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Parikh N, Chaudhuri A, Syam SB, Singh P, Pal P, Pillala P. Diseases and Disparities: The Impact of COVID-19 Disruptions on Sexual and Reproductive Health Services Among the HIV Community in India. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:315-329. [PMID: 35048205 PMCID: PMC8769775 DOI: 10.1007/s10508-021-02211-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 05/07/2023]
Abstract
People with HIV navigate numerous challenges to access healthcare in India. The lockdown in response to the COVID-19 pandemic presents further challenges in accessing sexual and reproductive health (SRH) services. This research explored the impact of the pandemic on SRH services, and the depth of disruptions faced by people living with HIV (PLHIV) in accessing treatment. Using purposive sampling with maximum variation technique, we recruited and conducted 150 telephonic in-depth interviews with PLHIV and HIV care providers (HCPs) from five states in India (Karnataka, Tamil Nadu, Maharashtra, Andhra Pradesh, and Telangana). The interviews were recorded, transcribed, coded, and analyzed using interpretative phenomenological analysis. Five main themes were identified: the effect of COVID-19 on (1) access to care, (2) quality of care, (3) social determinants of health, (4) system and community resilience, and (5) support required to address population-specific vulnerabilities. Despite the availability of free government treatment services during the pandemic, profound disruptions in the SRH services, particularly antiretroviral therapy and HIV care, were reported by PLHIV and HCPs. This qualitative study revealed how existing inequities in HIV treatment and care are exacerbated by the pandemic. These findings highlight that the pandemic response should be community-centered to prevent extreme disruptions in healthcare which will have a disastrous effect on the lives of PLHIV.
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Affiliation(s)
- Neha Parikh
- Swasti Health Catalyst, 25, 3rd Floor, Raghavendra Nilaya, 1st Main Road, AECS Layout, Ashwathnagar, near Paratha Plaza, Bengaluru, Karnataka, 560094, India.
| | - Angela Chaudhuri
- Swasti Health Catalyst, 25, 3rd Floor, Raghavendra Nilaya, 1st Main Road, AECS Layout, Ashwathnagar, near Paratha Plaza, Bengaluru, Karnataka, 560094, India
| | - Syama B Syam
- Swasti Health Catalyst, 25, 3rd Floor, Raghavendra Nilaya, 1st Main Road, AECS Layout, Ashwathnagar, near Paratha Plaza, Bengaluru, Karnataka, 560094, India
| | - Pratishtha Singh
- Swasti Health Catalyst, 25, 3rd Floor, Raghavendra Nilaya, 1st Main Road, AECS Layout, Ashwathnagar, near Paratha Plaza, Bengaluru, Karnataka, 560094, India
| | - Prachi Pal
- Institute of Development Studies, University of Sussex, Brighton, UK
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Shewade HD, Shringarpure KS, Parmar M, Patel N, Kuriya S, Shihora S, Ninama N, Gosai N, Khokhariya R, Popat C, Thanki H, Modi B, Dave P, Baxi RK, Kumar AMV. Delay and attrition before treatment initiation among MDR-TB patients in five districts of Gujarat, India. Public Health Action 2018; 8:59-65. [PMID: 29946521 DOI: 10.5588/pha.18.0003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 03/24/2018] [Indexed: 12/26/2022] Open
Abstract
Setting: Gujarat, a state in west India. Background: Although treatment initiation has been improving among patients diagnosed with multidrug-resistant tuberculosis (MDR-TB) in programme settings, it has still not reached 100%. Objectives: To determine pre-treatment attrition (not initiated on treatment within 6 months of diagnosis), delay in treatment initiation (>7 days from diagnosis) and associated factors among MDR-TB patients diagnosed in 2014 in five selected districts served by two genotypic drug susceptibility testing (DST) facilities and a drug-resistant TB centre in Gujarat. Design: This was a retrospective cohort study involving record review. Results: Among 257 MDR-TB patients, pre-treatment attrition was seen in 20 (8%, 95%CI 5-12). Patients with 'follow-up sputum-positive' as their DST criterion and sputum smear microscopy status 'unknown' at the time of referral for DST were less likely to be initiated on treatment. The median delay to treatment initiation was 8 days (interquartile range 6-13). Patients referred for DST from medical colleges were more likely to face delays in treatment initiation. Conclusion: The Gujarat TB programme is performing well in initiating laboratory-confirmed MDR-TB patients on treatment. However, there is further scope for reducing delay.
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Affiliation(s)
- H D Shewade
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi, India.,The Union, Paris, France
| | - K S Shringarpure
- Department of Preventive and Social Medicine, Medical College, Vadodara, India
| | - M Parmar
- World Health Organization Country Office for India, New Delhi, India
| | - N Patel
- Department of Preventive and Social Medicine, Medical College, Vadodara, India
| | - S Kuriya
- Department of Preventive and Social Medicine, Medical College, Vadodara, India
| | - S Shihora
- Department of Preventive and Social Medicine, Medical College, Vadodara, India
| | - N Ninama
- Department of Preventive and Social Medicine, Medical College, Vadodara, India
| | - N Gosai
- Department of Preventive and Social Medicine, Medical College, Vadodara, India
| | - R Khokhariya
- Department of Preventive and Social Medicine, Medical College, Vadodara, India
| | - C Popat
- Department of Preventive and Social Medicine, Medical College, Vadodara, India
| | - H Thanki
- World Health Organization Country Office for India, New Delhi, India
| | - B Modi
- Department of Community Medicine, Gujarat Medical Education & Research Society Medical College and Hospital, Gandhinagar, India
| | - P Dave
- Department of Health and Family Welfare, Government of Gujarat, Gandhinagar, India
| | - R K Baxi
- Department of Preventive and Social Medicine, Medical College, Vadodara, India
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi, India.,The Union, Paris, France
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