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Dadi TL, Wiemers AMC, Tegene Y, Medhin G, Spigt M. Experiences of people living with HIV in low- and middle-income countries and their perspectives in self-management: a meta-synthesis. AIDS Res Ther 2024; 21:7. [PMID: 38297363 PMCID: PMC10829476 DOI: 10.1186/s12981-024-00595-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 01/17/2024] [Indexed: 02/02/2024] Open
Abstract
INTRODUCTION Availability of anti-retroviral treatment has changed HIV in to a manageable chronic disease, making effective self-management essential. However, only a few studies in low- and middle-income countries (LMICs) reported experiences of people living with HIV (PLWH) on self-management. METHODS This meta-synthesis of qualitative studies investigated perspectives of PLWH in LMICs on self-management. Various databases, including PubMed, EMBASE, EBSCO, and CINHAL, were searched through June 2022. Relevant additional articles were also included using cross-referencing of the identified papers. We used a thematic synthesis guided by the "Model of the Individual and Family Self-Management Theory" (IFSMT). RESULT PLWH in LIMICs experience a variety of challenges that restrict their options for effective self-management and compromises their quality of life. The main ones include: misconceptions about the disease, poor self-efficacy and self-management skills, negative social perceptions, and a non-patient-centered model of care that reduces the role of patients. The experiences that influenced the ability to practice self-management are summarized in context (the condition itself, physical and environmental factors, individual and family factors) and process factors (knowledge and beliefs, relationship with the health care worker, self-regulation skills and abilities, and social facilitation). Context and process greatly impacted quality of life through the self-management practices of the patients. CONCLUSION AND RECOMMENDATION PLWH encounter multiple challenges, are not empowered enough to manage their own chronic condition, and their needs beyond medical care are not addressed by service providers. Self-management practice of these patients is poor, and service providers do not follow service delivery approaches that empower patients to be at the center of their own care and to achieve an effective and sustainable outcome from treatment. These findings call for a comprehensive well thought self-management interventions.
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Affiliation(s)
- Tegene Legese Dadi
- School of Public Health, College of Medicine & Health Science, Hawassa University, Hawassa, Ethiopia.
- Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands.
| | - Anja M C Wiemers
- Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Yadessa Tegene
- School of Public Health, College of Medicine & Health Science, Hawassa University, Hawassa, Ethiopia
- Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
- MERQ Consultancy PLC, Addis Ababa, Ethiopia
| | - Mark Spigt
- Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- General Practice Research Unit, Department of Community Medicine, UiT the Arctic University of Norway, Tromsö, Norway
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Dinh LV, Wiemers AMC, Forse RJ, Phan YTH, Codlin AJ, Annerstedt KS, Dong TTT, Nguyen L, Pham TH, Nguyen LH, Dang HMT, Tuan MH, Le PT, Lonnroth K, Creswell J, Khan A, Kirubi B, Nguyen HB, Nguyen NV, Vo LNQ. Comparing Catastrophic Costs: Active vs. Passive Tuberculosis Case Finding in Urban Vietnam. Trop Med Infect Dis 2023; 8:423. [PMID: 37755885 PMCID: PMC10535862 DOI: 10.3390/tropicalmed8090423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/28/2023] Open
Abstract
Active case finding (ACF) is a strategy that aims to identify people with tuberculosis (TB) earlier in their disease. This outreach approach may lead to a reduction in catastrophic cost incurrence (costs exceeding 20% of annual household income), a main target of WHO's End TB Strategy. Our study assessed the socio-economic impact of ACF by comparing patient costs in actively and passively detected people with TB. Longitudinal patient cost surveys were prospectively fielded for people with drug-sensitive pulmonary TB, with 105 detected through ACF and 107 passively detected. Data were collected in four Vietnamese cities between October 2020 and March 2022. ACF reduced pre-treatment (USD 10 vs. 101, p < 0.001) and treatment costs (USD 888 vs. 1213, p < 0.001) in TB-affected individuals. Furthermore, it reduced the occurrence of job loss (15.2% vs. 35.5%, p = 0.001) and use of coping strategies (28.6% vs. 45.7%, p = 0.004). However, catastrophic cost incurrence was high at 52.8% and did not differ between cohorts. ACF did not significantly decrease indirect costs, the largest contributor to catastrophic costs. ACF reduces costs but cannot sufficiently reduce the risk of catastrophic costs. As income loss is the largest driver of costs during TB treatment, social protection schemes need to be expanded.
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Affiliation(s)
| | | | - Rachel J. Forse
- Friends for International TB Relief, Ha Noi 10000, Vietnam
- WHO Collaboration Centre on Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Yen T. H. Phan
- Center for Development of Community Health Initiatives, Ha Noi 10000, Vietnam
| | - Andrew J. Codlin
- Friends for International TB Relief, Ha Noi 10000, Vietnam
- WHO Collaboration Centre on Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Kristi Sidney Annerstedt
- WHO Collaboration Centre on Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, 171 76 Stockholm, Sweden
| | | | - Lan Nguyen
- IRD VN, Ho Chi Minh City 700000, Vietnam
| | | | - Lan H. Nguyen
- Pham Ngoc Thach Hospital, Ho Chi Minh City 700000, Vietnam
| | - Ha M. T. Dang
- Pham Ngoc Thach Hospital, Ho Chi Minh City 700000, Vietnam
| | - Mac H. Tuan
- Hai Phong Lung Hospital, Hai Phong 188140, Vietnam
| | | | - Knut Lonnroth
- WHO Collaboration Centre on Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Jacob Creswell
- Stop TB Partnership, Le Grand-Saconnex, 1218 Geneva, Switzerland
| | - Amera Khan
- Stop TB Partnership, Le Grand-Saconnex, 1218 Geneva, Switzerland
| | - Beatrice Kirubi
- Stop TB Partnership, Le Grand-Saconnex, 1218 Geneva, Switzerland
| | | | | | - Luan N. Q. Vo
- Friends for International TB Relief, Ha Noi 10000, Vietnam
- WHO Collaboration Centre on Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, 171 76 Stockholm, Sweden
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