Delivery of TB preventive therapy to incarcerated people living with HIV in southern African correctional facilities.
Ontology highlight
ABSTRACT:
SUBMITTER: Chimoyi L
PROVIDER: S-EPMC8680178 | biostudies-literature | 2021 Dec
REPOSITORIES: biostudies-literature
Publications
Delivery of TB preventive therapy to incarcerated people living with HIV in southern African correctional facilities.
Chimoyi L L Smith H H Hausler H H Fielding K K Hoffmann C J CJ Herce M E ME Charalambous S S
Public health action 20211201 4
TB preventive treatment (TPT) is recommended for high-risk and hard-to-reach populations such as incarcerated people living with HIV (PLHIV). To assess implementation of TPT delivery in correctional settings, we conducted an exploratory analysis of data from a multisite cohort study in South Africa and Zambia. From 975 participants, 648 were screened for TB, and 409 initiated TPT mostly within a month after initiation of antiretroviral therapy (190/409, 46.5%). We observed a median gap of one mo ...[more]
Similar Datasets
Project description:IntroductionTB is the most frequent opportunistic infection and cause of death among People living with HIV/AIDS. Human immunodeficiency virus-positive individuals are routinely screened for tuberculosis as a means of monitoring efforts to mitigate the consequences of the disease on HIV-positive patients. TB status assessment identifies HIV-positive clients who show no evidence of active TB by symptom screening and would benefit from treatment with isoniazid for prevention of TB disease among HIV positives.MethodsA facility-based cross-sectional study design was conducted in public health facilities of West Shewa Zone from January to February 2019. Of the 28 Public health facilities providing HIV/AIDS care and support (HCT and ART services) 13 of them were selected by simple random sampling techniques. Finally, 815 study participants were recruited by systematics sampling techniques & proportional sample size allocation was applied depending on the HIV patient load in each health facility. After reviewing relevant literature, a structured questionnaire adapted from standardized WHO guidelines, prepared for monitoring & evaluation of TB/HIV activities was used to collect data via interviewer.ResultsOf the total, 769 (94.4%) PLHIV were screened for tuberculosis, among which 212 (27.6%) were found to be positive for active tuberculosis. Among 557 (72.4%) individuals eligible for IPT, only 300 (53.9%) were provided IPT; 257 (46.1%) eligible PLHIV were not provided IPT. Resident (adjusted odds ratio [AOR] 5.6), those who didn't attend school (AOR 4.0), primary school (grade 1-8) (AOR 3.2), and secondary school (grade 9-12) (AOR 4.2) were significantly associated with the likelihood of tuberculosis infection.ConclusionThe present study findings demonstrated that tuberculosis screening for PLHIV at West Shewa Zone public health facilities was improved in comparison with reports from many African countries and other parts of Ethiopia. The IPT implementation rate fell short of both national and WHO guidelines, notwithstanding this improvement. In the study area, diagnostic methods for tuberculosis and existing preventive measures should be improved overall.
| S-EPMC11892821 | biostudies-literature
Project description:BackgroundStigma affects engagement with HIV healthcare services. We investigated the prevalence and experience of stigma among incarcerated people living with HIV (PLHIV) in selected South African correctional settings during roll-out of universal test and treat.MethodsA cross-sectional mixed-methods study design included 219 incarcerated PLHIV and 30 in-depth interviews were conducted with four different types of PLHIV. HIV-related stigma was assessed through survey self-reporting and during the interviews. A descriptive analysis of HIV-related stigma was presented, supplemented with a thematic analysis of the interview transcripts.ResultsART uptake was high (n = 198, 90.4%) and most reported HIV-related stigma (n = 192, 87.7%). The intersectional stigma occurring due to individual and structural stigma around provision of healthcare in these settings mostly contributed to perceived stigma through involuntary disclosure of HIV status. Interpersonal and intrapersonal factors led to negative coping behaviours. However, positive self-coping strategies and relationships with staff encouraged sustained engagement in care.ConclusionWe encourage continuous peer support to reduce stigmatization of those infected with HIV and whose status may be disclosed inadvertently in the universal test and treat era.
| S-EPMC8323907 | biostudies-literature
Project description: Not available
| S-EPMC11684683 | biostudies-literature
Project description:IntroductionIn 2017, the Aurum Institute, with support from Unitaid, launched an initiative to expand short-course therapy for the prevention of tuberculosis (TB) in 12 high-burden countries. This study aimed to investigate the importance of "catalytic" effects beyond the original project timeframe when estimating cost-effectiveness of such large investments.MethodsWe estimated the cost-effectiveness of the IMPAACT4TB (I4TB) initiative from a health system perspective, using a 10-year time horizon. We first conservatively estimated costs using a "top-down" approach considering only the direct health benefits of providing TB preventive therapy to people initiating antiretroviral therapy (ART) through I4TB activities. We then re-estimated the incremental cost-effectiveness of I4TB incorporating the costs and health benefits of potential catalytic effects beyond the program itself.ResultsWe estimated that TB preventive therapy through the I4TB initiative alone would prevent 14 201 cases of active TB and 1562 TB deaths over 10 years with an up-front investment of $52.5 million; the estimated incremental cost-effectiveness was $1580 per disability-adjusted life year (DALY) averted. If this initiative could achieve its desired catalytic effects, an additional 375 648 cases and 41 321 deaths could be averted, at an incremental cost of $546 million and cost-effectiveness of $713 per DALY averted.ConclusionsOur findings provide donors with reasonable evidence of value for money to support investment in short-course TB preventive therapy for people initiating ART in high-burden settings. Our study also illustrates the importance of considering long-term secondary ("catalytic") effects when evaluating the cost-effectiveness of large-scale initiatives designed to change a global policy landscape.
| S-EPMC7588607 | biostudies-literature
Project description:BackgroundTuberculosis (TB) preventive treatment (TPT) substantially reduces the risk of developing active TB for people living with HIV (PLHIV). We utilized a novel implementation strategy based on choice architecture (CAT) which makes TPT prescribing the default option. Through CAT, health care workers (HCWs) need to "opt-out" when choosing not to prescribe TPT to PLHIV. We assessed the prospective, concurrent, and retrospective acceptability of TPT prescribing among HCWs in Malawi who worked in clinics participating in a cluster randomized trial of the CAT intervention.Methods28 in-depth semi-structured interviews were conducted with HCWs from control (standard prescribing approach) and intervention (CAT approach) clinics. The CAT approach was facilitated in intervention clinics using a default prescribing module built into the point-of-care HIV Electronic Medical Record (EMR) system. An interview guide for the qualitative CAT assessment was developed based on the theoretical framework of acceptability and on the normalization process theory. Thematic analysis was used to code the data, using NVivo 12 software.ResultsWe identified eight themes belonging to the three chronological constructs of acceptability. HCWs expressed no tension for changing the standard approach to TPT prescribing (prospective acceptability); however, those exposed to CAT described several advantages, including that it served as a reminder to prescribe TPT and routinized TPT prescribing (concurrent acceptability). Some felt that CAT may reduce HCW´s autonomy and might lead to inappropriate TPT prescribing (retrospective acceptability).ConclusionsThe default prescribing module for TPT has now been incorporated into the point-of-care EMR system nationally in Malawi. This seems to fit the acceptability of the HCWs. Moving forward, it is important to train HCWs on how the EMR can be leveraged to determine who is eligible for TPT and who is not, while acknowledging the autonomy of HCWs.
| S-EPMC10768226 | biostudies-literature
Project description:Symptom research across conditions has historically focused on single symptoms, and the burden of multiple symptoms and their interactions has been relatively neglected especially in people living with HIV. Symptom cluster studies are required to set priorities in treatment planning, and to lessen the total symptom burden. This study aimed to identify and compare symptom clusters among people living with HIV attending five palliative care facilities in two sub-Saharan African countries.Data from cross-sectional self-report of seven-day symptom prevalence on the 32-item Memorial Symptom Assessment Scale-Short Form were used. A hierarchical cluster analysis was conducted using Ward's method applying squared Euclidean Distance as the similarity measure to determine the clusters. Contingency tables, X2 tests and ANOVA were used to compare the clusters by patient specific characteristics and distress scores.Among the sample (N=217) the mean age was 36.5 (SD 9.0), 73.2% were female, and 49.1% were on antiretroviral therapy (ART). The cluster analysis produced five symptom clusters identified as: 1) dermatological; 2) generalised anxiety and elimination; 3) social and image; 4) persistently present; and 5) a gastrointestinal-related symptom cluster. The patients in the first three symptom clusters reported the highest physical and psychological distress scores. Patient characteristics varied significantly across the five clusters by functional status (worst functional physical status in cluster one, p<0.001); being on ART (highest proportions for clusters two and three, p=0.012); global distress (F=26.8, p<0.001), physical distress (F=36.3, p<0.001) and psychological distress subscale (F=21.8, p<0.001) (all subscales worst for cluster one, best for cluster four).The greatest burden is associated with cluster one, and should be prioritised in clinical management. Further symptom cluster research in people living with HIV with longitudinally collected symptom data to test cluster stability and identify common symptom trajectories is recommended.
| S-EPMC4429062 | biostudies-other
Project description:BackgroundUnder- and over nutrition as well as nutrition risk factors such as communicable and non-communicable diseases are a common and major cause of morbidity and mortality in correctional facilities. Consequently, medical nutrition therapy (MNT), a spectrum of nutrition services aimed at optimizing individual well-being, is being recognized as integral to the health of people who experience incarceration. However, there is a paucity of research that explores the delivery of MNT in correctional facilities.MethodsA scoping review combined with secondary analysis of qualitative data (field notes, in-depth stakeholder interviews) from a 2-year ethnographic study about food insecurity and incarceration was undertaken to gain insights about the delivery of corrections-based MNT in Canada. Thematic analysis of all documents was done using an interpretive framework.ResultsAn understanding about MNT was developed within three themes: 1) specialized service provision in a unique environment; 2) challenges with the provision of MNT; and 3) consideration of corrections-based MNT alternatives. An incarcerated individual's nutritional health was conceptualized as culminating from various factors that included dietary intake and health status, enabling environments, access to quality health services, and clinical nutrition services. Nutrition care practices, which range from health promotion to rehabilitation, are challenged by issues of access, visibility, adequacy, and environmental barriers. Their success is dependent on demand (e.g., ability of recipient to act) and factors that enable quality health and food services. Advancing corrections-based MNT will require policies that provide supportive food and health environments and creating sustainable services by integrating alternatives such as peer approaches and telehealth.ConclusionsProfessional associations, government, researchers and other stakeholders can help to strengthen corrections-based MNT by fostering shifts in thinking about the role of health practitioners in these contexts, preparing future health professionals with the specialized skills needed to work in these environments, generating evidence that can best inform practice, and cultivating collaborations aimed at crime prevention, successful societal reintegration, and the reduction of recidivism.
| S-EPMC6359784 | biostudies-literature
Project description:BackgroundTuberculosis screening of people living with HIV (PLHIV) - an intervention to reduce the burden of TB among PLHIV - is being implemented at HIV clinics in Ghana since 2007, but TB screening coverage remains low. Facility adherence to intervention guidelines may be a factor but is missing in implementation science literature. This study assesses the level of HIV clinic adherence to the guidelines and related facility characteristics in selected district hospitals in Ghana.MethodsThis cross-sectional study was conducted in all 27 district hospitals with HIV clinics, X-ray and geneXpert machines in Ghana. These hospitals are in 27 districts representing about 27% of the 100 district hospitals with HIV clinics in Ghana. A data collection tool with 18-items (maximum score of 29) was developed from the TB/HIV collaborative guidelines to assess facility adherence to four interrelated components of the TB screening programme as stated in the guidelines: intensive TB case-finding among PLHIV (ITCF), Isoniazid preventive therapy initiation (IPT), TB infection control (TIC), and programme review meetings (PRM). Data were collected through record review and interviews with 27 key informants from each hospital. Adherence scores per component were summed to determine an overall adherence score per facility and summarized using medians and converted to proportions. Facility characteristics were assessed and compared across facilities with high (above median) versus low (below median) overall adherence scores, using nonparametric test statistics.ResultsFrom the 27 key interviews and facility records reviewed, the median adherence scores for ITCF, IPT, TIC, and PRM components were 85.7% (IQR: 85.5-100.0), 0% (IQR: 0-66.7), 33.3% (IQR: 33.3-50.0), and 90.0% (IQR: 70.0-90.0), respectively. The overall median adherence score was 62.1% (IQR: 58.6-65.1), and 17 clinics (63%) with overall adherence score above the median were categorized as high adherence. Compared to low adherence facilities, high adherence facilities had statistically significant lower PLHIV clinic attendees per month (256 (IQR: 60-904) vs. 900 (IQR: 609-2622); p = 0.042), and lower HIV provider workloads (28.6 (IQR: 8.6-113) vs. 90 (IQR: 66.7-263.5); p = 0.046), and most had screening guidelines (76%, p < 0.01) and questionnaire (80%, p < 0.01) available on-site.ConclusionPRM had highest score while the IPT component had the lowest score. Almost a third of the facilities implemented the TB screening programme activities with a high level of adherence to the guidelines. We suggest to ensure adherence to all four components, reducing staff workloads and making TB screening questionnaires and guidelines available on-site would increase facility adherence to the intervention and ultimately achieve intervention targets.
| S-EPMC8520611 | biostudies-literature
Project description:ObjectiveTo provide an overview of the use of and evidence for eConsult in correctional facilities worldwide.DesignScoping review.Data sourcesThree academic databases (MEDLINE, Embase and CINAHL) were searched to identify papers published between 1990 and 2020 that presented data on eConsult use in correctional facilities. The grey literature was also searched for any resources that discussed eConsult use in correctional facilities. Articles and resources were excluded if they discussed synchronous, patient-to-provider or unsecure communication. The reference lists of included articles were also hand searched.ResultsOf the 226 records retrieved from the academic literature search and 595 from the grey literature search, 22 were included in the review. Most study populations included adult male offenders in a variety of correctional environments. These resources identified 13 unique eConsult services in six countries. Six of these services involved multiple medical specialties, while the remaining services were single specialty. The available evidence was organised into five identified themes: feasibility, cost-effectiveness, access to care, provider satisfaction and clinical impact.ConclusionsThis study identified evidence that the use of eConsult in correctional facilities is beneficial and avoids unnecessary transportation of offenders outside of the facilities. It is feasible, cost-effective, increases access to care, has an impact on clinical care and has high provider satisfaction. Some gaps in the literature remain, and we suggest further research on patient satisfaction, enablers and barriers to implementation, and women, youth and transgender populations in this setting to inform service providers and stakeholders. Despite some gaps, eConsult is evidently an important tool to provide timely, high-quality care to offenders.
| S-EPMC9352998 | biostudies-literature
Project description:BackgroundA 12-dose, once-weekly regimen of isoniazid and rifapentine (3HP) is effective in preventing tuberculosis (TB) among people living with HIV (PLHIV). We sought to identify potential barriers to and facilitators of acceptance and completion of 3HP treatment from the perspective of people living with HIV (PLHIV) and health workers in a routine HIV care setting in Kampala, Uganda.MethodsWe conducted semi-structured interviews with 25 PLHIV and 10 health workers at an HIV/AIDS clinic in Kampala, Uganda. For both groups, we explored their understanding and interpretations of TB and TB preventive therapy (TPT), and perceptions about social and contextual factors that might influence the willingness of PLHIV to initiate and complete 3HP. We analyzed the data using an inductive thematic approach and aligned the emergent themes to the Behavior Change Wheel framework to identify sources of behavior and targeted behavior change interventions.ResultsFacilitators of acceptance and completion of 3HP treatment among PLHIV were fear of contracting TB, awareness of being at risk of getting TB, willingness to take TPT, trust in health workers, and the perceived benefits of directly observed therapy (DOT) and self-administered therapy (SAT) 3HP delivery strategies. Barriers included inadequate understanding of TPT, fear of potential side effects, concerns about the effectiveness of 3HP, and the perceived challenges of DOT or SAT. Among health workers, perceived facilitators included knowledge that TB is a common cause of mortality for PLHIV, fear of getting TB, and trust in the health workers by PLHIV, the advantages of once-weekly 3HP dosing, and the benefits of DOT and SAT 3HP delivery strategies. Health worker-reported barriers for PLHIV included inadequate understanding of TB and benefits of TPT, TB-associated stigma, potential side effects pill burden, and challenges of DOT and SAT 3HP delivery strategies. Lack of experience in the use of digital technology to monitor patient care was identified as a health worker-specific barrier. Identified intervention functions to address the facilitators or barriers included education, persuasion, environmental restructuring, enablement, and training.ConclusionsUsing a formative qualitative and comprehensive theoretical approach, we identified key barriers, facilitators, and appropriate interventions, including patient education, enhancing trust, and patient-centered treatment support that could be used to optimize the delivery of 3HP to PLHIV in our setting. These interventions are likely generalizable to other clinical interventions in similar populations in sub-Saharan Africa and other TB high-burden settings.
| S-EPMC8247167 | biostudies-literature