Dataset Information

Facility-Level Factors Influencing Retention of Patients in HIV Care in East Africa.

ABSTRACT: Losses to follow-up (LTFU) remain an important programmatic challenge. While numerous patient-level factors have been associated with LTFU, less is known about facility-level factors. Data from the East African International epidemiologic Databases to Evaluate AIDS (EA-IeDEA) Consortium was used to identify facility-level factors associated with LTFU in Kenya, Tanzania and Uganda. Patients were defined as LTFU if they had no visit within 12 months of the study endpoint for pre-ART patients or 6 months for patients on ART. Adjusting for patient factors, shared frailty proportional hazard models were used to identify the facility-level factors associated with LTFU for the pre- and post-ART periods. Data from 77,362 patients and 29 facilities were analyzed. Median age at enrolment was 36.0 years (Interquartile Range: 30.1, 43.1), 63.9% were women and 58.3% initiated ART. Rates (95% Confidence Interval) of LTFU were 25.1 (24.7-25.6) and 16.7 (16.3-17.2) per 100 person-years in the pre-ART and post-ART periods, respectively. Facility-level factors associated with increased LTFU included secondary-level care, HIV RNA PCR turnaround time >14 days, and no onsite availability of CD4 testing. Increased LTFU was also observed when no nutritional supplements were provided (pre-ART only), when TB patients were treated within the HIV program (pre-ART only), and when the facility was open ≤4 mornings per week (ART only). Our findings suggest that facility-based strategies such as point of care laboratory testing and separate clinic spaces for TB patients may improve retention.

SUBMITTER: Rachlis B

PROVIDER: S-EPMC4980048 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

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Facility-Level Factors Influencing Retention of Patients in HIV Care in East Africa.

Rachlis Beth B Bakoyannis Giorgos G Easterbrook Philippa P Genberg Becky B Braithwaite Ronald Scott RS Cohen Craig R CR Bukusi Elizabeth A EA Kambugu Andrew A Bwana Mwebesa Bosco MB Somi Geoffrey R GR Geng Elvin H EH Musick Beverly B Yiannoutsos Constantin T CT Wools-Kaloustian Kara K Braitstein Paula P

PloS one 20160810 8

Losses to follow-up (LTFU) remain an important programmatic challenge. While numerous patient-level factors have been associated with LTFU, less is known about facility-level factors. Data from the East African International epidemiologic Databases to Evaluate AIDS (EA-IeDEA) Consortium was used to identify facility-level factors associated with LTFU in Kenya, Tanzania and Uganda. Patients were defined as LTFU if they had no visit within 12 months of the study endpoint for pre-ART patients or 6 ...[more]

PMID: 27509182

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Project description:IntroductionMaternal mortality remains high, especially in sub-Saharan Africa. Institutional delivery is one of the key intervention to reduce it. Despite service utilization reflects an interplay of demand- and supply-side factors, previous studies mainly focused on either sides due to methodological challenges and data availability. But, a more comprehensive understanding can be obtained by assessing both sides. The aim of this study is to assess individual, household, community, and health facility factors associated with deliveryplace in Ethiopia.MethodsWe have used the 2019 Performance Monitoring for Action survey data set, which is a nationally representative sample of women linked with national sample of health facilities in Ethiopia. A total of 2547 women who recently delivered were linked with 170 health centers and 41 hospitals. Facility readiness index was calculated based on previous study conducted by Stierman EK on similar data set. We applied survey weights for descriptive statistics. Multilevel mixed-effects logistic regression was used to identify factors influencing delivery place.ResultsCoverage of institutional delivery was 54.49%. Women aged 20-34 [AOR; 0.55 (0.32-0.85)] compared with those younger than 20 years; those with no formal education [AOR: 0.19 (10.05-0.76)] or attended only primary school [AOR: 0.20 (0.05-0.75)] compared with those attended above secondary; and women whose partners didn't encourage antinatal visit [AOR; 0.57 (0.33-0.98)] all have decreased odd of institutional delivery. Attending at least one antenatal visit [AOR: 3.09 (1.87-5.10)] and increased availability of medicines in the closest facility [AOR: 17.33 (1.32-26.4)] increase odds of institutional deliver.ConclusionIn Ethiopia, nearly half of the total deliveries take place outside health facilities. In addition to improving women's education, utilization of antenatal care, and encouragement by partners, it is important to consider the availability of medicine and commodities in the nearby health facilities while designing and implementing programs to reduce home delivery.

Project description:BackgroundHandwashing is one of the most effective ways to prevent transmission of infectious diseases. A substantial body of research has examined the status and determinants of handwashing facilities in healthcare settings and schools. However, its status at home in the community, especially in developing countries, remains unclear. This study aimed to examine the availability and factors influencing basic handwashing facilities at households in Ethiopia.MethodWe analysed the 2016 Ethiopian Demographic and Health Survey (EDHS) data. EDHS employed a two-stage stratified cluster sampling technique. Data were collected from the lowest administrative unit (kebele). A multivariable logistic regression model that allowed cluster-level random effects was employed to examine factors that affect the availability of basic handwashing facilities (water plus soap) at households. Estimates from the regression model are reported as odds ratios (ORs) with standard errors clustered at the DHS cluster level to account for a sampling methodology.ResultsIn our sample, only 1292 (8% [95% CI, 7.6%-8.4%]) of the households had basic handwashing facilities. Compared with head of household who had no formal education, the odds of having basic handwashing facilities was higher among head of household who completed secondary level of education (adjusted odds ratio [AOR] = 1.83; 95% CI: 1.35-2.49) and higher level of education (AOR = 2.35; 95% CI: 1.63-3.39). Odds of having basic handwashing facilities was increased with having radio (AOR = 1.32; 95% CI: 1.10-1.63) and television (AOR = 1.49; 95% CI: 1.10-2.02) at home. Households that had improved latrine were two times more likely to have basic handwashing facilities (AOR = 2.09; 95% CI: 1.56-2.80). Being at higher household wealth quintiles was associated with increased odds of having basic handwashing facilities.ConclusionVery low basic handwashing facilities was demonstrated by this study, whereas, awareness and socio-economic related factors were identified as a determinants for its availability in the household. Greater efforts are needed to increase the coverage of community-level handwashing facilities.

Project description:BackgroundThe COVID-19 pandemic wreaked havoc on long-term care facilities (LTCFs). Some LTCFs performed better than others at slowing COVID-19 transmission. Emerging literature has mostly described infection prevention and control strategies implemented by LTCFs during the pandemic. However, there is a need for a comprehensive review of factors that influenced the performance of LTCFs in containing COVID-19 spread to inform public health policy.ObjectiveTo build on the existing literature, we conducted a scoping review of factors that influenced LTCF performance during the COVID-19 pandemic using a multidimensional conceptual framework of performance.MethodsWe followed the Joanna Briggs Institute's methodology for scoping reviews. We queried CINAHL, MEDLINE (Ovid), CAIRN, Science Direct, Scopus, and Web of Science for peer-reviewed literature in English or French published between January 1st, 2020 and December 31st, 2021. Retrieved records were screened for context (COVID-19 pandemic), population (LTCFs), interest (internal and external factors that influenced LTCF performance), and outcomes (dimensions of performance: equity, accessibility, reactivity, safety, continuity, efficacy, viability, efficiency). Descriptive characteristics of included articles were summarized. Dimensions of performance as well as internal (e.g., facility characteristics) and external (e.g., visitors) factors identified to have influenced LTCF performance were presented.ResultsWe retained 140 articles of which 68% were classified as research articles, 47% originated in North America, and most covered a period between March and July 2020. The most frequent dimensions of performance were "efficacy" (75.7%) and "safety" (75.7%). The most common internal factors were "organizational context" (72.9%) and "human resources" (62.1%), and the most common external factors were "visitors" (27.1%) and "public health guidelines" (25.7%).ConclusionsOur review contributes to a global interest in understanding the impact of the COVID-19 pandemic on vulnerable populations residing and working in LTCFs. Though a myriad of factors were reported, a lack of randomized controlled trials makes it impossible to establish causality between the identified factors and LTCF performance. The use of a multidimensional framework can be recommended to evaluate healthcare system performance not merely in terms of efficacy and safety, but alongside other critical dimensions such as efficiency and equity.Trial registrationResearch Registry ID: researchregistry7026.

Project description:Diabetes prevalence is rising globally, especially in low- and middle-income countries like Mexico, posing challenges for healthcare systems that require efficient primary care to manage the disease. However, healthcare efficiency is influenced by factors beyond decision-makers, including socioeconomic and political conditions. This study aims to evaluate the technical efficiency of primary healthcare for diabetes patients in Mexico over a 12-year period and explore the impact of contextual variables on efficiency. A longitudinal analysis was conducted using administrative and socio-demographic data from 242 health jurisdictions between 2009 and 2020. Data envelopment analysis with bootstrapping and output orientation was used to measure the technical efficiency; health resources in infrastructure and human resources were used as inputs. As outcome, the number of patients receiving treatment for diabetes and the number of patients with controlled diabetes were considered. Machine learning algorithms were employed to analyse multiple factors affecting the provision of diabetes health services and assess heterogeneity and trends in efficiency across different health jurisdictions. The average technical efficiency in primary healthcare for diabetes patients was 0.44 (CI: 0.41-0.46) in 2009, reaching a peak of 0.71 (CI: 0.69-0.72) in 2016, and moderately declining to 0.60 (CI: 0.57-0.62) in 2020; these differences were statistically significant. The random forest analysis identified the marginalization index, primary healthcare coverage, proportion of indigenous population and demand for health services as the most influential variables in predicting efficiency levels. This research underscores the crucial need for the formulation of targeted public policies aimed at extending the scope of primary healthcare services, with a particular focus on addressing the unique challenges faced by marginalized and indigenous populations. According to our results, it is necessary that medical care management adjust to the specific demands and needs of these populations to guarantee equitable care in Mexico.

Dataset Information

Facility-Level Factors Influencing Retention of Patients in HIV Care in East Africa.

Publications

Facility-Level Factors Influencing Retention of Patients in HIV Care in East Africa.

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