scholarly journals Strengthening Health Systems for Chronic Care: Leveraging HIV Programs to Support Diabetes Services in Ethiopia and Swaziland

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Miriam Rabkin ◽  
Zenebe Melaku ◽  
Kerry Bruce ◽  
Ahmed Reja ◽  
Alison Koler ◽  
...  
Keyword(s):  
Chronic Care ◽  
Rapid Assessment ◽  
Scale Up ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
The Status ◽  
Care Systems ◽  
Care And Treatment ◽  
Sub Saharan ◽  
Hiv Programs

The scale-up of HIV services in sub-Saharan Africa has catalyzed the development of highly effective chronic care systems. The strategies, systems, and tools developed to support life-long HIV care and treatment are locally owned contextually appropriate resources, many of which could be adapted to support continuity care for noncommunicable chronic diseases (NCD), such as diabetes mellitus (DM). We conducted two proof-of-concept studies to further the understanding of the status of NCD programs and the feasibility and effectiveness of adapting HIV program-related tools and systems for patients with DM. In Swaziland, a rapid assessment illustrated gaps in the approaches used to support DM services at 15 health facilities, despite the existence of chronic care systems at HIV clinics in the same hospitals, health centers, and clinics. In Ethiopia, a pilot study found similar gaps in DM services at baseline and illustrated the potential to rapidly improve the quality of care and treatment for DM by adapting HIV-specific policies, systems, and tools.

scholarly journals Changing forms of HIV-related stigma along the HIV care and treatment continuum in sub-Saharan Africa: a temporal analysis

2017 ◽  
Vol 93 (Suppl 3) ◽  
pp. e052975 ◽  
Author(s):  
O Bonnington ◽  
J Wamoyi ◽  
W Ddaaki ◽  
D Bukenya ◽  
K Ondenge ◽  
...  
Keyword(s):  
Temporal Analysis ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Related Stigma ◽  
Care And Treatment ◽  
Sub Saharan

scholarly journals Availability of nutritional support services in HIV care and treatment sites in sub-Saharan African countries

2011 ◽  
Vol 15 (5) ◽  
pp. 938-947 ◽  
Author(s):  
Aranka Anema ◽  
Wendy Zhang ◽  
Yingfeng Wu ◽  
Batya Elul ◽  
Sheri D Weiser ◽  
...  
Keyword(s):  
Support Services ◽  
Nutritional Support ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Severe Malnutrition ◽  
Micronutrient Supplementation ◽  
African Countries ◽  
Nutritional Counselling ◽  
Care And Treatment ◽  
Sub Saharan

AbstractObjectiveTo examine the availability of nutritional support services in HIV care and treatment sites across sub-Saharan Africa.DesignIn 2008, we conducted a cross-sectional survey of sites providing antiretroviral therapy (ART) in nine sub-Saharan African countries. Outcomes included availability of: (i) nutritional counselling; (ii) micronutrient supplementation; (iii) treatment for severe malnutrition; and (iv) food rations. Associations with health system indicators were explored using bivariate and multivariate methods.SettingPresident's Emergency Plan for AIDS Relief-supported HIV treatment and care sites across nine sub-Saharan African countries.SubjectsA total of 336 HIV care and treatment sites, serving 467 175 enrolled patients.ResultsOf the sites under study, 303 (90 %) offered some form of nutritional support service. Nutritional counselling, micronutrient supplementation, treatment for severe acute malnutrition and food rations were available at 98 %, 64 %, 36 % and 31 % of sites, respectively. In multivariate analysis, secondary or tertiary care sites were more likely to offer nutritional counselling (adjusted OR (AOR): 2·2, 95 % CI 1·1, 4·5). Rural sites (AOR: 2·3, 95 % CI 1·4, 3·8) had increased odds of micronutrient supplementation availability. Sites providing ART for >2 years had higher odds of availability of treatment for severe malnutrition (AOR: 2·4, 95 % CI 1·4, 4·1). Sites providing ART for >2 years (AOR: 1·6, 95 % CI 1·3, 1·9) and rural sites (AOR: 2·4, 95 % CI 1·4, 4·4) had greater odds of food ration availability.ConclusionsAvailability of nutritional support services was high in this large sample of HIV care and treatment sites in sub-Saharan Africa. Further efforts are needed to determine the uptake, quality and effectiveness of these services and their impact on patient and programme outcomes.

scholarly journals Accessing antiretroviral therapy for children: Caregivers' voices

2016 ◽  
Vol 21 ◽  
pp. 331-338
Author(s):  
Margaret Williams ◽  
Dalena R.M. Van Rooyen ◽  
Esmeralda J. Ricks
Keyword(s):  
Antiretroviral Therapy ◽  
Tertiary Care ◽  
Scale Up ◽  
Target Population ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Hiv Positive ◽  
Eastern Cape ◽  
Care Facilities ◽  
Sub Saharan

Despite efforts to scale up access to antiretroviral therapy (ART), particularly at primary health care (PHC) facilities, antiretroviral therapy (ART) continues to be out of reach formany human immunodeficiency virus (HIV)-positive children in sub-Saharan Africa. In resource limited settings decentralisation of ART is required to scale up access to essential medication. Traditionally, paediatric HIV care has been provided in tertiary care facilities which have better human and material resources, but limited accessibility in terms of distance for caregivers of HIV-positive children. The focus of this article is on the experiences of caregivers whilst accessing ART for HIV-positive children at PHC (decentralised care) facilities in Nelson Mandela Bay (NMB) in the Eastern Cape, South Africa. A qualitative, explorative, descriptive and contextual research design was used. The target population comprised caregivers of HIV-positive children. Data were collected by means of indepth individual interviews, which were thematically analysed. Guba's model was usedto ensure trustworthiness. Barriers to accessing ART at PHC clinics for HIV-positive children included personal issues, negative experiences, lack of support and finance, stigma and discrimination. The researchers recommend standardised programmes be developed and implemented in PHC clinics to assist in providing treatment, care and support for HIV positive children.

scholarly journals Scaling up interventions for depression in sub-Saharan Africa: lessons from Zimbabwe

2016 ◽  
Vol 3 ◽  
Author(s):  
D. Chibanda ◽  
R. Verhey ◽  
E. Munetsi ◽  
S. Rusakaniko ◽  
F. Cowan ◽  
...  
Keyword(s):  
Health Workers ◽  
Core Competencies ◽  
Scale Up ◽  
Health Care Facilities ◽  
Sub Saharan Africa ◽  
District Health ◽  
Key Stakeholders ◽  
Extensive Consultation ◽  
Sub Saharan ◽  
Hiv Programs

BackgroundThere is a dearth of information on how to scale-up evidence-based psychological interventions, particularly within the context of existing HIV programs. This paper describes a strategy for the scale-up of an intervention delivered by lay health workers (LHWs) to 60 primary health care facilities in Zimbabwe.MethodsA mixed methods approach was utilized as follows: (1) needs assessment using a semi-structured questionnaire to obtain information from nurses (n = 48) and focus group discussions with District Health Promoters (n = 12) to identify key priority areas; (2) skills assessment to identify core competencies and current gaps of LHWs (n = 300) employed in the 60 clinics; (3) consultation workshops (n = 2) with key stakeholders to determine referral pathways; and (4) in-depth interviews and consultations to determine funding mechanisms for the scale-up.ResultsFive cross-cutting issues were identified as critical and needing to be addressed for a successful scale-up. These included: the lack of training in mental health, unavailability of psychiatric drugs, depleted clinical staff levels, unavailability of time for counseling, and poor and unreliable referral systems for people suffering with depression. Consensus was reached by stakeholders on supervision and support structure to address the cross-cutting issues described above and funding was successfully secured for the scale-up.ConclusionKey requirements for success included early buy-in from key stakeholders, extensive consultation at each point of the scale-up journey, financial support both locally and externally, and a coherent sustainability plan endorsed by both government and private sectors.

scholarly journals Chronic care models and opportunities for improving health care practice and outcomes in Sub-Saharan Africa: Protocol for systematic review

2020 ◽  
Author(s):  
Peter Otieno ◽  
Charles Agyemang ◽  
Razak M. Gyasi ◽  
Anthony K. Ngugi ◽  
Catherine Kyobutungi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Chronic Care ◽  
Critical Appraisal ◽  
Health Care Systems ◽  
Grey Literature ◽  
Sub Saharan Africa ◽  
Care Models ◽  
Care Systems ◽  
Sub Saharan

Abstract Background: The rising burden of chronic diseases in sub-Saharan Africa (SSA) where health care systems are least developed has led to recent calls for increased investment in chronic care models (CCM) appropriate for low-resource settings. In SSA, limited resources are often allocated to treating acute diseases thus management of chronic conditions is a major challenge for health care systems. A large diversity of CCM exist in the literature but evidence supporting their use has been derived from high income settings. This is the motivation for conducting a systematic review to identify the existing CCM and their relevance and applicability in SSA.Methods and analysis: All peer-reviewed published and grey literature on CCM will be included. PubMed/MEDLINE, Embase, Scopus, Web of Science and Global Health Cinahl, African Journals Online, Informit Online, and PsycINFO will be searched to identify relevant articles. OpenSIGLE will be reviewed for grey literature. The articles retrieved will be independently screened for inclusion by two independent investigators while a third reviewer will arbitrate the disagreements. An independent critical appraisal of retrieved studies will be performed using standardized critical appraisal checklists. The data will be extracted from the key elements of CCM. Outcome measures for the effectiveness of the models in the context of SSA will include any reported improvement to the health care service delivery or changes in the health outcomes of patients with chronic illnesses. The study findings will be reported according to the Preferred Reporting Items for Systematic Reviews (PRISMA).Discussion: This systematic review is expected to generate crucial evidence on the applicability of CCM in SSA and unearth the CCM components that are suitable for different levels of health care delivery systems and the emerging needs of the people living with comorbidities and multimorbidities in SSA.Systematic review registration: This review is registered in PROSPERO International Prospective Register of Systematic reviews CRD42020187756.

scholarly journals Bottlenecks to HIV care and treatment in sub-Saharan Africa: a multi-country qualitative study

2017 ◽  
Vol 93 (Suppl 3) ◽  
pp. e053172 ◽  
Author(s):  
Alison Wringe ◽  
Jenny Renju ◽  
Janet Seeley ◽  
Mosa Moshabela ◽  
Morten Skovdal
Keyword(s):  
Qualitative Study ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Care And Treatment ◽  
Sub Saharan

scholarly journals Healthcare Workers’ Perspectives on the Barriers to Providing HIV Services to Children in Sub-Saharan Africa

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Chipo Mutambo ◽  
Khumbulani Hlongwana
Keyword(s):  
Hiv Testing ◽  
Healthcare Workers ◽  
Scale Up ◽  
Primary Caregivers ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Public Health Response ◽  
Hiv Services ◽  
Child Friendly ◽  
Sub Saharan

Background. In order to accelerate the HIV response to meet the UNAIDS 90-90-90 indicators for children, healthcare workers need to lead a scale-up of HIV services in primary healthcare settings. Such a scale-up will require investigation into existing barriers that prevent healthcare workers from effectively providing those services to children. Furthermore, if the identified barriers are not well understood, designing context-specific and effective public health response programmes may prove difficult. Objective. This study reviews the current literature pertaining to healthcare workers' perspectives on the barriers to providing HIV services to children in the primary care setting in Sub-Saharan Africa. Methods. English articles published between 2010 and April 2018 were searched in electronic databases including Sabinet, MEDLINE, PubMed, and Google Scholar. Key search words used during the search were “healthcare workers’ perspectives” and “barriers to providing HIV testing to children” OR “barriers to ART adherence AND children” and “barriers to HIV disclosure AND children.” Results. There are various barriers to provider-initiated counselling and testing (PICT) of children and disclosure of HIV status to children, including the following: lack of child-friendly infrastructure at clinics; lack of consensus on legal age of consent for both HIV testing and disclosure; healthcare worker unfamiliarity with HIV testing and disclosure guidelines; lack of training in child psychology; and confusion around the healthcare worker’s role, which most believed was only to provide health education and clinical services and to correct false information, but not to participate in disclosure. Additionally, primary caregivers were reported to be a barrier to care and treatment of children as they continue to refuse HIV testing for their children and delay disclosure. Conclusion. Training, mentoring, and providing healthcare workers with guidelines on how to provide child-focused HIV care have the potential to address the majority of the barriers to the provision of child-friendly HIV services to children. However, the need to educate primary caregivers on the importance of testing children and disclosing to them is equally important.

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