HIV/AIDS Epidemic and COVID-19 Pandemic in Africa

Correlates and effects of information, motivation and behavioral skills on primary sexual abstinence among female university students in Ethiopia: a cross-sectional study

BACKGROUND

The burden of sexually transmitted infections (STIs) and unintended pregnancies continue to pose significant public health challenges, disproportionately affecting young women. The information-motivation-behavioral (IMB) skills model is useful for understanding risky and safe sexual behavior. However, while the IMB models have been used primarly to understand and promote HIV prevention with condom use behavior, there is limtted research using the IMB model to understand and promote safer sexual dual-protection behaviors, such as abstinence, to address the risk of both STI/HIV and unwanted pregnancy among youth in Ethiopia. This study aimed to fill this gap by applying the IMB model to assess the correlates and effects of information, motivation, and behavioral skills on primary sexual abstinence among female university students in Ethiopia.

METHODS

A cross-sectional study was conducted with a sample of 1,020 female university students at Mattu University between May and June 2023. Data were collected using a self-administered questionnaire and analyzed using SPSS version 23. Descriptive statistics were used to summarize the percentage distribution of participants by their sociodemographic characteristics and levels of HIV risk reduction/dual protection information, motivation, behavioral skills, and risky and safer sexual behaviors. Bivariate and multivariate analyses were conducted using structural equation modeling (SEM) with AMOS 23 to examine the correlations and effects of information, motivation, and behavioral skills on primary sexual abstinence.

RESULTS

Of 1,020 participants, 624 (61.2%) reported having practiced primary sexual abstinence.Multivariate analyses showed that primary sexual abstinence was significantly predicted by motivation (β = 0.34, P < 0.001), behavioral skills (β = 0.24, P < 0.001) and information (β = 0.11, P < 0.001) after controlling for the effects of other confounding variables. Overall, approximately 28% of the variance in primary sexual abstinence was explained by the IMB model constructs.

CONCLUSIONS

The findings indicate that the IMB model is a useful tool for identifying powerful determinants of sexual abstinence, which has potential implications for interventions aimed at enhancing specific information, motivation, and behavioral skills to promote sexual abstinence and reduce the risk of HIV/STI and unintended pregnancy among youth in settings with high HIV burdens.

Lessons for Strengthening a Resilient Health System from the View of Health Facilities During the COVID-19 Pandemic: A Qualitative Study

Background

Coronavirus disease 2019 caused significant negative damage to the health status of populations and health systems globally. In Uganda, our previous study revealed that the strict Public Health and Social measures (PHSMs) and the closure of Entebbe Regional Referral Hospital (ERRH) led to missed healthcare access among the citizens in the Entebbe municipality. Limited studies, however, exist on the impact of the response measures on the local health systems. This study aims to explore the impacts of these measures on the local health service provision from the views of health facilities in Entebbe.

Methods

We used a thematic framework method, grounded by the health systems resilience framework consisting of five components: (1) health service delivery; (2) medical products and technology; (3) health workforce; (4) public health functions; and (5) governance and financing. Key informant interviews with eight representatives from four private hospitals and four health centers were conducted from September to October 2022.

Results

Fifteen themes and 25 subthemes were identified. With the closure of the ERRH and the strict PHSMs, the citizens faced various difficulties in accessing the needed health services. The facilities received an overwhelming number of patients and faced various challenges, such as a lack of medicine, healthcare workers, facility capacity, and no means to transfer patients. Nevertheless, the facilities made efforts to maintain the required services. Moreover, mobilizing vertical and horizontal actors through a flexible network, from the district health office to community health volunteers, helped to coordinate the medicines, transportation for both patients and healthcare workers, conduct patient tracking, etc.

Conclusion

Our study suggested the importance of an integrated system of public health and health service delivery systems, the formalization of a vertical cooperative mechanism, and the introduction of public health insurance for strengthening resilient health systems. These insights may benefit other sub-Saharan cities.

Impact of Hospital Closure on Patients with Communicable and Non-Communicable Diseases During the COVID-19 Pandemic in Uganda: A Cross-Sectional and Mixed-Methods Study

Background

The COVID-19 pandemic and its measures have had a profound impact on universal access to health services. We investigated the impact of the closure of the Entebbe Regional Referral Hospital (ERRH) for two years on the accessibility to necessary healthcare among non-COVID-19 patients.

Methods

This mixed-methods study focused on ERRH patients with tuberculosis (TB), human immunodeficiency virus (HIV), diabetes/hypertension, and mental illness. A quantitative study used a structured-questionnaire with a primary outcome measure to assess the discontinuation of healthcare accessibility. A qualitative study with a focus group discussion (FGD) was conducted on eight patients.

Results

Of the 202 quantitative survey participants, 17.8% discontinued necessary healthcare due to the ERRH closure, and the discontinuation rates differed by disease: 48.1% of TB patients, 16.0% of HIV patients, 7.8% of diabetes/hypertension patients, and 4.0% of mental health patients (P < 0.001). Almost 90% of the patients reported a worsened health condition, regardless of the disease. Multivariable logistic regression analysis showed that patients with diabetes/hypertension (adjusted odds ratio [AOR], 12.69; 95% confidence interval [CI], 2.57-62.52) and HIV (AOR, 7.52; 95% CI, 1.37-41.27) were more likely to discontinue healthcare than those with mental illness. The factors associated with discontinued healthcare included age ≥50 years vs ≤30 years (AOR, 4.88; 95% CI, 1.07-22.34), and high transportation cost vs low cost (AOR, 3.15; 95% CI, 1.13-8.75). The FGD also identified difficulties in obtaining medication, especially for TB, even though ERRH provided the outreach services.

Conclusion

Our study revealed that the ERRH closure and lockdowns had an overall profound negative impact on access to healthcare and health conditions. Younger patients and those with TB were the most affected patients. This study provides practical suggestions from the field for policy makers to strengthen universal health access during health crises in Uganda and other sub-Saharan countries.

Third wave of COVID-19 pandemic in Africa: Challenges and recommendations

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has evolved in different waves and is currently in its third wave for the majority of countries around the world. Each wave emanated with its own set of challenges. Lower- and middle-income countries such as most African countries have faced additional challenges compared to high-income countries. This paper highlights the challenges faced by Africa during the third wave of COVID-19 and proposes recommendations and strategies to contain the spread. We conducted a mini-review for the newly released articles and researches about the challenges faced by Africa during COVID-19. Fragmented healthcare sectors, limited healthcare resources and emergence of co-infections in COVID-19 patients, inadequate vaccination rollout and political conflicts are the major challenges faced by the African countries. Our recommendations to defeat this outbreak and subsequent pandemics is to raise the public's awareness about vaccines through campaigns and social media in order to lessen vaccine hesitancy. Governments as well should focus on under-served and vulnerable populations, patients with comorbidities, and communities living in endemic-striking settings as these people are more prone to the severe form of the disease. Moreover, by adopting socio-ecological perspectives, one can implement multi-level integrated interventions to help control COVID-19 more effectively.

COVID-19 outcomes in HIV patients: A review

The effect of COVID-19 is enormous, and high-risk COVID-19 case arises when underlying infections like diabetes, chronic obstructive pulmonary disease, heart failure, coronary artery disease, or cardiomyopathy are present, and an immunocompromised state such as Human Immunodeficiency Virus (HIV). People living with HIV(PLHIV) may be exposed to severe COVID-19, mostly in areas with poor access to proper care and complex intervention for HIV infection. During the lockdown, those with medical appointments will not access health facilities, which may be detrimental to people living with HIV. Emerging evidence suggests COVID-19 pandemic fear may lead to adverse mental health outcomes and affect preventive behavior. In addition to the stigma and discrimination associated with HIV, COVID-19 is also causing concerns. People with HIV tend to have mental health issues such as depression, anxiety, and post-traumatic stress (PTSD), which can be both a cause and a harmful impact of HIV. Discussed in this research is the effect of the COVID-19 pandemic on HIV patients, their similarities, differences, and urgent attention from healthcare centers to take charge and respond to patients with HIV and other immunosuppressed conditions during the COVID-19 pandemic.

The impact of COVID-19 on communicable and non-communicable diseases in Africa: a narrative review

The global pandemic of coronavirus disease 2019 (COVID-19) has disproportionately impacted global human health, economy, and security. Because of weaker health-care systems, existing comorbidities burden (HIV, malaria, tuberculosis, and non-communicable conditions), and poor socioeconomic determinants, initial predictive models had forecast a disastrous impact of COVID-19 in Africa in terms of transmission, severity, and deaths. Nonetheless, current epidemiological data seem not to have matched expectations, showing lower SARS-CoV-2 infection and fatality rates compared to Europe, the Americas and Asia. However, only few studies were conducted in low- and middle-income African settings where high poverty and limited access to health services worsen underlying health conditions, including endemic chronic infectious diseases such as HIV and tuberculosis. Furthermore, limited, and heterogeneous research was conducted to evaluate the indirect impact of the pandemic on general health services and on major diseases across African countries. International mitigation measures, such as resource reallocation, lockdowns, social restrictions, and fear from the population have had multi-sectoral impacts on various aspects of everyday life, that shaped the general health response. Despite the vast heterogeneity of data across African countries, available evidence suggests that the COVID-19 pandemic has severely impacted the control and prevention programs, the diagnosis capacity and the adherence to treatment of major infectious diseases (HIV, TB, and Malaria) - including neglected diseases - and non-communicable diseases. Future research and efforts are essential to deeply assess the medium- and long-term impact of the pandemic, and to implement tailored interventions to mitigate the standstill on decades of improvement on public health programs.