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Seang K, Vogt F, Ky S, Ouk V, Kaldor J, Vallely A, Saphonn V. Access to and utilization of COVID-19 antigen rapid diagnostic tests (Ag-RDTs) among people living with HIV (PLWH): A mixed methods study from Cambodia. PLOS Glob Public Health 2024; 4:e0002940. [PMID: 38349909 PMCID: PMC10863891 DOI: 10.1371/journal.pgph.0002940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/22/2024] [Indexed: 02/15/2024]
Abstract
Several COVID-19 antigen rapid diagnostic tests have been approved in Cambodia, but no evidence exists about the access to and utilization of these tests. This limits public health interventions to increase testing, especially among vulnerable populations such as people living with HIV (PLWH). We conducted a mixed method study among PLWH in Phnom Penh, Cambodia, between July and August 2022 to understand their current Ag-RDT access and utilization levels, as well as key barriers and drivers. We undertook a cross-sectional survey and focus group discussions among 280 and 10 PLWH, respectively, from five HIV treatment centres using a probability-proportional-to-size and simple random sampling approach. Access was defined as having received a COVID-19 Ag-RDT within the six months and utilization as having administered a COVID-19 Ag-RDT, either to oneself or to others, within the 12 months prior to the study. We calculated means, standard deviations and proportions for continuous and categorical variables, using a linear regression model with random effects to account for clustering. Additionally, we fitted a logistic model with random effects to assess factors associated with Ag-RDT access. For the qualitative data, we used thematic analyses to identify barriers/enablers of Ag-RDT access and utilization. About 35% (n = 101) of PLWH reported having had access to an Ag-RDT test in the past six months. About 11% (n = 32) of the study participants administered the Ag-RDT to themselves, 4% (n = 10) to others and 9% (n = 24) have done both, in the past 12 months. Age and education appeared to be associated with Ag-RDT access in the logistic models. Price and advice from pharmacists were commonly reported to be the main selection criteria for the brand of Ag-RDT chosen. Ag-RDTs are an important diagnostic tool for COVID-19 among PLWH in Cambodia, but familiarity of use and price could hinder better uptake, access and utilization.
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Affiliation(s)
- Kennarey Seang
- Grant Management Office, University of Health Sciences, Phnom Penh, Cambodia
| | - Florian Vogt
- The Kirby Institute, University of New South Wales, Sydney, Australia
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Sovathana Ky
- National Center for HIV/AIDS, Dermatology and STDs, Phnom Penh, Cambodia
| | - Vichea Ouk
- National Center for HIV/AIDS, Dermatology and STDs, Phnom Penh, Cambodia
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Andrew Vallely
- The Kirby Institute, University of New South Wales, Sydney, Australia
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Wang X, Sanders HM, Liu Y, Seang K, Tran BX, Atanasov AG, Qiu Y, Tang S, Car J, Wang YX, Wong TY, Tham YC, Chung KC. ChatGPT: promise and challenges for deployment in low- and middle-income countries. Lancet Reg Health West Pac 2023; 41:100905. [PMID: 37731897 PMCID: PMC10507635 DOI: 10.1016/j.lanwpc.2023.100905] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/14/2023] [Accepted: 09/03/2023] [Indexed: 09/22/2023]
Abstract
In low- and middle-income countries (LMICs), the fields of medicine and public health grapple with numerous challenges that continue to hinder patients' access to healthcare services. ChatGPT, a publicly accessible chatbot, has emerged as a potential tool in aiding public health efforts in LMICs. This viewpoint details the potential benefits of employing ChatGPT in LMICs to improve medicine and public health encompassing a broad spectrum of domains ranging from health literacy, screening, triaging, remote healthcare support, mental health support, multilingual capabilities, healthcare communication and documentation, medical training and education, and support for healthcare professionals. Additionally, we also share potential concerns and limitations associated with the use of ChatGPT and provide a balanced discussion on the opportunities and challenges of using ChatGPT in LMICs.
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Affiliation(s)
- Xiaofei Wang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Hayley M. Sanders
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Yuchen Liu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Kennarey Seang
- Grant Management Office, University of Health Sciences, Phnom Penh, Cambodia
| | - Bach Xuan Tran
- Department of Health Economics, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
- Institute of Health Economics and Technology, Hanoi, Vietnam
| | - Atanas G. Atanasov
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Jastrzebiec, 05-552, Magdalenka, Poland
| | - Yue Qiu
- Institute for Hospital Management, Tsinghua University, Beijing, China
| | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Ophthalmology and Visual Science Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Tsinghua Medicine, Tsinghua University, Beijing, China
- School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Yih-Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Centre for Innovation and Precision Eye Health, Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Kevin C. Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
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Seang K, Ky S, Ngauv B, Mam S, Ouk V, Saphonn V. Using Relational Community Engagement within the Digital Health Intervention (DHI) to Improve Access and Retention among People Living with HIV (PLWH): Findings from a Mixed-Method Study in Cambodia. Int J Environ Res Public Health 2023; 20:5247. [PMID: 37047863 PMCID: PMC10093806 DOI: 10.3390/ijerph20075247] [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] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/14/2023] [Accepted: 03/22/2023] [Indexed: 06/19/2023]
Abstract
We examined the impact of COVID-19-associated restrictive measures on the HIV care system in Cambodia through a complexity lens and aimed to use the findings to integrate social and relational processes into the design and implementation of proposed solutions that could support program outcomes during these times. Through a mixed-method design, we generated data on the strength of connection and quality of relationships between stakeholders and how this, in turn, provided a more holistic understanding of the challenges experienced during a pandemic. We interviewed 43 HIV care providers and 13 patients from eight HIV clinics and 13 policy-level stakeholders from relevant institutions involved in HIV care from April to May 2021. We identified several challenges, as well as an opportunity to improve HIV care access that built upon a strong foundation of trust between the HIV care providers and receivers in Cambodia. Trusting relationships between providers and patients provided the basis for intervention development aiming to improve the care experience and patients' engagement in care. Iterative research processes could better inform the intervention, and communication resources provided through relational skills training are key to their application and sustainability.
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Affiliation(s)
- Kennarey Seang
- Grant Management Office, University of Health Sciences, Phnom Penh 12201, Cambodia
| | - Sovathana Ky
- National Center for HIV/AIDS, Dermatology and STDs, Phnom Penh 121002, Cambodia
| | - Bora Ngauv
- National Center for HIV/AIDS, Dermatology and STDs, Phnom Penh 121002, Cambodia
| | - Sovatha Mam
- Rectorate, University of Health Sciences, Phnom Penh 12201, Cambodia
| | - Vichea Ouk
- National Center for HIV/AIDS, Dermatology and STDs, Phnom Penh 121002, Cambodia
| | - Vonthanak Saphonn
- Rectorate, University of Health Sciences, Phnom Penh 12201, Cambodia
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Seang K, Khim K, Vyas K, Khuon D, Saphonn V, Gorbach P. Medical injection and infusion practices among HIV-seronegative people and people living with HIV: a behavioural survey of 10 HIV testing and opportunistic infections/antiretroviral therapy sites in Cambodia. BMJ Open 2022; 12:e065026. [PMID: 36180125 PMCID: PMC9528614 DOI: 10.1136/bmjopen-2022-065026] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES In late 2014, an HIV outbreak occurred in rural Cambodia among villagers who received medical injections from unlicensed medical providers, justifying the need to assess medical injection practices among those who are at risk of acquiring and/or transmitting HIV. This study examined medical injection/infusion behaviours among people living with HIV (PLWH) and those who were HIV negative in Cambodia. These behaviours should be properly assessed, especially among PLWH, as their prevalence might influence a future risk of other outbreaks. DESIGN A cross-sectional survey was conducted in order to examine injection behaviours and estimate injection prevalence and rates by HIV status. Unsafe injections/infusions were those received from village providers who do not work at a health centre or hospital, or traditional providers at the participant's (self-injection included) or provider's home. Logistic regression was performed to examine the relationship between unsafe injection/infusion and HIV, adjusting for sex, age, education, occupation, residence location and other risk factors. SETTING The survey was conducted in 10 HIV testing and treatment hospitals/clinics across selected provinces in Cambodia, from February to March 2017. PARTICIPANTS A total number of 500 volunteers participated in the survey, 250 PLWH and 250 HIV-negative individuals. OUTCOME MEASURES Measures of injection prevalence and other risk behaviours were based on self-reports. RESULTS Both groups of participants reported similar past year's injection/infusion use, 47% (n=66) among PLWH and 54% (n=110) HIV-negative participants (p=0.24). However, 15% (n=11) of PLWH reported having received unsafe last injection compared with only 7% (n=11) of HIV-negative participants. In logistic regression, this association remained numerically positive, but was not statistically significant (adjusted OR 1.84 (95% CI: 0.71 to 4.80)). CONCLUSIONS The inclination for medical injections and infusions (unsafe at times) among PLWH and the general population in Cambodia was common and could possibly represent yet another opportunity for parenteral transmission outbreak.
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Affiliation(s)
- Kennarey Seang
- Grant Management Office, University of Health Sciences, Phnom Penh, Cambodia
| | - Keovathanak Khim
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kartavya Vyas
- Epidemiology, Emory University, Atlanta, Georgia, USA
| | - Dyna Khuon
- Public Health Unit, University of Health Sciences, Phnom Penh, Cambodia
| | | | - Pamina Gorbach
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, USA
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Seang K, Javanbakht M, Lee SJ, Brookmeyer R, Pheng P, Chea P, Saphonn V, Gorbach PM. Differences in prevalence and risk factors of non-communicable diseases between young people living with HIV (YLWH) and young general population in Cambodia. PLoS One 2022; 17:e0269989. [PMID: 35727763 PMCID: PMC9212152 DOI: 10.1371/journal.pone.0269989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 06/01/2022] [Indexed: 11/18/2022] Open
Abstract
Understanding non-communicable diseases (NCDs) among young people living with HIV (YLWH) is critical given the potential for aging-associated comorbidities resulting from HIV, especially in Cambodia where such data are limited. Therefore, we examined the prevalence and correlates of NCDs in YLWH and compared it to a nationally representative sample of young people not otherwise infected. We collected data from a sample of 370 YLWH aged 18-29 years attending three HIV clinics in Cambodia between 2019 and 2020. Our comparison group were 486 young people who participated in the Ministry of Health/WHO 2016 Noncommunicable Disease Risk Factor Surveillance (STEP survey). Both surveys used a standardized questionnaire to collect information on lifestyle factors and World Health Organization protocols for physical and biochemical measurements. We compared the prevalence of diabetes, hypertension, and high cholesterolemia between the two groups and examined the relationship between these conditions and HIV. We found 16 (4%), 22 (6%), and 72 (20%) had diabetes, hypertension, and high cholesterolemia, respectively, among YLWH, compared to 4 (1%), 22 (4%), and 49 (11%) among the general population. In logistic regression, YLWH were at higher odds of diabetes/prediabetes and high cholesterolemia compared with the young general population, aOR = 6.64 (95% CI 3.62-12.19) and aOR = 7.95 (95% CI 3.98-15.87), respectively. Our findings demonstrate that YLWH in Cambodia face multiple metabolic disorders and NCDs despite their young age and that accessible screening measures and treatment for these conditions are needed in order to combat NCDs in the future.
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Affiliation(s)
- Kennarey Seang
- Grant Management Office, University of Health Sciences, Phnom Penh, Cambodia
- * E-mail:
| | - Marjan Javanbakht
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Sung-Jae Lee
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Ron Brookmeyer
- Department of Biostatistics, University of California Los Angeles, Los Angeles, California, United States of America
| | - Phearavin Pheng
- Grant Management Office, University of Health Sciences, Phnom Penh, Cambodia
| | - Phalla Chea
- International Relation Division, University of Health Sciences, Phnom Penh, Cambodia
| | | | - Pamina M. Gorbach
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America
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