"We did not know what was wrong"-Barriers along the care cascade among hospitalized adolescents with HIV in Gaborone, Botswana.
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ABSTRACT:
SUBMITTER: Enane LA
PROVIDER: S-EPMC5890999 | biostudies-literature | 2018
REPOSITORIES: biostudies-literature
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"We did not know what was wrong"-Barriers along the care cascade among hospitalized adolescents with HIV in Gaborone, Botswana.
Enane Leslie A LA Mokete Keboletse K Joel Dipesalema D Daimari Rahul R Tshume Ontibile O Anabwani Gabriel G Mazhani Loeto L Steenhoff Andrew P AP Lowenthal Elizabeth D ED
PloS one 20180409 4
High mortality among adolescents with HIV reflects delays and failures in the care cascade. We sought to elucidate critical missed opportunities and barriers to care among adolescents hospitalized with HIV at Botswana's tertiary referral hospital. We enrolled all HIV-infected adolescents (aged 10-19 years) hospitalized with any diagnosis other than pregnancy from July 2015 to January 2016. Medical records were reviewed for clinical variables and past engagement in care. Semi-structured interview ...[more]
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Project description:BackgroundHIV prevalence among female sex workers (FSW) in sub-Saharan Africa is much higher than in the general population. HIV self-testing (HIVST) may be useful for increasing testing rates in FSW.MethodsWe conducted semi-structured in-depth interviews among FSW, nurses and lay counsellors providing services to FSWs in Botswana. We aimed to gain understanding of perceived acceptability, anticipated barriers, and preferred approaches to HIVST among FSW. Interviews were audio-recorded, transcribed and translated. Transcripts were reviewed and coded independently by two investigators; high inter-coder agreement was achieved (Kappa = 0.80).ResultsWe interviewed five care providers whose average age was 40 years (SD = 2,64, range = 37-43); three nurses and two counsellors. Thirty FSW were interviewed, with mean age 34 years (range = 20-52). Most (27; 90%) FSW expressed great interest in using HIVST kits. Facilitators of HIVST were: awareness of own risky sexual behaviours, desire to stay healthy, and perceived autonomy over one's healthcare decisions. Perceived advantages of HIVST included convenience, privacy, and perception of decreased stigma. Identified barriers to HIVST included lack of knowledge about the HIVST kit, fear of testing due to anticipated stigma, mistrust of the test's accuracy, doubt of self-competency to perform HIVST, and concerns about not linking to care. Assisting someone to test was noted as good for providing emotional support, but there were concerns about confidentiality breaches. Providers expressed concerns over low literacy among FSWs which could affect comprehension of testing instructions, and competency to perform testing and interpret results. Participants' recommendations for implementation of HIVST included: ensuring wide dissemination of information on HIVST, engaging peers in information-sharing and education, making test kits accessible in FSW-friendly centres, and having clear instructions for linkage to healthcare and support.ConclusionHIVST shows high acceptability among FSWs in Gaborone Botswana, with providers expressing some concerns. Implementation should be peer-driven with healthcare provider oversight.
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Project description:BackgroundOral HIV self-testing (HIVST) may be useful for increasing testing in persons at elevated risk of acquiring HIV.MethodsWe conducted a pilot study to evaluate the feasibility (defined by uptake) of HIVST among FSW in Gaborone, Botswana. FSW age 18 years and above were recruited through a non-governmental organization serving FSW. FSW with unknown or negative HIV status at screening performed HIVST in the study clinic following brief training. FSW testing HIV-negative were each given two test kits to take home: one kit to perform unassisted HIVST and another to share with others. Feasibility (use) of HIVST (and sharing of test kits with others) was assessed in these women at a study visit four months later.ResultsTwo hundred FSW were screened. Their average age was 34 years (range 18-59), and 115 (58%) were HIV-positive. Eighty-five (42%) tested HIV-negative at entry and were eligible to take part in the HIVST pilot study. All 85 (100%) agreed to take home HIVST kits. Sixty-nine (81%) of these 85 participants had a follow-up visit, 56 (81%) of whom reported performing HIVST at a mean of three and half months after the initial visit. All 56 participants who performed HIVST reported negative HIVST results. Fifty (73%) of the 69 participants who took HIVST kits home shared them with others. Of the 50 women sharing HIVST kits, 25 (50%) shared with their non-client partners, 15 with a family member, 8 with friends, and 3 with a client. One participant did not test herself but shared both her test kits. Most participants 53/56 (95%) found oral HIVST very easy to use whilst 3/56 (5%) felt it was fairly easy.ConclusionOral HIVST is feasible among FSW in Gaborone, Botswana. The majority of FSW used the HIVST kits themselves and also shared extra HIVST kits with other individuals.
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Project description:ObjectivesOver the past decade, concerning trends in antimicrobial resistance have emerged in Southern Africa. Given a paucity of pediatric data, our objectives were to (1) describe antibiotic utilization trends at a national referral center in Southern Africa and (2) assess the proportion of patients receiving antibiotics appropriately. In addition, risk factors for inappropriate use were explored.MethodsWe performed a prospective cohort study on medical and surgical pediatric patients aged below 13 years admitted to the country's tertiary care referral hospital in Gaborone, Botswana. We collected demographics, clinical, laboratory, and microbiology details, in addition to information on antibiotic use. We separately categorized antibiotic prescriptions using the World Health Organization AWaRe Classification of Access, Watch, and Restrict.ResultsOur final cohort of 299 patients was 44% female and 27% HIV-exposed; most (68%) were admitted to the General Pediatrics ward. Infections were a common cause of hospitalization in 29% of the cohort. Almost half of our cohort were prescribed at least one antibiotic during their stay, including 40% on admission; almost half (47%) of these prescriptions were deemed appropriate. At the time of discharge, 52 (21%) patients were prescribed an antibiotic, of which 37% were appropriate. Of all antibiotics prescribed, 42% were from the World Health Organization Access antibiotic list, 58% were from the Watch antibiotic list, and 0% were prescribed antibiotics from the Restrict antibiotic list. Univariate analyses revealed that surgical patients were significantly more likely to have inappropriate antibiotics prescribed on admission. Patients who were treated for diseases for which there was a clinical pathway, or who had blood cultures sent at the time of admission were less likely to have inappropriate antibiotics prescribed. On multivariate analysis, apart from admission to the surgical unit, there were no independent predictors for inappropriate antibiotic use, although there was a trend for critically ill patients to receive inappropriate antibiotics.ConclusionOur study reveals high rates of antibiotic consumption, much of which was inappropriate. Promising areas for antimicrobial stewardship interventions include (1) standardization of management approaches in the pediatric surgical population and (2) the implementation of feasible and generalizable clinical pathways in this tertiary care facility.
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Project description:BackgroundAs children living with HIV transition from adolescence into adulthood, they face a considerable burden of psychiatric disorders (PDs) which may vary between the perinatally and behaviorally infected. The knowledge of the pattern of these PDs in relation to the varying needs of the adolescents living with HIV (ALWHIV) is unclear but necessary for maximizing their linkage to care and improving their quality of life in Botswana. AIM: To determine the pattern of PDs in ALWHIV in Botswana; to compare and explore the differences in the pattern and their associated factors between congenitally infected adolescents (CIAs) and behaviorally infected adolescents (BIAs).MethodsA cross-sectional survey of 622 ALWHIV (399 CIA and 223 BIA) with the Mini International Neuropsychiatric Interview-Kid Screen.ResultsThe participants' mean age (SD) was 17.71 (1.60) years, with more males (54%), of whom 52.9% had at least one PD, with depression (23.6%) and generalised anxiety disorder (18.0%) being the most prevalent. The externalising disorders were associated with being CIA (OR = 3.99; 95% CI:1.87-8.54), male gender (OR = 3.93; 95% CI:2.02-7.64), and a viral load of 400 and above copies (OR = 3.53; 95%CI:1.92-6.48). Internalising disorders were associated with being BIA (OR = 3.64; 95%; CI: 2.39-5.56), females (OR = 2.59; 95% CI:1.75-3.83), poor counselling (OR = 2.23; 95% CI: 1.42-3.51) and struggling to accept HIV status (OR = 1.73; 95% CI:1.14-2.62).ConclusionsDepression and anxiety disorders were the most prevalent PDs in ALWHIV, who differed in psychiatric presentations, the BIAs being more likely to present with internalizing disorders, while the CIAs had more externalizing disorders. Due to the varying needs of ALWHIV, individualized management plans that consider gender, mode of infection, and other psycho-social needs, should be further studied and encouraged.
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Project description:BackgroundPeople living with HIV (PLWH) in sub-Saharan Africa are vulnerable to end organ dysfunction such as albuminuria, which is associated with an increased risk of cardiovascular and renal events. However, the prevalence of persistent albuminuria among PLWH in Africa is unclear. This observational prospective study assessed for persistence of albuminuria in a cohort of PLWH on longterm antiretroviral therapy (ART) across various HIV service platforms in Gaborone, Botswana.MethodsA subgroup of ART treated PLWH (n = 867) from a larger cross-sectional study (n = 1537) assessing prevalence of albuminuria among PLWH at a referral hospital HIV clinic and satellite HIV clinics in Gaborone, were invited to participate in a 12-month long albuminuria prospective cohort study between January 2020 and March 2022. During three planned study visits, albumin-creatinine (ACR) was computed using urine albumin measured using immunoturbidimetric assay and urine creatinine using colorimetric assay (Jaffe method), at the Botswana Harvard HIV Reference Laboratory. ACR trajectory groups were identified using growth mixture models, and factors associated with ACR trajectory were analyzed using modified Poisson regression.ResultsAmong the 623 adults with complete data for all 3 study visits, their baseline median age was 50 (42-57) years with a median HIV disease duration of 13.1 (8.7-16.7) years, and 266 (42.7%) of them were female. Study participants were categorized into two ACR trajectory groups: low increasing ACR, N = 290 (46.5%) and moderate increasing ACR, N = 333 (53.5%) groups. ACR increased by 4.7 mg/g in the slow increasing ACR groups versus 11.5 mg/g in the moderate increasing ACR trajectory group by end of follow-up. Active use of Tenofovir, aRR 1.27 [95% CI 1.02-1.60], p = 0.036, or ACEi/ARB, aRR 1.31 [95% CI 1.07-1.61], p = 0.008, and an elevated baseline ACR, aRR 1.34 [95% CI 1.28-1.41], p < 0.001, were all associated with being in the moderate increasing ACR trajectory group.ConclusionChronic, treated HIV infection was associated with more than 5 fold increase in ACR over 12 months. Future studies should explore the extent to which modifiable risk factors and HIV specific factors for progressive increase in albuminuria could be aggressively controlled among PLWH.
| S-EPMC11889908 | biostudies-literature