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Peer Reviewed

Title: Improvement of the patient flow in a large urban clinic with high HIV seroprevalence in Kampala, Uganda.
Author: Castelnuovo B; Babigumira J; Lamorde M; Muwanga A; Kambugu A; Colebunders R
Source: International Journal of STD and AIDS. 2009 Feb;20(2):123-4.
Abstract: Antiretroviral treatment roll-out programmes in Africa often have difficulties to cope with the increasing number of clients. Based on the findings of a survey carried out in 2005 that showed long waiting times, innovative organizational changes (nurse visits and pharmacy-only refill visits) were introduced in our clinic. In August 2007, the survey was repeated to evaluate the impact of these changes. During both surveys we used the same standardized questionnaire. In 2007, 400 patients visited the clinic on the study day compared to 250 in 2005. The median time spent at the clinic decreased from 157 minutes in 2005 (range 22-426) to 124 minutes (15-314). All the waiting times for different services decreased except the time between the visit to the triage nurse and the doctors' visit. A similar methodology could be used by other health services to evaluate and compare different models of care.
Language: English
Keywords:
UGANDA | RESEARCH REPORT | CLINICAL RESEARCH | SURVEYS | URBAN POPULATION | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | CLINIC VISITS | ANTIRETROVIRAL THERAPY | AIDS PREVENTION | CAPACITY BUILDING | TIME FACTORS | ORGANIZATION AND ADMINISTRATION | WAITING AREAS AND QUEUES | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Sampling Studies | Studies | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Service Statistics | Program Activities | Programs | HIV | AIDS | Program Sustainability | Population Dynamics | Workplace | Employment | Macroeconomic Factors | Economic Factors
Document Number: 331091

Peer Reviewed

Title: Youth, unemployment, and male gender predict mortality in AIDS patients started on HAART in Nigeria.
Author: DeSilva MB; Merry SP; Fischer PR; Rohrer JE; Isichei CO; Cha SS
Source: AIDS Care. 2009 Jan;21(1):70-7.
Abstract: This retrospective study identifies risk factors for mortality in a cohort of HIV-positive adult patients treated with highly active antiretroviral therapy (HAART) in Jos, Nigeria. We analyzed clinical data from a cohort of 1552 patients enrolled in a HIV/acquired immune deficiency syndrome treatment program and started on HAART between December 2004 and 30 April 2006. Death was our study endpoint. Patients were followed in the study until death, being lost to follow-up, or the end of data collection, 1 December 2006. Baseline patient characteristics were compared using Wilcoxon Rank Sum Test for continuous variables and Pearson Chi-Square test for categorical variables to determine if certain demographic factors were associated with more rapid progression to death. The Cox proportional hazard multivariate model analysis was used to find risk factors. As of 1 December 2006, a total of 104 cases progressed to death. In addition to the expected association of CD4 count less than 50 at initiation of therapy and active tuberculosis with mortality, the patient characteristics independently associated with a more rapid progression to death after initiation of HAART were male gender, age less than 30 years old, and unemployment or unknown occupation status. Future research is needed to identify the confounding variables that may be amenable to targeted interventions aimed at ameliorating these health disparities.
Language: English
Keywords:
NIGERIA | RESEARCH REPORT | RETROSPECTIVE STUDIES | YOUTH | MEN | PERSONS LIVING WITH HIV/AIDS | UNEMPLOYMENT | AIDS | HIV INFECTIONS | ANTIRETROVIRAL THERAPY | MORTALITY | DEATH | GENDER ISSUES | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Employment | Macroeconomic Factors | Economic Factors | HIV | Population Dynamics | Sociocultural Factors
Document Number: 331211

Peer Reviewed

Title: Assessing HIV Risk in Workplaces for Prioritizing HIV Preventive Interventions in Karnataka State, India.
Author: Halli SS; Buzdugan R; Ramesh BM; Gurnani V; Sharma V; Moses S; Blanchard JF
Source: Sexually Transmitted Diseases. 2009 Jul 16;
Abstract: OBJECTIVE:: To develop a modelfor prioritizing economic sectors for HIV preventive intervention programs in the workplace. METHODS:: This study was undertaken in Karnataka state, India. A 3-stage survey process was undertaken. In the first stage, we reviewed secondary data available from various government departments, identified industries in the private sector with large workforces, and mapped their geographical distribution. In the second stage, an initial rapid risk assessment of industrial sectors was undertaken, using key-informant interviews conducted in relation to a number of enterprises, and in consultation with stakeholders. In the third stage, we used both quantitative (polling booth survey) and qualitative methods (key informant interviews, in-depth interviews, focus group discussions) to study high-risk sectors in-depth, and assessed the need and feasibility of HIV workplace intervention programs. RESULTS:: The highest risk sectors were found to be mining, garment/textile, sugar, construction/infrastructure, and fishing industries. Workers in all sectors had at best partial knowledge about HIV/AIDS, coupled with common misconceptions about HIV transmission. There were intersector and intrasector variations in risk and vulnerability across different geographical locations and across different categories of workers. This has implications for the design and implementation of workplace intervention programs. CONCLUSIONS:: There is tremendous scope for HIV preventive interventions in workplaces in India. Given the variation in HIV risk across economic sectors and limited available resources, there will be increased pressure to prioritize intervention efforts towards high-risk sectors. This study offers a model for rapidly assessing the risk level of economic sectors for HIV intervention programs.
Language: English
Keywords:
INDIA | RESEARCH REPORT | WORKERS | WORKPLACE | HIV PREVENTION | INTERVENTIONS | SOCIOECONOMIC FACTORS | PROGRAM EVALUATION | Asia, Southern | Asia | Developing Countries | Labor Force | Human Resources | Economic Factors | Employment | Macroeconomic Factors | HIV Infections | Viral Diseases | Diseases | Programs | Organization and Administration
Document Number: 342228

Title: Family-Friendly Workplace: A model for estimating the cost savings of implementing family-friendly policies.
Author: Plosky WD; Winfrey B
Source: Washington, D.C., Futures Group International, Health Policy Initiative, 2009 Jan. 21 p. (USAID Contract No. GPO-I-01-05-00040-00)
Abstract: The Family-Friendly Workplace (FFW) Model is designed to engage individuals and groups from diverse institutions in all sectors to make workplaces more family-friendly. The FFW model will help reproductive health advocates and employers of women understand the benefits and costs of implementing policies that support women in their reproductive years. Users of the model may be human resource departments of medium-sized and large companies, family planning advocates, maternal health advocates or groups representing women in the workplace.
Language: English
Keywords:
GLOBAL | SUMMARY REPORT | MANUAL | WOMEN | WORKPLACE | FAMILY POLICY | REPRODUCTIVE HEALTH | EXPENDITURES | COST BENEFIT ANALYSIS | PREGNANCY | WORKPLAN | MATERNITY BENEFITS | Demographic Factors | Population | Employment | Macroeconomic Factors | Economic Factors | Social Policy | Policy | Political Factors | Sociocultural Factors | Health | Financial Activities | Quantitative Evaluation | Evaluation | Reproduction | Planning | Organization and Administration | Microeconomic Factors
Document Number: 331541

Title: Rising U.S. teen fertility.
Author: Saenz R; Conde E
Source: Washington, D.C., Population Reference Bureau [PRB], 2009 Feb. [3] p.
Abstract: The United States has higher fertility rates among teenage girls compared with other developed countries of the world. For example, girls ages 15 to 19 have fertility rates more than five times higher than their counterparts in developed countries such as France, Italy, Japan, Slovenia, and Switzerland. Nonetheless, the fertility rate of girls ages 15 to 19 declined consecutively over the period from 1991 to 2005. During this time, the fertility rate of the age group dropped by one-third, from 61.8 births per 1,000 girls ages 15 to 19 in 1991 to 40.5 in 2005. However, the latest data for 2006 may point to a reversal of this trend, with the fertility rate inching upward to 41.9. This trend is of great concern because adolescent pregnancy has been associated with unemployment, poverty, repeated pregnancy, sexually transmitted diseases, infant mortality, high risk pregnancy, and lower educational achievement. Furthermore, teenage pregnancy is a primary indicator of adult poverty among women.
Language: English
Keywords:
FRANCE | ITALY | JAPAN | SLOVENIA | SWITZERLAND | SUMMARY REPORT | ADOLESCENTS, FEMALE | ADOLESCENT PREGNANCY | UNEMPLOYMENT | POVERTY | SEXUALLY TRANSMITTED DISEASES | INFANT MORTALITY | PREGNANCY, HIGH RISK | FERTILITY RATE | Developed Countries | Europe, Western | Europe | Europe, Southern | Asia, Eastern | Asia | Developing Countries | Europe, Central | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Reproductive Behavior | Fertility | Population Dynamics | Employment | Macroeconomic Factors | Economic Factors | Socioeconomic Factors | Reproductive Tract Infections | Infections | Diseases | Mortality | Pregnancy | Reproduction | Birth Rate | Fertility Measurements
Document Number: 331480

Title: Youth unemployment and underemployment in Africa brings uncertainty and opportunity.
Author: Zuehlke E
Source: Washington, D.C., Population Reference Bureau [PRB], 2009 Feb. [2] p.
Abstract: The World Bank's Youth and Unemployment in Africa: The Potential, The Problem, The Promise report, released in December 2008, investigates the nature of Africa's youth demographics and recommends policies to give its youth access to stable employment. It argues that creating viable jobs for young people is a recondition for Africa's poverty eradication, sustainable development, and peace; and in countries emerging from conflict, access to employment for youth is integral to peace-building processes. (Excerpt)
Language: English
Keywords:
AFRICA | SUMMARY REPORT | YOUTH | UNEMPLOYMENT | TOTAL FERTILITY RATE | DEMOGRAPHIC FACTORS | MIGRATION | Developing Countries | Age Factors | Population Characteristics | Population | Employment | Macroeconomic Factors | Economic Factors | Fertility Rate | Birth Rate | Fertility Measurements | Fertility | Population Dynamics
Document Number: 331481

Title: 'I am at the lowest end of all'. Rural women living with HIV face human rights abuses in South Africa.
Author: Amnesty International
Source: London, United Kingdom, Amnesty International Publications, Mar 2008. 124 p.
Abstract: South Africa is continuing to experience a severe HIV epidemic. Five and a half million South Africans are HIV-infected, the largest number in any country in the world. Over half of them are women. This report provides an analysis of patterns of human rights abuses against women who are exposed to the risk of or are already living with HIV in rural contexts of widespread poverty and unemployment. It draws on the testimonies of 37 women who, to varying extents, had experienced incidents of violence from intimate partners or strangers, were unable to secure a stable income, faced periods of hunger, but were striving to maintain their access to health services and adhere to treatment despite the consequences of poverty, stigma and their low social status. This report makes a number of specific recommendations to the national and provincial authorities, and to donor countries and institutions supporting initiatives in South Africa. These recommendations are aimed at addressing the impact of discrimination, violence and poverty on rural women living with HIV.
Language: English
Keywords:
SOUTH AFRICA | RECOMMENDATIONS | HIV INFECTIONS | PERSONS LIVING WITH HIV/AIDS | WOMEN | HUMAN RIGHTS | WOMEN'S RIGHTS | VIOLENCE AGAINST WOMEN | STIGMA | POVERTY | UNEMPLOYMENT | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Viral Diseases | Diseases | Demographic Factors | Population | Political Factors | Sociocultural Factors | Domestic Violence | Crime | Social Problems | Socioeconomic Factors | Economic Factors | Employment | Macroeconomic Factors
Document Number: 328100

Title: Private Sector Mobilization for Family Health (PRISM). Year 4 annual report, 1 October 2007 to 30 September 2008. Contract No. 492-C-00-04-0036-00.
Author: Chemonics International
Source: [Manila], Philippines, Chemonics International, 2008 Nov 15. 81 p. (USAID Contract No. 492-C-00-04-0036-00)
Abstract: The Private Sector Mobilization for Family Health (PRISM) project successfully completed the fourth of its five years with most targets accomplished and many activities yielding valuable lessons and new capacities for increasing private sector responses to meeting family health needs of Filipinos. PRISM has generated results from engaging the private sector to take advantage of commercial opportunities in providing family health goods and services to the market through the following: Workplace-based family health services at 500 companies and cooperatives, 365 of which have signed letters of commitment; Commercial sales of four low-priced contraceptives by pharmaceutical companies; Community-based health services of 213 private-practice midwives; Synergistic combinations of these three elements (workplace programs, commercial pharmaceutical market, midwives in private practice (PPMs)) in 33 provinces and cities. (Excerpt)
Language: English
Keywords:
PHILIPPINES | ANNUAL REPORT | USAID | SOCIAL MOBILIZATION | PRIVATE SECTOR | PRIMARY HEALTH CARE | HEALTH SERVICES | NEEDS | CONTRACEPTIVE PREVALENCE | CONTRACEPTIVE USAGE | COUNSELING | REPRODUCTIVE HEALTH | FAMILY PLANNING | WORKPLACE | MATERNAL-CHILD HEALTH SERVICES | CHILD HEALTH | FUNDS | PROGRAM DEVELOPMENT | Developing Countries | Asia, Southeastern | Asia | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Social Change | Macroeconomic Factors | Economic Factors | Delivery of Health Care | Health | Contraception | Clinic Activities | Program Activities | Programs | Organization and Administration | Employment | Financial Activities
Document Number: 331438

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Title: Bridging the gap between VCT and HIV/AIDS treatment uptake: perspectives from a mining-sector workplace in South Africa.
Author: Arend ED
Source: African Journal of AIDS Research. 2008 Nov;7(3):271-279.
Abstract: This qualitative study sought to understand users' perceptions of the voluntary counselling and testing (VCT) and HIV-treatment services offered by a mining company in South Africa, with the intention of making recommendations to improve the rates of uptake. A purposive sample of 75 employees was interviewed and three focus groups were conducted with VCT users as well as with HIV-positive employees currently enrolled in the company's treatment programme. The relatively high uptake of VCT at the workplace appeared to be a function of the convenience afforded by rapid testing and the on-site nature of the company's annual campaign, the group nature of the campaign, and increased HIV awareness facilitated by pre-test counselling. Notwithstanding this, the study revealed barriers to uptake of VCT in the workplace, including: perceived violations of confidentiality by healthcare staff and doubts about the voluntary basis of HIV testing; organisational factors, including the visible group nature of the VCT campaign; and fear of a HIV-positive result and discrimination in that event. In contrast to VCT uptake, there was a relatively low rate of enrolment in the treatment programme: a significant proportion of HIV-positive employees identified in the VCT campaign did not present to the company's clinic for treatment. Impediments to treatment uptake included fears of being identified in the workplace as HIV-positive, which arose from perceived confidentiality violations on the part of the healthcare staff as well as organisational factors they believed allowed easy identification of the programme's users; limited time to attend the clinic; poor quality of post-test counselling and follow-up; difficulties in coping with the diagnosis; and traditional explanatory models of illness, which precluded medical care. A combination of the current annual, opt-in VCT campaign and a provider-initiated opt-out approach to VCT should be carefully considered in order to bridge the gap between the current levels of VCT and HIV-treatment uptake by employees at the company.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | QUALITATIVE RESEARCH | MINE WORKERS | VOLUNTARY COUNSELING AND TESTING | TREATMENT | PREVENTION AND CONTROL | EMPLOYMENT-BASED SERVICES | WORKPLACE | PERCEPTION | CONFIDENTIAL INFORMATION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Labor Force | Human Resources | Economic Factors | HIV Testing | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Diseases | Programs | Organization and Administration | Employment | Macroeconomic Factors | Psychological Factors | Behavior | Ethics | Sociocultural Factors
Document Number: 341271

13.

Title: Fertility behavior in Armenia and Moldova: the decline during the post-Soviet transition and current preferences.
Author: Billingsley S
Source: Calverton, Maryland, Macro International, MEASURE DHS, 2008 Jul. 45 p. (USAID Contract No. GPO-C-00-03-00002-00DHS Working Papers No. 45)
Abstract: In the context of a fertility decline across the countries of the former Eastern bloc, this paper analyzes the fertility decline in Armenia and Moldova using 2005 Demographic Health Surveys (DHS) data. Easterlin's (1976) hypothesis about the negative impact on fertility of reducing living standards is contrasted with Becker's (1981) theory of opportunity costs. If Easterlin's hypothesis is true, we would expect to see women with lower resources suppress fertility because of the hardships brought on by the economic transition, especially for those with fewer marketable skills. Conversely, if Becker's theory is correct, opportunity costs would lead women with the highest earning potential to suppress their fertility. Specifically, the extent of parity declines is analyzed during the transition from Communism, with special attention given to identifying women for whom parity declines are greater. The conditions under which women currently want children are also analyzed to determine if a relationship exists between economic conditions and the desire for another child or the desired timing of childbirth. Since 1986, parity progression ratios have declined more for women with vocational education than for women with higher education or secondary education only. Logistic analyses of current fertility preferences suggest that women who are employed are more likely to want a second birth in both countries, whereas the wealthiest women in Armenia have higher odds of wanting a third birth. Armenian women have higher odds of wanting to postpone the next birth if their partners are unemployed, whereas Moldovan women who are employed prefer to postpone their next childbirth.
Language: English
Keywords:
ARMENIA | MOLDOVA | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | CROSS-CULTURAL COMPARISONS | WOMEN IN DEVELOPMENT | SEXUAL PARTNERS | REPRODUCTIVE BEHAVIOR | FERTILITY DECLINE | FERTILITY PREFERENCES | STANDARD OF LIVING | MICROECONOMIC FACTORS | ECONOMIC DEVELOPMENT | FAMILY SIZE, DESIRED | UNEMPLOYMENT | Asia, Southwestern | Asia | Developing Countries | Europe, Eastern | Europe | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Comparative Studies | Studies | Research Methodology | Economic Factors | Sex Behavior | Behavior | Fertility | Fertility Changes | Family Size | Family Characteristics | Family and Household | Sociocultural Factors | Employment | Macroeconomic Factors
Document Number: 329537

14.

Peer Reviewed

Title: Traditional medicine, delays and hospital mortality of children under five years of age in the rural district of Kigoma, western Tanzania: an observational hospital-based study.
Author: Blanke CH; Naisabha GB; Lange CR
Source: Tropical Doctor. 2008 Jul;38(3):150-2.
Abstract: The use of traditional medicine in the treatment of 596 children aged 0-60 months before admission was common (41.4 %). Children were more likely to die if they had first been treated with traditional medicine (50/244; 20.5% vs 29/342; 8.5%) or were younger (median 9 vs 12 months old.) Children who had received traditional medicine were younger (median 11 vs. 13 months), came later for hospital treatment (median three vs. five days), had a longer journey on foot to reach the health centre (3.4 vs. 2.9 h), and died from common diseases and not from an obvious toxic syndrome.
Language: English
Keywords:
TANZANIA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | RURAL POPULATION | CHILDREN | TRADITIONAL HEALTH PRACTICES | WAITING AREAS AND QUEUES | TIME FACTORS | CHILD MORTALITY | RISK FACTORS | HOSPITALS | HARMFUL TRADITIONAL PRACTICES | AGE FACTORS | DISTANCE | TRANSPORTATION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Population Characteristics | Demographic Factors | Population | Youth | Culture | Sociocultural Factors | Workplace | Employment | Macroeconomic Factors | Economic Factors | Population Dynamics | Mortality | Biology | Health Facilities | Delivery of Health Care | Health | Geographic Factors
Document Number: 328430

15.

Title: The road less travelled: gender-based interventions in the education-sector response to HIV.
Author: Boler T
Source: In: Gender equality, HIV, and AIDS. A challenge for the education sector edited by Sheila Aikman, Elaine Unterhalter, and Tania Boler. Oxford, United Kingdom, Oxfam GB, 2008. :105-128.
Abstract: This chapter takes stock of the experience of nearly two decades of responding to HIV through the education sector and considers how gender issues have been addressed. It seeks to identify what interventions might be effective, and points to the steps that need to be taken by ministries of education to put these in place. In summary, it concludes that responses to HIV need to prioritise maximising the synergies between concerns with gender, education, and the HIV response. In particular there are lessons to be learned from gender-disaggregated data, and consideration of the ways in which masculinities and femininities shape experiences of education. There is a long way to go in most education systems in relation to developing an evidence base through monitoring and evaluation of gender issues and developing gender-sensitive practices in administration and in learning about HIV.However, there are some islands of good practice which give pointers to developments that can take place. (excerpt)
Language: English
Keywords:
DEVELOPING COUNTRIES | LITERATURE REVIEW | INTERVENTIONS | YOUTH | ADOLESCENTS, FEMALE | RISK FACTORS | HIV INFECTIONS | AIDS | GENDER ISSUES | EDUCATION | WORKPLACE | POLICY | TREATMENT | CARE AND SUPPORT | CURRICULUM | Programs | Organization and Administration | Age Factors | Population Characteristics | Demographic Factors | Population | Adolescents | Biology | Viral Diseases | Diseases | Sociocultural Factors | Employment | Macroeconomic Factors | Economic Factors | Political Factors | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 330175

16.
Title: HIV risk behavior and work in Uganda: a cross-sectional study.
Author: Buregyeya E; Bazeyo W; Moen BE; Michelo C; Fylkesnes K
Source: East African Journal of Public Health. 2008 Apr;5(1):43-8.
Abstract: OBJECTIVE: The study assessed the prevalence of factors associated with HIV risky behaviour among employees of a Sugar Factory in Jinja District, Uganda. METHODS: A cross-sectional study of 321 participants was carried out in a Sugar Factory where several workers were migrants. Using an interviewer-administered questionnaire, information on socio-demographic characteristics, work factors and sexual behaviours was obtained. RESULTS: Fifty-one percent of the men and 32% of the women reported having multiple sex partners in the past year. Thirty-six percent of the respondents reported using condoms during the last casual sex. Twenty-four percent of men and 15% women reported sexually transmitted infection-related symptoms in the last one-year. Having multiple sex partners was associated with being a contract worker (OR = 2.1, 95% CI = 1.10-3.79) and being married but not living with spouse (OR = 2.1, 95% CI = 1.16-4.00). CONCLUSION: HIV risk behaviour among Sugar Factory workers is associated with separation from partner. HIV intervention strategies should include work related factors of this type.
Language: English
Keywords:
UGANDA | RESEARCH REPORT | KAP SURVEYS | CROSS SECTIONAL ANALYSIS | WORKERS | WORKPLACE | RISK BEHAVIOR | HIV TRANSMISSION | DEMOGRAPHIC FACTORS | SEX BEHAVIOR | SEX FACTORS | CONDOM USE | CONTRACEPTIVE PREVALENCE | SEXUALLY TRANSMITTED DISEASES | MARITAL STATUS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Labor Force | Human Resources | Economic Factors | Employment | Macroeconomic Factors | Behavior | HIV Infections | Viral Diseases | Diseases | Population | Population Characteristics | Risk Reduction Behavior | Contraceptive Usage | Contraception | Family Planning | Reproductive Tract Infections | Infections | Nuptiality
Document Number: 328964

17.

Peer Reviewed

Title: "That is why I stopped the ART": Patients' and providers' perspectives on barriers to and enablers of HIV treatment adherence in a South African workplace programme.
Author: Dahab M; Charalambous S; Hamilton R; Fielding K; Kielmann K
Source: BMC Public Health. 2008 Feb 18;8:63.
Abstract: As ART programmes in African settings expand beyond the pilot stages, adherence to treatment may become an increasing challenge. This qualitative study examines potential barriers to, and facilitators of, adherence to ART in a workplace programme in South Africa. We conducted key informant interviews with 12 participants: six ART patients, five health service providers (HSPs) and one human resources manager. The main reported barriers were denial of existence of HIV or of one's own positive status, use of traditional medicines, speaking a different language from the HSP, alcohol use, being away from home, perceived severity of side-effects, feeling better on treatment and long waiting times at the clinic. The key facilitators were social support, belief in the value of treatment, belief in the importance of one's own life to the survival of one's family, and the ability to fit ART into daily life schedules. Given the reported uncertainty about the existence of HIV disease and the use of traditional medicines while on ART, despite a programme emphasising ART counselling, there is a need to find effective ways to support adherence to ART even if the individual does not accept biomedical concepts of HIV disease or decides to use traditional medicines. Additionally, providers should identify ways to minimize barriers in communication with patients with whom they have no common language. Finally, dissatisfaction with clinical services, due to long waiting times, should be addressed. (author's)
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | INTERVIEWS | QUALITATIVE EVALUATION | PERSONS LIVING WITH HIV/AIDS | PROVIDERS WITH CLIENTS | ANTIRETROVIRAL THERAPY | TREATMENT | WORKPLACE | TRADITIONAL MEDICINE | BELIEFS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Data Collection | Research Methodology | Evaluation | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Health Services | Delivery of Health Care | Health | HIV | Medical Procedures | Medicine | Employment | Macroeconomic Factors | Economic Factors | Culture | Sociocultural Factors
Document Number: 324652

18.

Title: Workplace peer educators and stress.
Author: Dickinson D; Kgatea KD
Source: African Journal of AIDS Research. 2008 Nov;7(3):293-303.
Abstract: Peer educators form an important component of company responses to HIV and AIDS. Based on interviews with peer educators working in and around a mining company in South Africa's North-West Province, the study examines the relationship between involvement in peer education and stress. The paper discusses how becoming a peer educator can be a response to the often personal stress brought about by the HIV epidemic. In addition, structural difficulties, skills deficiencies and other obstacles to effective communication with their peers can create stress. The stress that active peer education brings to individuals is discussed, particularly in regard to the embeddedness of peer educators within their communities. The need for confidentiality also magnifies stress in the case of individuals who disregard peer educators' advice. Peer educators face many stresses in managing and supporting their own lives, thus their (voluntary) work as peer educators should not be taken out of context. Using this approach, we discuss how the role of peer educator should be conceptualised and how they can be organised and supported in order that their stress be minimised and effective engagement maximised.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | CASE STUDIES | PEER EDUCATORS | EMPLOYMENT-BASED SERVICES | HIV INFECTIONS | AIDS | STRESS | INTERVIEWS | VOLUNTARY COUNSELING AND TESTING | WORKPLACE | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Education | Programs | Organization and Administration | Viral Diseases | Diseases | Psychological Factors | Behavior | Data Collection | HIV Testing | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Employment | Macroeconomic Factors | Economic Factors
Document Number: 341273

19.
Title: Tuberculosis risk among staff of a large public hospital in Kenya.
Author: Galgalo T; Dalal S; Cain KP; Oeltmann J; Tetteh C; Kamau JG; Njenga MK; Breiman RF; Chakaya JM; Irimu HM; Miller B; De Cock KM; Bock NN; Ijaz K
Source: International Journal of Tuberculosis and Lung Disease. 2008 Aug;12(8):949-54.
Abstract: SETTING: In sub-Saharan Africa, high rates of tuberculosis (TB) and human immunodeficiency virus (HIV) infection pose a serious threat for occupationally acquired TB among health care workers. OBJECTIVE: To identify factors associated with TB disease among staff of an 1800-bed hospital in Kenya. DESIGN: We calculated TB incidence among staff and conducted a case-control study where cases (n = 65) were staff diagnosed with TB and controls (n = 316) were randomly selected staff without recent TB. RESULTS: The annual incidence of TB from 2001 to 2005 ranged from 645 to 1115 per 100000 population. Factors associated with TB disease were additional daily hours spent in rooms with patients (adjusted odds ratio [aOR] 1.3, 95%CI 1.2-1.5), working in areas where TB patients received care (aOR 2.1, 95%CI 1.1-4.2), HIV infection (aOR 29.1, 95%CI 5.1-167) and living in a slum (aOR 4.7, 95%CI 1.8-12.5) or hospital-provided low-income housing (aOR 2.6, 95%CI 1.2-5.6). CONCLUSION: Hospital exposures were associated with TB disease among staff at this hospital regardless of their job designation, even after controlling for living conditions, suggesting transmission from patients. Health care facilities should improve infection control practices, provide quality occupational health services and encourage staff testing for HIV infection to address the TB burden in hospital staff.
Language: English
Keywords:
KENYA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | HEALTH PERSONNEL | SLUMS | PREVALENCE | HOSPITALS | TUBERCULOSIS | RISK ASSESSMENT | OCCUPATIONAL HEALTH | WORKPLACE | TIME FACTORS | LIVING ARRANGEMENTS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Delivery of Health Care | Health | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Population | Measurement | Health Facilities | Infections | Diseases | Evaluation | Employment | Macroeconomic Factors | Economic Factors | Population Dynamics | Demographic Factors | Residence Characteristics
Document Number: 329457

20.

Peer Reviewed

Title: High risk for occupational exposure to HIV and utilization of post-exposure prophylaxis in a teaching hospital in Pune, India.
Author: Gupta A; Anand S; Sastry J; Krisagar A; Basavaraj A; Bhat SM; Gupte N; Bollinger RC; Kakrani AL
Source: BMC Infectious Diseases. 2008;8:142.
Abstract: BACKGROUND: The risk for occupational exposure to HIV has been well characterized in the developed world, but limited information is available about this transmission risk in resource-constrained settings facing the largest burden of HIV infection. In addition, the feasibility and utilization of post-exposure prophylaxis (PEP) programs in these settings are unclear. Therefore, we examined the rate and characteristics of occupational exposure to HIV and the utilization of PEP among health care workers (HCW) in a large, urban government teaching hospital in Pune, India. METHODS: Demographic and clinical data on occupational exposures and their management were prospectively collected from January 2003-December 2005. US Centers for Diseases Control guidelines were utilized to define risk exposures, for which PEP was recommended. Incidence rates of reported exposures and trends in PEP utilization were examined using logistic regression. RESULTS: Of 1955 HCW, 557 exposures were reported by 484 HCW with an incidence of 9.5 exposures per 100 person-years (PY). Housestaff, particularly interns, reported the greatest number of exposures with an annual incidence of 47.0 per 100 PY. Personal protective equipment (PPE) was used in only 55.1% of these exposures. The incidence of high-risk exposures was 6.8/100 PY (n = 339); 49.1% occurred during a procedure or disposing of equipment and 265 (80.0%) received a stat dose of PEP. After excluding cases in which the source tested HIV negative, 48.4% of high-risk cases began an extended PEP regimen, of whom only 49.5% completed it. There were no HIV or Hepatitis B seroconversions identified. Extended PEP was continued unnecessarily in 7 (35%) of 20 cases who were confirmed to be HIV-negative. Over time, there was a significant reduction in proportion of percutaneous exposures and high-risk exposures (p < 0.01) and an increase in PEP utilization for high risk exposures (44% in 2003 to 100% in 2005, p = 0.002). CONCLUSION: Housestaff are a vulnerable population at high risk for bloodborne exposures in teaching hospital settings in India. With implementation of a hospital-wide PEP program, there was an encouraging decrease of high-risk exposures over time and appropriate use of PEP. However, overall use of PPE was low, suggesting further measures are needed to prevent occupational exposures in India.
Language: English
Keywords:
INDIA | RESEARCH REPORT | INCIDENCE | HEALTH PERSONNEL | WORKPLACE | EXPOSURE | HIV | TRANSMISSION | ACCIDENTS AND INJURIES | OCCUPATIONAL HEALTH | Developing Countries | Asia, Southern | Asia | Measurement | Research Methodology | Delivery of Health Care | Health | Employment | Macroeconomic Factors | Economic Factors | Risk Factors | Biology | HIV Infections | Viral Diseases | Diseases | Infections
Document Number: 329361

21.

Peer Reviewed

Title: Default from tuberculosis treatment in Tashkent, Uzbekistan; who are these defaulters and why do they default?
Author: Hasker E; Khodjikhanov M; Usarova S; Asamidinov U; Yuldashova U; van der Werf MJ; Uzakova G; Veen J
Source: BMC Infectious Diseases. 2008;8:97.
Abstract: BACKGROUND: In Tashkent (Uzbekistan), TB treatment is provided in accordance with the DOTS strategy. Of 1087 pulmonary TB patients started on treatment in 2005, 228 (21%) defaulted. This study investigates who the defaulters in Tashkent are, when they default and why they default. METHODS: We reviewed the records of 126 defaulters (cases) and 132 controls and collected information on time of default, demographic factors, social factors, potential risk factors for default, characteristics of treatment and recorded reasons for default. RESULTS: Unemployment, being a pensioner, alcoholism and homelessness were associated with default. Patients defaulted mostly during the intensive phase, while they were hospitalized (61%), or just before they were to start the continuation phase (26%). Reasons for default listed in the records were various, 'Refusal of further treatment' (27%) and 'Violation of hospital rules' (18%) were most frequently recorded. One third of the recorded defaulters did not really default but continued treatment under 'non-DOTS' conditions. CONCLUSION: Whereas patient factors such as unemployment, being a pensioner, alcoholism and homelessness play a role, there are also system factors that need to be addressed to reduce default. Such system factors include the obligatory admission in TB hospitals and the inadequately organized transition from hospitalized to ambulatory treatment.
Language: English
Keywords:
UZBEKISTAN | RESEARCH REPORT | RECORDS | CLIENTS | HOMELESS PERSONS | TUBERCULOSIS | SOCIOECONOMIC FACTORS | TREATMENT | UNEMPLOYMENT | ALCOHOL USE AND ABUSE | RETIREMENT | Developing Countries | Asia, Central | Asia | Information Processing | Information | Program Activities | Programs | Organization and Administration | Residence Characteristics | Population Distribution | Geographic Factors | Population | Infections | Diseases | Economic Factors | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Employment | Macroeconomic Factors | Behavior | Employment Status | Socioeconomic Status
Document Number: 329121

22.

Peer Reviewed

Title: Antiretroviral therapy using zidovudine, lamivudine, and efavirenz in South Africa: Tolerability and clinical events.
Author: Hoffmann CJ; Fielding KL; Charalambous S; Sulkowski MS; Innes C
Source: AIDS. 2008 Jan 2;22(1):67-74.
Abstract: The objective was to describe the safety and tolerability of zidovudine, lamivudine, and efavirenz in a low-income setting. We conducted a prospective cohort study in a workplace HAART programme in South Africa, which uses a first-line regimen of efavirenz, zidovudine, and lamivudine and provides routine clinical and laboratory monitoring 6-monthly pre-HAART and at 2, 6, 12, 24, 36, 48 weeks during HAART. We assessed the incidence of specified clinical and laboratory events (AIDS Clinical Trials Group grade 3 or higher) and associated regimen changes, hospitalizations, and deaths one year before HAART initiation and one year on-HAART using person-year analysis. Between November 2002 and October 2005, 853 subjects (98% male, median age 40 years, and median CD4 cell count at HAART initiation 186 cells/ml) met enrollment criteria. The incidence of events on-HAART was higher than pre-HAART for neutropenia and nausea/vomiting. Dizziness was common early after HAART initiation (not evaluated pre-HAART).Of those with neutropenia, 88% had no apparent clinical consequences. The incidence of anemia, hepatotoxicity, peripheral neuropathy, and rash was similar or higher pre-HAART than on-HAART. Mean hemoglobin rose during the time on-HAART and was higher at 24 and 48 weeks than at baseline (P<0.001). This regimen was well tolerated with a short-term increase in neutropenia, nausea, and probably neurocerebellar events. Most significantly, in contrast to reports from high-income countries, we observed a long-term improvement in the hemoglobin concentration. (author's)
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | CLINICAL RESEARCH | PROSPECTIVE STUDIES | COHORT ANALYSIS | EPIDEMIOLOGIC METHODS | WORKERS | ANTIRETROVIRAL THERAPY | WORKPLACE | INCIDENCE | COMPLICATIONS | AIDS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Studies | Labor Force | Human Resources | Economic Factors | HIV | HIV Infections | Viral Diseases | Diseases | Employment | Macroeconomic Factors | Measurement
Document Number: 322742

23.

Peer Reviewed

Title: Hepatitis B virus infection and response to antiretroviral therapy (ART) in a South African ART program.
Author: Hoffmann CJ; Charalambous S; Martin DJ; Innes C; Churchyard GJ; Chaisson RE; Grant AD; Fielding KL; Thio CL
Source: Clinical Infectious Diseases. 2008 Dec 1;47(11):1479-85.
Abstract: BACKGROUND: Coinfection with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) is common in Africa; however, the impact of HBV infection on the outcomes of antiretroviral therapy programs is unclear. We evaluated the impact of chronic hepatitis B on HIV virologic response, changes in CD4 cell count, hepatotoxicity, and mortality among Africans receiving highly active antiretroviral therapy (HAART). METHODS: We conducted a retrospective cohort study involving a workplace HAART program in South Africa. Participants received HAART according to a protocol and were followed up for up to 72 weeks. On the basis of pre-HAART serum assays, patients were classified as being hepatitis B surface antigen (HBsAg) negative, HBsAg positive with a low HBV DNA level ( 1 x 10(4) copies/mL). The relationships between HBV status and HIV RNA suppression, change in CD4 cell count, mortality, and hepatotoxicity were assessed with use of regression techniques. RESULTS: Five hundred thirty-seven individuals fulfilled the inclusion criteria; 431 (80.3%) of these patients were HBsAg negative, 60 (11.2%) were HBsAg positive with a low HBV DNA level, and 46 (8.6%) were HBsAg positive with a high HBV DNA level. All groups had similar rates of HIV RNA suppression (P = .61), CD4 cell count increases (P =.75), and mortality (17 total deaths; P=.11) for up to 72 weeks after the initiation of HAART. Baseline transaminase levels were highest in the group with high HBV DNA levels (P=.004). Hepatotoxicity was similar between the HBsAg-negative group and the group with low HBV DNA levels but was higher in the group with high HBV DNA levels (incidence rate ratio, 4.4). CONCLUSIONS: We revealed that HBV status does not affect HIV RNA suppression, CD4 cell count response, or mortality during the first 72 weeks of HAART in an African setting. The risk of HBV-associated hepatotoxicity, however, is associated with the baseline HBV DNA level.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | WORKPLACE | LABOR FORCE | ANTIRETROVIRAL THERAPY | HEPATITIS | TREATMENT | PROGRAM EFFECTIVENESS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Employment | Macroeconomic Factors | Economic Factors | Human Resources | HIV | HIV Infections | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Program Evaluation | Programs | Organization and Administration
Document Number: 329365

24.

Peer Reviewed

Title: Environmental support and HIV prevention behaviors among female sex workers in China.
Author: Hong Y; Fang X; Li X; Liu Y; Li M
Source: Sexually Transmitted Diseases. 2008 Jul;35(7):662-667.
Abstract: The objective of this study was to examine the influence of environmental support on HIV prevention behaviors (i.e., condom use behaviors, communication and intention, and HIV/STD testing) among female sex workers (FSWs) in China. A cross-sectional survey was administered among 310 FSWs recruited from entertainment establishments in Liuzhou City in Southwest China in 2006. Sex workers were asked about their demographic and working characteristics and their HIV prevention behaviors. Environmental support was measured by a scale consisting of 8 items regarding condom availability, managerial, and social support of HIV prevention (Cronbach alpha = 0.73). After adjusting for demographic and working characteristics, condom use self-efficacy and knowledge, environmental support was strongly associated with following HIV prevention behaviors: overall consistent condom use (aOR = 1.7, 95% CI = 1.3, 2.3), consistent condom use in the last 3 sexual acts (aOR = 1.5, 95% CI = 1.1, 2.0), intention to use condoms consistently (aOR = 1.6, 95% CI = 1.1, 2.2), and HIV testing (aOR = 1.6, 95% CI = 1.1, 2.2). Environmental support is a significant predictor of HIV prevention behaviors among establishment-based FSWs in China. The data underscore the importance of developing environmental/structural HIV/STD interventions for FSWs. Condoms need to be easily accessible in the establishments. Gatekeepers need to be educated to create a supportive environment for condom use and HIV prevention. (author's)
Language: English
Keywords:
CHINA | RESEARCH REPORT | SURVEYS | CROSS SECTIONAL ANALYSIS | WOMEN | SEX WORKERS | HIV PREVENTION | WORKPLACE | CONDOM USE | RISK REDUCTION BEHAVIOR | Asia, Eastern | Asia | Developing Countries | Sampling Studies | Studies | Research Methodology | Demographic Factors | Population | Sex Behavior | Behavior | HIV Infections | Viral Diseases | Diseases | Employment | Macroeconomic Factors | Economic Factors
Document Number: 327521

25.

Title: Unmet need and the demand for family planning in Uganda. Further analysis of the Uganda Demographic and Health Surveys, 1995-2006.
Author: Khan S; Bradley SE; Fishel J; Mishra V
Source: Calverton, Maryland, Macro International, MEASURE DHS, 2008 Aug. 42 p. (USAID Contract No. GPO-C-00-03-00002-00DHS Further Analysis No. 60)
Abstract: Uganda is the third fastest growing country in the world. Contraceptive use is low, and the unmet need for family planning is high. This study examines unmet need in Uganda from 1995 to 2006 using data from three consecutive rounds of the Demographic and Heath Surveys. The study provides levels, trends, and differentials for unmet need; the factors associated with unmet need; reasons for contraceptive nonuse; and the likely impact of reducing unmet need. The results show that unmet need is highest among currently married women, women in rural areas, and women in the Northern region. Unmet need is increasing among the all-women group, currently married women, all sexually active women, and never-married sexually active women. Unmet need remains steady at low levels among never-married women and formerly married women. Unmet need for spacing is more prevalent than for limiting. Women with an unmet need for spacing and limiting both tend to have more than two living children. Women with an unmet need for spacing are more likely to lack employment, live in the Northern region, and not receive family planning messages in the media while women with an unmet need for limiting, in contrast, tend to be older and live in rural areas. Total unmet need is associated with higher parity (2 or more children) and living in the Northern region. Substantial proportions of women do not use, and do not intend to use, contraception in the future due to the fear of side effects and opposition from the husband or partner. Based on statistical models, modest declines in unmet need and increases in contraceptive prevalence in Uganda can substantially reduce the country's total fertility rate.
Language: English
Keywords:
UGANDA | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | WOMEN IN DEVELOPMENT | COUPLES | RURAL POPULATION | FAMILY PLANNING | CONTRACEPTIVE PREVALENCE | MARITAL STATUS | HUMAN GEOGRAPHY | BIRTH SPACING | MASS MEDIA | UNEMPLOYMENT | AGE FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Economic Development | Economic Factors | Family Characteristics | Family and Household | Sociocultural Factors | Population Characteristics | Contraceptive Usage | Contraception | Nuptiality | Geography | Social Sciences | Science | Communication | Employment | Macroeconomic Factors
Document Number: 329539

26.

Title: Risk of infection in health care workers following occupational exposure to a noninfectious or unknown source.
Author: Kuruuzum Z; Yapar N; Avkan-Oguz V; Aslan H; Ozbek OA; Cakir N; Yuce A
Source: American Journal of Infection Control. 2008 Dec;36(10):e27-31.
Abstract: BACKGROUND: The major concern after occupational exposures is the possible transmission of blood-borne pathogens, especially hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). This study was undertaken to evaluate the risk of infection after exposure to blood or body fluids of an unknown or an HBV-, HCV-, and HIV-negative source and to determine the epidemiologic characteristics of these incidents in health care workers. METHODS: The survey was conducted over a 6-year period at a university hospital in Turkey, using a questionnaire to elicit demographic and epidemiologic information. Serologic tests for HBV, HCV, and HIV were performed and repeated after 3 months. RESULTS: Of the 449 incidents, complete follow-up was achieved in 320 (71.3%), and no seroconversion was observed for HBV, HCV and HIV. Most of the incidents occurred in medical (34.7%) and surgical (25.4%) work areas. The most frequent type of exposure was percutaneous injury (94%), most commonly caused by handling of garbage bags (58.4%), needle recapping (16.5%), and invasive interventions (13.4%). CONCLUSION: Infection risk seems to be extremely low for HCV and HIV, because of low endemicity, and for HBV in groups immunized against HBV.
Language: English
Keywords:
TURKEY | RESEARCH REPORT | SURVEYS | HEALTH PERSONNEL | OCCUPATIONAL HEALTH | EXPOSURE | RISK FACTORS | INFECTIONS | ACCIDENTS AND INJURIES | WORKPLACE | Developing Countries | Europe, Southeastern | Europe | Sampling Studies | Studies | Research Methodology | Delivery of Health Care | Health | Biology | Diseases | Employment | Macroeconomic Factors | Economic Factors
Document Number: 329756

27.
Title: Evaluation of STD/HIV/AIDS peer-education and danger: a local perspective.
Author: Laperriere H
Source: Ciencia and Saude Coletiva. 2008 Nov-Dec;13(6):1817-24.
Abstract: An evaluation of peer-education projects with sex workers, men who have sex with men and marginalized adolescents, was introduced in a remote region of Brazil. The context of varied limits of predictability made it difficult to conduct inquiry. To go beyond available epidemiological surveys and questionnaires on sexual behavior, a self-evaluation aimed at increasing pragmatic knowledge about prevention in a challenging socio-political context. During five-months, a participatory-action research explored participant observation; individual and collective exchanges with users, peer-educators, coordinators, administrators, politicians and regional health professionals. Collective understanding of peer-education in prostitution zones underlines the reality of unforeseen social repercussions and confluence/divergence of multiple actors' perspectives. It identifies meaningful dimensions at a community-level, such as the collective history and dangerous working conditions. Nurses face complex struggles and negotiations over multiple actors in their practice. This study suggests that nurses have a role to play in the conceptualization of participatory evaluation. It also underlines the threats to their physical and social safety, which they might share with peer-educators.
Language: English
Keywords:
BRAZIL | CRITIQUE | LABOR FORCE | PERSONS LIVING WITH HIV/AIDS | PEER EDUCATORS | POVERTY | DRUG USE AND ABUSE | UNEMPLOYMENT | ALCOHOL USE AND ABUSE | AIDS PREVENTION | KNOWLEDGE | PERCEPTION | SOCIAL CHANGE | PROGRAM EVALUATION | South America, Eastern | South America | Latin America | Americas | Developing Countries | Human Resources | Economic Factors | HIV Infections | Viral Diseases | Diseases | Education | Socioeconomic Factors | Behavior | Employment | Macroeconomic Factors | AIDS | Sociocultural Factors | Psychological Factors | Programs | Organization and Administration
Document Number: 330753

28.

Peer Reviewed

Title: Institutional support for HIV/AIDS care in China: a multilevel analysis.
Author: Li L; Liang LJ; Wu Z; Lin C; Wu S
Source: AIDS Care. 2008 Nov;20(10):1190-6.
Abstract: A total of 1,101 Chinese healthcare workers were surveyed to determine the perception of institutional support for HIV/AIDS care in China. Multilevel regression models with random effects were used to estimate individual and facility-level effects on healthcare workers' perceived institutional support. Regional workers (at the provincial, city, county levels) reported higher institutional support for HIV/AIDS care than local workers (at the township and village levels). Estimated relationships between perceived institutional support and HIV-related training were greater for the regional than for the local level. Urgent need exists to address the unbalanced healthcare system in China and to consider the policy implications for an effective response to the HIV/AIDS epidemic.
Language: English
Keywords:
CHINA | RESEARCH REPORT | HOSPITALS | HEALTH PERSONNEL | PERSONS LIVING WITH HIV/AIDS | OCCUPATIONAL HEALTH | WORKPLACE | RISK FACTORS | KNOWLEDGE | BEHAVIOR | Asia, Eastern | Asia | Developing Countries | Health Facilities | Delivery of Health Care | Health | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Employment | Macroeconomic Factors | Economic Factors | Biology | Sociocultural Factors
Document Number: 329735

29.
Title: Clients' satisfaction with services for prevention of mother-to-child transmission of HIV in Dodoma Rural district.
Author: Lyatuu MB; Msamanga GI; Kalinga AK
Source: East African Journal of Public Health. 2008 Dec;5(3):174-9.
Abstract: OBJECTIVE: The study was conducted to assess clients' satisfaction with PMTCT services on privacy, waiting time and counselling in PMTCT of HIV /AIDS in Dodoma Rural district. METHODS: A cross sectional study was conducted to 208 women assessing Reproductive Child Health (RCH) and PMTCT of HIV services. Data collection method involved both client exit interviews and focus group discussions (FGD) with women attending RCH services. Systematic random sampling technique was used to obtain the required sample of 208 clients for the exit interviews. A total of five FGDs were conducted each with eight to ten people. The data obtained were analysed using Epi Info. SETTINGS: Dodoma Rural district, central Tanzania RESULTS: Of 113 clients' who accessed PMTCT services, 75.2% were satisfied with the counselling provided. A significant difference (P = 0.02) was observed between clients with no formal education as compared to those with primary level of education and above. Nearly a quarter of the clients who accessed PMTCT of HIV services were not satisfied with the privacy in the settings providing the service. It was also found that 71.7% of clients accessing PMTCT of HIV service was satisfied with the waiting time spent for the service; however a difference was observed (P = 0.001) between clients who accessed services at health centre (77.6%) and hospital (33.3%). CONCLUSION: A quarter of the clients were not satisfied either with the counselling they received on PMTCT of HIV, privacy or waiting time they spent while accessing services. Some of the reasons contributing to dissatisfaction included inadequacy in individual counselling, inadequate on site test supplies and equipment and cost incurred when travelling to seek for PMTCT service from a referral or satellite health facility.
Language: English
Keywords:
TANZANIA | RESEARCH REPORT | KAP SURVEYS | CROSS SECTIONAL ANALYSIS | FOCUS GROUPS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | RURAL POPULATION | SATISFACTION | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | EDUCATIONAL STATUS | WAITING AREAS AND QUEUES | TIME FACTORS | HOSPITALS | RURAL HEALTH SERVICES | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | Data Collection | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Psychological Factors | Behavior | Disease Transmission Control | Prevention and Control | Diseases | Socioeconomic Status | Socioeconomic Factors | Workplace | Employment | Macroeconomic Factors | Population Dynamics | Health Facilities | Delivery of Health Care | Health | Health Services
Document Number: 331265

30.

Peer Reviewed

Title: Evaluation of the WHO criteria for antiretroviral treatment failure among adults in South Africa.
Author: Mee P; Fielding KL; Charalambous S; Churchyard GJ; Grant AD
Source: AIDS. 2008 Oct 1;22(15):1971-7.
Abstract: OBJECTIVE: To assess the performance of WHO clinical and CD4 cell count criteria for antiretroviral treatment (ART) failure among HIV-infected adults in a workplace HIV care programme in South Africa. DESIGN: Cohort study. METHODS: We included initially ART-naive participants who remained on first-line therapy and had an evaluable HIV viral load result at the 12-month visit. WHO-defined clinical and CD4 cell count criteria for ART failure were compared against a gold standard of virological failure. RESULTS: Among 324 individuals (97.5% men, median age 40.2, median starting CD4 cell count and viral load 154 cells/mul and 47,503 copies/ml, respectively), 33 (10.2%) had definite or probable virological failure at 12 months, compared with 19 (6.0%) and 40 (12.5%) with WHO-defined CD4 and clinical failure, respectively. CD4 criteria had a sensitivity of 21.2% and a specificity of 95.8% in detecting virological failure, and clinical criteria had sensitivity of 15.2% and specificity of 88.1%. The positive predictive value of CD4 and clinical criteria in detecting virological failure were 36.8 and 12.8%, respectively. Exclusion of weight loss or tuberculosis failed to improve the performance of clinical criteria. CONCLUSION: WHO clinical and CD4 criteria have poor sensitivity and specificity in detecting virological failure. The low specificities and positive predictive values mean that individuals with adequate virological suppression risk being incorrectly classified as having treatment failure and unnecessarily switched to second-line therapy. Virological failure should be confirmed before switching to second-line therapy.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | EVALUATION | COHORT ANALYSIS | MIDDLE AGED ADULTS | PERSONS LIVING WITH HIV/AIDS | WORKPLACE | HIV INFECTIONS | TREATMENT | ANTIRETROVIRAL THERAPY | BODY WEIGHT | TUBERCULOSIS | ANTIRETROVIRAL DRUGS | MONITORING | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Adults | Age Factors | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Employment |