15 research outputs found
SUPPORTING THE IMPLEMENTATION OF GUIDELINES TO PREVENT MOTHER-TO-CHILD-TRANSMISSION OF HIV IN MALAWI: A QUALITATIVE DESCRIPTIVE CASE STUDY
No full textChifundo Colleta Zimba: Supporting the implementation of guidelines to prevent mother-to-child transmission of HIV in Malawi: A qualitative descriptive case study (Under the direction of Jennifer Leeman) The burden of human immunodeficiency virus (HIV) on women aged 15–49 years is high in Malawi (13%), resulting in HIV transmission to 12,000 children in 2011. Malawi has adopted the Option B+ guidelines which, if fully implemented, could prevent over 95% of HIV cases in children born to HIV-infected women. Because adoption of guidelines is not enough to move science into practice, the UNC Project—a partner organization to the Malawi government—provided prevention support (e.g., training and technical assistance [TA]), to 134 Malawian clinics between 2011 and 2014 to enhance implementation of the Option B+ guidelines. This qualitative, descriptive multiple-case study aimed to describe the types of prevention support the UNC Project provided to 4 clinics, how support varied across low- and high-performing clinics, and factors that may explain variations in Option B+ implementation across clinics (N=4). Data were gathered through 21 in-depth interviews with 18 key stakeholders (n=6 TA providers and n=12 care providers). Observation supplemented data from in-depth-interviews. Directed content, thematic, and cross-case analyses were used to analyze data. The study found that the UNC Project used the following prevention support strategies: off-site trainings of the service providers; ongoing, onsite TA that employed collaborative and audit and feedback approaches; tools such as standard operating procedures (SOPs); and resources such as HIV testing kits. Variations occurred in TA dose (i.e., time TA providers spent on guidelines activities in the clinic and community) and on TA focus (i.e., the unit where TA providers spent more hours). All four clinics reported full implementation of most of the Option B+ guideline core components. Implementation gaps were found on community mobilization, documentation, and components done during the post-delivery period. Staffing and transportation emerged as the most salient contextual factors influencing TA delivery while size of the clinic staff, service space/infrastructure, stocks of the HIV testing kits, and magnitude of the served population explained differences in guideline implementation between low- and high-performing clinics. Results of this study can help advance understanding of the way prevention support enhances implementation of new evidence-based interventions and contextual factors that may need to be addressed.Doctor of Philosoph
Perceived implementation of guidelines to prevent mother-to-child transmission of HIV in Malawi: A qualitative multiple case study
No full textSession presented on Thursday, July 21, 2016 and Friday, July 22, 2016:
Purpose: To describe the extent to which four rural Malawi clinics implemented the core components of the 2011 Malawian Option B+ guidelines following three years of an extensive implementation support program.
Methods: This study used a descriptive multiple case-study design. N=4 clinics were purposefully sampled from a total population of 134 health facilities. Of the 4, n=2 fell into the highest while n=2 into the lowest quartile of the proportion of eligible women who were tested for HIV in Fiscal Year 2012-2013. In-depth interviews were done with 18 informants who were actively involved in either implementing (n=12) or providing support for implementation (e.g., technical assistance, tools; n=6) of the guidelines at the study clinics. To assess perceived implementation of the guidelines at clinic level, all informants were asked to what extent the study clinics were carrying out each of the core components of the Option B+ guidelines. Responses were ranked from 0 to 3, with 0 assigned when the interviewee reported that the component was never implemented and 3 when always implemented as specified by the guidelines. Each clinic\u27s responses were then averaged for each item to create a final score. Clinics were coded as HP-1, HP-2, LP-1 and LP-2.
Results: All four clinics reported full implementation of most of the core components. Self-rating of implementation ranged from 2.3 to 2.8 on a scale of 3.0. An outstanding performance was reported to have occurred at HP-2 clinic with an overall score of 2.8 while both LP clinics reported scores of 2.3. A critical assessment of each of the core components across all the four study sites showed that all but HP-2 clinic minimally conducted community sensitization and mobilization activities; both LP clinics failed to fully identify and ascertain HIV status of the HIV exposed children at 6 weeks, 12, and 24 months; and all but the LP-1 clinic reported documentation problems.
Conclusion: After three years of implementation of the Option B+ guidelines with an aid of extensive supporting strategies, all four Malawian rural clinics reported full implementation of most of the core components of the implemented guidelines. On a scale of 0 to 3, self-rating of implementation ranged from 2.3 to 2.8. Documentation of rendered activities; failure to fully sensitize and mobilize the served communities; and failure to identify and ascertain HIV status of the HIV exposed children are gaps that exist in implementation of the Option B+ guidelines. If communities are not well informed, fewer women in need of ART will benefit from the implemented guidelines which could lead to many babies contacting HIV infection from their mothers. Failure to properly document the rendered activities and identify and test the HIV-exposed children as per guidelines hindered clinics\u27 ability to assess the impact of the Option B+ guidelines on Maternal transmission of HIV. Further research is required to test implementation support strategies that may enhance community awareness, quality documentation and early identification of HIV exposed children in order to prevent mother-to-child transmission of HIV in Malawi
Psychosocial interventions among patients with cancer and their family caregivers in the Sub-Saharan Region: A systematic review
No full textCancer is becoming a public health issue in the Sub-Saharan Africa (SSA).
This systematic review aims to synthesise psychosocial interventions and
their effects on the health outcomes of adult cancer patients and their
family caregivers in SSA. We identified eligible publications in English
language from PubMed, Cumulative Index of Nursing and Allied Health
Literature Plus with Full Text, Embase, APA PsycInfo, Scopus, and
African Index Medicus databases. We included psychosocial
interventions targeted adult cancer patients/survivors or their family
caregivers in SSA. This review identified five psychosocial interventions
from six studies that support adult cancer patients and their family
caregivers in SSA. The interventions focused on providing informational,
psycho-cognitive, and social support. Three interventions significantly
improved quality of life outcomes for cancer patients and their
caregivers. Significant gaps exist between the rapidly increasing cancer
burdens and the limited psychosocial educational interventions
supporting adult cancer patients and their families in SSA. The reviewed
studies provide preliminary evidence on development and testing
interventions that aim to improve patients’ and caregivers’ quality of life
Quality of life among patients with cancer and their family caregivers in the Sub-Saharan region: A systematic review of quantitative studies.
No full textGuided by the World Health Organization quality of life (WHOQOL) framework, this systematic review aimed to examine evidence about the prevalence and severity of QOL-related health problems and their influencing factors in Sub-Saharan Africa (SSA). We identified eligible publications in English language from PubMed, Cumulative Index of Nursing and Allied Health Literature Plus with Full Text, Embase, APA PsycInfo, Scopus, and African Index Medicus databases. We included quantitative descriptive studies that measured overall and subdomains of QOL as the outcome in adult patients/survivors with cancer in SSA. Twenty-six descriptive cross-sectional studies (27 papers) that were conducted since 1988 in different SSA countries among patients with various types of cancer met our inclusion criteria. We found inconsistencies in how the prevalence and severity of QOL-related health problems have been researched and reported across studies, which complicated comparing findings and drawing conclusions. The most common factors that influenced the overall and subdomains of QOL included coping; internal and external locus of control; symptoms and symptom management; and religious beliefs and religious care. Demographics (e.g., age and marital status), cancer-related factors (cancer stage and type of treatment), and social determinants of health (e.g., education, access to information and resources, financial distress, and urban vs rural residency) also impacted QOL and its subdomains. Our findings indicate the significant need for recognizing and managing QOL-related problems for cancer patients and caregivers in SSA. Research needs to use culturally adapted, standardized assessment tools and analysis approaches to better understand the QOL challenges this population faces. Comprehensive supportive care is needed to address the complex QOL issues in resource-limited SSA
Barriers and potential solutions for effective integration of depression care into non-communicable diseases clinics in Malawi: a qualitative end-point evaluation of the SHARP randomized controlled trial
No full textBackground The sub-Saharan African Regional Partnership for mental health and capacity building (SHARP) study was a clinic-randomized trial of two implementation strategies for integrating depression screening and treatment into non-communicable diseases’ (NCD) clinics in Malawi between 2019 and 2022. We report on the barriers to implementing depression care integration at SHARP study sites and potential solutions. Methods N = 39 in-depth interviews with participants from all ten sites were conducted, recorded, transcribed, coded in NVivo 12 and analyzed by qualitative experts. We used thematic analysis to identify implementation challenges and potential solutions. The Consolidated Framework for Implementation Research helped to develop guides and organize the results. Results Outer setting barriers included high workload (due to high patient volume, increased paperwork, shortage of staff), the effects of coronavirus disease 2019 (COVID-19) pandemic, staff turnover and negative provider attitudes. Limited clinic space arose as an inner setting barrier. Workload can be overcome by increasing the number of NCD personnel, decentralizing the depression/NCD services and integrating mental health and NCD documents (implementation process). The COVID-19 pandemic presented unique challenges including fear of interpersonal contact and changes in scheduling staff that were difficult to overcome in the short term. To deal with the effects of staff turnover, participants identified the need for continuous depression training to new providers. Lobbying for more rooms from leadership can address concerns of limited space. To reduce negative provider attitudes, participants urged facility leadership to make themselves available for consultations and mentorship and to provide continuous learning opportunities such as refresher trainings. Conclusion The experience in the SHARP study highlights the need for a culture of continuous learning and adaptation in healthcare settings, enabling the development of strategies to overcome evolving challenges. Planning for the integration of mental health and NCD care should extend beyond immediate challenges and consider long-term goals and sustainability.Trial registrationThis study reports part of the findings from the endpoint evaluation of the SHARP clinical trial that is registered at ClinicalTrials.gov, NCT03711786 first posted 20,181,018
Community Stakeholders’ Perspectives on Recruiting Young Adolescents (Age 10–14) in Sexual Health Research
No full textBackground/Objectives: Sexual health research involving young adolescents remains scarce despite rising rates of early sexual debut, pregnancies, and sexually transmitted infections (STIs) in this population. We explored community stakeholders’ perspectives on engaging young adolescents in sexual health research in Western New York to inform strategies for engaging young adolescents in sexual health research. Methods: This qualitative descriptive study was conducted from April 2022 to June 2023. Seventeen community stakeholders, including health education teachers, youth counselors, and adolescent health providers, participated in semi-structured in-depth interviews. Data were analyzed using conventional content analysis, managed by MAXQDA 2020. The rigor and trustworthiness of the data were ensured through triangulation with observations, peer debriefing, team analysis, and respondent validation. Results: Participants were predominantly female (94.1%), 52.9% Black/African American, 41.2% White, and 5.9% Caucasian–Indian American, and aged 23–59 years. Four themes emerged: perspectives on conducting sexual health research with young adolescents, recruitment strategies, sexual health questions appropriate for young adolescents, and building readiness for participation in sexual health research. Participants reported the need for sexual health research with young adolescents and recommended building a trusting relationship and involving schools, parents, and trusted community organizations in the research process. Suggested research questions included those related to awareness of sex, STIs, available resources, experiences with sexual education, and desired support. The findings also revealed the need to initiate sexual health conversations early when children start asking questions, as a foundation for meaningful participation in sexual health research. Conclusions: The findings suggest that sexual health research with young adolescents is feasible and necessary, with implications for the design of developmentally appropriate sexual health research and interventions grounded in trust and community collaboration. Future research should explore the perspectives of caregivers and young adolescents to inform studies and programs that are attuned to young adolescents’ developmental needs
Facilitators, barriers and potential solutions to the integration of depression and non-communicable diseases (NCDs) care in Malawi: a qualitative study with service providers
No full textAbstract Background Integration of depression services into infectious disease care is feasible, acceptable, and effective in sub-Saharan African settings. However, while the region shifts focus to include chronic diseases, additional information is required to integrate depression services into chronic disease settings. We assessed service providers’ views on the concept of integrating depression care into non-communicable diseases’ (NCD) clinics in Malawi. The aim of this analysis was to better understand barriers, facilitators, and solutions to integrating depression into NCD services. Methods Between June and August 2018, we conducted nineteen in-depth interviews with providers. Providers were recruited from 10 public hospitals located within the central region of Malawi (i.e., 2 per clinic, with the exception of one clinic where only one provider was interviewed because of scheduling challenges). Using a semi structured interview guide, we asked participants questions related to their understanding of depression and its management at their clinic. We used thematic analysis allowing for both inductive and deductive approach. Themes that emerged related to facilitators, barriers and suggested solutions to integrate depression assessment and care into NCD clinics. We used CFIR constructs to categorize the facilitators and barriers. Results Almost all providers knew what depression is and its associated signs and symptoms. Almost all facilities had an NCD-dedicated room and reported that integrating depression into NCD care was feasible. Facilitators of service integration included readiness to integrate services by the NCD providers, availability of antidepressants at the clinic. Barriers to service integration included limited knowledge and lack of training regarding depression care, inadequacy of both human and material resources, high workload experienced by the providers and lack of physical space for some depression services especially counseling. Suggested solutions were training of NCD staff on depression assessment and care, engaging hospital leaders to create an NCD and depression care integration policy, integrating depression information into existing documents, increasing staff, and reorganizing clinic flow. Conclusion Findings of this study suggest a need for innovative implementation science solutions such as reorganizing clinic flow to increase the quality and duration of the patient-provider interaction, as well as ongoing trainings and supervisions to increase clinical knowledge. Trial registration This study reports finding of part of the formative phase of “The Sub-Saharan Africa Regional Partnership (SHARP) for Mental Health Capacity Building—A Clinic-Randomized Trial of Strategies to Integrate Depression Care in Malawi” registered as NCT0371178
