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Muddu M, Jaffari A, Brant LCC, Kiplagat J, Okello E, Masyuko S, Su Y, Longenecker CT. Lifting all boats: strategies to promote equitable bidirectional research training opportunities to enhance global health reciprocal innovation. BMJ Glob Health 2023; 8:e013278. [PMID: 38103895 PMCID: PMC10729234 DOI: 10.1136/bmjgh-2023-013278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/28/2023] [Indexed: 12/19/2023] Open
Abstract
Inequities in global health research are well documented. For example, training opportunities for US investigators to conduct research in low-income and middle-income countries (LMIC) have exceeded opportunities for LMIC investigators to train and conduct research in high-income countries. Reciprocal innovation addresses these inequities through collaborative research across diverse global settings.The Fogarty International Center of the US National Institutes of Health (NIH) promotes research capacity building in LMICs. Fogarty K-grants for mentored career development in global health are available for both US and LMIC investigators, whereas the D43 is the standard grant to support institutional training programmes in LMIC. Other NIH institutes fund T32 training grants to support biomedical research training in the USA, but very few have any global health component. Most global health training partnerships have historically focused on research conducted solely in LMIC, with few examples of bidirectional training partnerships. Opportunities may exist to promote global health reciprocal innovation (GHRI) research by twinning K-awardees in the USA with those from LMIC or by intentionally creating partnerships between T32 and D43 training programmes.To sustain independent careers in GHRI research, trainees must be supported through the path to independence known as the K (mentored grantee)-to-R (independent grantee) transition. Opportunities to support this transition include comentorship, research training at both LMIC and US institutions and protected time and resources for research. Other opportunities for sustainability include postdoctoral training before and after the K-award period, absorption of trained researchers into home institutions, South-South training initiatives and innovations to mitigate brain drain.
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Affiliation(s)
- Martin Muddu
- Makerere University School of Medicine, Kampala, Uganda
| | - Adiya Jaffari
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Luisa C C Brant
- Faculty of Medicine and Hospital das Clínicas Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Jepchirchir Kiplagat
- Moi University College of Health Sciences, Eldoret, Kenya
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Emmy Okello
- Makerere University School of Medicine, Kampala, Uganda
- Uganda Heart Institute Ltd, Kampala, Uganda
| | - Sarah Masyuko
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Yanfang Su
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Chris Todd Longenecker
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
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Ishimwe MCS, Kiplagat J, Kadam Knowlton A, Livinski AA, Kupfer LE. Reversing the trend: a scoping review of health innovation transfer or exchange from low- and middle-income countries to high-income countries. BMJ Glob Health 2023; 8:e013583. [PMID: 37967892 PMCID: PMC10660955 DOI: 10.1136/bmjgh-2023-013583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/21/2023] [Indexed: 11/17/2023] Open
Abstract
The transfer of innovations from low and middle-income countries (LMICs) to high-income countries (HICs) has received little attention, leaving gaps in the understanding of the process, its benefits and the factors influencing it. This scoping review, part of a National Institutes of Health (NIH) project and the focus for a 2022 NIH-sponsored workshop on Global Health Reciprocal Innovation, sought to identify publications describing health innovations that were researched, developed and implemented in LMICs and adapted to address similar health challenges in HICs. A protocol was written a priori and registered on Open Science Framework. Four databases were searched for articles published in English from 2000 to 2022 and described health innovations developed in LMICs and were transferred to HICs. Using Covidence, two reviewers initially screened the title and abstract and then the full text; discrepancies were resolved through discussion. Two reviewers collected the data from each article using Covidence and Microsoft Excel; discrepancies were resolved by a separate third reviewer. 7191 records were retrieved and screened of which 12 studies were included. Various frameworks and methodologies were employed in these studies, with a particular emphasis on adaptation and adoption of innovations. The review uncovered different paradigms of LMIC to HIC innovation transfer and exchange, including unidirectional transfers from LMICs to HICs as well as bidirectional or multidirectional mutually beneficial exchanges. The use of both qualitative and quantitative data collection methods was common across all the included articles. Facilitators for innovation transfers included stakeholder engagement, relevance of local context, simplicity, and sufficient funding, promotion and branding. Barriers to transfers were mostly the opposite of the facilitators. Our results highlighted the underexplored field of LMIC to HIC innovation transfer and exchange and lay the foundation for future research studies.
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Affiliation(s)
| | - Jepchirchir Kiplagat
- College of Health Sciences, Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Arina Kadam Knowlton
- Center for Global Health Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Alicia A Livinski
- Division of Library Services, Office of Research Services, National Institutes of Health, Bethesda, Maryland, USA
| | - Linda E Kupfer
- Center for Global Health Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
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Das A, Dixit S, Kumar Barik M, Ghosal J, Babu B, Bal M, Ranjit M. Knowledge and perception related to sickle cell disease among tribal community, India: A mixed-method study. J Natl Med Assoc 2023; 115:441-453. [PMID: 37407379 DOI: 10.1016/j.jnma.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/14/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) is a public health problem. In absence of a pan-country intervention program in India, SCD prevalence is ascending without control. Since knowledge and perception of a community is a prerequisite for developing an intervention strategy, the current study was designed to assess it in a high SCD burden tribal-dominated district of Odisha. METHODS A mixed-method study combining qualitative and quantitative methods was conducted in the Kandhamal district, Odisha, India. A cross-sectional survey was conducted among randomly selected 1600 individuals, using a pre-tested questionnaire and 26 in-depth interviews were conducted with key informants. RESULTS Although 74.2% of the participants in the studied area had heard about the disease, only 13.6% know the cause of the disease. 69% had the knowledge to opt for modern medication. However, treatment compliance was poor, patients resort to using medications only during the crisis stage. Individuals who had knowledge about disease aetiology got to know about SCD from lived experiences of themselves, close relatives, or villagers and rarely from health workers. The community members had no clarity regarding which health centre to be approached for routine medication and management of SCD crisis. CONCLUSION The area is endemic for SCD, yet, the community lacks knowledge about the cause and treatment modality of the disease. In addition, currently there is no government-run intervention programme for screening and management of SCD related morbidity. Hence, a community based intervention strategy needs to be implemented urgently for enhancing the knowledge, perception, and aptitude related to SCD.
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Affiliation(s)
- Arundhuti Das
- Indian Council of Medical Research-Regional Medical Research Centre, Chandreashekharpur, Bhubaneswar-751023, Odisha, India
| | - Sujata Dixit
- Indian Council of Medical Research-Regional Medical Research Centre, Chandreashekharpur, Bhubaneswar-751023, Odisha, India
| | - Manas Kumar Barik
- Indian Council of Medical Research-Regional Medical Research Centre, Chandreashekharpur, Bhubaneswar-751023, Odisha, India
| | - Jyoti Ghosal
- Indian Council of Medical Research-Regional Medical Research Centre, Chandreashekharpur, Bhubaneswar-751023, Odisha, India
| | - Bontha Babu
- Indian Council of Medical Research, Ansari Nagar, New Delhi- 110029
| | - Madhusmita Bal
- Indian Council of Medical Research-Regional Medical Research Centre, Chandreashekharpur, Bhubaneswar-751023, Odisha, India.
| | - Manoranjan Ranjit
- Indian Council of Medical Research-Regional Medical Research Centre, Chandreashekharpur, Bhubaneswar-751023, Odisha, India.
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Al Mohajer M. Designing a Local Policy to Reduce HIV in Mexico City. Avicenna J Med 2023; 13:187-191. [PMID: 37799182 PMCID: PMC10550362 DOI: 10.1055/s-0043-1773791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
The Joint United Nations Program on human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) (Joint United Nations Program on HIV/AIDS, UNAIDS) has recommended 90-90-90 goals to increase the number of patients who are aware of their status, on antiretroviral therapy, and have undetectable viral loads. Mexico City has made several achievements to aid in prevention, early diagnosis, and treatment; however, the incidence of HIV has not decreased over the past decade. This article reviews global initiatives that were successful in achieving some or all these metrics and provide a road map for Mexico to reach the desired goals.
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Affiliation(s)
- Mayar Al Mohajer
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, United States
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Global Learning for Health Equity: A Literature Review. Ann Glob Health 2022; 88:89. [DOI: 10.5334/aogh.3810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/04/2022] [Indexed: 11/20/2022] Open
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Allaham S, Kumar A, Morriss F, Lakhanpaul M, Wilson E, Sikorski C, Martin J, Costello A, Manikam L, Heys M. Participatory learning and action (PLA) to improve health outcomes in high-income settings: a systematic review protocol. BMJ Open 2022; 12:e050784. [PMID: 35228277 PMCID: PMC8886484 DOI: 10.1136/bmjopen-2021-050784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Participatory learning and action (PLA) is a form of group reflection and learning with documented efficacy in low-income countries to improve social and health outcomes. PLA represents both a learning philosophy and a practical framework that could be applied to a variety of contexts. To date, PLA has not been widely implemented within high-income countries (HICs) to improve health and health-related outcomes. We aim to synthesise the literature currently available by means of a systematic review to form a foundation for future applications of PLA methodology in HICs. METHODS AND ANALYSIS Two reviewers will independently search predefined terms in the following electronic bibliographic databases: MEDLINE, EMBASE, CINAHL and Cochrane Library. The search terms will encompass PLA and PDSA (Plan-Do-Study-Act) projects, as well as studies using the Triple/Quadruple Aim model. We will include randomised controlled trials that incorporate online or face-to-face components using the PLA/PDSA methodology. Our data will be extracted into a standardised prepiloted form with subsequent narrative review according to the SWiM (Synthesis Without Meta-Analysis) guidelines. ETHICS AND DISSEMINATION No ethics approval is required for this study. The results of this study will be submitted for publication in a leading peer-reviewed academic journal in this field. Additionally, a report will be produced for the funders of this review, which can be viewed for free on their website. PROSPERO REGISTRATION NUMBER CRD42020187978.
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Affiliation(s)
- Shereen Allaham
- Department of Epidemiology and Public Health, University College London Institute of Epidemiology and Health Care, London, UK
- Aceso Global Health Consultants, London, UK
| | - Ameeta Kumar
- Royal Berkshire NHS Foundation Trust, Reading, UK
| | | | - Monica Lakhanpaul
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
- Whittington Health NHS Trust, London, UK
| | - Emma Wilson
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Catherine Sikorski
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jennifer Martin
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Anthony Costello
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Logan Manikam
- Department of Epidemiology and Public Health, University College London Institute of Epidemiology and Health Care, London, UK
- Aceso Global Health Consultants, London, UK
| | - Michelle Heys
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
- Specialist Children's and Young People's Services, East London NHS Foundation Trust, London, UK
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Sisson N, Starke J. Promotores de Salud in Montana: An Analysis of a Rural Health Care Intervention Rooted in Catholic Social Teaching and its Place in Medical Curricula. Linacre Q 2022; 89:21-35. [PMID: 35321492 PMCID: PMC8935425 DOI: 10.1177/00243639211059346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The Latino population in the United States faces significant health disparities compared to their White counterparts. Community-based processes in Gallatin County, Montana, through academic-community partnerships have identified strategies to overcome these barriers. One such strategy includes the utilization of community health workers (CHWs) in the Latino population-in Spanish, "Promotores de Salud." CHWs are often selected to target community health problems because they share the cultural, social, and demographic features of the population they serve. This paper explores the inherent ties between Catholic Social Teaching and the CHW health care model while focusing on a community-academic partnership in Montana that is implementing a CHW program. Catholic health care providers are called to apply CST principles to their health care systems and communities in order to achieve health equity for their patients. This paper proposes that community organizing and advocacy should be taught in medical school curricula across the country in order to promote physician involvement in solving public health disparities. Additionally, the authors suggest that practicing Catholic health care providers immediately incorporate community organizing through the use of CHWs to attain health equity for their patient panels.
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Affiliation(s)
- Nathaniel Sisson
- School of Medicine, University of Washington, Seattle, WA, USA,Nathaniel Sisson, School of Medicine, University of Washington, 1959 NE Pacific St, A-300 Health Sciences Center, Box 356340, Seattle, WA 98195-0005, USA.
| | - Jenna Starke
- School of Medicine, University of Washington, Seattle, WA, USA
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Ndayizigiye M, Allan-Blitz LT, Dally E, Abebe S, Andom A, Tlali R, Gingras E, Mokoena M, Msuya M, Nkundanyirazo P, Mohlouoa T, Mosebo F, Motsamai S, Mabathoana J, Chetane P, Ntlamelle L, Curtain J, Whelley C, Birru E, McBain R, Andrea DM, Schwarz D, Mukherjee JS. Improving access to health services through health reform in Lesotho: Progress made towards achieving Universal Health Coverage. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000985. [PMID: 36962564 PMCID: PMC10021396 DOI: 10.1371/journal.pgph.0000985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 10/06/2022] [Indexed: 11/17/2022]
Abstract
In 2014 the Kingdom of Lesotho, in conjunction with Partners In Health, launched a National Health Reform with three components: 1) improved supply-side inputs based on disease burden in the catchment area of each of 70 public primary care clinics, 2) decentralization of health managerial capacity to the district level, and 3) demand-side interventions including paid village health workers. We assessed changes in the quarterly average of quality metrics from pre-National Health Reform in 2013 to 2017, which included number of women attending their first antenatal care visit, number of post-natal care visits attended, number of children fully immunized at one year of age, number of HIV tests performed, number of HIV infection cases diagnosed, and the availability of essential health commodities. The number of health centers adequately equipped to provide a facility-based delivery increased from 3% to 95% with an associated increase in facility-based deliveries from 2% to 33%. The number of women attending their first antenatal and postnatal care visits rose from 1,877 to 2,729, and 1,908 to 2,241, respectively. The number of children fully immunized at one year of life increased from 191 to 294. The number of HIV tests performed increased from 5,163 to 12,210, with the proportion of patients living with HIV lost to follow-up falling from 27% to 22%. By the end of the observation period, the availability of essential health commodities increased to 90% or above. Four years after implementation of the National Health Reform, we observed increases in antenatal and post-natal care, and facility-based deliveries, as well as child immunization, and HIV testing and retention in care. Improved access to and utilization of primary care services are important steps toward improving health outcomes, but additional longitudinal follow-up of the reform districts will be needed.
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Affiliation(s)
| | - Lao-Tzu Allan-Blitz
- Division of Global Health Equity: Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States of America
| | - Emily Dally
- Partners In Health, Boston, Massachusetts, United States of America
| | | | - Afom Andom
- Partners In Health, Boston, Massachusetts, United States of America
| | | | | | | | - Meba Msuya
- Partners In Health, Boston, Massachusetts, United States of America
| | | | | | | | | | | | | | | | - Joel Curtain
- Partners In Health, Boston, Massachusetts, United States of America
| | - Collin Whelley
- Homebase Center for Common Concerns, San Francisco, California, United States of America
| | - Ermyas Birru
- University of Washington, Seattle, Washington, United States of America
| | - Ryan McBain
- RAND Corporation, Boston, Massachusetts, United States of America
| | - Di Miceli Andrea
- Analysis Group Inc., Boston, Massachusetts, United States of America
| | - Dan Schwarz
- Division of Global Health Equity: Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Ariadne Labs, Boston, Massachusetts, United States of America
| | - Joia S Mukherjee
- Division of Global Health Equity: Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Partners In Health, Boston, Massachusetts, United States of America
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Raymondville M, Rodriguez CA, Richterman A, Jerome G, Katz A, Gilbert H, Anderson G, Joseph JP, Franke MF, Ivers LC. Barriers and facilitators influencing facility-based childbirth in rural Haiti: a mixed method study with a convergent design. BMJ Glob Health 2021; 5:bmjgh-2020-002526. [PMID: 32830129 PMCID: PMC7445336 DOI: 10.1136/bmjgh-2020-002526] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/03/2020] [Accepted: 07/05/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction Haiti has the highest maternal mortality rate in the Western Hemisphere. Facility-based childbirth is promoted as the standard of care for reducing maternal and neonatal mortality. We conducted a convergent, mixed methods study to assess barriers and facilitators to facility-based childbirth at Hôpital Universitaire de Mirebalais (HUM) in Mirebalais, Haiti. Methods We conducted secondary analyses of a prospective cohort of pregnant women seeking antenatal care at HUM and quantitatively assessed predictors of not having a facility-based childbirth at HUM. We prospectively enrolled 30 pregnant women and interviewed them about their experiences delivering at home or at HUM. Results Of 1105 pregnant women seeking antenatal care at the hospital between May and December 2017, 773 (70%) returned to the hospital for facility-based childbirth. In multivariable analyses, living farther from the hospital (adjusted OR (AOR)=0.73; 95% CI 0.56 to 0.96), poverty (AOR=0.93; 95% CI 0.88 to 0.99) and household hunger (AOR=0.45; 95% CI 0.26 to 0.79) were associated with not having a facility-based childbirth. Primigravid women were more likely to have a facility-based childbirth (AOR=1.34, 95% CI 1.02 to 1.76). Qualitative data provided insight into the value women place on traditional birth attendants (‘matrons’) during home-based childbirths. While women perceived facility-based childbirths as better equipped to handle birth complications, barriers such as distance, costs of transportation and supplies, discomfort of facility birthing practices and mistreatment by medical staff resulted in negative perceptions of facility-based childbirths. Conclusion Pregnant women in rural Haiti must overcome substantial structural barriers and forfeit valued support from traditional birth attendants when they pursue facility-based childbirths. If traditional birth attendants could be involved in care alongside midwives at facilities, women may be more inclined to deliver there. While complex structural barriers remain, the inclusion of matrons at facilities may increase uptake of facility-based childbirths, and ultimately improve maternal and neonatal outcomes.
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Affiliation(s)
- Maxi Raymondville
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA .,Zanmi Lasante, Partners In Health, Port-au-Prince, Haiti
| | - Carly A Rodriguez
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Aaron Richterman
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA.,Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gregory Jerome
- Zanmi Lasante, Partners In Health, Port-au-Prince, Haiti
| | - Arlene Katz
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Hannah Gilbert
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | | | - Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Louise C Ivers
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
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Sprague Martinez L, Davoust M, Rajabiun S, Baughman A, Bachman SS, Bowers-Sword R, Campos Rojo M, Sullivan M, Drainoni ML. "Part of getting to where we are is because we have been open to change" integrating community health workers on care teams at ten Ryan White HIV/AIDS program recipient sites. BMC Public Health 2021; 21:922. [PMID: 33990190 PMCID: PMC8120741 DOI: 10.1186/s12889-021-10943-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/28/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Community Health Workers (CHWs) have long been integrated in the delivery of HIV care in middle- and low-income countries. However, less is known about CHW integration into HIV care teams in the United States (US). To date, US-based CHW integration studies have studies explored integration in the context of primary care and patient-centered medical homes. There is a need for research related to strategies that promote the successful integration of CHWs into HIV care delivery systems. In 2016, the Health Resources and Services Administration HIV/AIDS Bureau launched a three-year initiative to provide training, technical assistance and evaluation for Ryan White HIV/AIDS Program (RWHAP) recipient sites to integrate CHWs into their multidisciplinary care teams, and in turn strengthen their capacity to reach communities of color and reduce HIV inequities. METHODS Ten RWHAP sites were selected from across eight states. The multi-site program evaluation included a process evaluation guided by RE-AIM to understand how the organizations integrated CHWs into their care teams. Site team members participated in group interviews to walk-the-process during early implementation and following the program period. Directed content analysis was employed to examine program implementation. Codes developed using implementation strategies outlined in the Expert Recommendations for Implementing Change project were applied to group interviews (n = 20). FINDINGS Implementation strategies most frequently described by sites were associated with organizational-level adaptations in order to integrate the CHW into the HIV care team. These included revising, defining, and differentiating professional roles and changing organizational policies. Strategies used for implementation, such as network weaving, supervision, and promoting adaptability, were second most commonly cited strategies, followed by training and Technical Assistance strategies. CONCLUSIONS Wrapped up in the implementation experience of the sites there were some underlying issues that pose challenges for healthcare organizations. Organizational policies and the ability to adapt proved significant in facilitating CHW program implementation. The integration of the CHWs in the delivery of HIV care requires clearly distinguishing their role from the roles of other members of the healthcare delivery team.
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Affiliation(s)
- Linda Sprague Martinez
- Center for Innovation in Social Work in Health, Boston University School of Social Work, 264 Baystate Road, Boston, MA, 02215, USA.
| | - Melissa Davoust
- Department of Health Law, Policy and Management at Boston University School of Public Health, Boston, USA
| | - Serena Rajabiun
- Center for Innovation in Social Work in Health, Boston University School of Social Work, 264 Baystate Road, Boston, MA, 02215, USA
- Department of Public Health, University of Massachusetts, Lowell, USA
| | - Allyson Baughman
- Center for Innovation in Social Work and Health, Boston University School of Social Work, Boston, USA
| | - Sara S Bachman
- School of Social Policy and Practice at the University of Pennsylvania, Philadelphia, USA
| | | | - Maria Campos Rojo
- Center for Innovation in Social Work in Health, Boston University School of Social Work, 264 Baystate Road, Boston, MA, 02215, USA
| | - Marena Sullivan
- Center for Innovation in Social Work in Health, Boston University School of Social Work, 264 Baystate Road, Boston, MA, 02215, USA
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, School of Medicine & Department of Health Law Policy, School of Public Health, Boston University, Boston, USA
- Evans Center for Implementation and Improvement Science, Boston University, Boston, USA
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Louart S, Bonnet E, Ridde V. Is patient navigation a solution to the problem of "leaving no one behind"? A scoping review of evidence from low-income countries. Health Policy Plan 2021; 36:101-116. [PMID: 33212491 PMCID: PMC7938515 DOI: 10.1093/heapol/czaa093] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2020] [Indexed: 12/25/2022] Open
Abstract
Patient navigation interventions, which are designed to enable patients excluded from health systems to overcome the barriers they face in accessing care, have multiplied in high-income countries since the 1990s. However, in low-income countries (LICs), indigents are generally excluded from health policies despite the international paradigm of universal health coverage (UHC). Fee exemption interventions have demonstrated their limits and it is now necessary to act on other dimensions of access to healthcare. However, there is a lack of knowledge about the interventions implemented in LICs to support the indigents throughout their care pathway. The aim of this paper is to synthesize what is known about patient navigation interventions to facilitate access to modern health systems for vulnerable populations in LICs. We therefore conducted a scoping review to identify all patient navigation interventions in LICs. We found 60 articles employing a total of 48 interventions. Most of these interventions targeted traditional beneficiaries such as people living with HIV, pregnant women and children. We utilized the framework developed by Levesque et al. (Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health 2013;12:18) to analyse the interventions. All acted on the ability to perceive, 34 interventions on the ability to reach, 30 on the ability to engage, 8 on the ability to pay and 6 on the ability to seek. Evaluations of these interventions were encouraging, as they often appeared to lead to improved health indicators and service utilization rates and reduced attrition in care. However, no intervention specifically targeted indigents and very few evaluations differentiated the impact of the intervention on the poorest populations. It is therefore necessary to test navigation interventions to enable those who are worst off to overcome the barriers they face. It is a major ethical issue that health policies leave no one behind and that UHC does not benefit everyone except the poorest.
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Affiliation(s)
- Sarah Louart
- Univ. Lille, CNRS, UMR 8019 - CLERSE - Centre Lillois d’Études et de Recherches sociologiques et Économiques, F-59000 Lille, France
| | - Emmanuel Bonnet
- Institute for Research on Sustainable Development, UMI Résiliences 236, Bondy, France
| | - Valéry Ridde
- Institute for Research on Sustainable Development, CEPED (IRD-Université de Paris), Université de Paris, ERL INSERM SAGESUD, 45 Rue des Saints-Pères, Paris 75006, France
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Roland KB, Higa DH, Leighton CA, Mizuno Y, DeLuca JB, Koenig LJ. HIV Patient Navigation in the United States: A Qualitative Meta-Synthesis of Navigators' Experiences. Health Promot Pract 2020; 23:74-85. [PMID: 33356623 DOI: 10.1177/1524839920982603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patient navigation is increasingly used to link and (re)engage persons with human immunodeficiency virus (HIV) to care. A more holistic understanding of patient navigation can be achieved by exploring the experiences of navigators, the persons who comprise half of the navigation process. We conducted a meta-synthesis of navigator experiences with HIV patient navigation using a phenomenological approach. We identified nine relevant studies. Data were analyzed using thematic synthesis. Analysis identified two overarching themes relating to (1) the breadth and depth of bidirectional relationships and functional activities that navigators undertake to connect their clients to care and (2) the inherently personal experience of delivering navigation services. From these thematic findings, we recommend that HIV patient navigators exhibit capacity and expertise in developing and maintaining interpersonal relationships with clients and health care systems/providers and develop self-care practices and emotional boundaries with clients. Our review seeks to advance public health research and practice by articulating key experiences and perspectives of HIV patient navigators, drawing findings and recommendations applicable to the development, implementation, and evaluation of HIV patient navigation.
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Affiliation(s)
| | - Darrel H Higa
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Yuko Mizuno
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Julia B DeLuca
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Linda J Koenig
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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13
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Harvey M, Neff J, Knight KR, Mukherjee JS, Shamasunder S, Le PV, Tittle R, Jain Y, Carrasco H, Bernal-Serrano D, Goronga T, Holmes SM. Structural competency and global health education. Glob Public Health 2020; 17:341-362. [PMID: 33351721 DOI: 10.1080/17441692.2020.1864751] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Structural competency is a new curricular framework for training health professionals to recognise and respond to disease and its unequal distribution as the outcome of social structures, such as economic and legal systems, healthcare and taxation policies, and international institutions. While extensive global health research has linked social structures to the disproportionate burden of disease in the Global South, formal attempts to incorporate the structural competency framework into US-based global health education have not been described in the literature. This paper fills this gap by articulating five sub-competencies for structurally competent global health instruction. Authors drew on their experiences developing global health and structural competency curricula-and consulted relevant structural competency, global health, social science, social theory, and social determinants of health literatures. The five sub-competencies include: (1) Describe the role of social structures in producing and maintaining health inequities globally, (2) Identify the ways that structural inequalities are naturalised within the field of global health, (3) Discuss the impact of structures on the practice of global health, (4) Recognise structural interventions for addressing global health inequities, and (5) Apply the concept of structural humility in the context of global health.
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Affiliation(s)
- Michael Harvey
- College of Public Health, Temple University, Philadelphia, PA, USA
| | - Joshua Neff
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Kelly R Knight
- School of Medicine, University of California, San Francisco, CA, USA
| | - Joia S Mukherjee
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Sriram Shamasunder
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Phuoc V Le
- School of Medicine, University of California, San Francisco, CA, USA.,School of Public Health, University of California, Berkeley, CA, USA
| | - Robin Tittle
- Division of Hospital and Specialty Medicine, Portland VA Medical Center, Oregon Health and Sciences University, Portland, OR, USA
| | | | - Héctor Carrasco
- School of Medicine and Health Sciences, Tecnológico de Monterrey, Mexico City Campus, Mexico
| | - Daniel Bernal-Serrano
- School of Medicine and Health Sciences, Tecnológico de Monterrey, Mexico City Campus, Mexico
| | | | - Seth M Holmes
- Division of Society and Environment, Department of Environmental Science, Policy, and Management, University of California, Berkeley, CA, USA
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14
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Worster DT, Franke MF, Bazúa R, Flores H, García Z, Krupp J, Maza J, Palazuelos L, Rodríguez K, Newman PM, Palazuelos D. Observational stepped-wedge analysis of a community health worker-led intervention for diabetes and hypertension in rural Mexico. BMJ Open 2020; 10:e034749. [PMID: 32152172 PMCID: PMC7064075 DOI: 10.1136/bmjopen-2019-034749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES There is emerging interest and data supporting the effectiveness of community health workers (CHWs) in non-communicable diseases (NCDs) in low/middle-income countries (LMICs). This study aimed to determine whether a CHW-led intervention targeting diabetes and hypertension could improve markers of clinical disease control in rural Mexico. DESIGN AND SETTING A prospective observational stepped-wedge study was conducted across seven communities in rural Chiapas, Mexico from March 2014 to April 2018. PARTICIPANTS 149 adults with hypertension and/or diabetes. INTERVENTION This study was conducted in the context of the programmatic roll-out of an accompaniment-based CHW-led intervention designed to complement comprehensive primary care for adults with diabetes and/or hypertension. Implementation occurred sequentially at 3-month intervals with point-of-care data collected at baseline and every 3 months thereafter for 12 months following roll-out in all communities. OUTCOME MEASURES Primary outcomes were glycated haemoglobin (HbA1c) and systolic blood pressure (SBP), overall and stratified by baseline disease control. We conducted an individual-level analysis using mixed effects regression, adjusting for time, cohort and clustering at the individual and community levels. RESULTS Among patients with diabetes, the CHW-led intervention was associated with a decrease in HbA1c of 0.35%; however, CIs were wide (95% CI -0.90% to 0.20%). In patients with hypertension, there was a 4.7 mm Hg decrease in SBP (95% CI -8.9 to -0.6). In diabetic patients with HbA1c ≥9%, HbA1c decreased by 0.96% (95% CI -1.69% to -0.23%), and in patients with uncontrolled hypertension, SBP decreased by 10.2 mm Hg (95% CI -17.7 to -2.8). CONCLUSIONS We found that a CHW-led intervention resulted in clinically meaningful improvement in disease markers for patients with diabetes and hypertension, most apparent among patients with hypertension and patients with uncontrolled disease at baseline. These findings suggest that CHWs can play a valuable role in supporting NCD management in LMICs. TRIAL REGISTRATION NUMBER NCT02549495.
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Affiliation(s)
- Devin T Worster
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Compañeros en Salud, Ángel Albino Corzo, Mexico
| | - Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Hugo Flores
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Compañeros en Salud, Ángel Albino Corzo, Mexico
| | | | | | - Jimena Maza
- Compañeros en Salud, Ángel Albino Corzo, Mexico
| | | | | | - Patrick M Newman
- Compañeros en Salud, Ángel Albino Corzo, Mexico
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Daniel Palazuelos
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Compañeros en Salud, Ángel Albino Corzo, Mexico
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
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15
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Brown C, Lalla A, Curley C, King C, Muskett O, Salt S, Ray K, Begay MG, Nelson AK, Shin S. Community-clinic linkages: qualitative provider perspectives on partnering with community health representatives in Navajo Nation. BMJ Open 2020; 10:e031794. [PMID: 32054623 PMCID: PMC7044898 DOI: 10.1136/bmjopen-2019-031794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To understand providers' opinions about the Community Outreach and Patient Empowerment (COPE) Project designed to strengthen Navajo Community Health Representative (CHR) outreach to individuals living with diabetes. DESIGN This was a qualitative study nested within a larger evaluation of a programme intervention. SETTING The study took place in Navajo Nation and evaluated a programme initiative designed to strengthen collaboration between CHRs and clinic-based healthcare providers and provide structured outreach to individuals living with diabetes in Navajo Nation. The CHR Programme is a formal community health worker programme that exists in most tribal healthcare systems across the USA. PARTICIPANTS Healthcare providers involved in the programme took part in one-on-one interviews. ANALYSIS We used thematic analysis for this study. A team of three study staff used open-coding to create a codebook. Coded material were summarised and patterns were identified and tied into a narrative using concept mapping. The study design and instrument construction were guided by a Community Health Advisory Panel. RESULTS A total of 13 interviews were completed. Providers acknowledged CHRs as an asset to the clinical team and were enthusiastic about the COPE coaching materials, mentioning they provided a consistent message to CHRs and the community. Providers that led COPE trainings with CHRs valued the face-to-face time and opportunity to build relationships. Providers (n=4) supported CHRs' access to electronic health record to record patient visits and streamline referrals. Among their requests were having designated personnel to manage referrals with CHRs and a formal system to record modules CHRs have completed. CONCLUSION Providers participating in COPE activities valued the work of CHRs and endorsed further strengthening relationships and communication with CHRs. Healthcare programmes should consider systems changes to integrate community health workers into clinic-based teams. TRIAL REGISTRATION NUMBER NCT03326206; Results.
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Affiliation(s)
- Christian Brown
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Amber Lalla
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Cameron Curley
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Caroline King
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Olivia Muskett
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Shine Salt
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kathy Ray
- Navajo Area Indian Health Service, Saint Michael, Arizona, USA
| | - Mae-Gilene Begay
- Community Health Representative Outreach Program, Navajo Nation Department of Health, Window Rock, Arizona, USA
| | - Adrianne Katrina Nelson
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Sonya Shin
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
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16
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Grimsrud AT, Pike C, Bekker LG. The power of peers and community in the continuum of HIV care. LANCET GLOBAL HEALTH 2020; 8:e167-e168. [PMID: 31924538 DOI: 10.1016/s2214-109x(19)30544-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 12/11/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Anna T Grimsrud
- International AIDS Society, HIV Programmes & Advocacy, Cape Town, South Africa; Desmond Tutu HIV Centre, University of Cape Town, Cape Town 7925, South Africa.
| | - Carey Pike
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town 7925, South Africa
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town 7925, South Africa
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17
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Franz B, Murphy JW. What role should philosophy play in community-based health services? J Eval Clin Pract 2019; 25:970-976. [PMID: 31037795 DOI: 10.1111/jep.13148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/24/2019] [Accepted: 03/28/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Berkeley Franz
- Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio
| | - John W Murphy
- Department of Sociology, University of Miami, Coral Gables, Florida
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18
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Flood D, Chary A, Austad K, Coj M, Lopez W, Rohloff P. Patient Navigation and Access to Cancer Care in Guatemala. J Glob Oncol 2018; 4:1-3. [PMID: 30241260 PMCID: PMC6223473 DOI: 10.1200/jgo.18.00027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- David Flood
- All authors: Wuqu' Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala
| | - Anita Chary
- All authors: Wuqu' Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala
| | - Kirsten Austad
- All authors: Wuqu' Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala
| | - Merida Coj
- All authors: Wuqu' Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala
| | - Waleska Lopez
- All authors: Wuqu' Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala
| | - Peter Rohloff
- All authors: Wuqu' Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala
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19
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Anders S, Aaron H, Jackson GP, Novak LL. Supporting Caregivers in Pregnancy: A Qualitative Study of Their Activities and Roles. J Patient Exp 2018; 6:126-132. [PMID: 31218258 PMCID: PMC6558945 DOI: 10.1177/2374373518785570] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: The significant role of lay caregivers has been explored in chronic and acute illnesses. In pregnancy, caregivers’ (eg, the baby’s father, friends, and family) roles in promoting the health of the mother and baby are not well understood. Objective: We characterize the activities and roles of pregnancy caregivers and offer opportunities for engaging this important group. Method: We conducted interviews with 29 pregnancy caregivers. Interview transcripts were analyzed inductively, resulting in a coding scheme of actions and roles that pregnancy caregivers perform. Results: The most common actions and roles included searching for information (97%), accompanying patients to medical appointments (69%), and being a source of emotional support (76%). Identified actions and roles fit a patient work framework, including work types identified by Corbin and Strauss: illness, everyday life, biographical, articulation, and invisible. Conclusion: The patient work framework can be employed to describe the activities and roles of pregnancy caregivers. We have contributed new insights into the experiences of pregnancy caregivers and recommendations for educational and technological interventions.
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Affiliation(s)
- Shilo Anders
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hannah Aaron
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gretchen Purcell Jackson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatric Surgery, Vanderbilt University Medical Center.,Department of Pediatrics, Vanderbilt University Medical Center
| | - Laurie L Novak
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
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20
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Abstract
Increasing attention has been devoted to the important role that primary care will play in improving population health. One innovation, the patient-centered medical home (PCMH), aims to unite a variety of professionals with patients in the prevention and treatment of illness. Although patient perspectives are critical to this model, this article questions whether the PCMH in practice is truly community-based. That is, do physicians, planners, and other health care professionals take seriously the value of integrating local knowledge into medical care? The argument presented is that community-based philosophy contains a foundational principle that the perspectives of health care practitioners and community members must be integrated. Although many proponents of the PCMH aim to offer patient-centered and sustainable health care, focusing on this philosophical shift will ensure that services are organized by communities in collaboration with health care professionals.
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Affiliation(s)
- Berkeley A Franz
- Assistant Professor of Community-Based Health at the Heritage College of Osteopathic Medicine in Athens, OH.
| | - John W Murphy
- Professor of Sociology at the University of Miami in FL.
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21
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Newman PM, Franke MF, Arrieta J, Carrasco H, Elliott P, Flores H, Friedman A, Graham S, Martinez L, Palazuelos L, Savage K, Tymeson H, Palazuelos D. Community health workers improve disease control and medication adherence among patients with diabetes and/or hypertension in Chiapas, Mexico: an observational stepped-wedge study. BMJ Glob Health 2018. [PMID: 29527344 PMCID: PMC5841495 DOI: 10.1136/bmjgh-2017-000566] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Non-communicable diseases (NCDs) contribute greatly to morbidity and mortality in low-income and middle-income countries (LMICs). Community health workers (CHWs) may improve disease control and medication adherence among patients with NCDs in LMICs, but data are lacking. We assessed the impact of a CHW-led intervention on disease control and adherence among patients with diabetes and/or hypertension in Chiapas, Mexico. Methods We conducted a prospective observational study among adult patients with diabetes and/or hypertension, in the context of a stepped-wedge roll-out of a CHW-led intervention. We measured self-reported adherence to medications, blood pressure and haemoglobin A1c at baseline and every 3 months, timed just prior to expansion of the intervention to a new community. We conducted individual-level mixed effects analyses of study data, adjusting for time and clustering by patient and community. Findings We analysed 108 patients. The CHW-led intervention was associated with a twofold increase in the odds of disease control (OR 2.04, 95% CI 1.15 to 3.62). It was also associated with optimal adherence assessed by 30-day recall (OR 1.86; 95% CI 1.15 to 3.02) and a positive self-assessment of adherence behaviour (OR 2.29; 95% CI 1.26 to 4.15), but not by 5-day recall. Interpretation A CHW-led adherence intervention was associated with disease control and adherence among adults with diabetes and/or hypertension. This study supports a role of CHWs in supplementing comprehensive primary care for patients with NCDs in LMICs. Trial registration number NCT02549495.
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Affiliation(s)
- Patrick M Newman
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Molly F Franke
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Jafet Arrieta
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Hector Carrasco
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Patrick Elliott
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Hugo Flores
- Compañeros en Salud, Angel Albino Corzo, Chiapas, Mexico
| | - Alexandra Friedman
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | | | - Luis Martinez
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Kevin Savage
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Hayley Tymeson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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22
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Chary A, Flood D, Austad K, Colom M, Hawkins J, Cnop K, Martinez B, Lopez W, Rohloff P. Accompanying indigenous Maya patients with complex medical needs: A patient navigation system in rural Guatemala. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2017; 6:144-149. [PMID: 28919513 DOI: 10.1016/j.hjdsi.2017.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 08/26/2017] [Indexed: 10/24/2022]
Affiliation(s)
- Anita Chary
- Wuqu' Kawoq
- Maya Health Alliance, Guatemala; Department of Emergency Medicine, Massachusetts General Hospital, United States.
| | - David Flood
- Wuqu' Kawoq
- Maya Health Alliance, Guatemala; Departments of Internal Medicine and Pediatrics, University of Minnesota, United States
| | - Kirsten Austad
- Wuqu' Kawoq
- Maya Health Alliance, Guatemala; Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, United States
| | | | - Jessica Hawkins
- Wuqu' Kawoq
- Maya Health Alliance, Guatemala; University of California, San Francisco, United States
| | - Katia Cnop
- Wuqu' Kawoq
- Maya Health Alliance, Guatemala; Burrell College of Osteopathic Medicine, United States
| | | | | | - Peter Rohloff
- Wuqu' Kawoq
- Maya Health Alliance, Guatemala; Division of Global Health Equity, Brigham and Women's Hospital, United States
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23
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Eustache E, Gerbasi ME, Severe J, Fils-Aimé JR, Smith Fawzi MC, Raviola GJ, Darghouth S, Boyd K, Thérosmé T, Legha R, Pierre EL, Affricot E, Alcindor Y, Grelotti DJ, Becker AE. Formative research on a teacher accompaniment model to promote youth mental health in Haiti: Relevance to mental health task-sharing in low-resource school settings. Int J Soc Psychiatry 2017; 63:314-324. [PMID: 28367718 PMCID: PMC5982582 DOI: 10.1177/0020764017700173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Task-sharing with teachers to promote youth mental health is a promising but underdeveloped strategy in improving care access in low-income countries. AIMS To assess feasibility, acceptability and utility of the teacher accompaniment phase of a school-based Teacher- Accompagnateur Pilot Study (TAPS) in Haiti. METHODS We assigned student participants, aged 18-22 years ( n = 120), to teacher participants ( n = 22) within four Haitian schools; we instructed participants to arrange meetings with their assigned counterparts to discuss mental health treatment, academic skills, and/or well-being. We measured student and teacher perceived feasibility, acceptability and utility of meetings with self-report Likert-style questions. We examined overall program feasibility by the percentage of students with a documented meeting, acceptability by a composite measure of student satisfaction and utility by the percentage with identified mental health need who discussed treatment with a teacher. RESULTS Favorable ratings support feasibility, acceptability and utility of teacher- accompagnateur meetings with students. The majority of students (54%) met with a teacher. Among students with an identified mental disorder, 43.2% discussed treatment during a meeting. CONCLUSION This accompaniment approach to mental health task-sharing with teachers provided a school-based opportunity for students with mental health need to discuss treatment and has potential relevance to other low-income settings.
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Affiliation(s)
- Eddy Eustache
- 1 Zanmi Lasante, Mental Health and Psychosocial Service, Mirebalais, Haiti
| | - Margaret E Gerbasi
- 2 Department of Global Health & Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Jennifer Severe
- 2 Department of Global Health & Social Medicine, Harvard Medical School, Boston, MA, USA.,3 Department of Psychiatry, Tufts University School of Medicine and Baystate Medical Center, Springfield, MA, USA
| | | | - Mary C Smith Fawzi
- 2 Department of Global Health & Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Giuseppe J Raviola
- 2 Department of Global Health & Social Medicine, Harvard Medical School, Boston, MA, USA.,4 Partners In Health, Boston, MA, USA.,5 Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA
| | - Sarah Darghouth
- 6 Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Kate Boyd
- 7 Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Tatiana Thérosmé
- 1 Zanmi Lasante, Mental Health and Psychosocial Service, Mirebalais, Haiti
| | - Rupinder Legha
- 8 Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
| | - Ermaze L Pierre
- 1 Zanmi Lasante, Mental Health and Psychosocial Service, Mirebalais, Haiti
| | - Emmeline Affricot
- 1 Zanmi Lasante, Mental Health and Psychosocial Service, Mirebalais, Haiti
| | - Yoldie Alcindor
- 1 Zanmi Lasante, Mental Health and Psychosocial Service, Mirebalais, Haiti
| | - David J Grelotti
- 9 Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Anne E Becker
- 2 Department of Global Health & Social Medicine, Harvard Medical School, Boston, MA, USA.,6 Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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24
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Dheda K, Gumbo T, Maartens G, Dooley KE, McNerney R, Murray M, Furin J, Nardell EA, London L, Lessem E, Theron G, van Helden P, Niemann S, Merker M, Dowdy D, Van Rie A, Siu GKH, Pasipanodya JG, Rodrigues C, Clark TG, Sirgel FA, Esmail A, Lin HH, Atre SR, Schaaf HS, Chang KC, Lange C, Nahid P, Udwadia ZF, Horsburgh CR, Churchyard GJ, Menzies D, Hesseling AC, Nuermberger E, McIlleron H, Fennelly KP, Goemaere E, Jaramillo E, Low M, Jara CM, Padayatchi N, Warren RM. The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis. THE LANCET. RESPIRATORY MEDICINE 2017; 5:S2213-2600(17)30079-6. [PMID: 28344011 DOI: 10.1016/s2213-2600(17)30079-6] [Citation(s) in RCA: 376] [Impact Index Per Article: 53.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/24/2016] [Accepted: 12/08/2016] [Indexed: 12/25/2022]
Abstract
Global tuberculosis incidence has declined marginally over the past decade, and tuberculosis remains out of control in several parts of the world including Africa and Asia. Although tuberculosis control has been effective in some regions of the world, these gains are threatened by the increasing burden of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis. XDR tuberculosis has evolved in several tuberculosis-endemic countries to drug-incurable or programmatically incurable tuberculosis (totally drug-resistant tuberculosis). This poses several challenges similar to those encountered in the pre-chemotherapy era, including the inability to cure tuberculosis, high mortality, and the need for alternative methods to prevent disease transmission. This phenomenon mirrors the worldwide increase in antimicrobial resistance and the emergence of other MDR pathogens, such as malaria, HIV, and Gram-negative bacteria. MDR and XDR tuberculosis are associated with high morbidity and substantial mortality, are a threat to health-care workers, prohibitively expensive to treat, and are therefore a serious public health problem. In this Commission, we examine several aspects of drug-resistant tuberculosis. The traditional view that acquired resistance to antituberculous drugs is driven by poor compliance and programmatic failure is now being questioned, and several lines of evidence suggest that alternative mechanisms-including pharmacokinetic variability, induction of efflux pumps that transport the drug out of cells, and suboptimal drug penetration into tuberculosis lesions-are likely crucial to the pathogenesis of drug-resistant tuberculosis. These factors have implications for the design of new interventions, drug delivery and dosing mechanisms, and public health policy. We discuss epidemiology and transmission dynamics, including new insights into the fundamental biology of transmission, and we review the utility of newer diagnostic tools, including molecular tests and next-generation whole-genome sequencing, and their potential for clinical effectiveness. Relevant research priorities are highlighted, including optimal medical and surgical management, the role of newer and repurposed drugs (including bedaquiline, delamanid, and linezolid), pharmacokinetic and pharmacodynamic considerations, preventive strategies (such as prophylaxis in MDR and XDR contacts), palliative and patient-orientated care aspects, and medicolegal and ethical issues.
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Affiliation(s)
- Keertan Dheda
- Lung Infection and Immunity Unit, Department of Medicine, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa.
| | - Tawanda Gumbo
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Kelly E Dooley
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ruth McNerney
- Lung Infection and Immunity Unit, Department of Medicine, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Megan Murray
- Department of Global Health and Social Medicine, Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Edward A Nardell
- TH Chan School of Public Health, Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Leslie London
- School of Public Health and Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Grant Theron
- SA MRC Centre for Tuberculosis Research/DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Stellenbosch University, Tygerberg, South Africa
| | - Paul van Helden
- SA MRC Centre for Tuberculosis Research/DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Stellenbosch University, Tygerberg, South Africa
| | - Stefan Niemann
- Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Schleswig-Holstein, Germany; German Centre for Infection Research (DZIF), Partner Site Borstel, Borstel, Schleswig-Holstein, Germany
| | - Matthias Merker
- Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Schleswig-Holstein, Germany
| | - David Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Annelies Van Rie
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; International Health Unit, Epidemiology and Social Medicine, Faculty of Medicine, University of Antwerp, Antwerp, Belgium
| | - Gilman K H Siu
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Jotam G Pasipanodya
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Camilla Rodrigues
- Department of Microbiology, P.D. Hinduja National Hospital & Medical Research Centre, Mumbai, India
| | - Taane G Clark
- Faculty of Infectious and Tropical Diseases and Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Frik A Sirgel
- SA MRC Centre for Tuberculosis Research/DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Stellenbosch University, Tygerberg, South Africa
| | - Aliasgar Esmail
- Lung Infection and Immunity Unit, Department of Medicine, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Hsien-Ho Lin
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Sachin R Atre
- Center for Clinical Global Health Education (CCGHE), Johns Hopkins University, Baltimore, MD, USA; Medical College, Hospital and Research Centre, Pimpri, Pune, India
| | - H Simon Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Kwok Chiu Chang
- Tuberculosis and Chest Service, Centre for Health Protection, Department of Health, Hong Kong SAR, China
| | - Christoph Lange
- Division of Clinical Infectious Diseases, German Center for Infection Research, Research Center Borstel, Borstel, Schleswig-Holstein, Germany; International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany; Department of Medicine, Karolinska Institute, Stockholm, Sweden; Department of Medicine, University of Namibia School of Medicine, Windhoek, Namibia
| | - Payam Nahid
- Division of Pulmonary and Critical Care, San Francisco General Hospital, University of California, San Francisco, CA, USA
| | - Zarir F Udwadia
- Pulmonary Department, Hinduja Hospital & Research Center, Mumbai, India
| | | | - Gavin J Churchyard
- Aurum Institute, Johannesburg, South Africa; School of Public Health, University of Witwatersrand, Johannesburg, South Africa; Advancing Treatment and Care for TB/HIV, South African Medical Research Council, Johannesburg, South Africa
| | - Dick Menzies
- Montreal Chest Institute, McGill University, Montreal, QC, Canada
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Eric Nuermberger
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Helen McIlleron
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Kevin P Fennelly
- Pulmonary Clinical Medicine Section, Division of Intramural Research, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Eric Goemaere
- MSF South Africa, Cape Town, South Africa; School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Marcus Low
- Treatment Action Campaign, Johannesburg, South Africa
| | | | - Nesri Padayatchi
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), MRC HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - Robin M Warren
- SA MRC Centre for Tuberculosis Research/DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Stellenbosch University, Tygerberg, South Africa
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Flood DC, Chary AN, Austad K, Garcia P, Rohloff PJ. A Patient Navigation System to Minimize Barriers for Peritoneal Dialysis in Rural, Low-Resource Settings: Case Study From Guatemala. Kidney Int Rep 2017; 2:762-765. [PMID: 29142991 PMCID: PMC5678837 DOI: 10.1016/j.ekir.2017.02.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 02/25/2017] [Indexed: 02/02/2023] Open
Affiliation(s)
- David C Flood
- Wuqu' Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala
| | - Anita N Chary
- Wuqu' Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala
| | - Kirsten Austad
- Wuqu' Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala
| | - Pablo Garcia
- Wuqu' Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala
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Smith Fawzi MC, Ng L, Kanyanganzi F, Kirk C, Bizimana J, Cyamatare F, Mushashi C, Kim T, Kayiteshonga Y, Binagwaho A, Betancourt TS. Mental Health and Antiretroviral Adherence Among Youth Living With HIV in Rwanda. Pediatrics 2016; 138:peds.2015-3235. [PMID: 27677570 PMCID: PMC5051202 DOI: 10.1542/peds.2015-3235] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In Rwanda, significant progress has been made in advancing access to antiretroviral therapy (ART) among youth. As availability of ART increases, adherence is critical for preventing poor clinical outcomes and transmission of HIV. The goals of the study are to (1) describe ART adherence and mental health problems among youth living with HIV aged 10 to 17; and (2) examine the association between these factors among this population in rural Rwanda. METHODS A cross-sectional analysis was conducted that examined the association of mental health status and ART adherence among youth (n = 193). ART adherence, mental health status, and related variables were examined based on caregiver and youth report. Nonadherence was defined as ever missing or refusing a dose of ART within the past month. Multivariate modeling was performed to examine the association between mental health status and ART adherence. RESULTS Approximately 37% of youth missed or refused ART in the past month. In addition, a high level of depressive symptoms (26%) and attempt to hurt or kill oneself (12%) was observed in this population of youth living with HIV in Rwanda. In multivariate analysis, nonadherence was significantly associated with some mental health outcomes, including conduct problems (odds ratio 2.90, 95% confidence interval 1.55-5.43) and depression (odds ratio 1.02, 95% confidence interval 1.01-1.04), according to caregiver report. A marginally significant association was observed for youth report of depressive symptoms. CONCLUSIONS The findings suggest that mental health should be considered among the factors related to ART nonadherence in HIV services for youth, particularly for mental health outcomes, such as conduct problems and depression.
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Affiliation(s)
- Mary C. Smith Fawzi
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Lauren Ng
- Division of Global Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Catherine Kirk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Felix Cyamatare
- Partners In Health-Rwanda/ Inshuti Mu Buzima (PIH/IMB), Rwinkwavu, Rwanda
| | - Christina Mushashi
- Partners In Health-Rwanda/ Inshuti Mu Buzima (PIH/IMB), Rwinkwavu, Rwanda
| | - Taehoon Kim
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | | | - Agnes Binagwaho
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts;,Dartmouth College, Hanover, New Hampshire; and,University of Global Health Equity, Kigali, Rwanda
| | - Theresa S. Betancourt
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Whiteman LN, Gibbons MC, Smith WR, Stewart RW. Top 10 Things You Need to Know to Run Community Health Worker Programs: Lessons Learned in the Field. South Med J 2016; 109:579-82. [PMID: 27598368 PMCID: PMC5014228 DOI: 10.14423/smj.0000000000000504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Lauren N Whiteman
- From the School of Medicine, School of Public Health, Johns Hopkins University; the School of Medicine, Virginia Commonwealth University, Richmond; and the School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - M Christopher Gibbons
- From the School of Medicine, School of Public Health, Johns Hopkins University; the School of Medicine, Virginia Commonwealth University, Richmond; and the School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Wally R Smith
- From the School of Medicine, School of Public Health, Johns Hopkins University; the School of Medicine, Virginia Commonwealth University, Richmond; and the School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Rosalyn W Stewart
- From the School of Medicine, School of Public Health, Johns Hopkins University; the School of Medicine, Virginia Commonwealth University, Richmond; and the School of Medicine, Johns Hopkins University, Baltimore, Maryland
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28
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Hsu LL, Green NS, Donnell Ivy E, Neunert CE, Smaldone A, Johnson S, Castillo S, Castillo A, Thompson T, Hampton K, Strouse JJ, Stewart R, Hughes T, Banks S, Smith-Whitley K, King A, Brown M, Ohene-Frempong K, Smith WR, Martin M. Community Health Workers as Support for Sickle Cell Care. Am J Prev Med 2016; 51:S87-98. [PMID: 27320471 PMCID: PMC4918511 DOI: 10.1016/j.amepre.2016.01.016] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 01/07/2016] [Accepted: 01/07/2016] [Indexed: 11/25/2022]
Abstract
Community health workers are increasingly recognized as useful for improving health care and health outcomes for a variety of chronic conditions. Community health workers can provide social support, navigation of health systems and resources, and lay counseling. Social and cultural alignment of community health workers with the population they serve is an important aspect of community health worker intervention. Although community health worker interventions have been shown to improve patient-centered outcomes in underserved communities, these interventions have not been evaluated with sickle cell disease. Evidence from other disease areas suggests that community health worker intervention also would be effective for these patients. Sickle cell disease is complex, with a range of barriers to multifaceted care needs at the individual, family/friend, clinical organization, and community levels. Care delivery is complicated by disparities in health care: access, delivery, services, and cultural mismatches between providers and families. Current practices inadequately address or provide incomplete control of symptoms, especially pain, resulting in decreased quality of life and high medical expense. The authors propose that care and care outcomes for people with sickle cell disease could be improved through community health worker case management, social support, and health system navigation. This paper outlines implementation strategies in current use to test community health workers for sickle cell disease management in a variety of settings. National medical and advocacy efforts to develop the community health workforce for sickle cell disease management may enhance the progress and development of "best practices" for this area of community-based care.
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Affiliation(s)
- Lewis L Hsu
- Department of Pediatrics, University of Illinois, Chicago, Illinois
| | - Nancy S Green
- Department of Pediatrics, Columbia University, New York, New York.
| | - E Donnell Ivy
- Health Resources and Services Administration, Rockville, Maryland
| | - Cindy E Neunert
- Department of Pediatrics, Columbia University, New York, New York
| | - Arlene Smaldone
- Department of Pediatrics, Columbia University, New York, New York
| | - Shirley Johnson
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Sheila Castillo
- Department of Pediatrics, University of Illinois, Chicago, Illinois
| | - Amparo Castillo
- Department of Pediatrics, University of Illinois, Chicago, Illinois
| | - Trevor Thompson
- Sickle Cell Disease Foundation of Tennessee, Memphis, Tennessee
| | - Kisha Hampton
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana
| | - John J Strouse
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rosalyn Stewart
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - TaLana Hughes
- Sickle Cell Disease Association of Illinois, Chicago, Illinois
| | - Sonja Banks
- Sickle Cell Disease Association of America, Baltimore, Maryland
| | - Kim Smith-Whitley
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Allison King
- Department of Pediatrics, Washington University, St. Louis, Missouri
| | - Mary Brown
- Sickle Cell Disease Foundation of California, Los Angeles, California
| | - Kwaku Ohene-Frempong
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Wally R Smith
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Molly Martin
- Department of Pediatrics, University of Illinois, Chicago, Illinois
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Kasper J, Greene JA, Farmer PE, Jones DS. All Health Is Global Health, All Medicine Is Social Medicine: Integrating the Social Sciences Into the Preclinical Curriculum. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:628-32. [PMID: 26703416 DOI: 10.1097/acm.0000000000001054] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
As physicians work to achieve optimal health outcomes for their patients, they often struggle to address the issues that arise outside the clinic. Social, economic, and political factors influence patients' burden of disease, access to treatment, and health outcomes. This challenge has motivated recent calls for increased attention to the social determinants of health. At the same time, advocates have called for increased attention to global health. Each year, more U.S. medical students participate in global health experiences. Yet, the global health training that is available varies widely. The discipline of social medicine, which attends to the social determinants of disease, social meanings of disease, and social responses to disease, offers a solution to both challenges. The analyses and techniques of social medicine provide an invaluable toolkit for providing health care in the United States and abroad.In 2007, Harvard Medical School implemented a new course, required for all first-year students, that teaches social medicine in a way that integrates global health. In this article, the authors argue for the importance of including social medicine and global health in the preclinical curriculum; describe Harvard Medical School's innovative, integrated approach to teaching these disciplines, which can be used at other medical schools; and explore the barriers that educators may face in implementing such a curriculum, including resistance from students. Such a course can equip medical students with the knowledge and tools that they will need to address complex health problems in the United States and abroad.
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Affiliation(s)
- Jennifer Kasper
- J. Kasper is assistant professor and chair, Faculty Advisory Committee on Global Health, Harvard Medical School, and faculty member, Division of Global Health, Massachusetts General Hospital for Children, Boston, Massachusetts. J.A. Greene is associate professor of medicine and of the history of medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. P.E. Farmer is Kolokotrones University Professor of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts. D.S. Jones is A. Bernard Ackerman Professor of the Culture of Medicine, Faculty of Medicine, Harvard Medical School, Boston, Massachusetts, and Faculty of Arts and Sciences, Harvard University, Cambridge, Massachusetts
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Community-Based Accompaniment Mitigates Predictors of Negative Outcomes for Adults on Antiretroviral Therapy in Rural Rwanda. AIDS Behav 2016; 20:1009-16. [PMID: 26346334 DOI: 10.1007/s10461-015-1185-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Clinical, socioeconomic, and access barriers remain a critical problem to antiretroviral (ART) programs in sub-Saharan Africa. Community-based accompaniment (CBA), including daily home visits and psychosocial and socioeconomic support, has been associated with improved patient outcomes at 1 year. We conducted a prospective observational cohort study of 578 HIV-infected adults initiating ART in 2007-2008 with or without CBA in rural Rwanda. Among patients without CBA, those with advanced HIV disease, low CD4 cell counts, lower social support, and transport costs had significantly higher odds of negative outcomes at 1 year; amongst patients who received CBA, only those with low CD4 cell counts had significantly higher odds of negative outcomes at 1 year. CBA also significantly mitigated the effect of transport costs and inaccessibility of services on the likelihood of negative outcome. CBA may be one approach to mitigating known risk factors for negative outcomes for patients on ART in resource-poor settings.
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Alibhai A, Kipp W, Saunders LD, Rubaale T, Mill J, Konde-Lule J. Relationship between characteristics of volunteer community health workers and antiretroviral treatment outcomes in a community-based treatment programme in Uganda. Glob Public Health 2016; 12:1092-1103. [PMID: 27080727 DOI: 10.1080/17441692.2016.1170179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Community health workers (CHWs) can help to redress the shortages of health human resources needed to scale up antiretroviral treatment (ART). However, the selection of CHWs could influence the effectiveness of a CHW programme. The purpose of this observational study was to assess whether sociodemographic characteristics and geographic proximity to patients of volunteer CHWs were predictors of clinical outcomes in a community-based ART (CBART) programme in Kabarole, Uganda. Data from CHW surveys for 41 CHWs and clinic charts for 185 patients in the CBART programme were analysed using multivariable logistic and Cox regression models. Time to travel to patients was the only statistically significant characteristic of CHWs associated with ART outcomes. Patients whose CHWs had to travel one or more hours had a 71% lower odds of virologic suppression (adjusted OR = 0.29, 95% CI = 0.13-0.65, p = .002) and a 4.52 times higher mortality hazard rate (adjusted HR = 4.52, 95% CI = 1.20-17.09, p = .026) compared to patients whose CHWs had to travel less than one hour. The findings show that the sociodemographic characteristics of CHWs were not as important as the geographic distance they had to travel to patients.
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Affiliation(s)
- Arif Alibhai
- a School of Public Health , University of Alberta , Edmonton , Canada
| | - Walter Kipp
- a School of Public Health , University of Alberta , Edmonton , Canada
| | - L Duncan Saunders
- a School of Public Health , University of Alberta , Edmonton , Canada
| | - Tom Rubaale
- b Community-Based ARV Project , Fort Portal , Uganda
| | - Judy Mill
- c Faculty of Nursing , University of Alberta , Edmonton , Canada
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Transitional Care for Homeless Persons: An Opportunity for Nursing Leadership, Innovation, and Creativity. Creat Nurs 2016. [DOI: 10.1891/1078-4535.22.2.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Homelessness in the United States is decreasing. However, homeless persons exhibit high levels of illness and frequently move between institutional and community settings. These moves are complicated by a complex health care and service industry landscape that is often difficult to navigate. In this article, we describe an innovative transitional care program for homeless persons that augments nurse-led transitional care with community health workers who provide accompaniment and linkage to services for program participants. This model offers promise in surmounting the myriad structural barriers to health and health care that many homeless persons in our communities routinely face.
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Addressing basic resource needs to improve primary care quality: a community collaboration programme. BMJ Qual Saf 2015; 25:164-72. [DOI: 10.1136/bmjqs-2015-004521] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 11/03/2015] [Indexed: 01/30/2023]
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A two-way street: what the United States can learn from resource-limited countries to improve health care delivery and reduce costs. Jt Comm J Qual Patient Saf 2015; 41:236-9. [PMID: 25977252 DOI: 10.1016/s1553-7250(15)41032-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Rouzier V, Farmer PE, Pape JW, Jerome JG, Van Onacker JD, Morose W, Joseph P, Leandre F, Severe P, Barry D, Deschamps MM, Koenig SP. Factors impacting the provision of antiretroviral therapy to people living with HIV: the view from Haiti. Antivir Ther 2014; 19 Suppl 3:91-104. [PMID: 25310257 DOI: 10.3851/imp2904] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2014] [Indexed: 10/24/2022]
Abstract
Haiti is the poorest country in the Western Hemisphere and has the highest number of people living with HIV in the Caribbean, the region most impacted by HIV outside of Africa. Despite continuous political, socioeconomic and natural catastrophes, Haiti has mounted a very successful response to the HIV epidemic. Prevention and treatment strategies implemented by the government in collaboration with non-governmental organizations have been instrumental in decreasing the national HIV prevalence from a high of 6.2% in 1993 to 2.2% in 2012. We describe the history and epidemiology of HIV in Haiti and the expansion of antiretroviral therapy (ART) over the past decade, with the achievement of universal access to ART for patients meeting the 2010 World Health Organization guidelines. We also describe effective models of care, successes and challenges of international funding, and current challenges in the provision of ART. We are optimistic that the goal of providing ART for all in need remains in reach.
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Affiliation(s)
- Vanessa Rouzier
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti.
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Irvine MK, Chamberlin SA, Robbins RS, Myers JE, Braunstein SL, Mitts BJ, Harriman GA, Laraque F, Nash D. Improvements in HIV care engagement and viral load suppression following enrollment in a comprehensive HIV care coordination program. Clin Infect Dis 2014; 60:298-310. [PMID: 25301208 DOI: 10.1093/cid/ciu783] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Substantial evidence gaps remain regarding human immunodeficiency virus (HIV) intervention strategies that improve engagement in care (EiC) and viral load suppression (VLS). We assessed EiC and VLS before and after enrollment in a comprehensive intervention for persons at risk of poor HIV care outcomes. METHODS New York City's Ryan White Part A HIV Care Coordination Program (CCP), launched at 28 agencies in 2009, applies multiple strategies to promote optimal utilization of medical and social services. Using laboratory test records from an HIV surveillance registry, we examined pre-post outcomes among 3641 CCP clients enrolled before April 2011. For the year before and after enrollment, we assessed EiC (defined as ≥2 tests, ≥90 days apart, with ≥1 in each half-year) and VLS (defined as viral load [VL] ≤200 copies/mL on latest VL test in the second half of the year). We estimated relative risks (RRs), comparing pre- and postenrollment proportions achieving EiC and VLS. RESULTS Among newly diagnosed clients, 90.5% (95% confidence interval [CI], 87.9%-93.2%) and 66.2% (95% CI, 61.9%-70.6%) achieved EiC and VLS, respectively. Among previously diagnosed clients, EiC increased from 73.7% to 91.3% (RR = 1.24; 95% CI, 1.21-1.27) and VLS increased from 32.3% to 50.9% (RR = 1.58; 95% CI, 1.50-1.66). Clients without evidence of HIV care during the 6 months preenrollment contributed most to overall improvements. Pre-post improvements were robust, retaining statistical significance within most sociodemographic and clinical subgroups, and in 89% (EiC) and 75% (VLS) of CCP agencies. CONCLUSIONS Clients in comprehensive HIV care coordination for persons with evident barriers to care showed substantial and consistent improvement in short-term outcomes.
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Affiliation(s)
- Mary K Irvine
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene
| | - Stephanie A Chamberlin
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene
| | - Rebekkah S Robbins
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene
| | - Julie E Myers
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center
| | - Sarah L Braunstein
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene
| | - Beau J Mitts
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene
| | - Graham A Harriman
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene
| | | | - Denis Nash
- School of Public Health Hunter College, The City University of New York, New York
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Binagwaho A, Nutt CT, Mugwaneza P, Wagner CM, Nsanzimana S. Convergence of mortality rates among patients on antiretroviral therapy in South Africa and North America. PLoS Med 2014; 11:e1001719. [PMID: 25202913 PMCID: PMC4159121 DOI: 10.1371/journal.pmed.1001719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Agnes Binagwaho and colleagues explore the narrowing gap between South African and North American cohorts in survival on HIV treatment, described in the study by Andrew Boulle and colleagues. Please see later in the article for the Editors' Summary
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Affiliation(s)
- Agnes Binagwaho
- Ministry of Health of Rwanda, Kigali, Rwanda
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States of America
| | - Cameron T. Nutt
- Partners In Health, Boston, Massachusetts, United States of America
| | - Placidie Mugwaneza
- HIV and Other Sexually Transmitted Infections Division, Rwanda Biomedical Center, Kigali, Rwanda
| | - Claire M. Wagner
- Center for Global Cancer Medicine, Dana Farber Cancer Institute, Boston, Massachusetts, United States of America
| | - Sabin Nsanzimana
- HIV and Other Sexually Transmitted Infections Division, Rwanda Biomedical Center, Kigali, Rwanda
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Riza AL, Pearson F, Ugarte-Gil C, Alisjahbana B, van de Vijver S, Panduru NM, Hill PC, Ruslami R, Moore D, Aarnoutse R, Critchley JA, van Crevel R. Clinical management of concurrent diabetes and tuberculosis and the implications for patient services. Lancet Diabetes Endocrinol 2014; 2:740-53. [PMID: 25194887 PMCID: PMC4852378 DOI: 10.1016/s2213-8587(14)70110-x] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Diabetes triples the risk for active tuberculosis, thus the increasing burden of type 2 diabetes will help to sustain the present tuberculosis epidemic. Recommendations have been made for bidirectional screening, but evidence is scarce about the performance of specific tuberculosis tests in individuals with diabetes, specific diabetes tests in patients with tuberculosis, and screening and preventive therapy for latent tuberculosis infections in individuals with diabetes. Clinical management of patients with both diseases can be difficult. Tuberculosis patients with diabetes have a lower concentration of tuberculosis drugs and a higher risk of drug toxicity than tuberculosis patients without diabetes. Good glycaemic control, which reduces long-term diabetes complications and could also improve tuberculosis treatment outcomes, is hampered by chronic inflammation, drug-drug interactions, suboptimum adherence to drug treatments, and other factors. Besides drug treatments for tuberculosis and diabetes, other interventions, such as education, intensive monitoring, and lifestyle interventions, might be needed, especially for patients with newly diagnosed diabetes or those who need insulin. From a health systems point of view, delivery of optimum care and integration of services for tuberculosis and diabetes is a huge challenge in many countries. Experience from the combined tuberculosis and HIV/AIDS epidemic could serve as an example, but more studies are needed that include economic assessments of recommended screening and systems to manage concurrent tuberculosis and diabetes.
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Affiliation(s)
- Anca Lelia Riza
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands; Human Genomics Laboratory, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Fiona Pearson
- Population Health Research Institute, St Georges University, London, UK
| | - Cesar Ugarte-Gil
- Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bachti Alisjahbana
- Center for TB-HIV research, Medical Faculty, Padjadjaran University, Hasan Sadikin Hosptial, Bandung, Indonesia
| | - Steven van de Vijver
- African Population and Health Research Center, Nairobi, Kenya; Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Nicolae M Panduru
- Human Genomics Laboratory, University of Medicine and Pharmacy of Craiova, Craiova, Romania; 2nd Clinical Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Philip C Hill
- Centre for International Health, Faculty of Medicine, Otago University, Dunedin, New Zealand
| | - Rovina Ruslami
- Department of Pharmacology and Therapy, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - David Moore
- London School of Hygiene and Tropical Medicine, London, UK
| | - Rob Aarnoutse
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, Netherlands
| | - Julia A Critchley
- Population Health Research Institute, St Georges University, London, UK
| | - Reinout van Crevel
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands.
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Community-based accompaniment and psychosocial health outcomes in HIV-infected adults in Rwanda: a prospective study. AIDS Behav 2014; 18:368-80. [PMID: 23443977 DOI: 10.1007/s10461-013-0431-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We examined whether the addition of community-based accompaniment to Rwanda's national model for antiretroviral treatment (ART) was associated with greater improvements in patients' psychosocial health outcomes during the first year of therapy. We enrolled 610 HIV-infected adults with CD4 cell counts under 350 cells/μL initiating ART in one of two programs. Both programs provided ART and required patients to identify a treatment buddy per national protocols. Patients in one program additionally received nutritional and socioeconomic supplements, and daily home-visits by a community health worker ("accompagnateur") who provided social support and directly-observed ingestion of medication. The addition of community-based accompaniment was associated with an additional 44.3 % reduction in prevalence of depression, more than twice the gains in perceived physical and mental health quality of life, and increased perceived social support in the first year of treatment. Community-based accompaniment may represent an important intervention in HIV-infected populations with prevalent mental health morbidity.
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Kenerson JG. Hypertension in Haiti: The Challenge of Best Possible Practice. J Clin Hypertens (Greenwich) 2014; 16:107-14. [DOI: 10.1111/jch.12242] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 07/10/2013] [Indexed: 12/17/2022]
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Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health 2014; 35:399-421. [PMID: 24387091 DOI: 10.1146/annurev-publhealth-032013-182354] [Citation(s) in RCA: 469] [Impact Index Per Article: 46.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Over the past half-century, community health workers (CHWs) have been a growing force for extending health care and improving the health of populations. Following their introduction in the 1970s, many large-scale CHW programs declined during the 1980s, but CHW programs throughout the world more recently have seen marked growth. Research and evaluations conducted predominantly during the past two decades offer compelling evidence that CHWs are critical for helping health systems achieve their potential, regardless of a country's level of development. In low-income countries, CHWs can make major improvements in health priority areas, including reducing childhood undernutrition, improving maternal and child health, expanding access to family-planning services, and contributing to the control of HIV, malaria, and tuberculosis infections. In many middle-income countries, most notably Brazil, CHWs are key members of the health team and essential for the provision of primary health care and health promotion. In the United States, evidence indicates that CHWs can contribute to reducing the disease burden by participating in the management of hypertension, in the reduction of cardiovascular risk factors, in diabetes control, in the management of HIV infection, and in cancer screening, particularly with hard-to-reach subpopulations. This review highlights the history of CHW programs around the world and their growing importance in achieving health for all.
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Affiliation(s)
- Paul E Farmer
- From the Department of Global Health and Social Medicine, Harvard Medical School, and the Division of Global Health Equity, Brigham and Women's Hospital - both in Boston
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Kenya S, Jones J, Arheart K, Kobetz E, Chida N, Baer S, Powell A, Symes S, Hunte T, Monroe A, Carrasquillo O. Using community health workers to improve clinical outcomes among people living with HIV: a randomized controlled trial. AIDS Behav 2013; 17:2927-34. [PMID: 23515640 DOI: 10.1007/s10461-013-0440-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIDS-related mortality remains a leading cause of preventable death among African-Americans. We sought to determine if community health workers could improve clinical outcomes among vulnerable African-Americans living with HIV in Miami, Florida. We recruited 91 medically indigent persons with HIV viral loads ≥1,000 and/or a CD4 cell count ≤350. Patients were randomized to a community health worker (CHW) intervention or control group. Viral load and CD4 cell count data were abstracted from electronic medical records. At 12 months, the mean VL in the intervention group was log 0.9 copies/μL lower than the control group. The CD4 counts were not significantly different among the groups. Compared to the control group, patients randomized to CHWs experienced statistically significant improvements in HIV viral load. Larger multi-site studies of longer duration are needed to determine whether CHWs should be incorporated into standard treatment models for vulnerable populations living with HIV.
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van de Vijver S, Oti S, Tervaert TC, Hankins C, Kyobutungi C, Gomez GB, Brewster L, Agyemang C, Lange J. Introducing a model of cardiovascular prevention in Nairobi's slums by integrating a public health and private-sector approach: the SCALE-UP study. Glob Health Action 2013; 6:22510. [PMID: 24149078 PMCID: PMC3805842 DOI: 10.3402/gha.v6i0.22510] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 09/10/2013] [Accepted: 09/30/2013] [Indexed: 12/23/2022] Open
Abstract
Introduction Cardiovascular disease (CVD) is a leading cause of death in sub-Saharan Africa (SSA), with annual deaths expected to increase to 2 million by 2030. Currently, most national health systems in SSA are not adequately prepared for this epidemic. This is especially so in slum settlements where access to formal healthcare and resources is limited. Objective To develop and introduce a model of cardiovascular prevention in the slums of Nairobi by integrating public health and private sector approaches. Study design Two non-profit organizations that conduct public health research, Amsterdam Institute for Global Health and Development (AIGHD) and African Population and Health Research Center (APHRC), collaborated with private-sector Boston Consulting Group (BCG) to develop a service delivery package for CVD prevention in slum settings. A theoretic model was designed based on the integration of public and private sector approaches with the focus on costs and feasibility. Results The final model includes components that aim to improve community awareness, a home-based screening service, patient and provider incentives to seek and deliver treatment specifically for hypertension, and adherence support. The expected outcomes projected by this model could prove potentially cost effective and affordable (1 USD/person/year). The model is currently being implemented in a Nairobi slum and is closely followed by key stakeholders in Kenya including the Ministry of Health, the World Health Organization (WHO), and leading non-governmental organizations (NGOs). Conclusion Through the collaboration of public health and private sectors, a theoretically cost-effective model was developed for the prevention of CVD and is currently being implemented in the slums of Nairobi. If results are in line with the theoretical projections and first impressions on the ground, scale-up of the service delivery package could be planned in other poor urban areas in Kenya by relevant policymakers and NGOs.
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Affiliation(s)
- Steven van de Vijver
- Health Challenges and Systems, African Population and Health Research Center, Nairobi, Kenya; Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands;
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Affiliation(s)
- Anne E Becker
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
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Amico KR, Orrell C. Antiretroviral therapy adherence support: recommendations and future directions. J Int Assoc Provid AIDS Care 2013; 12:128-37. [PMID: 23334155 DOI: 10.1177/1545109712459041] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Dramatic increases in the evidence-base for intervention approaches to support antiretroviral therapy (ART) adherence have resulted in numerous reviews, syntheses, and guidelines/recommendations. This review characterizes the current state of the literature and identifies areas in need of additional targeted focus to better align research and practice. Leading recommendations for the process of intervention development (relevant to both rigorous research and real-world intervention planning) and strategies to consider in working with individuals, communities, and systems are provided. In order to move systematically toward the identification of what kinds of interventions work best for whom and when, attending to both intervention outcomes and "drivers" of observed effects or lack of effects in controlled research is critically important. Further, evidence emerging from practice should be aggressively added to research agendas to promote better synergies between the practice and research communities.
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Affiliation(s)
- K Rivet Amico
- Center for Health, Intervention and Prevention, University of Connecticut, Storrs, CT 06269, USA.
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Franke MF, Kaigamba F, Socci AR, Hakizamungu M, Patel A, Bagiruwigize E, Niyigena P, Walker KDC, Epino H, Binagwaho A, Mukherjee J, Farmer PE, Rich ML. Improved retention associated with community-based accompaniment for antiretroviral therapy delivery in rural Rwanda. Clin Infect Dis 2012; 56:1319-26. [PMID: 23249611 DOI: 10.1093/cid/cis1193] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Minimizing death and ensuring high retention and good adherence remain ongoing challenges for human immunodeficiency virus (HIV) treatment programs. We examined whether the addition of community-based accompaniment (characterized by daily home visits from a community health worker, directly observed treatment, nutritional support, transportation stipends, and other support as needed) to the Rwanda national model for antiretroviral therapy (ART) delivery would improve retention in care, viral load suppression, and change in CD4 count, relative to the national model alone. METHODS We conducted a prospective observational cohort study among 610 HIV-infected adults initiating ART in 1 of 2 programs in rural Rwanda. Psychosocial and clinical characteristics were recorded at ART initiation. Death, treatment retention, and plasma viral load were assessed at 1 year. CD4 count was evaluated at 6-month intervals. Multivariable regression models were used to adjust for baseline differences between the 2 populations. RESULTS Eighty-five percent and 79% of participants in the community-based and clinic-based programs, respectively, were retained with viral load suppression at 1 year. After adjusting for CD4 count, depression, physical health quality of life, and food insecurity, community-based accompaniment was protective against death or loss to follow-up during the first year of ART (hazard ratio, 0.17; 95% confidence interval [CI], .09-.35; P < .0001). In a second multivariable analysis, individuals receiving accompaniment were more likely to be retained with a suppressed viral load at 1 year (risk ratio: 1.15; 95% CI, 1.03-1.27; P = .01). CONCLUSIONS These findings indicate that community-based accompaniment is effective in improving retention, when added to a clinic-based program with fewer patient support mechanisms.
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Affiliation(s)
- Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, 02115, USA.
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Browne SH. Editorial Commentary: Dialing for Doses: Enhancing Community-Based Adherence Support With Mobile Technologies. Clin Infect Dis 2012; 56:1327-9. [DOI: 10.1093/cid/cis1197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Management of Chronic Diseases in Sub-Saharan Africa: Cross-Fertilisation between HIV/AIDS and Diabetes Care. J Trop Med 2012; 2012:349312. [PMID: 23209477 PMCID: PMC3508584 DOI: 10.1155/2012/349312] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 10/16/2012] [Indexed: 12/19/2022] Open
Abstract
There is growing attention for chronic diseases in sub-Saharan Africa (SSA) and for bridges between the management of HIV/AIDS and other (noncommunicable) chronic diseases. This becomes more urgent with increasing numbers of people living with both HIV/AIDS and other chronic conditions. This paper discusses
the commonalities between chronic diseases by reviewing models of care, focusing on the two most dominant ones, diabetes mellitus type 2 (DM2) and HIV/AIDS. We argue that in order to cope with care for HIV patients and diabetes patients, health systems in SSA need to adopt new strategies taking into account essential elements of chronic disease care. We developed a “chronic dimension
framework,” which analyses the “disease dimension,” the “health provider dimension,” the patient or “person dimension,” and the “environment dimension” of chronic diseases. Applying this framework to HIV/AIDS and DM2 shows that it
is useful to think about management of both in tandem, comparing care delivery platforms and self-management strategies. A literature review on care delivery models for diabetes and HIV/AIDS in SSA revealed potential elements for cross-fertilisation: rapid scale-up approaches through the public health approach by simplification and decentralisation; community involvement, peer support, and self-management strategies; and strengthening health services.
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Busza J, Walker D, Hairston A, Gable A, Pitter C, Lee S, Katirayi L, Simiyu R, Mpofu D. Community-based approaches for prevention of mother to child transmission in resource-poor settings: a social ecological review. J Int AIDS Soc 2012; 15 Suppl 2:17373. [PMID: 22789640 PMCID: PMC3499910 DOI: 10.7448/ias.15.4.17373] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 05/16/2012] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Numerous barriers to optimal uptake of prevention of mother to child transmission (PMTCT) services occur at community level (i.e., outside the healthcare setting). To achieve elimination of paediatric HIV, therefore, interventions must also work within communities to address these barriers and increase service use and need to be informed by evidence. This paper reviews community-based approaches that have been used in resource-limited settings to increase rates of PMTCT enrolment, retention in care and successful treatment outcomes. It aims to identify which interventions work, why they may do so and what knowledge gaps remain. METHODS First, we identified barriers to PMTCT that originate outside the health system. These were used to construct a social ecological framework categorizing barriers to PMTCT into the following levels of influence: individual, peer and family, community and sociocultural. We then used this conceptual framework to guide a review of the literature on community-based approaches, defined as interventions delivered outside of formal health settings, with the goal of increasing uptake, retention, adherence and positive psychosocial outcomes in PMTCT programmes in resource-poor countries. RESULTS Our review found evidence of effectiveness of strategies targeting individuals and peer/family levels (e.g., providing household HIV testing and training peer counsellors to support exclusive breastfeeding) and at community level (e.g., participatory women's groups and home-based care to support adherence and retention). Evidence is more limited for complex interventions combining multiple strategies across different ecological levels. There is often little information describing implementation; and approaches such as "community mobilization" remain poorly defined. CONCLUSIONS Evidence from existing community approaches can be adapted for use in planning PMTCT. However, for successful replication of evidence-based interventions to occur, comprehensive process evaluations are needed to elucidate the pathways through which specific interventions achieve desired PMTCT outcomes. A social ecological framework can help analyze the complex interplay of facilitators and barriers to PMTCT service uptake in each context, thus helping to inform selection of locally relevant community-based interventions.
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Affiliation(s)
- Joanna Busza
- Department of Population Studies, London School of Hygiene & Tropical Medicine, London, UK.
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