroviral treatment (ART) for HIV infection are lost to follow-up. Causes for discontinuing ART follow-up in resource-limited settings are not well understood. A retrospective analysis was conducted of all adult patients receiving ART at an urban public clinic in Johannesburg, South Africa between April 2004 and June 2005. Patients discontinuing follow-up for at least 6 weeks were identified and further studied, and causes for treatment default were tabulated. Of 1631 adult patients studied, 267 (16.4%) discontinued follow-up during the study period. Gender, ethnicity, and age were not predictive of loss to follow-up. Of those discontinuing follow-up, 173 (64.8%) were successfully traced. Death accounted for 48% (n = 83) of those traced. Characteristics associated with death were older age at ART initiation (P = 0.022), lower baseline CD4 cell count (P = 0.0073), higher initial HIV RNA load (P = 0.024), and loss of weight on ART (P = 0.033). Date of death was known for 71% (n = 59) of patients traced deceased, of whom 83% (n = 49) had died within 30 days of active ART. Common nonmortality losses included relocation or clinic transfer (25.4%) and hospitalization or illness not resulting in death (10.4%). Few cited financial difficulty or medication toxicity as reasons for discontinuing follow-up. Nearly 1 in 6 patients receiving ART in a resource-constrained setting had discontinued follow-up over a 15-month period. Early mortality was high, especially in those with profound immunosuppression. Improving access to care and streamlining patient tracking may improve ART outcomes. (author's) Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | PERSONS LIVING WITH HIV/AIDS | ADULTS | ANTIRETROVIRAL THERAPY | HIV | AIDS | TREATMENT | CLINICS | USER COMPLIANCE | MORTALITY | RECORDS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | HIV Infections | Viral Diseases | Diseases | Age Factors | Population Characteristics | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Health Facilities | Behavior | Population Dynamics | Information Processing | Information Document Number: 314030 |
| 8. Title: Equipping Title X for the future. Author: Gold RB Source: Guttmacher Policy Review. 2008 Summer;11(3):19-23. Abstract: Providing critical financial support to a nationwide network of family planning provider agencies has been at the heart of the federal Title X program since its enactment nearly four decades ago. Among the various federal and state programs that subsidize clinical family planning services,Title X is uniquely equipped to play this role. And it will remain an essential role long into the future, even assuming Medicaid coverage expansions and eventual broader-based health insurance reform. Without a vibrant provider system, simply having a source of payment will still be little more than a hollow promise to many young and low-income people in need of contraceptive and closely related preventive health care (related article,Winter 2008, page 6). Today,Title X undergirds a network of family planning clinics located in nearly three in four U.S. counties. Despite stagnant funding levels through much of the last quarter century, rising costs of everything from medical supplies to personnel and the challenging politics of being the federal government's only program dedicated to providing family planning, this network continues to serve nearly five million women (and a small but important number of men) each year. Still, clinics have not been able to reach and serve everyone in need. As the ranks of the uninsured continue to increase, new data demonstrate that more women across the country- many more in some areas-are in need of publicly funded services. The demands facing the provider network are at once pressing and expanding, and Title X must be equipped to meet them. First, it must have increased funding to support high-quality clinical care-including counseling, education and outreach- in a way that both leverages the potential of and compensates for the shortcomings of Medicaid and other funding sources Equally important, however, it must support clinics' infrastructure needs more expansively than it now does, embrace new ways to assess the full impact of the program, and craft better mechanisms to ensure that care is supported by the latest scientific evidence and medical recommendations. (excerpt) Language: English Keywords: UNITED STATES OF AMERICA | RECOMMENDATIONS | CRITIQUE | EVALUATION | LOW INCOME POPULATION | ETHNIC GROUPS | WOMEN | PUBLIC ASSISTANCE | POVERTY | GOVERNMENT PROGRAMS | FAMILY PLANNING POLICY | FAMILY PLANNING CENTERS | QUALITY OF HEALTH CARE | CLINICS | COST EFFECTIVENESS | Developed Countries | North America | Americas | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Cultural Background | Population Characteristics | Demographic Factors | Population | Government Financing | Financial Activities | Programs | Organization and Administration | Family Planning | Population Policy | Social Policy | Policy | Political Factors | Sociocultural Factors | Health Facilities | Delivery of Health Care | Health | Health Services Evaluation | Program Evaluation | Evaluation Indexes | Quantitative Evaluation Document Number: 323170 |
| 9. Peer Reviewed Title: Antenatal clinic HIV data found to underestimate actual prevalence declines: Evidence from Zambia. Author: Michelo C; Sandoy I; Fylkesnes K Source: Tropical Medicine and International Health. 2008 Feb;13(2):171-179. Abstract: The objective was to determine to what extent antenatal clinic (ANC)-based estimates reflect HIV prevalence trends among men and women in a high prevalence urban population. Examination of data from serial population-based HIV surveys in 1995 (n = 2115), 1999 (n = 1962) and 2003 (n = 2692), and ANC-based surveillance in 1994 (n = 450), 1998 (n = 810) and 2002 (n = 786) in the same site in Lusaka, Zambia. The population-based surveys recorded refusal rates between 6% and 10% during the three rounds. Among ANC attendees, prevalence declined by 20% (25.0% to 19.9%; P = 0.101) in the age group 15-24 years and was stable overall. In the general population, the prevalence declined by 49% (P less than 0.001) and by 32% (P less than 0.001) in age group 15-24 and 15-49, respectively. Among women only, HIV prevalence declined by 44% (22.5% to 12.5%; P less than 0.001) and by 27% (29.6% to 21.7%; P less than 0.001) in age group 15-24 and 15-49 years, respectively. In addition, prevalence substantially declined in higher educated women aged 15-24 years (20.7% to 8.5%, P less than 0.001). ANC-based estimates substantially underestimated declines in HIV prevalence in the general population. This seemed to be partially explained by a combination of marked differentials in prevalence change by educational attainment and changes in fertility-related behaviours among young women. These results have important implications for the interpretation of ANC-based HIV estimates and underscore the importance of population-based surveys. (author's) Language: English Keywords: ZAMBIA | RESEARCH REPORT | ESTIMATION TECHNIQUES | POPULATION AT RISK | PREGNANT WOMEN | PERSONS LIVING WITH HIV/AIDS | ANTENATAL CARE | CLINICS | HIV INFECTIONS | PREVALENCE | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Health Facilities | Measurement Document Number: 325098 |
| 10. Title: Community-based approaches to combating malnutrition and poor education among girls in resource-poor settings: report of a large scale intervention in Pakistan. Author: Pappas G; Agha A; Rafique G; Khan KS; Badruddin SH; Peermohamed H Source: Rural and Remote Health. 2008 Jul-Sep;8(3):820. Abstract: INTRODUCTION: Malnutrition and low levels of education continue to be major problems in many developing countries, especially for female children. METHODS: In Pakistan, a large-scale school lunch program was implemented in 29 of the poorest rural districts through a public-private partnership. The project provided freshly prepared meals in 4035 government primary girls' schools over a 2 year period. The primary strategy was empowerment of women in the community who volunteered to plan the meals, purchase the food, and cook and serve the meals. The project collected data from growth monitoring, attendance records, pre- and post-intervention community based surveys, focus group discussions, and the use of other ethnographic methods. A study on changes in the levels of malnutrition was based on an analytical sample of 203,116 girls who received at least two sets of body measurements at least 6 months apart. RESULTS: Over the intervention period, wasting declined by almost half and school enrolment increased by 40%. Girls who entered the program early were found to have similar levels of malnutrition to girls who entered late, suggesting that factors external to the program were not associated with the decrease in malnutrition. CONCLUSION: This study demonstrates the potential success and scalability of school feeding programs in Pakistan. Lessons learned include that synergies are found when working across sectors (health, education, and empowerment) and that there are challenges to intersectoral projects. Globalization may undermine this successful model as Pakistan considers expanded school feeding programs. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | KAP SURVEYS | MEDICAL STUDENTS | RURAL POPULATION | PERCEPTION | SATISFACTION | RURAL HEALTH SERVICES | CLINICS | TRAINING PROGRAMS | FEEDBACK | CLINIC ACTIVITIES | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Students | Education | Population Characteristics | Demographic Factors | Population | Psychological Factors | Behavior | Health Services | Delivery of Health Care | Health | Health Facilities | Evaluation Methodology | Evaluation | Program Activities | Programs | Organization and Administration Document Number: 328881 |
| 11. Title: Family planning clinics prevent 1.4 million unplanned pregnancies annually, save billions of government dollars. Author: Sonfield A Source: Guttmacher Policy Review. 2008 Summer;11(3):24. Abstract: In 2004, publicly funded family planning clinics in the United States helped women and couples avoid more than 1.4 million unintended pregnancies, an estimated 600,000 of which would have ended in abortion. Without publicly subsidized clinics, the U.S. unintended pregnancy rate would be 46% higher, and the abortion rate would be 49% higher, than the most recent national estimates, according to a Guttmacher Institute study published in the Journal of Health Care for the Poor and Underserved in August 2008. Unintended pregnancies would be 68% more common among poor women. (excerpt) Language: English Keywords: UNITED STATES OF AMERICA | PROGRESS REPORT | ESTIMATION TECHNIQUES | WOMEN | POLICYMAKERS | FAMILY PLANNING CENTERS | CLINICS | GOVERNMENT FINANCING | PUBLIC ASSISTANCE | GOVERNMENT PROGRAMS | PREGNANCY, UNPLANNED | PREVENTION AND CONTROL | CONTRACEPTIVE AVAILABILITY | FAMILY PLANNING POLICY | Developed Countries | North America | Americas | Research Methodology | Demographic Factors | Population | Administrative Personnel | Organization and Administration | Health Facilities | Delivery of Health Care | Health | Financial Activities | Economic Factors | Programs | Reproductive Behavior | Fertility | Population Dynamics | Diseases | Contraception | Family Planning | Population Policy | Social Policy | Policy | Political Factors | Sociocultural Factors Document Number: 323171 |
| 12. Peer Reviewed Title: The impact of project closure on HIV incidence and mortality in a cohort of couples in Lusaka, Zambia. Author: Stephenson R; Shutes E; McKenna S; Allen S; Brill I Source: AIDS Care. 2008 Jul;20(6):683-691. Abstract: The objective of this study was to assess the impact of temporary closure of an HIV research clinic on the health of study participants. Primary data were collected quarterly from couples enrolled in research studies at an established HIV study site. There were 632 participating couples enrolled when the project closed, 475 of whom returned when it re-opened six months later. HIV sero-incidence, mortality rates and risk-taking behaviours were compared before and during the closure. Perceived impact of the closure was measured in returning participants. Demographic data collected at the last pre-closure study visit were used to look at the differences between returning and non-returning study participants. Serologic data from those who returned were compared pre- and post-closure to examine changes in HIV incidence. Mortality rates were estimated from reported deaths, and were compared pre- and during project closure. Perceptions of the impact of the closure among returning participants were examined through an interviewer administered questionnaire. It was found that couples who returned were not demographically different from couples who did not return. Most participants reported no problems with finding alternate sources of condoms and the incidence of HIV did not change significantly during the closure. Eighty-four percent respondents reported that the closure had a negative impact on them, 87% of whom rated loss of medical care as the main impact. The mortality rate among HIV-positive participants doubled from 6.7/ 100 person years to 12.4/100 person years during the closure (p=0.01). Results indicate that couples voluntary counselling and testing (CVCT) established durable risk-reduction behaviours that persisted during project closure. The loss of healthcare was perceived as the most negative impact on participants, reflected in increased mortality rates. Research projects should make transition plans and budget for mechanisms to reduce the negative impact on participants of project closures. (author's) Language: English Keywords: ZAMBIA | RESEARCH REPORT | QUESTIONNAIRES | PRE-POST TESTS | HIV | AIDS | RESEARCH ACTIVITIES | CLINICS | IMPACT | DELIVERY OF HEALTH CARE | PROGRAM SUSTAINABILITY | HIV INFECTIONS | INCIDENCE | CONTRACEPTIVE AVAILABILITY | CONDOM USE | HEALTH SERVICES | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Program Evaluation | Programs | Organization and Administration | Viral Diseases | Diseases | Research Methodology | Health Facilities | Health | Communication | Measurement | Contraception | Family Planning | Risk Reduction Behavior | Behavior Document Number: 327485 |
| 13. Peer Reviewed Title: Patterns of care in two HIV continuity clinics in Uganda, Africa: a time-motion study. Author: Were MC; Sutherland JM; Bwana M; Ssali J; Emenyonu N Source: AIDS Care. 2008 Jul;20(6):677-682. Abstract: The study objectives were to identify opportunities to improve the quality of care in resource-limited settings by examining the workflow and patient activities at two large outpatient HIV clinics in Uganda. Using time motion study techniques, we collected detailed data on all activities of patients and clinicians in two government sponsored HIV clinics in Uganda. Processes measured included amount of time clinicians (physicians, nurse practitioners and clinical officers) spend in clinic, the daily patient census and patient visit-length. We also recorded the time spent on various activities by providers and patients. We found that the mean time in clinic per workday at Masaka was 5.5 hours and at Mbarara 4.9 hours, with about 60% of this time spent in direct and indirect care of patients at both sites. Workday start-times varied by two hours in Masaka and one-and-a half hours in Mbarara and end-times by five and three hours respectively. One-hundred-and-nineteen patients (SD 34) visited Masaka each day and 107 (SD 45) visited Mbarara. The mean duration of the patient visit was 77 minutes at Masaka and 196 minutes at Mbarara, with 66% and 62% of the time spent at respective sites waiting for care. We conclude that clinicians in resource-poor settings spend limited amounts of time at the clinic site, with a large portion of the clinic-time taken up by tasks that do not require specialized patient-care skills. This study demonstrates that opportunities exist to improve clinic productivity and visit experience for patients, and provides a baseline for designing and evaluating the impact of process improvement interventions. (author's) Language: English Keywords: UGANDA | RESEARCH REPORT | HIV | AIDS | CLINICS | HEALTH SERVICES | QUALITY OF HEALTH CARE | DELIVERY OF HEALTH CARE | TIME FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | HIV Infections | Viral Diseases | Diseases | Health Facilities | Health | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Population Dynamics | Demographic Factors | Population Document Number: 327484 |
| 14. Peer Reviewed Title: The distribution of people seeking STD services in the various types of health care facilities in Chao Yang district, Beijing, China. Author: Zhao G; Detels R; Gu F; Li D; Li X Source: Sexually Transmitted Diseases. 2008 Jan;35(1):65-67. Abstract: Rates of sexually transmitted diseases (STDs) in China have soared over the past decade. Effective management of STDs is one of the cornerstones of HIV control and provides a unique opportunity for targeted education about HIV prevention. A recent study in Thailand revealed that 60% of patients suffering from an STD did not seek treatment from an STD clinic. To reach STD patients, it is important to determine the venues where people seek services and to evaluate the quality of treatment and prevention services in those facilities. The objectives of this study were to identify the facilities in Beijing where most people seek STD treatment and evaluate their prevention services. The study was conducted in Chao Yang District, Beijing, where only large and moderate-sized hospitals are authorized to provide STD treatment. (excerpt) Language: English Keywords: CHINA | RESEARCH REPORT | SAMPLING STUDIES | CROSS SECTIONAL ANALYSIS | SEXUALLY TRANSMITTED DISEASES | TREATMENT | CLINICS | HOSPITALS | PHARMACIES | DISTRIBUTIONAL ACTIVITIES | Asia, Eastern | Asia | Developing Countries | Studies | Research Methodology | Reproductive Tract Infections | Infections | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Health Facilities | Program Activities | Programs | Organization and Administration Document Number: 314027 |
| 15. Title: Clinical facility and services assessment field guide: quality assurance (QA) and quality improvement (QI). Author: Family Health International [FHI]. Asia Pacific Regional Office Source: Bangkok, Thailand, FHI, Asia Pacific Regional Office, [2007]. 22 p. Abstract: This guide is part of FHI's global efforts to create standards in quality care and to develop tools to support the achievement of quality services. In addition to the clinical QA/QI checklists, this guide also accompanies a QA/QI training package currently under development. The development of this guide has drawn heavily on the significant experience of FHI's Asia Pacific regional and country offices in delivering such clinical services, and on the tools they developed in support of QA/QI initiatives. However, it remains a work in progress, to be updated as and when appropriate. As such, feedback on its content and use is appreciated, and should be directed to Director, Technical Support, Public Health Programs, Asia Pacific Regional Office. In the following chapters, this guide provides an introduction to FHI's QA/QI initiative and operational framework (Chapter 1), a summary of the facility assessment process (Chapter 2), and then individual chapters on preparation for the service visit (Chapter 3), the clinical facility assessment visit itself (Chapter 4) and post-assessment visit actions (Chapter 5). (excerpt) Language: English Keywords: DEVELOPING COUNTRIES | MANUAL | KAP SURVEYS | HEALTH PERSONNEL | QUALITY CONTROL | PERFORMANCE IMPROVEMENT | AIDS PREVENTION | HIV PREVENTION | CLINICS | CLINIC ACTIVITIES | HEALTH SERVICES EVALUATION | QUESTIONNAIRES | TUBERCULOSIS | SEXUALLY TRANSMITTED DISEASE PREVENTION | CONFIDENTIAL INFORMATION | Surveys | Sampling Studies | Studies | Research Methodology | Delivery of Health Care | Health | Organization and Administration | Management | AIDS | HIV Infections | Viral Diseases | Diseases | Health Facilities | Program Activities | Programs | Program Evaluation | Infections | Sexually Transmitted Diseases | Reproductive Tract Infections | Ethics | Sociocultural Factors Document Number: 322037 |
| 16. Peer Reviewed Title: Implementing antiretroviral therapy in rural communities: The Lusikisiki model of decentralized HIV / AIDS Care. Author: Bedelu M; Ford N; Hilderbrand K; Reuter H Source: Journal of Infectious Diseases. 2007 Dec;196 Suppl 3:S464-S468. Abstract: Health worker shortages are a major bottleneck to scaling up antiretroviral therapy (ART), particularly in rural areas. In Lusikisiki, a rural area of South Africa with a population of 150,000 serviced by 1 hospital and 12 clinics, Me´decins Sans Frontie`res has been supporting a program to deliver human immunodeficiency virus (HIV) services through decentralization to primary health care clinics, task shifting (including nurse-initiated as opposed to physician-initiated treatment), and community support. This approach has allowed for a rapid scale-up of treatment with satisfactory outcomes. Although the general approach in South Africa is to provide ART through hospitals-which seriously limits access for many people, if not the majority of people-1-year outcomes in Lusikisiki are comparable in the clinics and hospital. The greater proximity and acceptability of services at the clinic level has led to a faster enrollment of people into treatment and better retention of patients in treatment (2% vs. 19% lost to follow-up). In all, 2200 people were receiving ART in Lusikisiki in 2006, which represents 95% coverage. Maintaining quality and coverage will require increased resource input from the public sector and full acceptance of creative approaches to implementation, including task shifting and community involvement. (author's) Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | EVALUATION | RURAL POPULATION | PERSONS LIVING WITH HIV/AIDS | NURSES AND NURSING | CLINICS | ANTIRETROVIRAL THERAPY | DELIVERY OF HEALTH CARE | COMMUNITY PARTICIPATION | DECENTRALIZATION | COMMUNITY HEALTH SERVICES | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Health Personnel | Health | Health Facilities | HIV | Organization and Administration | Political Factors | Sociocultural Factors | Primary Health Care | Health Services Document Number: 321905 |
| 17. Peer Reviewed Title: Detection of acute and established HIV infections in sexually transmitted disease clinics in Guangxi, China: Implications for screening and prevention of HIV infection. Author: Chen XS; Yin YP; Tucker JD; Gao X; Cheng F Source: Journal of Infectious Diseases. 2007 Dec 1;196(11):1654-16661. Abstract: Human immunodeficiency virus (HIV) has spread throughout China and to some degree has penetrated the general heterosexual population in some regions. A cross-sectional survey of 11,461 sexually transmitted disease (STD) clinic attendees in 8 cities in Guangxi, China, was conducted for syphilis and for acute and established HIV infections. The prevalence of acute and established HIV infections was 1.2% among the participants. Five acute (preseroconversion) HIV infections were detected. Multivariate analysis showed that HIV infection was independently related to unmarried status (odds ratio [OR], 1.73 [95% confidence interval {CI}, 1.00 -2.99), less education (OR for less than primary school, 4.21 [90% CI, 1.21-14.58]), residence in city A (OR, 11.48 [95% CI, 2.05-64.31]) or city B (OR, 7.93 [95% CI, 1.75-35.91]), working in the entertainment industry (OR, 3.98 [95% CI, 1.14 -13.88]), injection drug use (OR, 25.09 [95% CI, 10.43-60.39]), no condom use during most recent sexual intercourse (OR, 4.97 [95% CI, 1.38 -17.88]), and syphilitic infection (OR, 1.91 [95% CI, 1.03-3.56]). HIV prevalence in STD clinics is significantly greater than that in the general population, and subjects were identified who would be missed by conventional surveillance. China's nationwide system of public STD clinics, which reach down to the township level, should be used for HIV control programs. (author's) Language: English Keywords: CHINA | RESEARCH REPORT | CLINICAL RESEARCH | CROSS SECTIONAL ANALYSIS | EPIDEMIOLOGIC METHODS | PERSONS LIVING WITH HIV/AIDS | SCREENING | SEXUALLY TRANSMITTED DISEASE PREVENTION | CLINICS | SYPHILIS | HIV INFECTIONS | PREVALENCE | MARITAL STATUS | EDUCATIONAL STATUS | CONDOM USE | Asia, Eastern | Asia | Developing Countries | Research Methodology | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Health Facilities | Measurement | Nuptiality | Demographic Factors | Population | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Risk Reduction Behavior | Behavior Document Number: 322668 |
| 18. Peer Reviewed Title: Analysis of clinic attendances by under-14s to sexual health clinics in Gwent, South Wales, UK. Author: Cook L; Fleming C Source: Journal of Family Planning and Reproductive Health Care. 2007 Jan;33(1):23-26. Abstract: The objectives were to determine the gender, sexual history and reason(s) for visit for under-14s (young people) attending the authors' sexual health clinics. Analysis of case notes of 242 young people who made a total of 598 visits to a sexual health clinic in Gwent, South Wales, UK between 1 January and 31 December 2003. Of the 242 young people studied, 41% were male and males were responsible for 42% of visits. There was no written record relating to 7% of the total visits. Median age at both first registration and first heterosexual intercourse (when recorded) was 12 years for males and 13 years for females. Some 57% of females and 30% of males were already sexually active at first registration. Details relating to a young person's partner and their experience of sex (e.g. willingness, autonomy and consensual nature of sex) were infrequently recorded, especially for males. 96% of males requested condoms and 99% received them, whilst 72% of females requested condoms and/or hormonal contraception and 86% received them. 35% of females were seen for the consequences of sex (i.e. pregnancy testing, emergency contraception, screening and/or treatment of sexually transmitted infections and unplanned pregnancies). 80% of these subsequently received condoms and/or hormonal contraception. The majority of young people saw a nurse exclusively (96% males, 71% females). Of the young clients seen, 41% are male. Sexual history details are infrequently recorded, particularly for males. The majority of young people accessing the authors' service are taking action to protect their sexual health and most will see a nurse exclusively. (author's) Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | RETROSPECTIVE STUDIES | ADOLESCENTS | NURSES AND NURSING | CLINICS | REPRODUCTIVE HEALTH | ADOLESCENT HEALTH SERVICES | FIRST INTERCOURSE | PREMARITAL SEX BEHAVIOR | CONTRACEPTIVE DISTRIBUTION | SEXUALLY TRANSMITTED DISEASE PREVENTION | Europe, Western | Europe | Developed Countries | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Health Personnel | Delivery of Health Care | Health | Health Facilities | Health Services | Sex Behavior | Behavior | Distributional Activities | Program Activities | Programs | Organization and Administration | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases Document Number: 311579 |
| 19. Peer Reviewed Title: Audit of under-14s who attend sexual health clinics in Gwent, South Wales, UK: identifying young people at risk of abuse and exploitation. Author: Cook L; Fleming C Source: Journal of Family Planning and Reproductive Health Care. 2007 Jan;33(1):27-30. Abstract: The authors' service has child protection guidance listing locally agreed 'markers' of potential abuse and exploitation to aid identification of vulnerable young people. The objectives were to review whether staff are identifying markers of sexual abuse and exploitation, and to review documentation relating to assessment of Fraser criteria in under-14s (young people) attending sexual health clinics in Gwent, South Wales, UK. Analysis of case notes of 242 young people who made 598 visits to a sexual health clinic between 1 January and 31 December 2003. A total of 81 references to a marker of potential abuse or exploitation were recorded at 8% of visits and for 11% of young people. For 72 references a marker was present and for nine was absent. There was no reference to a marker being present or absent for any young males or for 81% of females. Increasing attendance was associated with increasing prevalence of recorded markers. All young people with three or more markers identified as present were referred onwards compared with 53% of those with one or two markers present. Referral did not deter future attendance. Reference to Fraser guidance assessment was recorded at 35% of visits or for 64% of young people and fully demonstrated at 7% of visits or for 16% of young people. There was no recorded assessment for 18% of females and 60% of males. The authors' service is not recording sufficient information to help identify young people (particularly males) at risk of abuse or exploitation or to demonstrate the service's compliance with Fraser guidance. (author's) Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | RETROSPECTIVE STUDIES | ADOLESCENTS | PROVIDERS WITH CLIENTS | CLINICS | SOCIAL PROTECTION | SEXUAL ABUSE | SEXUAL EXPLOITATION | RECORDS | REFERRAL AND CONSULTATION | SIGNS AND SYMPTOMS | Europe, Western | Europe | Developed Countries | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Health Services | Delivery of Health Care | Health | Health Facilities | Political Factors | Sociocultural Factors | Crime | Social Problems | Behavior | Information Processing | Information | Program Activities | Programs | Organization and Administration | Diseases Document Number: 311580 |
| 20. Title: Coinfection of Chlamydia trachomatis, Ureaplasma urealyticum and human papillomavirus among patients attending STD clinics in Estonia. Author: Denks K; Spaeth EL; Joers K; Randoja R; Talpsep T Source: Scandinavian Journal of Infectious Diseases. 2007;39:714-718. Abstract: Women visiting Estonian STD clinics were subjected to PCR assay for human papillomavirus (HPV), Chlamydia trachomatis and Ureaplasma urealyticum biovar 2. The overall prevalence of coinfection was 8%. The chlamydial infection was found to be associated with HPV, especially with high-risk HPV (OR = 2.5, p < 0.005) and most significantly in women over 41 y of age. C. trachomatis infection also occurred more frequently in U. urealyticum-infected than in U. urealyticum-free patients (OR = 2.6, p = 0.02). U. urealyticum infection did not associate with HPV status. The clinical significance of the association between C. trachomatis and U. urelyticum infection remains to be elucidated. (author's) Language: English Keywords: ESTONIA | RESEARCH REPORT | CLINICAL RESEARCH | CLIENTS | WOMEN | HPV | CHLAMYDIA | SEXUALLY TRANSMITTED DISEASES | CLINICS | LABORATORY EXAMINATIONS AND DIAGNOSES | PREVALENCE | AGE FACTORS | Developing Countries | Europe, Eastern | Europe | Research Methodology | Program Activities | Programs | Organization and Administration | Demographic Factors | Population | Viral Diseases | Diseases | Reproductive Tract Infections | Infections | Health Facilities | Delivery of Health Care | Health | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Measurement | Population Characteristics Document Number: 318720 |
| 21. Title: New start plus: Integration of family planning and STI treatment services within stand-alone VCT centers in Zimbabwe. Author: Didi A; Hatzold K Source: VCT in Focus. 2007 Feb;2(1):3. Abstract: In January 2002, PSI/Zimbabwe launched New Start-Plus (NS+), VCT programs that offer services for sexually-transmitted infections (STIs) and family planning (FP) in addition to VCT. From an initial two VCT centers in Harare and Bulawayo, NS+ had grown to include five of the 18 New Start VCT centers by January 2004. NS+ centers received minor renovations, and additional medical equipment was purchased. Nurses received FP and syndromic STI management refresher training according to national standards. STI treatment was purchased at local private pharmacies and followed local guidelines, using the same drugs as in the public health sector. Contracted medical doctors provided STI services on a part-time basis for complicated cases. All New Start sites were registered by the Health Professions Council. (excerpt) Language: English Keywords: ZIMBABWE | RESEARCH REPORT | PILOT PROJECTS | PERSONS LIVING WITH HIV/AIDS | NURSES AND NURSING | HIV/FP INTEGRATION | VOLUNTARY COUNSELING AND TESTING | HIV PREVENTION | CLINICS | SEXUALLY TRANSMITTED DISEASES | SYNDROMIC MANAGEMENT | COST EFFECTIVENESS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | HIV Infections | Viral Diseases | Diseases | Health Personnel | Delivery of Health Care | Health | Programs | Organization and Administration | HIV Testing | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Health Facilities | Reproductive Tract Infections | Infections | Treatment | Evaluation Indexes | Quantitative Evaluation | Evaluation Document Number: 323505 |
| 22. Peer Reviewed Title: Combination therapy for uncomplicated falciparum malaria in Ugandan children. A randomized trial. Author: Dorsey G; Staedke S; Clark TD; Njama-Meya D; Nzarubara B Source: JAMA. Journal of the American Medical Association. 2007 May 23-30;297(20):2210-2219. Abstract: Combination therapy is now widely advocated as first-line treatment for uncomplicated malaria in Africa. However, it is not clear which treatment regimens are optimal or how to best assess comparative efficacies in highly endemic areas. The objective was to compare the efficacy and safety of 3 leading combination therapies for the treatment of uncomplicated malaria. Single-blind randomized clinical trial, conducted between November 2004 and June 2006, of treatment for all episodes of uncomplicated malaria in children in an urban community in Kampala, Uganda. A total of 601 healthy children (aged 1-10 years) were randomly selected and were followed up for 13 to 19 months, receiving all medical care at the study clinic. Study participants were randomized to receive 1 of 3 combination therapies (amodiaquine plus sulfadoxine-pyrimethamine, amodiaquine plus artesunate, or artemether-lumefantrine) when diagnosed with their first episode of uncomplicated malaria. The same assigned treatment was given forall subsequent episodes. 28-Day risk of parasitological failure (unadjusted and adjusted by genotyping to distinguish recrudescence from new infection) for each episode of uncomplicated malaria treated with study drugs. Of enrolled children, 329 of 601 were diagnosed with at least 1 episode of uncomplicated malaria, and 687 episodes of Plasmodium falciparum malaria were treated with study drugs. The 28-day risk of treatment failure (unadjusted by genotyping) for individual episodes of malaria were 26.1% (95% CI, 21.1%-32.1%) for amodiaquine plus sulfadoxine-pyrimethamine, 17.4% (95% CI, 13.1%-23.1%) for amodiaquine plus artesunate, and 6.7% (95% CI, 3.9%-11.2%) for artemether-lumefantrine (P < .05 for all pairwise comparisons). When only recrudescent treatment failures were considered, the risks of failure were 14.1% (95% CI, 10.3%-19.2%), 4.6% (95% CI, 2.5%-8.3%), and 1.0% (95% CI, 0.3%-4.0%) for the same order of study drugs, respectively (P Language: English Keywords: UGANDA | RESEARCH REPORT | CLINICAL TRIALS | CHILDREN | MALARIA | ANTIMALARIAL DRUGS | CLINICS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Clinical Research | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Parasitic Diseases | Diseases | Health Facilities | Delivery of Health Care | Health Document Number: 317101 |
| 23. Title: Review: Systemic lupus erythematosus in the young: The importance of a transition clinic. Author: Falcini F; Nacci F Source: Lupus. 2007;16:613-617. Abstract: The objective of this report is to focus on the problems of patients with childhood onset systemic lupus erythematosus (SLE) at the age of transition to an adult care Unit. SLE is a multisystem disease characterised by diffuse internal organ involvement and by the presence of antinuclear and anti DNA antibodies. Central nervous system and renal damage are the main complications especially in children. Transition in health-care is a multifaceted, active process that attends to the medical, psychosocial and educational-vocational needs of adolescents when they move from child to adultoriented lifestyles and systems. Lack of institutional support and difficulty in communicating and in identifying adult specialists are the major concerns in a transition care Unit. Psychosocial matters can make this change dramatic and hard for young people and their families. Patients with juvenile-onset SLE require specialised and multidisciplinary care when entering a transition clinic; physicians need to focus on preventing long-term complications of SLE, including atherosclerosis, obesity, osteoporosis and their treatment. We report on our experience in a cohort of patients with juvenile SLE cared for at our transition clinic over last six years. (author's) Language: English Keywords: ITALY | LITERATURE REVIEW | RESEARCH REPORT | COHORT ANALYSIS | YOUTH | PROVIDERS WITH CLIENTS | SYSTEMIC LUPUS ERYTHEMATOSUS | CLINICS | PSYCHOSOCIAL FACTORS | COMPLICATIONS | PREVENTION AND CONTROL | Europe, Southern | Europe | Developed Countries | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Health Services | Delivery of Health Care | Health | Diseases | Health Facilities | Behavior Document Number: 322715 |
| 24. Peer Reviewed Title: How far should they walk? Increasing antiretroviral therapy access in a rural community in northern KwaZulu-Natal, South Africa. Author: Fredlund VG; Nash J Source: Journal of Infectious Diseases. 2007 Dec;196 Suppl 3:S469-S473. Abstract: Mseleni is a rural community located in northern KwaZulu-Natal, South Africa. As in most rural regions in sub-Saharan Africa, Mseleni's health care facilities are short staffed and suffer from significant resource constraints. Although these barriers exist, Mseleni's clinic-based antiretroviral therapy (ART) program is currently estimated to be meeting the needs of 60% of individuals who require therapy within its catchment area. To increase ART coverage, close attention must be paid to staffing levels and to collection of the appropriate data to inform improvements in clinical care. A number of reviews and interventions have been undertaken to fine-tune the system. The integrated team approach is key to programmatic development and should lead to strengthening of both primary health care and the ART program. Furthermore, to meet a greater percentage of treatment needs, full use of community networks is needed to draw asymptomatic patients into voluntary counseling and testing. (author's) Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | EVALUATION | RURAL POPULATION | PERSONS LIVING WITH HIV/AIDS | HEALTH PERSONNEL | CLINICS | ANTIRETROVIRAL THERAPY | PROGRAM ACCESSIBILITY | COMMUNITY HEALTH SERVICES | INTEGRATED PROGRAMS | PRIMARY HEALTH CARE | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Delivery of Health Care | Health | Health Facilities | HIV | Program Evaluation | Programs | Organization and Administration | Health Services Document Number: 321906 |
| 25. Peer Reviewed Title: Impact and process evaluation of integrated community and clinic-based HIV-1 control: A cluster-randomised trial in eastern Zimbabwe. Author: Gregson S; Adamson S; Papaya S; Mundondo J; Nyamukapa CA Source: PLoS Medicine. 2007 Mar;4(3):e102. Abstract: HIV-1 control in sub-Saharan Africa requires cost-effective and sustainable programmes that promote behaviour change and reduce cofactor sexually transmitted infections (STIs) at the population and individual levels. We measured the feasibility of community-based peer education, free condom distribution, income-generating projects, and clinic-based STI treatment and counselling services and evaluated their impact on the incidence of HIV-1 measured over a 3-y period in a cluster-randomised controlled trial in eastern Zimbabwe. Analysis of primary outcomes was on an intention-to-treat basis. The income-generating projects proved impossible to implement in the prevailing economic climate. Despite greater programme activity and knowledge in the intervention communities, the incidence rate ratio of HIV-1 was 1.27 (95% confidence interval [CI] 0.92-1.75) compared to the control communities. No evidence was found for reduced incidence of self-reported STI symptoms or high-risk sexual behaviour in the intervention communities. Males who attended programme meetings had lower HIV-1 incidence (incidence rate ratio 0.48, 95% CI 0.24-0.98), and fewer men who attended programme meetings reported unprotected sex with casual partners (odds ratio 0.45, 95% CI 0.28-0.75). More male STI patients in the intervention communities reported cessation of symptoms (odds ratio 2.49, 95% CI 1.21-5.12). Integrated peer education, condom distribution, and syndromic STI management did not reduce population-level HIV-1 incidence in a declining epidemic, despite reducing HIV-1 incidence in the immediate male target group. Our results highlight the need to assess the community-level impact of interventions that are effective amongst targeted population subgroups. (author's) Language: English Keywords: ZIMBABWE | RESEARCH REPORT | EVALUATION | PERSONS LIVING WITH HIV/AIDS | PEER EDUCATORS | COMMUNITY HEALTH SERVICES | CLINICS | INTEGRATED PROGRAMS | SEXUALLY TRANSMITTED DISEASE PREVENTION | INCOME GENERATION PROGRAMS | CONTRACEPTIVE DISTRIBUTION | SYNDROMIC MANAGEMENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | HIV Infections | Viral Diseases | Diseases | Education | Primary Health Care | Health Services | Delivery of Health Care | Health | Health Facilities | Programs | Organization and Administration | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Economic Development | Economic Factors | Distributional Activities | Program Activities | Treatment | Medical Procedures | Medicine Document Number: 318098 |
| 26. Title: Routine HIV testing pilot in Zimbabwe: What have we learned so far? Author: Hatzold K Source: VCT in Focus. 2007 May;2(2):1, 4. Abstract: Early serostatus detection increases timely care and treatment and assists in secondary prevention of HIV. Clinical settings provide an excellent entry point for potentially HIV-infected patients. In collaboration with the local health authorities, the Zimbabwe HIV/AIDS Partnership Project developed an implementation plan to transition from a VCT model to provide routine HIV testing to all consenting Murambinda Mission Hospital patients. The results were staggering: testing and counseling increased by 300% over the first 13 days of the program, from an average of 373 clients to 1,103 clients! (excerpt) Language: English Keywords: ZIMBABWE | RESEARCH REPORT | PILOT PROJECTS | PERSONS LIVING WITH HIV/AIDS | NURSES AND NURSING | VOLUNTARY COUNSELING AND TESTING | HIV PREVENTION | CLINICS | DELIVERY OF HEALTH CARE | INTERVENTIONS | INFORMED CONSENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | HIV Infections | Viral Diseases | Diseases | Health Personnel | Health | HIV Testing | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Health Facilities | Programs | Organization and Administration Document Number: 323504 |
| 27. Title: 'No worries!': Young people's experiences of nurse-led drop-in sexual health services in South West England. Author: Ingram J; Salmon D Source: Journal of Research in Nursing. 2007;12(4):305-316. Abstract: 'No Worries!' is a nurse-led drop-in sexual health service for young people in one Primary Care Trust in South West England. The service aims to provide sexual health promotion, contraception, STI testing and a range of health promotion advice. The service was evaluated from the young people's perspectives using quantitative and qualitative methodologies. Attendance data, questionnaires and interviews explored patterns of use, effectiveness and acceptability of three clinics, two in areas of social deprivation and a third with increasing teenage conception rates. Questionnaire data were collected from 153 young people (232 clinic attendances) and 18 were interviewed (aged 14-18 years). The pattern of service use varied across the clinics, with those from the lowest socio-economic community using fewer condoms, having more pregnancy tests and STI swabs. Average age of first intercourse was 15 years, and most visited the clinic after having sex rather than before. Young people found the service accessible and they highlighted close proximity to home and school, the drop-in nature, and confidentiality, professionalism and friendliness of staff. After using the service, respondents reported that they would be more likely to practise safer sex and change their behaviour. The clinics appeared to match up to young people's expectations of the service, but did not manage to attract many boys. Young people said the service made them feel more confident, more informed about sex, aware of sexually transmitted diseases and take fewer risks. (author's) Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | KAP SURVEYS | OPERATIONS RESEARCH | NURSES AND NURSING | YOUTH | SEXUALLY TRANSMITTED DISEASE PREVENTION | PERCEPTION | UTILIZATION OF HEALTH CARE | CLINICS | ADOLESCENT PREGNANCY | PREGNANCY RATE | SOCIAL PROBLEMS | SAFER SEX | SOCIOECONOMIC STATUS | Developed Countries | United Kingdom | Europe, Western | Europe | Surveys | Sampling Studies | Studies | Research Methodology | Program Evaluation | Programs | Organization and Administration | Health Personnel | Delivery of Health Care | Health | Age Factors | Population Characteristics | Demographic Factors | Population | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Psychological Factors | Behavior | Health Services | Health Facilities | Reproductive Behavior | Fertility | Population Dynamics | Fertility Measurements | Sociocultural Factors | Sex Behavior | Socioeconomic Factors | Economic Factors Document Number: 322704 |
| 28. Peer Reviewed Title: Offering integrated care for HIV / AIDS, diabetes and hypertension within chronic disease clinics in Cambodia. Author: Janssens B; Van Damme W; Raleigh B; Gupta J; Khem S Source: Bulletin of the World Health Organization. 2007 Nov;85(11):880-885. Abstract: In Cambodia, care for people with HIV/AIDS (prevalence 1.9%) is expanding, but care for people with type II diabetes (prevalence 5-10%), arterial hypertension and other treatable chronic diseases remains very limited. We describe the experience and outcomes of offering integrated care for HIV/AIDS, diabetes and hypertension within the setting of chronic disease clinics. Chronic disease clinics were set up in the provincial referral hospitals of Siem Reap and Takeo, 2 provincial capitals in Cambodia. At 24 months of care, 87.7% of all HIV/AIDS patients were alive and in active follow-up. For diabetes patients, this proportion was 71%. Of the HIV/AIDS patients, 9.3% had died and 3% were lost to follow-up, while for diabetes this included 3 (0.1%) deaths and 28.9% lost to follow-up. Of all diabetes patients who stayed more than 3 months in the cohort, 90% were still in follow-up at 24 months. Over the first three years, the chronic disease clinics have demonstrated the feasibility of integrating carefor HIV/AIDS with non-communicable chronic diseases in Cambodia. Adherence support strategies proved to be complementary, resulting in good outcomes. Services were well accepted by patients, and this has had a positive effect on HIV/AIDS-related stigma. This experience shows how care for HIV/AIDS patients can act as an impetus to tackle other common chronic diseases. (author's) Language: English Keywords: CAMBODIA | RESEARCH REPORT | PILOT PROJECTS | PERSONS LIVING WITH HIV/AIDS | CLIENTS | CLINICS | INTEGRATED PROGRAMS | DIABETES | CHRONIC DISEASES | HYPERTENSION | PROGRAM EVALUATION | Developing Countries | Asia, Southeastern | Asia | Studies | Research Methodology | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Program Activities | Programs | Organization and Administration | Health Facilities | Delivery of Health Care | Health | Vascular Diseases Document Number: 323439 |
| 29. Peer Reviewed Title: HIV / AIDS risk reduction counseling for alcohol using sexually transmitted infections clinic patients in Cape Town, South Africa. Author: Kalichman SC; Simbayi LC; Vermaak R; Cain D; Jooste S Source: JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2007 Apr 15;44(5):594-600. Abstract: HIV is ravaging southern Africa, and HIV transmission risk behaviors are facilitated by alcohol use in sexual contexts. There are no known interventions that directly target HIV risk behavior among people who drink and are at risk for HIV in Africa. The purpose was to test a behavioral risk reduction counseling intervention for use in sexually transmitted infection (STI) clinics in southern Africa. A randomized intervention trial was conducted with 143 STI clinic patients in Cape Town, South Africa. Participants received an experimental 60-minute HIV and alcohol risk reduction behavioral skills intervention or a control 20-minute HIV education condition. Participants were followed for 3 and 6 months after the intervention, with 73% retention. Overall, the experimental intervention demonstrated more than a 25% increase in condom use and a 65% reduction in unprotected intercourse over the 6-month follow-up period, with risk reduction significantly greater for the experimental condition than for the control condition at both follow-ups. Alcohol use in sexual contexts [F(1,94) = 6.2; P < 0.05] and expectancies that alcohol enhances sexual experiences [F(1,94) = 8.3; P < 0.01] were also significantly lower for the experimental condition at the 3-month follow-up. An HIV prevention counseling intervention reduced HIV transmission risks for up to 6 months in this STI clinic population. Effects may be sustained with structural interventions to reduce alcohol use in sexual contexts and support risk reduction behavior changes over the long-term. (author's) Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | CONTROL GROUPS | PERSONS LIVING WITH HIV/AIDS | CLINICS | SEXUALLY TRANSMITTED DISEASE PREVENTION | ALCOHOL USE AND ABUSE | RISK REDUCTION BEHAVIOR | |