Wilson, Erin C.; Arayasirikul, Sean; Johnson, Kelly
Low access to HIV care and support has led to survival rates for transwomen that are half that of other populations at risk for HIV. Within the population, HIV disproportionately impacts African American transwomen. Interventions to increase access to HIV care and support are needed to better serve those most affected and vulnerable within the population. We conducted a study of barriers and facilitators to care and support services for African American transwomen to fill a gap in the literature to improve access for this particularly impacted population. A total of 10 in-depth interviews were conducted with African American transwomen living with HIV who lived outside the metro area of San Francisco. Three overarching thematic topics emerged-gender stigma, peer, and institutional distrust - giving insight into African American transwomen's barriers to HIV care and support services. A number of factors within these themes impacted access, such as whether organizations offered gender-related care, the geography of organizations as it relates to safe transportation and location, confidentiality and trust of peers and organizations, and trauma. Specific instrumental, institutional and emotional supports are provided that that may increase access to care and support services for African American transwomen living with HIV. PMID:24817835
Full Text Available Introduction: Knowledge about experiences in accessing HIV services among persons with disabilities who are living with HIV in sub-Saharan Africa is limited. Although HIV transmission among persons with disabilities in Africa is increasingly acknowledged, there is a need to bring to life the experiences and voices from persons with disabilities living with HIV to raise awareness of programme implementers and policy makers about their barriers in accessing HIV services. This paper explores how the barriers faced by persons with disabilities living with HIV impede their ability to access HIV-related services and manage their disease. Methods: We conducted focus group discussions with 76 persons (41 females; 35 males with physical, visual and/or hearing impairments who were living with HIV in Ghana, Uganda and Zambia (2012–2013. We explored challenges and facilitators at different levels (individual, psychosocial and structural of access to HIV services. Transcripts were analyzed using a framework analysis approach. Results: Persons with disabilities living with HIV encountered a wide variety of challenges in accessing HIV services. Delays in testing for HIV were common, with most waiting until they were sick to be tested. Reasons for delayed testing included challenges in getting to the health facilities, lack of information about HIV and testing, and HIV- and disability-related stigma. Barriers to HIV-related services, including care and treatment, at health facilities included lack of disability-friendly educational materials and sign interpreters, stigmatizing treatment by providers and other patients, lack of skills to provide tailored services to persons with disabilities living with HIV and physically inaccessible infrastructure, all of which make it extremely difficult for persons with disabilities to initiate and adhere to HIV treatment. Accessibility challenges were greater for women than men due to gender-related roles. Challenges were
Mboya, Beati; Temu, Florence; Awadhi, Bayoum; Ngware, Zubeda; Ndyetabura, Elly; Kiondo, Gloria; Maridadi, Janneth
Introduction Currently, Tanzania's HIV prevalence is 5.7%. Gender inequality and Gender Based Violence (GBV) are among factors fuelling the spread of HIV in Tanzania. This study was conducted to assess universal access to HIV prevention services among GBV survivors in Iringa and Dar-es-Salaam where HIV prevalence is as high as 14.7% and 9% respectively compared to a national average of 5.7%. Methods In 2010, a mixed methods study using triangulation model was conducted in Iringa and Dar-es-Sa...
Madden, H C E; Phillips-Howard, P A; Hargreaves, S C; Downing, J; Bellis, M A; Vivancos, R; Morley, C; Syed, Q; Cook, P A
HIV disproportionately affects vulnerable populations such as black and minority ethnic groups, men who have sex with men (MSM) and migrants, in many countries including those in the UK. Community organisations in the UK are charitable non-governmental organisations with a proportion of the workforce who volunteer, and provide invaluable additional support for people living with HIV (PLWHIV). Information on their contribution to HIV care in vulnerable groups is relatively sparse. Data generated from an enhanced HIV surveillance system in North West England, UK, was utilised for this study. We aimed to determine the characteristics of individuals who chose to access community services in addition to clinical services (1375 out of 4195 records of PLWHIV in clinical services). Demographic information, risk factors including residency status, uniquely gathered in this region, and deprivation scores were examined. Multivariate logistic regression modelling was conducted to predict the relative effect of patient characteristics on attendance at community services. Attendance at community services was highest in those living in the most, compared with least, deprived areas (prefugees (AOR = 5.75, 95% CI 3.3-10.03; pmigrant workers (AOR = 5.48, 95% CI 2.22-13.51; pmigrant populations, community services are vital for the management of HIV in black and minority groups. Paradoxically, this coincides with increasing funding pressures on these services.
Andersen, Helle Elisabeth
Abstract This project is based on five weeks’ ethnographically inspired fieldwork in May 2006 in the Republic of Uganda. The study started out with the hypothesis that there was some kind of discrimination going on in the interaction between health workers at HIV/AIDS clinics, and person with dis......Abstract This project is based on five weeks’ ethnographically inspired fieldwork in May 2006 in the Republic of Uganda. The study started out with the hypothesis that there was some kind of discrimination going on in the interaction between health workers at HIV/AIDS clinics, and person...... with disabilities (PWDs) coming for HIV/AIDS testing or treatment. However, problems with discriminatory attitudes towards PWDs could not be confirmed from my fieldwork observations at five different HIV/AIDS clinics in Uganda. That observation was confirmed in my interviews with PWDs and health workers. Health...... workers said that PWDs were entitled to the same care and treatment as everybody else. However, I observed that only few PWDs seem to attend those HIV/AIDS services, and the question arose why that is so. Problems with access and confidence (for example lack of sign language interpreters) are often...
Wenzel, Suzanne L.; Rhoades, Harmony; Tucker, Joan S.; Golinelli, Daniela; Kennedy, David P.; Zhou, Annie; Ewing, Brett
HIV is a serious epidemic among homeless persons, where rates of infection are estimated to be three times higher than in the general population. HIV testing is an effective tool for reducing HIV transmission and for combating poor HIV/AIDS health outcomes that disproportionately affect homeless persons, however, little is known about the HIV…
Wenzel, Suzanne L.; Rhoades, Harmony; Tucker, Joan S.; Golinelli, Daniela; Kennedy, David P.; Zhou, Annie; Ewing, Brett
HIV is a serious epidemic among homeless persons, where rates of infection are estimated to be three times higher than in the general population. HIV testing is an effective tool for reducing HIV transmission and for combating poor HIV/AIDS health outcomes that disproportionately affect homeless persons, however, little is known about the HIV…
Ramos, Rebecca L; Green, Nancy Lorenza; Shulman, Lawrence C
Promotoras along the U.S.-Mexico border in the role of animadoras (motivators) used a chain referral strategy called Pasa la Voz (Spread the Word). Latinas at high to moderate risk of HIV infection became better informed about prevention, accessed prevention services, and referred other at-risk Latinas for services.
Full Text Available Introduction. Men who have sex with men (MSM are disproportionately impacted by HIV globally. Easily accessible combination HIV prevention strategies, tailored to the needs of MSM, are needed to effectively address the AIDS pandemic. Methods and Materials. We conducted a cross-sectional study among MSM (n=3748 from 145 countries from April to August 2012. Using multivariable random effects models, we examined factors associated with acceptability of preexposure prophylaxis (PrEP and access to condoms, lubricants, HIV testing, and HIV treatment. Results. Condoms and lubricants were accessible to 35% and 22% of all respondents, respectively. HIV testing was accessible to 35% of HIV-negative respondents. Forty-three percent of all HIV-positive respondents reported that antiretroviral therapy was easily accessible. Homophobia, outness, and service provider stigma were significantly associated with reduced access to services. Conversely, community engagement, connection to gay community, and comfort with service providers were associated with increased access. PrEP acceptability was associated with lower PrEP-related stigma, less knowledge about PrEP, less outness, higher service provider stigma, and having experienced violence for being MSM. Conclusions. Ensuring HIV service access among MSM will be critical in maximizing the potential effectiveness of combination approaches, especially given the interdependence of both basic and newer interventions like PrEP. Barriers and facilitators of HIV service access for MSM should be better understood and addressed.
Chersich Matthew F
Full Text Available Abstract Background HIV remains responsible for an estimated 40% of mortality in South African pregnant women and their children. To address these avoidable deaths, eligibility criteria for antiretroviral therapy (ART in pregnant women were revised in 2010 to enhance ART coverage. With greater availability of HIV services in public health settings and increasing government attention to poor maternal-child health outcomes, this study used the patient's journey through the continuum of maternal and child care as a framework to track and document women's experiences of accessing ART and prevention of mother-to-child HIV transmission (PMTCT programmes in the Eastern Cape (three peri-urban facilities and Gauteng provinces (one academic hospital. Results In-depth interviews identified considerable weaknesses within operational HIV service delivery. These manifested as missed opportunities for HIV testing in antenatal care due to shortages of test kits; insufficient staff assigned to HIV services; late payment of lay counsellors, with consequent absenteeism; and delayed transcription of CD4 cell count results into patient files (required for ART initiation. By contrast, individual factors undermining access encompassed psychosocial concerns, such as fear of a positive test result or a partner's reaction; and stigma. Data and information systems for monitoring in the three peri-urban facilities were markedly inadequate. Conclusions A single system- or individual-level delay reduced the likelihood of women accessing ART or PMTCT interventions. These delays, when concurrent, often signalled wholesale denial of prevention and treatment. There is great scope for health systems' reforms to address constraints and weaknesses within PMTCT and ART services in South Africa. Recommendations from this study include: ensuring autonomy over resources at lower levels; linking performance management to facility-wide human resources interventions; developing
Full Text Available Abstract Background Patient choice and access to health care is compromised by many barriers including travel distance. Individuals with the human immunodeficiency virus (HIV can seek free specialist care in Britain, without a referral, providing flexible access to care services. Willingness to travel beyond local services for preferred care has funding and service implications. Data from an enhanced HIV surveillance system were used to explore geodemographic and clinical factors associated with accessing treatment services. Methods We extracted data on the location, type and frequency of care services utilized by HIV positive persons (n = 3983 accessing treatment in north west England between January 1st 2005 and June 30th 2006. Individuals were allocated a deprivation score and grouped by urban/rural residence, and distance to care services was calculated. Analysis identified independent predictors of distance travelled (general linear modelling and, for those bypassing their nearest clinic, the probability of accessing a specialist service (logistic regression, SPSS ver 14. Inter-relationships between variables and distance travelled were visualised using detrended correspondence analysis (PC-ORD ver 4.1. Results HIV infected persons travelled an average of 4.8 km (95% confidence intervals (CI 4.6–4.9 per trip and had on average 6 visits (95% CI 5.9–6.2 annually for care. Longer trips were made by males (4.8 km vs 4.5 km, white people (6.2 km, the young (>15 years, 6.8 km and elderly (60+ years, 6.3 km, those on multiple therapy (5.3 km vs 4.0 km, and the more affluent living in rural areas (16.1 km, P Conclusion Distance travelled, and type of HIV services used, were associated with socioeconomic status, even after accounting for ethnicity, route of infection and age. Thus despite offering an 'equitable' service, travel costs may advantage those with higher income.
Full Text Available Background: HIV transmission from HIV-infected mother to child can occur through pregnancy, birth and lactation process; therefore, there should be Prevention of Mother to Child Transmission or PMTCT. Aims & Objectives: This research aimed to study the HIV-infected poor women’s accessibility to the Prevention of Mother to Child Transmission Service in Surakarta Indonesia. Material & Methods: This study was a qualitative research with explorative approach conducted in October-December 2015 and HIV-infected poor women as the unit of analysis. The sampling technique used was maximum variation sampling. Techniques of collecting data used were observation, in-depth interview and documentation, while data analysis was conducted using an Interactive Model of analysis with materialist theory. Results: Structural, financial and personal or cultural constraints were found: less target-appropriate health insurance policy, expensive cost of delivery with section caesarian surgery and breastfeed-substituting formula milk, and limited knowledge, experience and negotiation with the service provider leading to the HIV-infected Poor Women’s limited accessibility to comprehensive and sustainable PMTCT. PMTCT socialization, the giving-birth insurance and Food Supplementation program activation by Empowerment Work Group in AIDS Coping Commission in Surakarta City was the opportunity to access PMTCT service. Conclusion: Although PMTCT resulted in some problems, particularly formula milk administration and delivery process with section caesarian surgery, this attempt should be taken to make the baby born healthy. For that reasons, PMTCT service and health insurance should be improved from beneficiary data to accessible and sustainable procedure.
Murri, R; Franceschi, S; Ravizza, M; Fiore, S; Bini, T; Mussini, C; Fasolo, M; Liuzzi, G; Ippolito, G; D'Arminio Monforte, A
The objective of the study was to evaluate the access to Papanicolau (Pap) tests of HIV-infected women in Italy. A cross-sectional survey on a cohort of HIV-infected women seen at 27 HIV clinics was performed. At each clinic a female physician involved in the care of HIV-infected women was asked questions on clinic and patients' characteristics and on access to Pap tests. The outcome of the study was to find the percentage of women who had not had a Pap test before coming to the HIV clinic and the percentage having had a Pap test in 2001. In the survey, 7,600 HIV-infected women were represented. Women who came to the clinic without having ever had a Pap test were 62+/-22%, while women who had had a Pap test in 2001 were 43+/-36%. Women who reported never having had a Pap test before coming to the HIV clinic were more often from the south than the north of Italy (17.9+/-49% from the north, 18+/-53% from the center and 9.3+/-83.9% from the south; p<0.001). This a difference disappeared when comparing the women who had had a Pap test in 2001 (28+/-39.6% from the north, 31.6+/-44.2% from the center and 25.6+/-45.7% from the south; p=0.88). Despite the published guidelines in Italy, only 38% of women had ever had a Pap test before coming to the HIV clinic and only 43% had had a Pap test in 2001. Strategies aimed to improve these proportions should be rapidly implemented at all levels of care organization.
Wenzel, Suzanne L; Rhoades, Harmony; Harris, Taylor; Winetrobe, Hailey; Rice, Eric; Henwood, Ben
Homeless persons suffer disproportionately high rates of HIV infection, and moving into permanent supportive housing (PSH) can provide a stable base from which to access needed prevention services. However, little is known about HIV risk or prevention behavior during this critical time of transition. The current study investigated STI and HIV risk and prevention behavior and recent use of prevention and treatment services (i.e., education, testing, medication) among homeless persons preparing to move into PSH. Data come from interviews with 421 homeless adults before they moved into PSH. Thirty-seven percent of the respondents were sexually active; of those, 75.7% reported unprotected sex. Nearly two-thirds (64%) reported past year HIV testing and 40% reported testing for another STI. Fewer than one-third (31%) of respondents reported receiving posttest counseling at their last HIV test. HIV seropositivity was self-reported by 10%. Among those persons who were HIV-positive, 57.1% reported less than 100% antiretroviral (ARV) adherence. Among HIV-negative respondents, less than 1% had been prescribed preexposure prophylaxis (PrEP). Less than half (46.4%) of the sample reported any HIV prevention education in the past year. This population of homeless adults about to move into PSH report high rates of HIV risk behavior, but low rates of HIV prevention education and very little PrEP utilization. Further, low rates of ARV adherence among HIV-positive respondents indicate significant risk for HIV transmission and acquisition. Entering PSH is a period of transition for homeless persons when integrated care is critically important to ensure positive health outcomes, but these data suggest that PrEP and other HIV prevention services are poorly accessed among this population. As such, multipronged services that integrate PrEP and other HIV prevention services are needed to prevent transmission and acquisition of HIV in this high-risk, vulnerable population and ensure the
Ayden I Scheim
Full Text Available Introduction: Free or low-cost HIV testing, condoms, and lubricants are foundational HIV prevention strategies, yet are often inaccessible for men who have sex with men (MSM. In the global context of stigma and poor healthcare access, transgender (trans MSM may face additional barriers to HIV prevention services. Drawing on data from a global survey of MSM, we aimed to describe perceived access to prevention services among trans MSM, examine associations between stigma and access, and compare access between trans MSM and cisgender (non-transgender MSM. Methods: The 2014 Global Men's Health and Rights online survey was open to MSM (inclusive of trans MSM from any country and available in seven languages. Baseline data (n=3857 were collected from July to October 2014. Among trans MSM, correlations were calculated between perceived service accessibility and anti-transgender violence, healthcare provider stigma, and discrimination. Using a nested matched-pair study design, trans MSM were matched 4:1 to cisgender MSM on age group, region, and HIV status, and conditional logistic regression models compared perceived access to prevention services by transgender status. Results: About 3.4% of respondents were trans men, of whom 69 were included in the present analysis. The average trans MSM participant was 26 to 35 years old (56.5%; lived in western Europe, North America, or Oceania (75.4%; and reported being HIV-negative (98.6%. HIV testing, condoms, and lubricants were accessible for 43.5, 53.6, and 26.1% of trans MSM, respectively. Ever having been arrested or convicted due to being trans and higher exposure to healthcare provider stigma in the past six months were associated with less access to some prevention services. Compared to matched cisgender controls, trans MSM reported significantly lower odds of perceived access to HIV testing (OR=0.57, 95% CI=0.33, 0.98 and condom-compatible lubricants (OR=0.54, 95% CI=0.30, 0.98. Conclusions: This first
... HUMAN SERVICES Health Resources and Services Administration Ryan White HIV/AIDS Program Part D... Department, Orlando, Florida, that will ensure continuity of Part D HIV/AIDS care and treatment services without disruption to HIV/ AIDS-infected women, infants and children in Orange County and the...
Parsons, Janet A; Bond, Virginia A; Nixon, Stephanie A
The advent of anti-retroviral therapy (ART) in Southern Africa holds the promise of shifting the experience of HIV toward that of a manageable chronic condition. However, this potential can only be realized when persons living with HIV are able to access services without barriers, which can include stigma. Our qualitative study explored experiences of persons living with disabilities (PWD) in Lusaka, Zambia who became HIV-positive (PWD/HIV+). We conducted interviews with 32 participants (21 PWD/HIV+ and 11 key informants working in the fields of HIV and/or disability). Inductive thematic analysis of interview transcripts was informed by narrative theory. Participants' accounts highlighted the central role of stigma experienced by PWD/HIV+, with stigmatizing attitudes closely linked to prevailing societal assumptions that PWD are asexual. Seeking diagnostic and treatment services for HIV was perceived as evidence of PWD being sexually active. Participants recounted that for PWD/HIV+, stigma was enacted in a variety of settings, including the queue for health services, their interactions with healthcare providers, and within their communities. Stigmatizing accounts told about PWD/HIV+ were described as having important consequences. Not only did participants recount stories of internalized stigma (with its damaging effects on self-perception), but also that negative experiences resulted in some PWD preferring to "die quietly at home" rather than being subjected to the stigmatizing gaze of others when attempting to access life-preserving ART. Participants recounted how experiences of stigma also affected their willingness to continue ART, their willingness to disclose their HIV status to others, as well as their social relations. However, participants also offered counter-stories, actively resisting stigmatizing accounts and portraying themselves as resilient and resourceful social actors. The study highlights a significant barrier to healthcare experienced by PWD/HIV
Jill M Hagey
Full Text Available Introduction: Avoiding unintended pregnancies is important for the health of adolescents living with HIV and has the additional benefit of preventing potential vertical HIV transmission. Health facility providers represent an untapped resource in understanding the barriers and facilitators adolescents living with HIV face when accessing contraception. By understanding these barriers and facilitators to contraceptive use among adolescent females living with HIV, this study aimed to understand how best to promote contraception within this marginalized population. Methods: We conducted structured in-depth interviews with 40 providers at 21 Family AIDS Care & Education Services - supported clinics in Homabay, Kisumu and Migori counties in western Kenya from July to August 2014. Our interview guide explored the providers’ perspectives on contraceptive service provision to adolescent females living with HIV with the following specific domains: contraception screening and counselling, service provision, commodity security and clinic structure. Transcripts from the interviews were analyzed using inductive content analysis. Results: According to providers, interpersonal factors dominated the barriers adolescent females living with HIV face in accessing contraception. Providers felt that adolescent females fear disclosing their sexual activity to parents, peers and providers, because of repercussions of perceived promiscuity. Furthermore, providers mentioned that adolescents find seeking contraceptive services without a male partner challenging, because some providers and community members view adolescents unaccompanied by their partners as not being serious about their relationships or having multiple concurrent relationships. On the other hand, providers noted that institutional factors best facilitated contraception for these adolescents. Integration of contraception and HIV care allows easier access to contraceptives by removing the stigma of coming
Hagey, Jill M; Akama, Eliud; Ayieko, James; Bukusi, Elizabeth A; Cohen, Craig R; Patel, Rena C
Avoiding unintended pregnancies is important for the health of adolescents living with HIV and has the additional benefit of preventing potential vertical HIV transmission. Health facility providers represent an untapped resource in understanding the barriers and facilitators adolescents living with HIV face when accessing contraception. By understanding these barriers and facilitators to contraceptive use among adolescent females living with HIV, this study aimed to understand how best to promote contraception within this marginalized population. We conducted structured in-depth interviews with 40 providers at 21 Family AIDS Care & Education Services - supported clinics in Homabay, Kisumu and Migori counties in western Kenya from July to August 2014. Our interview guide explored the providers' perspectives on contraceptive service provision to adolescent females living with HIV with the following specific domains: contraception screening and counselling, service provision, commodity security and clinic structure. Transcripts from the interviews were analyzed using inductive content analysis. According to providers, interpersonal factors dominated the barriers adolescent females living with HIV face in accessing contraception. Providers felt that adolescent females fear disclosing their sexual activity to parents, peers and providers, because of repercussions of perceived promiscuity. Furthermore, providers mentioned that adolescents find seeking contraceptive services without a male partner challenging, because some providers and community members view adolescents unaccompanied by their partners as not being serious about their relationships or having multiple concurrent relationships. On the other hand, providers noted that institutional factors best facilitated contraception for these adolescents. Integration of contraception and HIV care allows easier access to contraceptives by removing the stigma of coming to a clinic solely for contraceptive services. Youth
Parsons, Janet A.; Bond, Virginia A.; Nixon, Stephanie A.
Background The advent of anti-retroviral therapy (ART) in Southern Africa holds the promise of shifting the experience of HIV toward that of a manageable chronic condition. However, this potential can only be realized when persons living with HIV are able to access services without barriers, which can include stigma. Our qualitative study explored experiences of persons living with disabilities (PWD) in Lusaka, Zambia who became HIV-positive (PWD/HIV+). Methods and Findings We conducted interviews with 32 participants (21 PWD/HIV+ and 11 key informants working in the fields of HIV and/or disability). Inductive thematic analysis of interview transcripts was informed by narrative theory. Participants’ accounts highlighted the central role of stigma experienced by PWD/HIV+, with stigmatizing attitudes closely linked to prevailing societal assumptions that PWD are asexual. Seeking diagnostic and treatment services for HIV was perceived as evidence of PWD being sexually active. Participants recounted that for PWD/HIV+, stigma was enacted in a variety of settings, including the queue for health services, their interactions with healthcare providers, and within their communities. Stigmatizing accounts told about PWD/HIV+ were described as having important consequences. Not only did participants recount stories of internalized stigma (with its damaging effects on self-perception), but also that negative experiences resulted in some PWD preferring to “die quietly at home” rather than being subjected to the stigmatizing gaze of others when attempting to access life-preserving ART. Participants recounted how experiences of stigma also affected their willingness to continue ART, their willingness to disclose their HIV status to others, as well as their social relations. However, participants also offered counter-stories, actively resisting stigmatizing accounts and portraying themselves as resilient and resourceful social actors. Conclusions The study highlights a
Janet A Parsons
Full Text Available The advent of anti-retroviral therapy (ART in Southern Africa holds the promise of shifting the experience of HIV toward that of a manageable chronic condition. However, this potential can only be realized when persons living with HIV are able to access services without barriers, which can include stigma. Our qualitative study explored experiences of persons living with disabilities (PWD in Lusaka, Zambia who became HIV-positive (PWD/HIV+.We conducted interviews with 32 participants (21 PWD/HIV+ and 11 key informants working in the fields of HIV and/or disability. Inductive thematic analysis of interview transcripts was informed by narrative theory. Participants' accounts highlighted the central role of stigma experienced by PWD/HIV+, with stigmatizing attitudes closely linked to prevailing societal assumptions that PWD are asexual. Seeking diagnostic and treatment services for HIV was perceived as evidence of PWD being sexually active. Participants recounted that for PWD/HIV+, stigma was enacted in a variety of settings, including the queue for health services, their interactions with healthcare providers, and within their communities. Stigmatizing accounts told about PWD/HIV+ were described as having important consequences. Not only did participants recount stories of internalized stigma (with its damaging effects on self-perception, but also that negative experiences resulted in some PWD preferring to "die quietly at home" rather than being subjected to the stigmatizing gaze of others when attempting to access life-preserving ART. Participants recounted how experiences of stigma also affected their willingness to continue ART, their willingness to disclose their HIV status to others, as well as their social relations. However, participants also offered counter-stories, actively resisting stigmatizing accounts and portraying themselves as resilient and resourceful social actors.The study highlights a significant barrier to healthcare
Dowshen, Nadia; Lee, Susan; Franklin, Joshua; Castillo, Marné; Barg, Frances
Purpose: (1) To describe psychosocial, medical, and mental health outcomes of young transgender women (YTW) living with or at risk for HIV infection and (2) to explore barriers and facilitators to medical and mental health services across the HIV care continuum. Methods: We conducted a cross-sectional observational study of YTW aged 16-24 years who were at risk for contracting or living with HIV. Participants were recruited from an adolescent HIV clinic and local community-based organizations that serve YTW. The single study visit included: a computer-assisted self-interview of demographics, medical and mental health measures, a qualitative semi-structured interview, optional rapid HIV testing for HIV-negative/status-unknown participants, and a chart review to determine rates of antiretroviral therapy (ART) prescription and viral suppression among HIV+ participants. Descriptive statistics were used for quantitative data, and a modified-grounded theory approach was used for qualitative analysis. Results: Participants (n=25) had a mean age of 21.2 years; the majority were non-white (76%), had less than a college education (76%), were unemployed (52%), and had an income Qualitative themes included lack of respect for or misunderstanding of gender identity, mismatch of mental health needs with available provider skills, challenges in finding HIV prevention services during adolescence or when transitioning to adult care, and importance of workforce diversity, including representation of transgender women in care teams. Conclusion: This study identified significant unmet mental health needs and several barriers and facilitators to engaging in healthcare for YTW across the HIV care continuum. Our data suggest an urgent need for provider competency training in gender-affirming care and integration of appropriate mental health and gender-affirming treatment with HIV prevention and treatment services for this population.
Darling, Katharine Ea; Hachfeld, Anna; Cavassini, Matthias
In 2014, there were 36.9 million people worldwide living with human immunodeficiency virus (PLWH), of whom 17.1 million did not know they were infected. Whilst the number of new human immunodeficiency virus (HIV) infections has declined globally since 2000, there are still regions where new...
Andersen, Helle Elisabeth
-internal dialectic, and created at the boundaries that a society creates between “normals” and “outsiders”. This project explores what it means to be infected with HIV/AIDS and/or disabled in Uganda and how this affects a person’s identity. The lower social value of disabled persons prevents them from participating......This project is based on five weeks’ ethnographically inspired fieldwork in May 2006 in the Republic of Uganda. The study started out with the hypothesis that there was some kind of discrimination going on in the interaction between health workers at HIV/AIDS clinics, and person with disabilities...... in processes of reciprocal exchange in areas such as education, employment, and marriage among other things. Especially normative expectations related to sexual behaviour seem to be determinants when disabled persons “choose” to cover up their serum-status, instead of seeking care and treatment. This project...
Garcia de la Hera, Manuela; Davo, Maria Carmen; Ballester-Añón, Rosa; Vioque, Jesus
The benefits of HIV treatment (Highly Active Antiretroviral Therapy [HAART]) have been less apparent in injecting drug users (IDUs), most probably as a result of poor adherence to treatment. We explored factors related to HIV treatment adherence as reported by 23 IDU-HIV patients and nine health professionals from healthcare services in Alicante and Valencia, Spain. We carried out a qualitative study based on personal interviews. Health professionals reported the lack of coordination among hospital services and difficulties in accessibility to nonspecialized services for IDU-HIV patients as relevant factors for treatment adherence. Their perception of a patient's likelihood of treatment adherence was also considered to influence the decision to prescribe HAART. A better treatment adherence was reported by those IDU-HIV patients with a good doctor-patient relationship and by women with family responsibilities. Patients considered the side effects of HIV treatment, the lack of social support, and the active use of recreational drugs as relevant factors to explain incompliance. Interventions and training of health providers should be aimed at the reduction of barriers in patient-provider communication and the overcoming of stereotypes, thus avoiding discriminatory attitudes in treatment in this vulnerable population.
Chersich Matthew F; Sprague Courtenay; Black Vivian
Abstract Background HIV remains responsible for an estimated 40% of mortality in South African pregnant women and their children. To address these avoidable deaths, eligibility criteria for antiretroviral therapy (ART) in pregnant women were revised in 2010 to enhance ART coverage. With greater availability of HIV services in public health settings and increasing government attention to poor maternal-child health outcomes, this study used the patient's journey through the continuum of materna...
Munyewende, Pascalia; Rispel, Laetitia C; Harris, Bronwyn; Chersich, Matthew
We present qualitative data from a 2005 exploratory study, recently published studies, and an analysis of the Department of Health's strategic plan to highlight the need for a broader policy debate on health-care access for migrants in South Africa. We conducted in-depth interviews with 15 Zimbabwean women living in inner-city Johannesburg to document the special characteristics of this group of migrants, enquiring about their perceptions of HIV risk, and experiences of health services in South Africa. We identified access barriers, namely perceptions of relatively low HIV risk, severely constrained financial circumstances, uncertain legal status, and experiences of unresponsive health workers. We recommend that migrant-health rights be placed on South Africa's policy agenda, migrants be included in HIV prevention programs and that health workers be sensitized to the needs of migrants.
Wanyenze, Rhoda K; Musinguzi, Geofrey; Kiguli, Juliet; Nuwaha, Fred; Mujisha, Geoffrey; Musinguzi, Joshua; Arinaitwe, Jim; Matovu, Joseph K B
HIV prevalence among female sex workers (FSWs) in high burden countries in sub-Saharan Africa varies between 24 and 72%, however their access to HIV services remains limited. This study explored FSWs' perspectives of the barriers and opportunities to HIV service access in Uganda. The cross-sectional qualitative study was conducted between October and December 2013. Twenty-four focus group discussions were conducted with 190 FSWs in 12 districts. Data were analysed using manifest content analysis, using Atlas.ti software, based on the socio-ecological model. FSWs indicated that HIV services were available and these included condoms, HIV testing and treatment, and management of sexually transmitted infections. However, access to HIV services was affected by several individual, societal, structural, and policy related barriers. Individual level factors included limited awareness of some prevention services, fears, and misconceptions while societal stigma was prominent. Structural and policy level barriers included inconvenient hours of operation of the clinics, inflexible facility based distribution of condoms, interuptions in the supply of condoms and other commodities, and limited package of services with virtually no access to lubricants, HIV pre- and post-exposure prophylaxis, and support following client perpetrated violence. Policies such as partner testing and involvement at antenatal care, and using only one facility for antiretroviral drug refills hindered HIV service uptake and retention in care. FSWs had major concerns with the quality of services especially discrimination and rude remarks from providers, denial or delay of services, and potential for breach of confidentiality. However, some FSWs reported positive experiences including interface with friendly providers and participated in formal and informal FSW groups, which supported them to access health services. Despite availability of services, FSWs faced major challenges in access to services
Kumta, Sameer; Lurie, Mark; Weitzen, Sherry; Jerajani, Hemangi; Gogate, Alka; Row-kavi, Ashok; Anand, Vivek; Makadon, Harvey; Mayer, Kenneth H
To describe sociodemographics, sexual risk behavior, and estimate HIV and sexually transmitted infection (STI) prevalence among men who have sex with men (MSM) in Mumbai, India. Eight hundred thirty-one MSM attending voluntary counseling and testing (VCT) services at the Humsafar Trust, answered a behavioral questionnaire and consented for Venereal Disease Research Laboratory and HIV testing from January 2003 through December 2004. Multivariate logistic regression was performed for sociodemographics, sexual risk behavior, and STIs with HIV result as an outcome. HIV prevalence among MSM was 12.5%. MSM who were illiterate [adjusted odds ratio (AOR) 2.28; 95% confidence interval (CI): 1.08 to 4.84], married (AOR 2.70; 95% CI: 1,56 to 4.76), preferred male partners (AOR 4.68; 95% CI: 1.90 to 11.51), had partners of both genders (AOR 2.73; 95% CI: 1.03 to 7.23), presented with an STI (AOR 3.31; 95% CI: 1.96 to 5.61); or presented with a reactive venereal disease research laboratory test (AOR 4.92; 95% CI: 2.55 to 9.53) at their VCT visit were more likely to be HIV infected. MSM accessing VCT services in Mumbai have a high risk of STI and HIV acquisition. Culturally appropriate interventions that focus on sexual risk behavior and promote condom use among MSM, particularly the bridge population of bisexual men, are needed to slow the urban Indian AIDS epidemic.
Abstract Background Despite massive scale up of funds from global health initiatives including the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and other donors, the ambitious target agreed by G8 leaders in 2005 in Gleneagles to achieve universal access to HIV\\/AIDS treatment by 2010 has not been reached. Significant barriers to access remain in former Soviet Union (FSU) countries, a region now recognised as a priority area by policymakers. There have been few empirical studies of access to HIV\\/AIDS services in FSU countries, resulting in limited understanding and implementation of accessible HIV\\/AIDS interventions. This paper explores the multiple access barriers to HIV\\/AIDS services experienced by a key risk group-injecting drug users (IDUs). Methods Semi-structured interviews were conducted in two FSU countries-Ukraine and Kyrgyzstan-with clients receiving Global Fund-supported services (Ukraine n = 118, Kyrgyzstan n = 84), service providers (Ukraine n = 138, Kyrgyzstan n = 58) and a purposive sample of national and subnational stakeholders (Ukraine n = 135, Kyrgyzstan n = 86). Systematic thematic analysis of these qualitative data was conducted by country teams, and a comparative synthesis of findings undertaken by the authors. Results Stigmatisation of HIV\\/AIDS and drug use was an important barrier to IDUs accessing HIV\\/AIDS services in both countries. Other connected barriers included: criminalisation of drug use; discriminatory practices among government service providers; limited knowledge of HIV\\/AIDS, services and entitlements; shortages of commodities and human resources; and organisational, economic and geographical barriers. Conclusions Approaches to thinking about universal access frequently assume increased availability of services means increased accessibility of services. Our study demonstrates that while there is greater availability of HIV\\/AIDS services in Ukraine and Kyrgyzstan, this does not equate with
Full Text Available Abstract Background Despite massive scale up of funds from global health initiatives including the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund and other donors, the ambitious target agreed by G8 leaders in 2005 in Gleneagles to achieve universal access to HIV/AIDS treatment by 2010 has not been reached. Significant barriers to access remain in former Soviet Union (FSU countries, a region now recognised as a priority area by policymakers. There have been few empirical studies of access to HIV/AIDS services in FSU countries, resulting in limited understanding and implementation of accessible HIV/AIDS interventions. This paper explores the multiple access barriers to HIV/AIDS services experienced by a key risk group-injecting drug users (IDUs. Methods Semi-structured interviews were conducted in two FSU countries-Ukraine and Kyrgyzstan-with clients receiving Global Fund-supported services (Ukraine n = 118, Kyrgyzstan n = 84, service providers (Ukraine n = 138, Kyrgyzstan n = 58 and a purposive sample of national and subnational stakeholders (Ukraine n = 135, Kyrgyzstan n = 86. Systematic thematic analysis of these qualitative data was conducted by country teams, and a comparative synthesis of findings undertaken by the authors. Results Stigmatisation of HIV/AIDS and drug use was an important barrier to IDUs accessing HIV/AIDS services in both countries. Other connected barriers included: criminalisation of drug use; discriminatory practices among government service providers; limited knowledge of HIV/AIDS, services and entitlements; shortages of commodities and human resources; and organisational, economic and geographical barriers. Conclusions Approaches to thinking about universal access frequently assume increased availability of services means increased accessibility of services. Our study demonstrates that while there is greater availability of HIV/AIDS services in Ukraine and Kyrgyzstan, this does not equate with greater
Daniel, O J; Adejumo, O A; Gidado, M; Abdur-Razzaq, H A; Jaiyesimi, E O
Contexte : Le virus de l'immunodéficience humaine (VIH) et la tuberculose (TB) sont les causes majeures de décès dû à une maladie infectieuse dans le monde. L'Organisation Mondiale de la Santé estime que la prévalence du VIH parmi les enfants atteints de TB dans des pays à prévalence modérée à élevée va de 10% à 60%. Cette étude a eu pour but de déterminer l'accès aux services VIH pour les enfants coinfectés par TB-VIH.Méthodes : Une revue rétrospective des données d'enfants ayant eu un diagnostic de TB dans l'état de Lagos au Nigeria entre le 1(e) janvier 2012 et le 31 décembre 2013.Résultats : Un total de 1199 enfants âgés de 0 à 14 ans ont eu un diagnostic de TB. Parmi eux, 1095 (91,3%) ont eu un test VIH, dont 320 (29,2%) ont été positifs. Le ratio garçon/fille de coinfection TB-VIH a été de 1:0,9. Sur les 320 enfants coinfectés TB-VIH, 57 (17,8%), 86 (26,9%) et 186 (58,1%) respectivement avaient VIH, 186 (58,1%) ont débuté le cotrimoxazole (CPT) tandis que 151 (47,2%) étaient sous traitement antirétroviral (ART). La mise sous ART n'a pas été significativement plus élevée dans les structures où les services TB-VIH se trouvaient au même endroit (P > 0,05).Conclusion : La mise sous CPT et ART a été faible. Il est nécessaire d'intensifier les efforts d'amélioration de l'accès aux services VIH à Lagos, Nigeria.
We would like to inform you that between 10 November and 15 December 2014, the access cards service in Building 55 will be disrupted, as the GS Department has decided to improve the facilities for users of this building. During the work, you will find the registration, biometric registration and dosimeter exchange services on the second floor of Building 55 and the vehicle sticker service on the ground floor along with the access cards service. We thank you for your understanding and apologise for any inconvenience caused.
"If You Tell People That You Had Sex with a Fellow Man, It Is Hard to Be Helped and Treated": Barriers and Opportunities for Increasing Access to HIV Services among Men Who Have Sex with Men in Uganda.
Rhoda K Wanyenze
Full Text Available Despite the high HIV prevalence among men who have sex with men (MSM in sub-Saharan Africa, little is known about their access to HIV services. This study assessed barriers and opportunities for expanding access to HIV services among MSM in Uganda.In October-December 2013, a cross-sectional qualitative study was conducted in 12 districts of Uganda. Semi-structured in-depth interviews were conducted with 85 self-identified MSM by snowball sampling and 61 key informants including HIV service providers and policy makers. Data were analysed using manifest content analysis and Atlas.ti software.Three quarters of the MSM (n = 62, 72.9% were not comfortable disclosing their sexual orientation to providers and 69 (81.1% felt providers did not respect MSM. Half (n = 44, 51.8% experienced difficulties in accessing health services. Nine major barriers to access were identified, including: (i unwelcoming provider behaviours; (ii limited provider skills and knowledge; (iii negative community perceptions towards MSM; (iv fear of being exposed as MSM; (v limited access to MSM-specific services; (vi high mobility of MSM, (vii lack of guidelines on MSM health services; viii a harsh legal environment; and ix HIV related stigma. Two-thirds (n = 56, 66% participated in MSM social networks and 86% of these (48 received support from the networks to overcome barriers to accessing services.Negative perceptions among providers and the community present barriers to service access among MSM. Guidelines, provider skills building and use of social networks for mobilization and service delivery could expand access to HIV services among MSM in Uganda.
Decker, Michele R; Lyons, Carrie; Billong, Serge Clotaire; Njindam, Iliassou Mfochive; Grosso, Ashley; Nunez, Gnilane Turpin; Tumasang, Florence; LeBreton, Matthew; Tamoufe, Ubald; Baral, Stefan
Female sex workers (FSWs) are at risk for HIV and physical and sexual gender-based violence (GBV). We describe the prevalence of lifetime GBV and its associations with HIV risk behaviour, access to health services and barriers in accessing justice among FSWs in Cameroon. FSWs (n=1817) were recruited for a cross-sectional study through snowball sampling in seven cities in Cameroon. We examined associations of lifetime GBV with key outcomes via adjusted logistic regression models. Overall, 60% (1098/1817) had experienced physical or sexual violence in their lifetime. GBV was associated with inconsistent condom use with clients (adjusted OR (AOR) 1.49, 95% CI 1.18 to 1.87), being offered more money for condomless sex (AOR 2.09, 95% CI 1.56 to 2.79), having had a condom slip or break (AOR 1.53, 95% CI 1.25 to 1.87) and difficulty suggesting condoms with non-paying partners (AOR 1.47, 95% CI 1.16 to 1.87). Violence was also associated with fear of health services (AOR 2.25, 95% CI 1.61 to 3.16) and mistreatment in a health centre (AOR 1.66, 95% CI 1.01 to 2.73). Access to justice was constrained for FSWs with a GBV history, specifically feeling that police did not protect them (AOR 1.41, 95% CI 1.12 to 1.78). Among FSWs in Cameroon, violence is prevalent and undermines HIV prevention and access to healthcare and justice. Violence is highly relevant to FSWs' ability to successfully negotiate condom use and engage in healthcare. In this setting of criminalised sex work, an integrated, multisectoral GBV-HIV strategy that attends to structural risk is needed to enhance safety, HIV prevention and access to care and justice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Choi, Stephanie; Boyle, Eleanor; Cairney, John;
speaking counterparts. For accessing specialist care, we found that those who were identified as homosexual/gay, non-English speakers, immigrants, having low income and residing in rural area were two times less likely to use these services. However, being a homosexual/gay, being an immigrant, and having...
Smith Fawzi, M C; Lambert, W; Singler, J M; Tanagho, Y; Léandre, F; Nevil, P; Bertrand, D; Claude, M S; Bertrand, J; Louissaint, M; Jeannis, L; Mukherjee, J S; Goldie, S; Salazar, J J; Farmer, P E
The goals of the current study were to: (1) estimate the prevalence of forced sex among women accessing services at a women's health clinic in rural Haiti; and (2) examine factors associated with forced sex in this population. Based on data from a case-control study of risk factors for sexually transmitted diseases (STDs), a cross-sectional analysis to examine factors associated with forced sex was performed. A number of factors related to gender inequality/socioeconomic vulnerability placed women in rural Haiti at higher risk of forced sex. The strongest factors associated with forced sex in multivariate analyses were: age, length of time in a relationship, occupation of the woman's partner, STD-related symptoms, and factors demonstrating economic vulnerability. The findings suggest that prevention efforts must go beyond provision of information and education to the pursuit of broader initiatives at both local and national levels. At the community level, policy-makers should consider advancing economic opportunities for women who are vulnerable to forced sex. Improving access to community-based income-generating activities may begin to address this problem. However, the viability of these local projects depends largely upon Haiti's 'macro-economic' situation. In order to ensure the success of local initiatives, external humanitarian and development assistance to Haiti should be supported. By broadening the definition of "prevention" interventions, we may begin to address the systemic problems that contribute to the occurrence of forced sex and the increasing incidence of HIV infection throughout the world, such as gender inequality and economic vulnerability. Taking into account factors influencing risk at the local level as well as the macro-level will potentially improve our capacity to reduce the risk of forced sex and the spread of STDs, including HIV infection, for millions of women living in poverty worldwide.
Full Text Available Introduction: Improvements in the availability and effectiveness of highly active antiretroviral therapy (HAART have prolonged the lives of people living with HIV/AIDS. However, mortality rates have remained high among populations that encounter barriers to accessing and adhering to HAART, notably people who use drugs. This population consequently has a high burden of illness and complex palliative and supportive care needs, but is often unable to access these services due to anti-drug policies and discrimination. In Vancouver, Canada, the Dr. Peter Centre (DPC, which operates a 24-bed residential HIV/AIDS care facility, has sought to improve access to palliative and supportive care services by adopting a comprehensive harm reduction strategy, including supervised injection services. We undertook this study to explore how the integration of comprehensive harm reduction services into this setting shapes access to and engagement with care. Methods: Qualitative interviews were conducted with 13 DPC residents between November 2010 and August 2011. Interviews made use of a semistructured interview guide which facilitated discussion regarding how the DPC Residence's model of care (a shaped healthcare access, (b influenced healthcare interactions and (c impacted drug use practices and overall health. Interview transcripts were analysed thematically. Results: Participant accounts highlight how the harm reduction policy altered the structural-environmental context of healthcare services and thus mediated access to palliative and supportive care services. Furthermore, this approach fostered an atmosphere in which drug use could be discussed without the risk of punitive action, and thus increased openness between residents and staff. Finally, participants reported that the environmental supports provided by the DPC Residence decreased drug-related risks and improved health outcomes, including HAART adherence and survival. Conclusions: This study highlights
Eduard J Beck
Full Text Available AIM: To calculate use, cost and cost-effectiveness of people living with HIV (PLHIV starting routine treatment and care before starting combination antiretroviral therapy (cART and PLHIV starting first-line 2NRTIs+NNRTI or 2NRTIs+PI(boosted, comparing PLHIV with CD4≤200 cells/mm3 and CD4>200 cells/mm3. Few studies have calculated the use, cost and cost-effectiveness of routine treatment and care before starting cART and starting cART above and below CD4 200 cells/mm3. METHODS: Use, costs and cost-effectiveness were calculated for PLHIV in routine pre-cART and starting first-line cART, comparing CD4≤200 cells/mm3 with CD4>200 cells/mm3 (2008 UK prices. RESULTS: cART naïve patients CD4≤200 cells/mm3 had an annual cost of £6,407 (95%CI £6,382 to £6,425 PPY compared with £2,758 (95%CI £2,752 to £2,761 PPY for those with CD4>200 cells/mm3; cost per life year gained of pre-cART treatment and care for those with CD4>200 cells/mm3 was £1,776 (cost-saving to £2,752. Annual cost for starting 2NRTIs+NNRTI or 2NRTIs+PI(boosted with CD4≤200 cells/mm3 was £12,812 (95%CI £12,685-£12,937 compared with £10,478 (95%CI £10,376-£10,581 for PLHIV with CD4>200 cells/mm3. Cost per additional life-year gained on first-line therapy for those with CD4>200 cells/mm3 was £4639 (£3,967 to £2,960. CONCLUSION: PLHIV starting to use HIV services before CD4≤200 cells/mm3 is cost-effective and enables them to be monitored so they start cART with a CD4>200 cells/mm3, which results in better outcomes and is cost-effective. However, 25% of PLHIV accessing services continue to present with CD4≤200 cells/mm3. This highlights the need to investigate the cost-effectiveness of testing and early treatment programs for key populations in the UK.
Ann E Kurth
Full Text Available Introduction: HIV testing is the portal to serostatus knowledge that can empower linkage to care for HIV treatment and HIV prevention. However, young people's access to HIV testing is uneven worldwide. The objective of this paper is to review the context and concerns faced by youth around HIV testing in low- as well as high-income country settings. Discussion: HIV testing is a critical entry point for primary and secondary prevention as well as care and treatment for young people including key populations of vulnerable youth. We provide a framework for thinking about the role of testing in the continuum of prevention and care for young people. Brief case study examples from Kenya and the US illustrate some of the common barriers and issues involved for young people. Conclusions: Young people worldwide need more routine access to HIV testing services that effectively address the developmental, socio-political and other issues faced by young women and men.
Full Text Available Adolescents represent a large proportion of the population. As they mature and become sexually active, they face more serious health risks. Most face these risks with too little factual information, too little guidance about sexual responsibility and multiple barriers to accessing health care. A typical descriptive and explanatory design was used to determine what the characteristics of an accessible adolescent health service should be. Important results and conclusions that were reached indicate that the adolescent want a medical doctor and a registered nurse to be part of the health team treating them and they want to be served in the language of their choice. Family planning, treatment of sexually transmitted diseases and psychiatric services for the prevention of suicide are services that should be included in an adolescent accessible health service. The provision of health education concerning sexual transmitted diseases and AIDS is a necessity. The service should be available thought out the week (included Saturdays and within easy reach. It is recommended that minor changes in existing services be made, that will contribute towards making a health delivery service an adolescent accessible service. An adolescent accessible health service can in turn make a real contribution to the community’s efforts to improve the health of its adolescents and can prove to be a rewarding professional experience to the health worker.
Sutton, Madeline; Anthony, Monique-Nicole; Vila, Christie; McLellan-Lemal, Eleanor; Weidle, Paul J.
Context: Forty percent of AIDS cases are reported in the southern United States, the region with the largest proportion of HIV/AIDS cases from rural areas. Data are limited regarding provider perspectives of the accessibility and availability of HIV testing and treatment services in southern rural counties. Purpose: We surveyed providers in the…
Sutton, Madeline; Anthony, Monique-Nicole; Vila, Christie; McLellan-Lemal, Eleanor; Weidle, Paul J.
Context: Forty percent of AIDS cases are reported in the southern United States, the region with the largest proportion of HIV/AIDS cases from rural areas. Data are limited regarding provider perspectives of the accessibility and availability of HIV testing and treatment services in southern rural counties. Purpose: We surveyed providers in the…
Silva-Santisteban, Alfonso; Segura, Eddy R; Sandoval, Clara; Girón, Maziel; Petrera, Margarita; Caceres, Carlos F
Equity in access to health care among people living with HIV (PLHA) has not been extensively studied in Peru despite the fact there is significant social diversity within this group. We aimed to assess the extent to which health care provision to PLHA, including ARVT, was equitable and, if appropriate, identify factors associated with lower access. We conducted a survey among adult PLHA in four cities in Peru, recruited through respondent-driven sampling (RDS), to collect information on socio-demographic characteristics, social network size, household welfare, economic activity, use of HIV-related services including ARV treatment, and health-related out-of-pocket expenses. Between September 2008 and January 2009, 863 individuals from PLHA organizations in four cities of Peru were enrolled. Median age was 35 (IQR = 29-41), and mostly male (62%). Overall, 25% reported to be gay, 11% bisexual and 3% transgender. Most PLHA (96%) reported access to some kind of HIV-related health service, and 84% were receiving those services at a public facility. Approximately 85% of those reporting access to care were receiving antiretroviral treatment (ARV), and 17% of those not in treatment already had indication to start treatment. Among those currently on ARV, 36% percent reported out-of-pocket expenses within the last month. Transgender identity and age younger than 35 years old, were associated with lower access to health care. Our findings contribute to a better social and demographic characterization of the situation of PLHAs, their access to HIV care and their source of care, and provide an assessment of equity in access. In the long term, it is expected that HIV care access, as well as its social determinants, will impact on the morbidity and mortality rates among those affected by the HIV/AIDS epidemic. HIV care providers and program managers should further characterize the barriers to healthcare access and develop strategies to resolve them by means of policy change
Paola Di Carlo
Full Text Available Introduction: The increased life expectancy of HIV patients in the era of highly active antiretroviral therapy has had profound consequences for the healthcare systems that provide their care. It is useful to assess whether healthcare resources need to be adapted to the different stages of HIV infection or to patient characteristics . To study how patient features influence utilization of out patient services, we retrospectively analyzed the electronic health record of HIV-positive patients who had followed day-care programs at the AIDS Center of the University of Palermo, Italy. Materials and Methods: 223 HIV-infected subjects were recruited and divided into two groups according to CD4 cell counts (117 with a CD4 count ≤500/mm3 and 106 with CD4 count ≥500/mm3. Data on age, gender, race, lifestyle habits (including educational level, drug abuse history, smoking status, alcohol consumption, sexual behaviour BMI, HIV-RNA, CD4+ T-cell count, antiretroviral therapy (ART, comorbidities such as HCV co-infection, osteoporosis biomarker, dyslipidemia, diabetes, renal function and systolic and diastolic blood pressure were recorded in a purposely designed database and were analyzed in relation to AIN by uni- and multivariable logistic regression. Results: Table 1 shows the characteristics of enrolled patients; the average age of the recruited patients was 45.4±9.5 years. 163 individuals were male (73%, 26 were immigrants (12% and 91 (40% were treatment-naïve. Mean day care access for laboratory tests to evaluate stage of HIV and for treatment monitoring was 6.5 days for CD4 cell count measurements and 9.6 for HIV RNA/drug-resistance testing. When patients were stratified according to CD4 count, mean day care access for laboratory tests to evaluate HIV stage and to monitor treatment was negatively correlated with CD4 cell counts. Table 1 Selected characteristics of 223 HIV-infected patients Variable HIV with a CD4 count ≤500/mm3 n = 117 HIV
Mutalemwa, Prince P; Kisinza, William N; Munga, Michael; Urassa, Janesta A E; Kibona, Stafford; Mwingira, Upendo; Lasway, Christina; Kilima, Stella; Tenu, Filemoni; Mujaya, Stella; Kisoka, William J
In Tanzania, reproductive health and HIV services are coordinated by the Ministry of Health and Social Welfare in two separate units namely Reproductive and Child Health Section and the National AIDS Control Programme. The importance of integrating the two services that are vertically run is expected to improve access to and uptake of key essential services and extend coverage to underserved and vulnerable populations and thus minimizing missed opportunities. Experts around the world recognize the central role of Sexual and Reproductive Health (SRH) services in preventing HIV infection. Evidence suggests that improving access to contraception for women to prevent pregnancy is an important and cost-effective way to prevent HIV-positive births. Integrating SRH and HlV services therefore verifies its importance for improving maternal and child health as well as leading to prevention of HIV infection. The primary objective of this review was to gain an understanding of the current linkages between SRH and HIV within Tanzania's policies, programmes, systems and services. Policy documents, guidelines, national laws, and published reports on SRH and HIV were reviewed. The majority of the reviewed documents mentioned fundamentals of integration between SRH and HIV. Majority of policies and guidelines both in family planning (FP) and HIV documents mandate bi-directional linkages. This review suggests that there are linkages between the two services and can be operationalised together. However, policies and guidelines only specify services to be integrated without due consideration of resources and structural orientation for linked services.
Full Text Available Financially stricken Cambodian patients with diabetes and HIV/AIDS typically encounter multiple, serious barriers to effective care. This process may extend over many years and involve numerous rounds of diagnosis and treatment as the disease progresses from initial symptoms to longer term complications. Living with both the impact of the disease and this ongoing struggle for care can severely disrupt the everyday life of both sufferers and their families. Our retrospective study adopted qualitative research methods to collect data from HIV/AIDS and diabetic patients enrolled and not enrolled in treatment programs at varying institutions in urban and rural settings. Using purposive sampling techniques, a total of 25 HIV/AIDS and 45 diabetic patients were recruited. Semi-structured and open-ended interviews were used to collect information on patient experiences of different phases in the on-going process of seeking care and treatment. The findings indicate that both HIV/AIDS and diabetic patients encounter multiple supply- and demand-side barriers to care at different stages of their illness. More strikingly, our research findings suggest that supply-side barriers, for example rationing systems or targeting strategies that limit access to free treatment or social assistance, are substantially higher for diabetic patients. This perceived inequity had a profound impact on diabetic patients to the extent that some “wished they had HIV/AIDS”. These findings suggest that there is an urgent need to widen the focus of health care to address the substantial and increasing burden of disease resulting from diabetes and other serious chronic disorders in Cambodia and many other low/middle income countries.
Lyons, Carrie E; Grosso, Ashley; Drame, Fatou M; Ketende, Sosthenes; Diouf, Daouda; Ba, Ibrahima; Shannon, Kate; Ezouatchi, Rebecca; Bamba, Amara; Kouame, Abo; Baral, Stefan
Violence is a human rights violation, and an important measure in understanding HIV among female sex workers (FSW). However, limited data exist regarding correlates of violence among FSW in Côte d'Ivoire. Characterizing prevalence and determinants of violence and the relationship with structural risks for HIV can inform development and implementation of comprehensive HIV prevention and treatment programs. FSW > 18 years were recruited through respondent driven sampling (RDS) in Abidjan, Côte d'Ivoire. In total, 466 participants completed a socio-behavioral questionnaire and HIV testing. Prevalence estimates of violence were calculated using crude and RDS-adjusted estimates. Relationships between structural risk factors and violence were analyzed using χ tests and multivariable logistic regression. The prevalence of physical violence was 53.6% (250/466), and sexual violence was 43.2% (201/465) among FSW in this study. Police refusal of protection was associated with physical (adjusted Odds Ratio [aOR]: 2.8; 95% confidence interval [CI]: 1.7 to 4.4) and sexual violence (aOR: 3.0; 95% CI: 1.9 to 4.8). Blackmail was associated with physical (aOR: 2.5; 95% CI: 1.5 to 4.2) and sexual violence (aOR: 2.4; 95% CI: 1.5 to 4.0). Physical violence was associated with fear (aOR: 2.2; 95% CI: 1.3 to 3.1) and avoidance of seeking health services (aOR: 2.3; 95% CI: 1.5 to 3.8). Violence is prevalent among FSW in Abidjan and associated with features of the work environment and access to care. These relationships highlight layers of rights violations affecting FSW, underscoring the need for structural interventions and policy reforms to improve work environments, and to address police harassment, stigma, and rights violations to reduce violence and improve access to HIV interventions.
Harkins, Judith E; Strauss, Karen Peltz
Access to emergency services is mandated by Title II of the Americans with Disabilities Act (ADA). The Department of Justice oversees the accessibility of public safety answering points (PSAPs), popularly called 9-1-1 centers. The Federal Communications Commission (FCC) has at least two roles in emergency number access: (1) as regulator of the ADA's Title IV on telecommunications access, and (2) as regulator of communications companies with regard to support of and interconnection with PSAPs. The rules of both agencies contributed significantly to the improvement during the 1990s of access to 9-1-1 for people who are deaf, hard of hearing, or speech disabled. However, as new technologies for text wireless communications and relay services have moved quickly to Internet protocol (IP)-based technologies over the past 5-8 years, the use of traditional wireline telephones and text telephones among deaf, hard of hearing, and speech-disabled people has declined. PSAPs cannot be contacted via the newer forms of telecommunications, such as e-mail, instant messaging, and IP-based forms of relay services, including video relay services. The gap between the technology supported by policy and the technologies currently being used by deaf and hard of hearing people has become a serious problem that is difficult to solve because of the separate jurisdictions of the two agencies, the need for coordination within the FCC, technological challenges, and funding issues. In this article, the key policy and technology challenges will be analyzed and recommendations made for short-and long-term solutions to this dilemma.
Zuurmond, Maria; Ferrand, Rashida; Kuper, Hannah
Introduction While the rapid expansion in antiretroviral therapy access in low and middle income countries has resulted in dramatic declines in mortality rates, many people living with HIV face new or worsening experiences of disability. As nearly 1 in 20 adults are living with HIV in sub-Saharan Africa–many of whom are likely to develop disabling sequelae from long-term infection, co-morbidities and side effects of their treatment–understanding the availability and accessibility of services to address HIV-related disabilities is of vital importance. The aim of this study thus is to explore knowledge of HIV-related disabilities amongst stakeholders working in the fields of HIV and disability and factors impacting uptake and provision of interventions for preventing, treating or managing HIV-related disabilities. Methods In-depth, semi-structured interviews were conducted with ten stakeholders based in Harare, Zimbabwe, who were working in the fields of either disability or HIV. Stakeholders were identified through a priori stakeholder analysis. Thematic Analysis, complemented by constant comparison as described in Grounded Theory, was used to analyse findings. Results All key informants reported some level of knowledge of HIV-related disability, mostly from observations made in their line of work. However, they reported no interventions or policies were in place specifically to address HIV-related disability. While referrals between HIV and rehabilitation providers were not uncommon, no formal mechanisms had been established for collaborating on prevention, identification and management. Additional barriers to accessing and providing services to address HIV-related disabilities included: the availability of resources, including trained professionals, supplies and equipment in both the HIV and rehabilitation sectors; lack of disability-inclusive adaptations, particularly in HIV services; heavy centralization of available services in urban areas, without
... depression, anxiety, post-traumatic stress disorder (PTSD), and insomnia than people without HIV. Read the AIDS info HIV and Mental Health fact sheet for more information. Below are some places to find mental health treatment services: Substance Abuse and Mental Health Services Administration ( ...
Mayer, Kenneth H; Ducharme, Robert; Zaller, Nickolas D; Chan, Philip A; Case, Patricia; Abbott, David; Rodriguez, Irma I; Cavanaugh, Timothy
American men who have sex with men (MSM) continue to have increased rates of HIV and sexually transmitted diseases (STD). Between 2004 and 2010, 1155 MSM were tested for HIV and/or STDs at Providence, RI bathhouse. The prevalence of HIV was 2.3%; syphilis, 2.0%; urethral gonorrhea, 0.1%; urethral chlamydia, 1.3%; 2.2% of the men had hepatitis C antibodies. Although 43.2% of the men engaged in unprotected anal intercourse in the prior 2 months, the majority of the men thought that their behaviors did not put them at increased risk for HIV or STDs. Multivariate analyses found that men who engaged in unprotected anal intercourse were more likely to have had sex with unknown status or HIV-infected partners; have sex although under the influence of drugs; tended to find partners on the internet; and were more likely to have a primary male partner. Men who were newly diagnosed with HIV or syphilis tended to be older than 30 years; had sex with an HIV-infected partner; had a prior STD diagnosis; and met partners on the internet. For 10.5% of the men, bathhouse testing was the first time that they had ever been screened for HIV. Of 24 men who were newly diagnosed with HIV infection, only 1 was not successfully linked to care. These data suggest that offering HIV and STD testing in a bathhouse setting is effective in attracting MSM who are at increased risk for HIV and/or STD acquisition or transmission.
Sang, Jian; Zhao, Yong-Heng; Cui, Chen-Zhou
With the development of technologies and the implementation of large quantity of astronomical observation projects, astronomy faces data avalanche and has entered an information era. A basic aim of the Virtual Observatory is to provide uniform access to highly distributed, complicated, huge astronomical datasets, and to realize federation of global astronomical data resources, so that astronomers can obtain required data efficiently and conveniently for their research. China Virtual Observatory (China-VO) project designs and implements astronomical data access services based on Grid technology, and provides uniform interface to Grid client application. In this paper, we introduce the data access service toolkit development using Globus Toolkit, the Grid services encapsulation of catalogs according to the latest astronomical data standards recommended by International Virtual Observatory Alliance, the implements of catalog Cone Search access service. Furthermore, we also introduce how to construct other Grid services using above data access services.
Patient satisfaction with health care services provided at HIV clinics at Amana and ... with the general physical environment of the clinic and with services offered by ... Key words: Patient satisfaction, Antiretroviral therapy, HIV care services ...
Carter, Allison; Greene, Saara; Nicholson, Valerie; O'Brien, Nadia; Sanchez, Margarite; de Pokomandy, Alexandra; Loutfy, Mona; Kaida, Angela
The meaningful involvement of women living with HIV/AIDS (MIWA) is a key feature of women-centred HIV care, yet little is known about transforming MIWA from principle to practice. Drawing on focus group data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS), we explored HIV-positive women's meaningful involvement in the design and delivery of HIV/AIDS services in British Columbia, Canada. In this article, we highlight the benefits and tensions that emerge as women traverse multiple roles as service users and service providers within their care communities, and the impact this has on their access to care and overall health.
McNamara Paul E
Full Text Available Abstract Background The evidence evaluating the benefits of programmatic nutrition interventions to HIV-infected individuals in developing countries, where there is a large overlap between HIV prevalence and malnutrition, is limited. This study evaluates the impact of food assistance (FA on change in weight and disease progression as measured by WHO staging. Methods We utilize program data from The AIDS Support Organization (TASO in Uganda to compare outcomes among FA recipients to a control group, using propensity score matching (PSM methods among 14,481 HIV-infected TASO clients. Results FA resulted in a significant mean weight gain of 0.36 kg over one year period. This impact was conditional on anti-retroviral therapy (ART receipt and disease stage at baseline. FA resulted in mean weight gain of 0.36 kg among individuals not receiving ART compared to their matched controls. HIV-infected individuals receiving FA with baseline WHO stage II and III had a significant weight gain (0.26 kg and 0.2 kg respectively compared to their matched controls. Individuals with the most advanced disease at baseline (WHO stage IV had the highest weight gain of 1.9 kg. The impact on disease progression was minimal. Individuals receiving FA were 2 percentage points less likely to progress by one or more WHO stage compared to their matched controls. There were no significant impacts on either outcome among individuals receiving ART. Conclusions Given the widespread overlap of HIV and malnutrition in sub-Saharan Africa, FA programs have the potential to improve weight and delay disease progression, especially among HIV-infected individuals not yet on ART. Additional well designed prospective studies evaluating the impact of FA are urgently needed.
Calabrese, Sarah K; Burke, Sara E; Dovidio, John F; Levina, Olga S; Uusküla, Anneli; Niccolai, Linda M; Heimer, Robert
Marked overlap between the HIV and injection drug use epidemics in St. Petersburg, Russia, puts many people in need of health services at risk for stigmatization based on both characteristics simultaneously. The current study examined the independent and interactive effects of internalized HIV and drug stigmas on health status and health service utilization among 383 people with HIV who inject drugs in St. Petersburg. Participants self-reported internalized HIV stigma, internalized drug stigma, health status (subjective rating and symptom count), health service utilization (HIV care and drug treatment), sociodemographic characteristics, and health/behavioral history. For both forms of internalized stigma, greater stigma was correlated with poorer health and lower likelihood of service utilization. HIV and drug stigmas interacted to predict symptom count, HIV care, and drug treatment such that individuals internalizing high levels of both stigmas were at elevated risk for experiencing poor health and less likely to access health services.
Lusi Herawati Sunyoto Usman Mark Zuidgeest
Full Text Available Equitable health care is a basic right for citizens and must be fulfilled by the government. This research analyzed communitydiscrepancy in access to reach health services in public hospitals and Puskesmas (health centers in Banyuwangi Regency.This research identified community accessibility to health facilities services using travel time and transport modes choiceas indicators. Flowmap tool is used to analyze catchment area of each health facility using different transport modes choice:becak and public transport for poor group and motorcycle and car for non-poor group with different travel time within 30, 60 and more than 60 minutes. It is concluded that there was an accessibility difference between poor and non-poor group. The accessibility to the health facilities of poor group was lower than non-poor group. This condition occurred because the government policy of equitable access to health service facility did not pay attention to accessibility of poor group.
Ding, Yingying; Li, Li; Ji, Guoping
This study examined the main reasons and predictors of HIV disclosure and its relationship to access to care among people living with HIV (PLH) in a rural area of China. A sample of 88 PLH from three counties was interviewed in 2009. In our sample, the rates of disclosure were higher within and outside family. Trust (31%), needing help (28%), and close relationships (26%) were the three main reasons of selecting the person to disclose by a PLH. Using a multivariate analysis, level of HIV disclosure to partners and members within the community was only significantly associated with use of antiretroviral treatment (ART) (β = 2.76; 95% Confidence Interval (CI): 0.77, 4.74). After adjusting for demographics, time since HIV diagnosis and ART, we found HIV disclosure (β = 0.07; 95% CI: 0.01, 0.13) was a significant predictor for access to care. In order to improve PLHs' access to health services and care, future intervention programs should consider both the potential benefits and risks associated with HIV disclosure (intentional and unintentional), and assist PLHs to prepare for HIV disclosure and reduce potential negative impacts that come with it.
Beck Eduard J
Full Text Available Abstract Background Individual-level data are needed to optimize clinical care and monitor and evaluate HIV services. Confidentiality and security of such data must be safeguarded to avoid stigmatization and discrimination of people living with HIV. We set out to assess the extent that countries scaling up HIV services have developed and implemented guidelines to protect the confidentiality and security of HIV information. Methods Questionnaires were sent to UNAIDS field staff in 98 middle- and lower-income countries, some reportedly with guidelines (G-countries and others intending to develop them (NG-countries. Responses were scored, aggregated and weighted to produce standard scores for six categories: information governance, country policies, data collection, data storage, data transfer and data access. Responses were analyzed using regression analyses for associations with national HIV prevalence, gross national income per capita, OECD income, receiving US PEPFAR funding, and being a G- or NG-country. Differences between G- and NG-countries were investigated using non-parametric methods. Results Higher information governance scores were observed for G-countries compared with NG-countries; no differences were observed between country policies or data collection categories. However, for data storage, data transfer and data access, G-countries had lower scores compared with NG-countries. No significant associations were observed between country score and HIV prevalence, per capita gross national income, OECD economic category, and whether countries had received PEPFAR funding. Conclusions Few countries, including G-countries, had developed comprehensive guidelines on protecting the confidentiality and security of HIV information. Countries must develop their own guidelines, using established frameworks to guide their efforts, and may require assistance in adapting, adopting and implementing them.
Beck, Eduard J; Mandalia, Sundhiya; Harling, Guy; Santas, Xenophon M; Mosure, Debra; Delay, Paul R
Individual-level data are needed to optimize clinical care and monitor and evaluate HIV services. Confidentiality and security of such data must be safeguarded to avoid stigmatization and discrimination of people living with HIV. We set out to assess the extent that countries scaling up HIV services have developed and implemented guidelines to protect the confidentiality and security of HIV information. Questionnaires were sent to UNAIDS field staff in 98 middle- and lower-income countries, some reportedly with guidelines (G-countries) and others intending to develop them (NG-countries). Responses were scored, aggregated and weighted to produce standard scores for six categories: information governance, country policies, data collection, data storage, data transfer and data access. Responses were analyzed using regression analyses for associations with national HIV prevalence, gross national income per capita, OECD income, receiving US PEPFAR funding, and being a G- or NG-country. Differences between G- and NG-countries were investigated using non-parametric methods. Higher information governance scores were observed for G-countries compared with NG-countries; no differences were observed between country policies or data collection categories. However, for data storage, data transfer and data access, G-countries had lower scores compared with NG-countries. No significant associations were observed between country score and HIV prevalence, per capita gross national income, OECD economic category, and whether countries had received PEPFAR funding. Few countries, including G-countries, had developed comprehensive guidelines on protecting the confidentiality and security of HIV information. Countries must develop their own guidelines, using established frameworks to guide their efforts, and may require assistance in adapting, adopting and implementing them.
Parag, Ayala; Jacobson, Eyal; Afek, Arnon
This article presents findings from professional and scientific articles written on the subject of direct access to physical therapy services. Direct access is sometimes referred to as "self-referral"--the patient does not require a physician's referral prior to receiving physiotherapy treatment. The article provides insight from the experience of countries where direct access is accepted practice, which will serve as a theoretical and scientific basis for the use of direct access in Israel. Findings include the influence of direct access on the health care system: cost-benefit analysis, advantages and challenges, as well as the perspective of main stakeholders: physicians, physical therapists and patient-clients. .
Allison J Carter
Full Text Available Introduction: The increasing proportion of women living with HIV has evoked calls for tailored services that respond to women's specific needs. The objective of this investigation was to explore the concept of women-specific HIV/AIDS services to identify and define what key elements underlie this approach to care. Methods: A comprehensive review was conducted using online databases (CSA Social Service Abstracts, OvidSP, Proquest, Psycinfo, PubMed, CINAHL, augmented with a search for grey literature. In total, 84 articles were retrieved and 30 were included for a full review. Of these 30, 15 were specific to HIV/AIDS, 11 for mental health and addictions and four stemmed from other disciplines. Results and discussion: The review demonstrated the absence of a consensual definition of women-specific HIV/AIDS services in the literature. We distilled this concept into its defining features and 12 additional dimensions (1 creating an atmosphere of safety, respect and acceptance; (2 facilitating communication and interaction among peers; (3 involving women in the planning, delivery and evaluation of services; (4 providing self-determination opportunities; (5 providing tailored programming for women; (6 facilitating meaningful access to care through the provision of social and supportive services; (7 facilitating access to women-specific and culturally sensitive information; (8 considering family as the unit of intervention; (9 providing multidisciplinary integration and coordination of a comprehensive array of services; (10 meeting women “where they are”; (11 providing gender-, culture- and HIV-sensitive training to health and social care providers; and (12 conducting gendered HIV/AIDS research. Conclusions: This review highlights that the concept of women-specific HIV/AIDS services is a complex and multidimensional one that has been shaped by diverse theoretical perspectives. Further research is needed to better understand this emerging concept and
Carter, Allison J; Bourgeois, Sonya; O'Brien, Nadia; Abelsohn, Kira; Tharao, Wangari; Greene, Saara; Margolese, Shari; Kaida, Angela; Sanchez, Margarite; Palmer, Alexis K; Cescon, Angela; de Pokomandy, Alexandra; Loutfy, Mona R
Introduction The increasing proportion of women living with HIV has evoked calls for tailored services that respond to women's specific needs. The objective of this investigation was to explore the concept of women-specific HIV/AIDS services to identify and define what key elements underlie this approach to care. Methods A comprehensive review was conducted using online databases (CSA Social Service Abstracts, OvidSP, Proquest, Psycinfo, PubMed, CINAHL), augmented with a search for grey literature. In total, 84 articles were retrieved and 30 were included for a full review. Of these 30, 15 were specific to HIV/AIDS, 11 for mental health and addictions and four stemmed from other disciplines. Results and discussion The review demonstrated the absence of a consensual definition of women-specific HIV/AIDS services in the literature. We distilled this concept into its defining features and 12 additional dimensions (1) creating an atmosphere of safety, respect and acceptance; (2) facilitating communication and interaction among peers; (3) involving women in the planning, delivery and evaluation of services; (4) providing self-determination opportunities; (5) providing tailored programming for women; (6) facilitating meaningful access to care through the provision of social and supportive services; (7) facilitating access to women-specific and culturally sensitive information; (8) considering family as the unit of intervention; (9) providing multidisciplinary integration and coordination of a comprehensive array of services; (10) meeting women “where they are”; (11) providing gender-, culture- and HIV-sensitive training to health and social care providers; and (12) conducting gendered HIV/AIDS research. Conclusions This review highlights that the concept of women-specific HIV/AIDS services is a complex and multidimensional one that has been shaped by diverse theoretical perspectives. Further research is needed to better understand this emerging concept and ultimately
Carter, Allison J; Bourgeois, Sonya; O'Brien, Nadia; Abelsohn, Kira; Tharao, Wangari; Greene, Saara; Margolese, Shari; Kaida, Angela; Sanchez, Margarite; Palmer, Alexis K; Cescon, Angela; de Pokomandy, Alexandra; Loutfy, Mona R
The increasing proportion of women living with HIV has evoked calls for tailored services that respond to women's specific needs. The objective of this investigation was to explore the concept of women-specific HIV/AIDS services to identify and define what key elements underlie this approach to care. A comprehensive review was conducted using online databases (CSA Social Service Abstracts, OvidSP, Proquest, Psycinfo, PubMed, CINAHL), augmented with a search for grey literature. In total, 84 articles were retrieved and 30 were included for a full review. Of these 30, 15 were specific to HIV/AIDS, 11 for mental health and addictions and four stemmed from other disciplines. The review demonstrated the absence of a consensual definition of women-specific HIV/AIDS services in the literature. We distilled this concept into its defining features and 12 additional dimensions (1) creating an atmosphere of safety, respect and acceptance; (2) facilitating communication and interaction among peers; (3) involving women in the planning, delivery and evaluation of services; (4) providing self-determination opportunities; (5) providing tailored programming for women; (6) facilitating meaningful access to care through the provision of social and supportive services; (7) facilitating access to women-specific and culturally sensitive information; (8) considering family as the unit of intervention; (9) providing multidisciplinary integration and coordination of a comprehensive array of services; (10) meeting women "where they are"; (11) providing gender-, culture- and HIV-sensitive training to health and social care providers; and (12) conducting gendered HIV/AIDS research. This review highlights that the concept of women-specific HIV/AIDS services is a complex and multidimensional one that has been shaped by diverse theoretical perspectives. Further research is needed to better understand this emerging concept and ultimately assess the effectiveness of women-specific services on HIV
Lazarus, Jeff; Laukamm-Josten, Ulrich; Atun, Rifat A;
there have been many declarations and strategies addressing HIV/AIDS, today the goal is universal access to HIV/AIDS prevention, treatment, care and support services by 2010. The articles included in this thematic issue of the Central European Journal of Public Health on HIV/AIDS reflect this, while the ten...
Full Text Available . This capability is used in basic service such as Short Message Service (SMS) as well as Unstructured Supplementary Service Data (USSD). There is a need for a service access and delivery pattern that can facilitate the delivery of services using common...
Language HTTP Hypertext Transfer Protocol HTTPS Secure Hypertext Transfer Protocol IDS intrusion detection system IEEE Institute for Electrical and...so we limit our focus to a subset of these services in order to convey the basic concepts of the framework. Specifically, we focus on Hypertext ...Transfer Protocol (HTTP), Secure Hypertext Transfer Protocol (HTTPS), and Internet Relay Chat (IRC). We also constrain our work in terms of network size
Lusi Herawati Sunyoto Usman Mark Zuidgeest
as indicators. Flowmap tool is used to analyze catchment area of each health facility using different transport modes choice:becak and public transport for poor group and motorcycle and car for non-poor group with different travel time within 30, 60 and more than 60 minutes. It is concluded that there was an accessibility difference between poor and non-poor group. The accessibility to the health facilities of poor group was lower than non-poor group. This condition occurred because the government policy of equitable access to health service facility did not pay attention to accessibility of poor group.
Firestone, Rebecca; MacCarthy, Sarah; Ferguson, Laura
Too little is known about how an HIV diagnosis and access to care and treatment affect women's childbearing intentions. As access to antiretroviral therapy improves, greater numbers of HIV-positive women are living longer, healthier lives, and many want to have children. Effectively supporting women's reproductive decisionmaking in the context of HIV requires understanding how pregnancy, reproduction, and HIV intersect and asking questions that bridge the biomedical and social sciences. Considering women to be at the center of decisions on health policy and service delivery can help provide an appropriate constellation of services. A clear research agenda is needed to create a more coordinated approach to policies and programs supporting the pregnancy intentions of women with HIV. PMID:18703432
Full Text Available This paper addresses methodology and tools applied to the monitoring of accessibility services in digital television at a time when the principles of accessibility and design are being considered in all new audiovisual media communication services. The main objective of this research is to measure the quality and quantity of existing accessibility services offered by digital terrestrial television (DTT. The preliminary results, presented here, offer the development of a prototype for automatic monitoring and a methodology for obtaining quality measurements, along with the conclusions drawn by initial studies carried out in Spain. The recent approval of the UN Convention on the Rights of Persons with Disabilities gives special relevance to this research because it provides valuable guidelines to help set the priorities to improve services currently available to users.
Dean, Richard A.; Levesque, Allen H.
The rapid introduction of digital wireless networks is an important part of the emerging digital communications scene. The introduction of Digital Cellular, LEO and GEO Satellites, and Personal Communications Services poses both a challenge and an opportunity for the data user. On the one hand wireless access will introduce significant new portable data services such as personal notebooks, paging, E-mail, and fax that will put the information age in the user's pocket. On the other hand the challenge of creating a seamless and transparent environment for the user in multiple access environments and across multiple network connections is formidable. A summary of the issues associated with developing techniques and standards that can support transparent and seamless data services is presented. The introduction of data services into the radio world represents a unique mix of RF channel problems, data protocol issues, and network issues. These problems require that experts from each of these disciplines fuse the individual technologies to support these services.
Brindicci, G; Trillo, G; Santoro, C R; Volpe, A; Monno, L; Angarano, G
This paper, part of a larger epidemiological study carried out between 2004 and 2010, analyzed immigrants frequenting the largest Apulian regional hospital (Bari Policlinico). Our aim was to evaluate the perception on the part of undocumented immigrants of their rights of access to the National Health Care services and whether this privilege is actually utilized. An anonymous multi-language questionnaire was distributed to all patients with STP (code number for temporary presence of foreigners) at the immigrant outpatient Infectious Diseases Clinic of Bari from June 2009 to June 2010. Questions were related to nationality, date of arrival in Italy, use of health facilities in the 2 years prior to the compilation of the questionnaire, and their understanding of STP. The patients were also screened for infectious diseases (HIV-Ab, HBsAg, HCV-Ab, VDRL, TPHA and Mantoux). A total of 256/272 patients completed the questionnaire; the meaning of STP was unknown to 156/256 (60.9%) patients, only 54/256 (21%) knew the exact meaning of STP and only 42/54 (76.6%) of the latter knew how long STP was valid. Moreover, 128/256 (50.7%) were aware that doctors from the emergency unit were not allowed to notify police regarding presence of illegal immigrants. Regarding clinical data 3% were HIV+ (8/256), 5% (13 patients) positive for TPHA, 5% for HBsAg, 2% were HCV (five patients). A >10 mm diameter infiltrate of Mantoux test was noted for 44% of patients. A lower prevalence than expected for infections such as HIV, HBV or HCV was noted for immigrants compared to data from their countries of origin. At present, large-scale political solutions to the challenges of facilitating access to health facilities for undocumented immigrants are lacking in Italy. The development of communication systems is fundamental to improving access to health services and to creating links between immigrants and the healthcare system.
Full Text Available INTRODUCTION: There has been insufficient attention to long-term care and treatment for pregnant women diagnosed with HIV. OBJECTIVE AND METHODS: This prospective cohort study of 100 HIV-positive women recruited within pregnancy-related services in a district hospital in Kenya employed quantitative methods to assess attrition between women testing HIV-positive in pregnancy-related services and accessing long-term HIV care and treatment services. Qualitative methods were used to explore barriers and facilitators to navigating these services. Structured questionnaires were administered to cohort participants at enrolment and 90+ days later. Participants' medical records were monitored prospectively. Semi-structured qualitative interviews were carried out with a sub-set of 19 participants. FINDINGS: Only 53/100 (53% women registered at an HIV clinic within 90 days of HIV diagnosis, of whom 27/53 (51% had a CD4 count result in their file. 11/27 (41% women were eligible for immediate antiretroviral therapy (ART; only 6/11 (55% started ART during study follow-up. In multivariable logistic regression analysis, factors associated with registration at the HIV clinic within 90 days of HIV diagnosis were: having cared for someone with HIV (aOR:3.67(95%CI:1.22, 11.09, not having to pay for transport to the hospital (aOR:2.73(95%CI:1.09, 6.84, and having received enough information to decide to have an HIV test (aOR:3.61(95%CI:0.83, 15.71. Qualitative data revealed multiple factors underlying high patient drop-out related to women's social support networks (e.g. partner's attitude to HIV status, interactions with health workers (e.g. being given unclear/incorrect HIV-related information and health services characteristics (e.g. restricted opening hours, long waiting times. CONCLUSION: HIV testing within pregnancy-related services is an important entry point to HIV care and treatment services, but few women successfully completed the steps needed for
Aletraris, Lydia; Roman, Paul M
The provision of HIV education and testing in substance use disorder (SUD) treatment programs is an important public health strategy for reducing HIV incidence. For many at-risk individuals, SUD treatment represents the primary point of access for testing and receiving HIV-related services. This study uses two waves of nationally representative data of 265 privately-funded SUD treatment programs in the U.S. to examine organizational and patient characteristics associated with offering a dedicated HIV/AIDS treatment track, onsite HIV/AIDS support groups, and onsite HIV testing. Our longitudinal analysis indicated that the majority of treatment programs reported providing education and prevention services, but there was a small, yet significant, decline in the number of programs providing these services. Programs placed more of an emphasis on providing information on the transmission of HIV rather than on acquiring risk-reduction skills. There was a notable and significant increase (from 26.0% to 31.7%) in programs that offered onsite HIV testing, including rapid HIV testing, and an increase in the percentage of patients who received testing in the programs. Larger programs were more likely to offer a dedicated HIV/AIDS treatment track and to offer onsite HIV/AIDS support groups, while accredited programs and programs with a medical infrastructure were more likely to provide HIV testing. The percentage of injection drug users was positively linked to the availability of specialized HIV/AIDS tracks and HIV/AIDS support groups, and the percentage of female clients was associated with the availability of onsite support groups. The odds of offering HIV/AIDS support groups were also greater in programs that had a dedicated LGBT track. The findings suggest that access to hospitals and medical care services is an effective way to facilitate adoption of HIV services and that programs are providing a needed service among a group of patients who have a heightened risk of HIV
Fogler, Jessica A; Weber, Shannon; Goldschmidt, Ronald H; Mahoney, Megan R; Cohan, Deborah
This study evaluates the consultation needs of clinicians who provide perinatal human immunodeficiency virus (HIV) care in the United States. The Perinatal Hotline (1-888-448-8765) is a telephone consultation service for providers who treat HIV-infected pregnant women and their infants. Hotline calls were analyzed for demographics about callers and their patients and information about consultation topics. There were 430 calls to the hotline from January 1, 2005, through June 30, 2006. Most calls (59.5%) were related to pregnant patients; 5.1% of the calls pertained to women currently in labor. The most common topic was HIV care in pregnancy (49.1%), particularly antiretroviral drug use (42.1%). HIV testing was discussed in 21.9%, and intrapartum treatment was discussed in 24.0%. Callers most often requested help choosing antiretroviral drug regimens; many of the discussions were about drug toxicities and viral resistance. Although the hotline received few calls about women in labor, the need for these consultations is expected to increase with the expanding use of rapid HIV testing. Access to 24-hour consultation can help ensure that state-of-the-art care is provided.
Levett, T; Slide, C; Mallick, F; Lau, R
A number of surveys highlight a shortage of dentists in the UK. There is also evidence of discrimination against those with HIV reported within the dental profession and service users. We decided to assess the extent of this problem in our HIV outpatients by conducting a cross-sectional survey, asking them to complete a questionnaire exploring issues related to dental care access, and using clients attending the routine genitourinary (GU) medicine outpatient clinic as controls. A total of 241 outpatients completed the survey, of whom 51 (21%) were HIV patients. Significantly, more HIV patients reported difficulty registering with a dentist than GU patients (58.8% versus 18.2%, chi(2) with Yates correction = 8.76, P = 0.0031). They also report significantly more dental health problems compared with controls (54.9% versus 32.1%, chi(2) with Yates correction = 8.02, P = 0.0046). In total, 34.6% of HIV patients who had declared their status to a dentist thought that it had negatively impacted on their care, with 6.2% being refused treatment. Our small survey confirms that discrimination in relation to access and level of dental care exists, with black African women being at most risk. Efforts are needed to raise professional standards and HIV awareness to prevent continuing inequalities in dental care provision.
Level: Formative Assessment with Village Health Teams in Uganda. Aurélie Brunie. 1 ... Little is known on integrating HIV and family planning (FP) services in community settings. Using a cluster ..... the risk of unplanned pregnancy and HIV.
DUAN Lei; SHEN Liren
Web services is used in Experimental Physics and Industrial Control System (EPICS). Combined with EPICS Channel Access protocol, Web services' high usability, platform independence and language independence can be used to design a fully transparent and uniform software interface layer, which helps us complete channel data acquisition, modification and monitoring functions. This software interface layer, a cross-platform of cross-language,has good interopcrability and reusability.
At least since the early 1990s, academic libraries have been merging Circulation and various other related functions into a single department typically labeled "Access Services." In many cases, however, that merger has proven to be administrative rather than functional, with minimal integration of common workflows. This article describes…
This article serves as a primer for assessment and evaluation design by describing the range of methods commonly employed in library settings. Quantitative methods, such as counting and benchmarking measures, are useful for investigating the internal operations of an access services department in order to identify workflow inefficiencies or…
Goga, Ameena Ebrahim; Singh, Yagespari; Singh, Michelle; Noveve, Nobuntu; Magasana, Vuyolwethu; Ramraj, Trisha; Abdullah, Fareed; Coovadia, Ashraf H; Bhardwaj, Sanjana; Sherman, Gayle G
Introduction Increasing access to HIV-related care and treatment for children aged 0-18 years in resource-limited settings is an urgent global priority. In 2011-2012 the percentage increase in children accessing antiretroviral therapy was approximately half that of adults (11 vs. 21 %). We propose a model for increasing access to, and retention in, paediatric HIV care and treatment in resource-limited settings. Methods Following a rapid appraisal of recent literature seven main challenges in paediatric HIV-related care and treatment were identified: (1) lack of regular, integrated, ongoing HIV-related diagnosis; (2) weak facility-based systems for tracking and retention in care; (3) interrupted availability of dried blood spot cards (expiration/stock outs); (4) poor quality control of rapid HIV testing; (5) supply-related gaps at health facility-laboratory interface; (6) poor uptake of HIV testing, possibly relating to a fatalistic belief about HIV infection; (7) community-associated reasons e.g. non-disclosure and weak systems for social support, resulting in poor retention in care. Results To increase sustained access to paediatric HIV-related care and treatment, regular updating of Policies, review of inter-sectoral Plans (at facility and community levels) and evaluation of Programme implementation and impact (at national, subnational, facility and community levels) are non-negotiable critical elements. Additionally we recommend the intensified implementation of seven main interventions: (1) update or refresher messaging for health care staff and simple messaging for key staff at early childhood development centres and schools; (2) contact tracing, disclosure and retention monitoring; (3) paying particular attention to infant dried blood spot (DBS) stock control; (4) regular quality assurance of rapid HIV testing procedures; (5) workshops/meetings/dialogues between health facilities and laboratories to resolve transport-related gaps and to facilitate return of
U.S. Department of Health & Human Services — The HIV Testing Sites & Care Services Locator is a first-of-its-kind, location-based search tool that allows you to search for testing services, housing...
Korhonen, Lauren C; DeGroote, Nicholas P; Shouse, R Luke; Valleroy, Linda A; Prejean, Joseph; Bradley, Heather
The prevalence of diagnosed human immunodeficiency virus (HIV) infection in Hispanics/Latinos in the United States is more than twice as high as the prevalence among non-Hispanic whites (1). Services that support retention in HIV medical care and assist with day-to-day living, referred to here as ancillary services, help persons living with HIV access HIV medical care, adhere to HIV treatment, and attain HIV viral suppression. The needs for these ancillary services among Hispanics/Latinos are not well described (2). To obtain nationally representative estimates of and reasons for unmet needs for such services among Hispanic/Latino adults receiving outpatient HIV medical care during 2013-2014, CDC analyzed data from the Medical Monitoring Project (MMP). The analysis found that Hispanics/Latinos in all age and sexual orientation/behavior subgroups reported substantial unmet needs, including 24% needing dental care, 21% needing eye or vision care, 15% needing food and nutrition services, and 9% needing transportation assistance. Addressing unmet needs for ancillary services among Hispanics/Latinos living with HIV might help increase access to HIV care, improve health outcomes, and reduce health disparities.
Barr, David; Odetoyinbo, Morolake; Mworeko, Lillian; Greenberg, Julia
HIV treatment and prevention strategies are life-long endeavours, requiring not only comprehensive, high-quality, consistent and equitable medical services but also appropriate political and cultural milieus to be effective. Communities directly affected by HIV offer a unique expertise and understanding in developing services to meet the needs of people seeking out and utilizing HIV treatment, prevention and support services. Through their organizations and networks, and through partnerships with health systems, these communities provide leadership, services and advocacy to ensure the delivery of high-quality, comprehensive services to meet the needs of diverse populations affected by HIV. This article describes integrated approaches to service delivery in which affected communities play a key role in the development and implementation of HIV programmes. Further scale-up of these approaches to care can improve overall quality, reduce stigma and discrimination, increase demand for services and improve retention in care.
Luseno, Winnie K; Wechsberg, Wendee M; Kline, Tracy L; Ellerson, Rachel Middlesteadt
HIV health services are critical in sub-Saharan African where the burden of the HIV pandemic is devastating. Existing studies suggest that HIV-infected individuals from marginalized populations who know their status do not seek health services because they are unaware of available treatment and care options, may not understand how to access services, or have poor access to and utilization of health care services. This study examined factors associated with health service utilization in a sample of poor, underserved recently diagnosed HIV-positive South African women with sexual and substance use risk behaviors. The data were collected between June 2004 and May 2008. Primary outcomes included consultation with a medical professional and utilization of any health services since learning of HIV status at 3- and 6-month follow-up assessments. The study findings suggest that denial of HIV status may be a barrier to care, leading study participants to avoid utilizing health services specific to their disease and to prefer more general medical care services. In multivariate analyses, prior use of health services, financially supporting others, and sex trading were strongly associated with health service use at follow-up assessments. The study findings suggest a reduced likelihood of health services utilization among participants who met DSM-IV criteria for drug abuse as well as participants with greater numbers of poor physical health symptoms. As an important preliminary step in examining the issue of health services utilization in sub-Saharan Africa, the findings suggest an urgent need to promote HIV prevention and early testing, to strengthen long-term HIV care services, and to increase access to services.
Seeman, Mary V
This article reviews how mental health services can best prevent and treat HIV infection among women with serious mental illness. This is a selective narrative review of the recent literature on mental health services and HIV. The author used the terms "HIV," "serious mental illness," and "women" to search Google Scholar. Out of 500 relevant papers retrieved, 82 were included, based on their state-of-the-art findings. Women with serious mental illness at risk of HIV were found to be an especially vulnerable group. The evidence suggests that discussion of the modes of viral transmission reduces the risk of infection in this population, as do psychoeducation; long-term antipsychotic medication; adherence therapy; community treatment orders; prevention of domestic violence and homelessness; disbursement of financial entitlements; provision of psychotherapy and social support; cognitive rehabilitation; promotion of abstinence, monogamy, or reduction in the number of sexual partners; access to and training in the use of condoms; prophylaxis with vaginal microbicides and oral antiretroviral drugs; prompt diagnosis and treatment of sexually transmitted diseases; across-the-board offers of HIV testing; and preservation and monitoring of reproductive health. For HIV-positive individuals, comprehensive treatment measures have included prompt HIV treatment; long-term retention in care; supervision of medication adherence and drug interactions; rapid management of substance use disorders and all other comorbidities as well as drug side effects; and preclusion of professional stigmatization. There is now sufficient evidence to recommend effective combinations of strategies to prevent and treat HIV within mental health services.
Vernooij, Eva; Mehlo, Mandhla; Hardon, Anita; Reis, Ria
This article explores how notions of the individual and population are evoked in two ongoing HIV treatment as prevention (TasP) implementation studies in Swaziland. By contrasting policy discourses with lived kinship experiences of people living with HIV, we seek to understand how TasP unfolds in the Swazi context. Data collection consisted of eight focus group discussions with people living with HIV who were members of support groups to examine their perspectives about TasP. In addition, 18 key informant interviews were conducted with study team members, national-level policy-makers and NGO representatives involved in the design of health communication messages about TasP in Swaziland. Thematic analysis was used to identify recurrent themes in transcripts and field notes. Policy-makers and people living with HIV actively resisted framing HIV treatment as a prevention technology but promoted it as (earlier) access to treatment for all. TasP was not conceptualised in terms of individual or societal benefits, which are characteristic of international public health debates; rather its locally situated meanings were embedded in kinship experiences, concerns about taking responsibility for one's own health and others, local biomedical knowledge about drug resistance, and secrecy. The findings from this study suggest that more attention is needed to understand how the global discourse of TasP becomes shaped in practice in different cultural contexts.
Full Text Available Clinical Voluntary Counseling Testing (VCT was established in 2009 in hospitals Paniai Papua. VCT Clinic Hospital Papua Paniai aims to prevent and break the chain of transmission of HIV, screening and early diagnosis, ongoing counseling, as well as preventing the transmission of HIV infection from mother to child. VCT is also becoming more access to management for people with HIV, either the antiretroviral drugs, prevention and treatment of opportunistic infections, and the treatment of HIV infection holistically. Objective: The identification of patient care management of HIV / AIDS in patient wards of hospitals Paniai Papua Province. Mixed Methods ie qualitative and quantitative research. The quantitative data obtained from medical records of 287 patients with HIV-AIDS hospitalizations in 2014-2016. The qualitative data obtained from interviews with key informants were 13 people selected by purposive sampling and analyzed descriptively. Characteristics of patients with HIV / AIDS are the patients most aged 25-49 years (54%, female gender (56%, high school (26%, not working (54%, risk factors for heterosexual (74%, tuberculosis coinfection (46%, duration of treatment ARV therapy for less than 1 year (57%, non-compliance with taking medication (61.1%, length of stay of 1-5 days (48%, stage III (65%, CD4 <200 mg (55%, the difference in the payment of fees at the rate parties BPJS RS Rp. 764 715 036. Inputs include human resources, facilities, infrastructure in the service of HIV / AIDS patients in hospitals Paniai accordance Hospital classification type D. Sources of funds from DAU (General Allocation Fund, DAK (Special Allocation Fund, Papua Health Card (KPS as well as the Public Service Board (BLUD. Optimal service process is already running with the service flow and SOP examination and treatment of HIV. Output inpatient care including HIV / AIDS patients were optimal given by SPM (Minimum Service Standards Hospital Health Ministerial Decree No
Templin-Branner W. and N. Dancy
The Equal Access Initiative: HIV/AIDS Information Resources from the National Library of Medicine training is designed specifically for the National Minority AIDS Council 2010 Equal Access Initiative (EAI) Computer Grants Program awardees to provide valuable health information resources from the National Library of Medicine and other reliable sources to increase awareness of the wealth of treatment information and educational materials that are available on the Internet and to improve prevention and treatment education for their clients. These resources will also meet the needs of community-based
Voluntary counseling and testing (VCT services and their contribution to access to HIV diagnosis in Brazil Contribuição dos Centros de Testagem e Aconselhamento (CTA para o acesso ao diagnóstico da infecção pelo HIV no Brasil
Full Text Available The Voluntary Counseling and Testing (VCT Network was implemented in Brazil in the 1980s to promote anonymous and confidential access to HIV diagnosis. As a function of the population and dimensions of the local epidemic, the study assessed the network's coverage, using data from a self-applied questionnaire and data from the Information Technology Department of the Unified National Health System (SUS, UNDP, and National STD/AIDS Program. The Student t test was used for comparison of means and the chi-square test for proportions. Brazil has 383 VCT centers, covering 48.9% of the population and 69.2% of the AIDS cases. The network has been implemented predominantly in regions where the epidemic shows a relevant presence, but 85.3% of the cities with high HIV incidence lack VCT centers; absence of VCT was associated with more limited health infrastructure and worse social indicators. A slowdown in expansion of the network was observed, with VCT Centers implemented on average 16 years after the first AIDS case in the given municipality. The number of HIV tests performed under the SUS is 2.3 times higher in cities with VCT centers. The network's scope is limited, thus minimizing the contribution by these services to the supply of HIV diagnosis in Brazil.A rede nacional de Centros de Testagem e Aconselhamento (CTA foi implantada no Brasil nos anos 1980 para promover, anônima e confidencialmente, o diagnóstico do HIV. Em função da população abrangida e das dimensões da epidemia local, o estudo avaliou a cobertura dessa rede, utilizando dados de questionário auto-aplicado e de bancos de informações do DATASUS, PNUD e Programa Nacional de DST e AIDS. Aplicou-se teste t para comparações de média e qui-quadrado para proporções. Existem no Brasil 383 CTA, abrangendo 48,9% da população e 69,2% dos casos de AIDS. A rede está predominantemente implantada em regiões em que a epidemia é relevante, entretanto 85,3% das cidades com alta incid
Full Text Available Background: The United Nations Political Declaration on HIV and AIDS of 2006 stressed the need to strengthen policy and programme linkages between HIV and Sexual and Reproductive Health (SRH. However, the effectiveness and best practices for strengthening SRH and HIV linkages are poorly researched in the context of family-planning services. In Cape Town, HIV-prevention services have been integrated into family-planning services. There are two models of service configuration: dedicated stand-alone reproductive health clinics and family planning services located in comprehensive primary-care facilities.Objective: To describe how reproductive health services are integrating HIV prevention and care strategies and to measure the coverage and quality of these integrated services.Methods: A cross-sectional study was conducted using structured interviews with facility managers; a facility-based checklist; and a patient record review to assess the availability of resources, training, access, quality and integration.Results: Facilities in Cape Town are equipped adequately to offer integrated HIV-prevention and SRH services. Overall there was poor coverage of integrated services with 54% of family planning clients having a known HIV status; 47% being screened for a sexually transmitted infection and 55% being offered HIV counselling and testing and receiving condoms. Quality and continuity of care seemed better at the dedicated clinics than at the comprehensive facilities,supported by better training coverage.Conclusion: Engaging middle-level management is crucial with regard to improving integration within a well-resourced setting.
Meng, Wei; Li, Fengmin; Pan, Juchen; Song, Song; Bian, Jiali
The development of mobile computing, cloud computing and distributed computing meets the growing individual service needs. Facing with complex application system, it's an urgent problem to ensure real-time, dynamic, and fine-grained data access control. By analyzing common data access control models, on the basis of mandatory access control model, the paper proposes a service-oriented access control model. By regarding system services as subject and data of databases as object, the model defines access levels and access identification of subject and object, and ensures system services securely to access databases.
... HUMAN SERVICES Health Resources and Services Administration Ryan White HIV/AIDS Program, Part C Early Intervention Services Grant Under the Ryan White HIV/AIDS Program AGENCY: Health Resources and Services Administration (HRSA), Department of Health and Human Services. ACTION: Notice of Ryan White HIV/AIDS...
... HUMAN SERVICES Health Resources and Services Administration Ryan White HIV/AIDS Program, Part C Early Intervention Services Grant Under the Ryan White HIV/AIDS Program AGENCY: Health Resources and Services Administration (HRSA), HHS. ACTION: Notice of Ryan White HIV/AIDS Program Part C Early Intervention Services...
... HUMAN SERVICES Health Resources and Services Administration Ryan White HIV/AIDS Program, Part C Early Intervention Services Grant Under the Ryan White HIV/AIDS Program AGENCY: Health Resources and Services Administration (HRSA), Department of Health and Human Services. ACTION: Notice of Ryan White HIV/AIDS...
... HUMAN SERVICES Health Resources and Services Administration Ryan White HIV/AIDS Program Part C Early Intervention Services Grant Under the Ryan White HIV/AIDS Program AGENCY: Health Resources and Services Administration (HRSA), Department of Health and Human Services. ACTION: Notice of Ryan White HIV/AIDS...
... HUMAN SERVICES Health Resources and Services Administration Ryan White HIV/AIDS Program, Part C Early Intervention Services Grant Under the Ryan White HIV/AIDS Program AGENCY: Health Resources and Services Administration (HRSA), Department of Health and Human Services. ACTION: Notice of Ryan White HIV/AIDS...
This article defines the elements of Access Services, explains the importance of those aspects in the library, and proposes a course centered on Access Services for library schools. The areas of circulation, interlibrary loan, course reserves, collection maintenance, and public relations are core components of Access Services. Each of those…
Bradley, H; Bedada, A; Tsui, A; Brahmbhatt, H; Gillespie, D; Kidanu, A
Integrating voluntary HIV counselling and testing (VCT) with family planning and other reproductive health services may be one effective strategy for expanding VCT service delivery in resource poor settings. Using 30,257 VCT client records with linked facility characteristics from Ethiopian non-governmental, non-profit, reproductive health clinics, we constructed multi-level logistic regression models to examine associations between HIV and family planning service integration modality and three outcomes: VCT client composition, client-initiated HIV testing and client HIV status. Associations between facility HIV and family planning integration level and the likelihood of VCT clients being atypical family planning client-types, versus older (at least 25 years old), ever-married women were assessed. Relative to facilities co-locating services in the same compound, those offering family planning and HIV services in the same rooms were 2-13 times more likely to serve atypical family planning client-types than older, ever-married women. Facilities where counsellors jointly offered HIV and family planning services and served many repeat family planning clients were significantly less likely to serve single clients relative to older, married women. Younger, single men and older, married women were most likely to self-initiate HIV testing (78.2 and 80.6% respectively), while the highest HIV prevalence was seen among older, married men and women (20.5 and 34.2% respectively). Compared with facilities offering co-located services, those integrating services at room- and counsellor-levels were 1.9-7.2 times more likely to serve clients initiating HIV testing. These health facilities attract both standard material and child health (MCH) clients, who are at high risk for HIV in these data, and young, single people to VCT. This analysis suggests that client types may be differentially attracted to these facilities depending on service integration modality and other facility
... Research for Women, Infants, Children and Youth Grant Under the Ryan White HIV/AIDS Program AGENCY: Health... Part D Comprehensive Services and Access to Research for Women, Infants, Children, and Youth for... services to women, infants, children, and youth in the Charlotte, North Carolina and surrounding...
... White HIV/AIDS Program, Part C Early Intervention Services Grant Under the Ryan White HIV/AIDS Program.... ACTION: Notice of Ryan White HIV/AIDS Program Part C Early Intervention Services One-Time Noncompetitive Award to Ensure Continued HIV Primary Medical Care. SUMMARY: To prevent a lapse in comprehensive primary...
Bailey, M. D.; Crumbly, C.
The evolving nature of the NASA space enterprise compels the agency to develop new and innovative space systems concepts. NASA, working with increasingly strained budgets and a declining manpower base, is attempting to transform from operational activities to procurement of commercial services. NASA's current generation reusable launch vehicle, the Shuttle, is in transition from a government owned and operated entity to a commercial venture to reduce the civil servant necessities for that program. NASA foresees its second generation launch vehicles being designed and operated by industry for commercial and government services. The "service" concept is a pioneering effort by NASA. The purpose the "service" is not only to reduce the civil servant overhead but will free up government resources for further research and enable industry to develop a space business case so that industry can sustain itself beyond government programs. In addition, NASA desires a decreased responsibility thereby decreasing liability. The Second Generation Reusable Launch Vehicle (RLV) program is implementing NASA's Space Launch Initiative (SLI) to enable industry to develop the launch vehicles of the future. The Alternate Access to Station (AAS) project office within this program is chartered with enabling industry to demonstrate an alternate access capability for the International Space Station (ISS). The project will not accomplish this by traditional government procurement methods, not by integrating the space system within the project office, or by providing the only source of business for the new capability. The project funds will ultimately be used to purchase a service to take re-supply cargo to the ISS, much the same as any business might purchase a service from FedEx to deliver a package to its customer. In the near term, the project will fund risk mitigation efforts for enabling technologies. AAS is in some ways a precursor to the 2nd Generation RLV. By accomplishing ISS resupply
Full Text Available Abstract Background Tuberculosis (TB and human immunodeficiency virus (HIV co-infection is a major source of morbidity and mortality globally. The World Health Organization (WHO has recommended that HIV counselling and testing be offered routinely to TB patients in order to increase access to HIV care packages. We assessed the uptake of provider-initiated testing and counselling (PITC, antiretroviral (ART and co-trimoxazole preventive therapies (CPT among TB patients in the Northwest Region, Cameroon. Methods A retrospective cohort study using TB registers in 4 TB/HIV treatment centres (1 public and 3 faith-based for patients diagnosed with TB between January 2006 and December 2007 to identify predictors of the outcomes; HIV testing/serostatus, ART and CPT enrolment and factors that influenced their enrolment between public and faith-based hospitals. Results A total of 2270 TB patients were registered and offered pre-HIV test counselling; 2150 (94.7% accepted the offer of a test. The rate of acceptance was significantly higher among patients in the public hospital compared to those in the faith-based hospitals (crude OR 1.97; 95% CI 1.33 - 2.92 and (adjusted OR 1.92; 95% CI 1.24 - 2.97. HIV prevalence was 68.5% (1473/2150. Independent predictors of HIV-seropositivity emerged as: females, age groups 15-29, 30-44 and 45-59 years, rural residence, previously treated TB and smear-negative pulmonary TB. ART uptake was 50.3% (614/1220 with 17.2% (253/1473 of missing records. Independent predictors of ART uptake were: previously treated TB and extra pulmonary TB. Finally, CPT uptake was 47.0% (524/1114 with 24% (590/1114 of missing records. Independent predictors of CPT uptake were: faith-based hospitals and female sex. Conclusion PITC services are apparently well integrated into the TB programme as demonstrated by the high testing rate. The main challenges include improving access to ART and CPT among TB patients and proper reporting and monitoring of
... 47 Telecommunication 2 2010-10-01 2010-10-01 false Network access services revenues. 36.213 Section 36.213 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES... Income Accounts Operating Revenues § 36.213 Network access services revenues. (a) End User...
Beck, Eduard J; Santas, Xenophon M; Delay, Paul R
The number of people in the world living with HIV is increasing as HIV-related mortality has declined but the annual number of people newly infected with HIV has not. The international response to contain the HIV pandemic, meanwhile, has grown. Since 2006, an international commitment to scale up prevention, treatment, care and support services in middle and lower-income countries by 2010 has been part of the Universal Access programme, which itself plays an important part in achieving the Millennium Development Goals by 2015. Apart from providing technical support, donor countries and agencies have substantially increased their funding to enable countries to scale up HIV services. Many countries have been developing their HIV monitoring and evaluation systems to generate the strategic information required to track their response and ensure the best use of the new funds. Financial information is an important aspect of the strategic information required for scaling up existing services as well as assessing the effect of new ones. It involves two components: tracking the money available and spent on HIV at all levels, through budget tracking, national health accounts and national AIDS spending assessments, and estimating the cost and efficiency of HIV services. The cost of service provision should be monitored over time, whereas evaluations of the cost-effectiveness of services are required periodically; both should be part of any country's HIV monitoring and evaluation system. This paper provides country examples of the complementary relationship between monitoring the cost of HIV services and evaluating their cost-effectiveness. It also summarizes global initiatives that enable countries to develop their own HIV monitoring and evaluation systems and to generate relevant, robust and up-to-date strategic information.
Full Text Available Abstract Background A growing number of studies highlight men's disinclination to make use of HIV services. This suggests there are factors that prevent men from engaging with health services and an urgent need to unpack the forms of sociality that determine men's acceptance or rejection of HIV services. Methods Drawing on the perspectives of 53 antiretroviral drug users and 25 healthcare providers, we examine qualitatively how local constructions of masculinity in rural Zimbabwe impact on men's use of HIV services. Results Informants reported a clear and hegemonic notion of masculinity that required men to be and act in control, to have know-how, be strong, resilient, disease free, highly sexual and economically productive. However, such traits were in direct conflict with the 'good patient' persona who is expected to accept being HIV positive, take instructions from nurses and engage in health-enabling behaviours such as attending regular hospital visits and refraining from alcohol and unprotected extra-marital sex. This conflict between local understandings of manhood and biopolitical representations of 'a good patient' can provide a possible explanation to why so many men do not make use of HIV services in Zimbabwe. However, once men had been counselled and had the opportunity to reflect upon the impact of ART on their productivity and social value, it was possible for some to construct new and more ART-friendly versions of masculinity. Conclusion We urge HIV service providers to consider the obstacles that prevent many men from accessing their services and argue for community-based and driven initiatives that facilitate safe and supportive social spaces for men to openly discuss social constructions of masculinity as well as renegotiate more health-enabling masculinities.
Adam N Akullian
Full Text Available Introduction: The availability of specialized HIV services is limited in rural areas of sub-Saharan Africa where the need is the greatest. Where HIV services are available, people living with HIV (PLHIV must overcome large geographic, economic and social barriers to access healthcare. The objective of this study was to understand the unique barriers PLHIV face when accessing healthcare compared with those not living with HIV in a rural area of sub-Saharan Africa with limited availability of healthcare infrastructure. Methods: We conducted a population-based cross-sectional study of 447 heads of household on Bugala Island, Uganda. Multiple linear regression models were used to compare travel time, cost and distance to access healthcare, and log binomial models were used to test for associations between HIV status and access to nearby health services. Results: PLHIV travelled an additional 1.9 km (95% CI (0.6, 3.2 km, p=0.004 to access healthcare compared with those not living with HIV, and they were 56% less likely to access healthcare at the nearest health facility to their residence, so long as that facility lacked antiretroviral therapy (ART services (aRR=0.44, 95% CI (0.24 to 0.83, p=0.011. We found no evidence that PLHIV travelled further for care if the nearest facility supplies ART services (aRR=0.95, 95% CI (0.86 to 1.05, p=0.328. Among those who reported uptake of care at one of two facilities on the island that provides ART (81% of PLHIV and 68% of HIV-negative individuals, PLHIV tended to seek care at a higher tiered facility that provides ART, even when this facility was not their closest facility (30% of PLHIV travelled further than the closest ART facility compared with 16% of HIV-negative individuals, and travelled an additional 2.2 km (p=0.001 to access that facility, relative to HIV-negative individuals (aRR=1.91, 95% CI (1.00 to 3.65, p=0.05. Among PLHIV, residential distance was associated with access to facilities providing
Full Text Available The paper presents research aimed at overcoming barriers to citizens’ ability to access electronic government services. Our concern is specifically ‘non-connectivity’ barriers to electronic service delivery including cultural background, language...
The recommendations for controlling HIV/AIDS, whether prescriptive or descriptive, underscore the value of information: its translation into knowledge, and knowledge into behaviour. Thus, accessing, evaluating, disseminating and applying authoritative, credible and scholarly information on HIV/AIDS are critical elements in the control of this pandemic in the Web 2.0 era. The University of the West Indies (UWI) Mona libraries have embraced this information role. This article provides insights into three of the information initiatives implemented by the UWI Mona libraries in this important capacity. In this regard, it also provides ideas for other West Indian information units and enhances communication on access to information products and services, albeit incrementally, in an important area of health services for the West Indies.
Kaklanis, Nikolaos; Votis, Konstantinos; Tzovaras, Dimitrios
This paper presents the Cloud4all Service Synthesizer Tool, a framework that enables efficient orchestration of accessibility services, as well as their combination into complex forms, providing more advanced functionalities towards increasing the accessibility of end-users with various types of functional limitations. The supported services are described formally within an ontology, enabling, thus, semantic service composition. The proposed service composition approach is based on semantic matching between services specifications on the one hand and user needs/preferences and current context of use on the other hand. The use of automatic composition of accessibility services can significantly enhance end-users' accessibility, especially in cases where assistive solutions are not available in their device.
Sangeeta Das Bhattacharya
Full Text Available This article reviews a case of a child with perinatal HIV followed for 30 months during a prospective cohort study on pneumonia prevention in HIV-infected children. The point of this case report is to illustrate how delayed access to antiretroviral therapy (ART in HIV-infected children impacts immunization response and growth. Given the WHO's early release guideline changes on ART recommendations and the expected full revised guidelines coming out this year, this article is a timely discussion on the need for access to ART for HIV infected Indian children regardless of CD4 count.
Olsen, Rasmus Løvenstein; Schwefel, Hans-Peter; Hansen, Martin Bøgsted
Remote access to dynamically changing information elements is a required functionality for various network services, including routing and instances of context-sensitive networking. Three fundamentally different strategies for such access are investigated in this paper: (1) a reactive approach......, network delay characterization) and specific requirements on mismatch probability, traffic overhead, and access delay. Finally, the analysis is applied to the use-case of context-sensitive service discovery....
Olsen, Rasmus Løvenstein; Schwefel, Hans-Peter; Hansen, Martin Bøgsted
Remote access to dynamically changing information elements is a required functionality for various network services, including routing and instances of context-sensitive networking. Three fundamentally different strategies for such access are investigated in this paper: (1) a reactive approach......, network delay characterization) and specific requirements on mismatch probability, traffic overhead, and access delay. Finally, the analysis is applied to the use-case of context-sensitive service discovery....
Laar, Amos; DeBruin, Debra
In line with its half century old penal code, Ghana currently criminalizes and penalizes behaviors of some key populations - populations deemed to be at higher risk of acquiring or transmitting Human Immunodeficiency Virus (HIV). Men who have sex with men (MSM), and sex workers (SWs) fit into this categorization. This paper provides an analysis of how enactment and implementation of rights-limiting laws not only limit rights, but also amplify risk and vulnerability to HIV in key and general populations. The paper derives from a project that assessed the ethics sensitivity of key documents guiding Ghana's response to its HIV epidemic. Assessment was guided by leading frameworks from public health ethics, and relevant articles from the international bill of rights. Ghana's response to her HIV epidemic does not adequately address the rights and needs of key populations. Even though the national response has achieved some public health successes, palpable efforts to address rights issues remain nascent. Ghana's guiding documents for HIV response include no advocacy for decriminalization, depenalization or harm reduction approaches for these key populations. The impact of rights-restricting codes on the nation's HIV epidemic is real: criminalization impedes key populations' access to HIV prevention and treatment services. Given that they are bridging populations, whatever affects the Ghanaian key populations directly, affects the general population indirectly. The right to the highest attainable standard of health, without qualification, is generally acknowledged as a fundamental human right. Unfortunately, this right currently eludes the Ghanaian SW and MSM. The paper endorses decriminalization as a means of promoting this right. In the face of opposition to decriminalization, the paper proposes specific harm reduction strategies as approaches to promote health and uplift the diminished rights of key populations. Thus the authors call on Ghana to remove impediments to
MacPherson, Peter; Munthali, Chigomezgo; Ferguson, Jane; Armstrong, Alice; Kranzer, Katharina; Ferrand, Rashida A; Ross, David A
Adolescents living with HIV face substantial difficulties in accessing HIV care services and have worse treatment outcomes than other age groups. The objective of this review was to evaluate the effectiveness of service delivery interventions to improve adolescents' linkage from HIV diagnosis to antiretroviral therapy (ART) initiation, retention in HIV care and adherence to ART. We systematically searched the Medline, SCOPUS and Web of Sciences databases and conference abstracts from the International AIDS Conference and International Conference on AIDS and STIs in Africa (ICASA). Studies published in English between 1st January 2001 and 9th June 2014 were included. Two authors independently evaluated reports for eligibility, extracted data and assessed methodological quality using the Cochrane risk of bias tool and Newcastle-Ottawa Scale. Eleven studies from nine countries were eligible for review. Three studies were randomised controlled trials. Interventions assessed included individual and group counselling and education; peer support; directly observed therapy; financial incentives; and interventions to improve the adolescent-friendliness of clinics. Most studies were of low to moderate methodological quality. This review identified limited evidence on the effectiveness of service delivery interventions to support adolescents' linkage from HIV diagnosis to ART initiation, retention on ART and adherence to ART. Although recommendations are qualified because of the small numbers of studies and limited methodological quality, offering individual and group education and counselling, financial incentives, increasing clinic accessibility and provision of specific adolescent-tailored services appear promising interventions and warrant further investigation. © 2015 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.
Full Text Available BACKGROUND: Access to HIV testing and subsequent care among health care workers (HCWs form a critical component of TB infection control measures for HCWs. Challenges to and gaps in access to HIV services among HCWs may thus compromise TB infection control. This study assessed HCWs HIV and TB screening uptake and explored their preferences for provision of HIV and TB care. METHODS: A cross-sectional mixed-methods study involving 499 HCWs and 8 focus group discussions was conducted in Mukono and Wakiso districts in Uganda between October 2010 and February 2011. RESULTS: Overall, 5% of the HCWs reported a history of TB in the past five years. None reported routine screening for TB disease or infection, although 89% were willing to participate in a TB screening program, 77% at the workplace. By contrast, 95% had previously tested for HIV; 34% outside their workplace, and 27% self-tested. Nearly half (45% would prefer to receive HIV care outside their workplace. Hypothetical willingness to disclose HIV positive status to supervisors was moderate (63% compared to willingness to disclose to sexual partners (94%. Older workers were more willing to disclose to a supervisor (adjusted prevalence ratio [APR] = 1.51, CI = 1.16-1.95. Being female (APR = 0.78, CI = 0.68-0.91, and working in the private sector (APR = 0.81, CI = 0.65-1.00 were independent predictors of unwillingness to disclose a positive HIV status to a supervisor. HCWs preferred having integrated occupational services, versus stand-alone HIV care. CONCLUSIONS: Discomfort with disclosure of HIV status to supervisors suggests that universal TB infection control measures that benefit all HCWs are more feasible than distinctions by HIVstatus, particularly for women, private sector, and younger HCWs. However, interventions to reduce stigma and ensuring confidentiality are also essential to ensure uptake of comprehensive HIV care including Isoniazid Preventive Therapy among HCWs.
Reviews the origin, current state of development, and subject coverage of the secondary access services available to American social scientists, including bibliographic services for the various academic disciplines and a large variety of specialized services for subdisciplines and interdisciplinary fields. A 10-item reference list accompanies the…
Acevedo-Polakovich, Ignacio David; Bell, Bailey; Gamache, Peter; Christian, Allison S.
Although Lesbian, Gay, Bisexual, Transgender, Queer and/or Questioning (LGBTQ) youth experience alarming rates of behavioral and social problems, service use among these youth is disproportionately low. It is likely that decreased service accessibility plays a causal role in service underutilization among LGBTQ youth. To expand the existing…
In the Casper College Legal Service (CCLS) program, Casper College paralegal students, under supervision of pro bono attorneys, use paralegal skills to provide legal services and work product. CCLS is different from other legal clinics; it is not law school based, bar based, or court based. CCLS is paralegal based.
Pottie, Kevin; Medu, Olanrewaju; Welch, Vivian; Dahal, Govinda P.; Tyndall, Mark; Rader, Tamara; Wells, George
Objective To assess the effects of rapid voluntary counselling and testing (VCT) for HIV on HIV incidence and uptake of HIV/AIDS services in people at high risk for HIV exposure. Design Cochrane systematic review and meta-analysis. Data sources We searched PubMed, EMBASE, AIDSearch, LILACS, Global Health, Medline Africa, PsychInfo, CINAHL, Cochrane CENTRAL, Cochrane HIV/AIDS Group Specialized Register and grey literature from 1 January 2001 to 5 June 2014 without language restriction. Data se...
Full Text Available Abstract HIV was first described as a "long-wave event" in 1990, well before the advent of antiretroviral therapy (ART. The pandemic was then seen as involving three curves: an HIV curve, an AIDS curve and a curve representing societal impact. Since the mid-2000's, free public delivery of life-saving ART has begun shifting HIV from a terminal disease to a chronic illness for those who can access and tolerate the medications. This increasing chronicity prompts revisiting HIV as a long-wave event. First, with widespread availability of ART, the HIV curve will be higher and last longer. Moreover, if patterns in sub-Saharan Africa mirror experiences in the North, people on ART will live far longer lives but with new experiences of disability. Disability, broadly defined, can result from HIV, its related conditions, and from side effects of medications. Individual experiences of disability will vary. At a population level, however, we anticipate that experiences of disability will become a common part of living with HIV and, furthermore, may be understood as a variation of the second curve. In the original conceptualization, the second curve represented the transition to AIDS; in the era of treatment, we can expect a transition from HIV infection to HIV-related disability for people on ART. Many such individuals may eventually develop AIDS as well, but after a potentially long life that includes fluctuating episodes of illness, wellness and disability. This shift toward chronicity has implications for health and social service delivery, and requires a parallel shift in thinking regarding HIV-related disability. A model providing guidance on such a broader understanding of disability is the World Health Organization's International Classification of Functioning, Disability and Health (ICF. In contrast to a biomedical approach concerned primarily with diagnoses, the ICF includes attention to the impact of these diagnoses on people's lives and
Nixon, Stephanie A; Hanass-Hancock, Jill; Whiteside, Alan; Barnett, Tony
HIV was first described as a "long-wave event" in 1990, well before the advent of antiretroviral therapy (ART). The pandemic was then seen as involving three curves: an HIV curve, an AIDS curve and a curve representing societal impact. Since the mid-2000's, free public delivery of life-saving ART has begun shifting HIV from a terminal disease to a chronic illness for those who can access and tolerate the medications. This increasing chronicity prompts revisiting HIV as a long-wave event. First, with widespread availability of ART, the HIV curve will be higher and last longer. Moreover, if patterns in sub-Saharan Africa mirror experiences in the North, people on ART will live far longer lives but with new experiences of disability. Disability, broadly defined, can result from HIV, its related conditions, and from side effects of medications. Individual experiences of disability will vary. At a population level, however, we anticipate that experiences of disability will become a common part of living with HIV and, furthermore, may be understood as a variation of the second curve. In the original conceptualization, the second curve represented the transition to AIDS; in the era of treatment, we can expect a transition from HIV infection to HIV-related disability for people on ART. Many such individuals may eventually develop AIDS as well, but after a potentially long life that includes fluctuating episodes of illness, wellness and disability. This shift toward chronicity has implications for health and social service delivery, and requires a parallel shift in thinking regarding HIV-related disability. A model providing guidance on such a broader understanding of disability is the World Health Organization's International Classification of Functioning, Disability and Health (ICF). In contrast to a biomedical approach concerned primarily with diagnoses, the ICF includes attention to the impact of these diagnoses on people's lives and livelihoods. The ICF also focuses on
Kimerling, Rachel; Baumrind, Nikki
The Anderson behavioral model was used to investigate racial and ethnic disparities in access to specialty mental health services among women in California as well as factors that might account for such disparities. The study was a cross-sectional examination of a probability sample of 3,750 California women. The main indicators of access to services were perceived need, service seeking, and service use. Multivariate models were constructed that accounted for need and enabling and demographic variables. Significant racial and ethnic variations in access to specialty mental health services were observed. African-American, Hispanic, and Asian women were significantly less likely to use specialty mental health services than white women. Multivariate analyses showed that Hispanic and Asian women were less likely than white women to report perceived need, even after frequent mental distress had been taken into account. Among women with perceived need, African-American and Asian women were less likely than white women to seek mental health services after differences in insurance status had been taken into account. Among women who sought services, Hispanic women were less likely than white women to obtain services after adjustment for the effects of poverty. Need and enabling factors did not entirely account for the observed disparities in access to services. Additional research is needed to identify gender- and culture-specific models for access to mental health services in order to decrease disparities in access. Factors such as perceived need and decisions to seek services are important factors that should be emphasized in future studies.
... Administration Ryan White HIV/AIDS Program Core Medical Services Waiver; Application Requirements AGENCY: Health... XXVI of the Public Health Service Act, as amended by the Ryan White HIV/AIDS Treatment Extension Act of... on core medical services, including antiretroviral drugs, for individuals with HIV/AIDS identified...
... HUMAN SERVICES Health Resources and Services Administration Ryan White HIV/AIDS Part C Early..., Florida, that will ensure continuity of Part C, Early Intervention Services (EIS), HIV/AIDS care and...: Critical funding for HIV/AIDS care and treatment to the target populations in Orange County, Orlando...
... reduce in Nigeria. KEYWORDS: Infant mortality, Maternal health care, Pregnancy care, Delivery care, Nigeria ... not go for antenatal care, and as a result may not access other cares ...... Inadequate Use of Prenatal Services Among. Brazilian ...
National Aeronautics and Space Administration — We propose to investigate the feasibility and value of the "Software as a Service" paradigm in facilitating access to Earth Science numerical models. We...
Robbins Kay A
Full Text Available Abstract Background Many bioinformatics algorithms and data sets are deployed using web services so that the results can be explored via the Internet and easily integrated into other tools and services. These services often include data from other sites that is accessed either dynamically or through file downloads. Developers of these services face several problems because of the dynamic nature of the information from the upstream services. Many publicly available repositories of bioinformatics data frequently update their information. When such an update occurs, the developers of the downstream service may also need to update. For file downloads, this process is typically performed manually followed by web service restart. Requests for information obtained by dynamic access of upstream sources is sometimes subject to rate restrictions. Findings SideCache provides a framework for deploying web services that integrate information extracted from other databases and from web sources that are periodically updated. This situation occurs frequently in biotechnology where new information is being continuously generated and the latest information is important. SideCache provides several types of services including proxy access and rate control, local caching, and automatic web service updating. Conclusions We have used the SideCache framework to automate the deployment and updating of a number of bioinformatics web services and tools that extract information from remote primary sources such as NCBI, NCIBI, and Ensembl. The SideCache framework also has been used to share research results through the use of a SideCache derived web service.
Ibrahim Hafeezur Rehman
Full Text Available As nearly a fifth of the world's population still lives without access to electricity and double that number with no access to modern cooking technologies, both public and private sector players have invested resources in developing infrastructure to address this energy gap. While there have been exceptional cases like China, Vietnam and Brazil, where the public sector led grid expansion achieved incredible gains in expanding access as to electricity, the general trend over the years in most developing countries has demonstrated that both public and private led approaches have been unsuccessful in independently yielding the desired acceleration and continuity to deliver universal energy access. Despite the inherent benefits of both public and private sector led initiatives, typical systemic inefficiencies and inadequate capacities in both approaches prevent them from fully addressing the principal objective of facilitating energy access for the poor in the long term. Also, even if required investments were adequately capitalized, with the current population growth rate continually outpacing the rate of interventions, the number of people who remained energy poor 15 years hence, would still be the same. Thus, not only is there is a need for providing energy access to the existing population mass, but an equal need to do it fast enough to truly reduce the number of energy poor across the globe. An alternative approach therefore needs to be explored that juxtaposes the social welfare objectives of public sector led initiatives with the enterprise development and growth objectives of the private sector, to support the creation of an enabling ecosystem and a viable value chain that successfully and effectively delivers energy solutions to the last mile. Such a pro-poor hybrid model will essentially address the inefficiencies and inadequacies of both public and private approaches and capitalize on their strengths through a complementary mix of social
Mu, X.; Wu, J.; Li, T.; Zhong, Y.; Gao, X.
Web service can bring together applications running on diverse platforms, users can access and share various data, information and models more effectively and conveniently from certain web service platform. Cloud computing emerges as a paradigm of Internet computing in which dynamical, scalable and often virtualized resources are provided as services. With the rampant growth of massive data and restriction of net, traditional web services platforms have some prominent problems existing in development such as calculation efficiency, maintenance cost and data security. In this paper, we offer a spatial statistics service based on Microsoft cloud. An experiment was carried out to evaluate the availability and efficiency of this service. The results show that this spatial statistics service is accessible for the public conveniently with high processing efficiency.
Meier, Benjamin Mason; Gelpi, Adriane; Kavanagh, Matthew M; Forman, Lisa; Amon, Joseph J
The scale of the HIV pandemic - and the stigma, discrimination and violence that surrounded its sudden emergence - catalyzed a public health response that expanded human rights in principle and practice. In the absence of effective treatment, human rights activists initially sought to protect individuals at high risk of HIV infection. With advances in antiretroviral therapy, activists expanded their efforts under international law, advocating under the human right to health for individual access to treatment. As a clinical cure comes within reach, human rights obligations will continue to play a key role in political and programmatic decision-making. Building upon the evolving development and implementation of the human right to health in the global response to HIV, we outline a human rights research agenda to prepare for HIV cure access, investigating the role of human rights law in framing 1) resource allocation, 2) international obligations, 3) intellectual property and 4) freedom from coercion. The right to health is widely recognized as central to governmental, intergovernmental and non-governmental responses to the pandemic and critical both to addressing vulnerability to infection and to ensuring universal access to HIV prevention, treatment, care and support. While the advent of an HIV cure will raise new obligations for policymakers in implementing the right to health, the resolution of past debates surrounding HIV prevention and treatment may inform claims for universal access.
Benjamin Mason Meier
Full Text Available Introduction: The scale of the HIV pandemic – and the stigma, discrimination and violence that surrounded its sudden emergence – catalyzed a public health response that expanded human rights in principle and practice. In the absence of effective treatment, human rights activists initially sought to protect individuals at high risk of HIV infection. With advances in antiretroviral therapy, activists expanded their efforts under international law, advocating under the human right to health for individual access to treatment. Discussion: As a clinical cure comes within reach, human rights obligations will continue to play a key role in political and programmatic decision-making. Building upon the evolving development and implementation of the human right to health in the global response to HIV, we outline a human rights research agenda to prepare for HIV cure access, investigating the role of human rights law in framing 1 resource allocation, 2 international obligations, 3 intellectual property and 4 freedom from coercion. Conclusions: The right to health is widely recognized as central to governmental, intergovernmental and non-governmental responses to the pandemic and critical both to addressing vulnerability to infection and to ensuring universal access to HIV prevention, treatment, care and support. While the advent of an HIV cure will raise new obligations for policymakers in implementing the right to health, the resolution of past debates surrounding HIV prevention and treatment may inform claims for universal access.
... be provided in a timely fashion. (iii) Format. A LEC shall provide access to its directory assistance... to allow competing providers full use of these services. (d) Branding of operator services...
Full Text Available Introduction: During the past two decades, HIV and Sexual and Reproductive Health services in Namibia have been provided in silos, with high fragmentation. As a consequence of this, quality and efficiency of services in Primary Health Care has been compromised. Methods: We conducted an operational research (observational pre-post study in a public health facility in Namibia. A health facility assessment was conducted before and after the integration of health services. A person-centred integrated model was implemented to integrate all health services provided at the health facility in addition to HIV and Sexual and Reproductive Health services. Comprehensive services are provided by each health worker to the same patients over time (longitudinality, on a daily basis (accessibility and with a good external referral system (coordination. Prevalence rates of time flows and productivity were done. Results: Integrated services improved accessibility, stigma and quality of antenatal care services by improving the provider-patient communication, reducing the time that patients stay in the clinic in 16% and reducing the waiting times in 14%. In addition, nurse productivity improved 85% and the expected time in the health facility was reduced 24% without compromising the uptake of TB, HIV, outpatient, antenatal care or first visit family planning services. Given the success on many indicators resulting from integration of services, the goal of this paper was to describe “how” health services have been integrated, the “process” followed and presenting some “results” from the integrated clinic. Conclusions: Our study shows that HIV and SRH services can be effectively integrated by following the person-centred integrated model. Based on the Namibian experience on “how” to integrate health services and the “process” to achieve it, other African countries can replicate the model to move away from the silo approach and contribute to
Mburu, Gitau; Hodgson, Ian; Teltschik, Anja; Ram, Mala; Haamujompa, Choolwe; Bajpai, Divya; Mutali, Beatrice
A rights-based approach in HIV service delivery for adults is increasingly taking root in sub-Saharan Africa in the context of greater availability of antiretroviral therapy. Yet there has been comparatively little progress in strengthening a rights-based approach to adolescent HIV services, which we learned during a qualitative study in 2010 among 111 adolescents living with HIV, 21 parents and 38 health providers in three districts in Zambia. Adolescents in the study expressed a range of information and support needs and wanted locally relevant interventions to meet those needs. They wanted greater access to HIV, sexual and reproductive health information, information on how to protect themselves, privacy and confidentiality in service sites, skills training so as to be able to earn money, and better control over disclosure of their HIV status to others. Both health workers and parents acknowledged that information and services needed to be improved to meet those needs far better. This paper provides examples of successful programmes in Zimbabwe, Uganda, Tanzania, Botswana and South Africa and calls for adolescent services to be linked to both paediatric and adult services, peer networks to be established to increase adolescents' ability to collectively voice their concerns and support each other, interventions supporting adolescents' control over self-disclosure, and lastly that adolescent health should become a training specialty in sub-Saharan Africa.
Full Text Available Abstract This paper reviews the healthcare issues facing nations which have a substantial caseload of chronic HIV cases. It considers the challenges of extending antiretroviral coverage to an expanding caseload as supplier price rises and international trade agreements come into force to reduce the availability of affordable antiretrovirals just as the economic downturn restricts donor funding. It goes on to review the importance in this context of supporting adherence to drug regimens in order to preserve access to affordable antiretrovirals for those already on treatment, and of removing key barriers such as patient fees and supply interruptions. The demands of those with chronic HIV for health services other than antiretroviral therapy are considered in the light of the fearful or discriminatory attitudes of non-specialist healthcare staff due to HIV-related stigma, which is linked with the weakness of infection control measures in many health facilities. The implications for prevention strategies including those involving criminalisation of HIV transmission or exposure are briefly summarised for the current context, in which the caseload of those whose chronic HIV infection must be controlled with antiretrovirals will continue to rise for the foreseeable future.
van Bemmel, J.; Wegdam, M.; Lagerberg, K.
Web Services fail to deliver on the promise of ubiquitous deployment and seamless interoperability due to the lack of a uniform, standards-based approach to all aspects of security. In particular, the enforcement of access policies in a Service Oriented Architecture is not addressed adequately. We
van Bemmel, J.; Wegdam, M.; Lagerberg, K.
Web Services fail to deliver on the promise of ubiquitous deployment and seamless interoperability due to the lack of a uniform, standards-based approach to all aspects of security. In particular, the enforcement of access policies in a Service Oriented Architecture is not addressed adequately. We p
Todrys Katherine W
Full Text Available Abstract Background Although HIV and tuberculosis (TB prevalence are high in prisons throughout sub-Saharan Africa, little research has been conducted on factors related to prevention, testing and treatment services. Methods To better understand the relationship between prison conditions, the criminal justice system, and HIV and TB in Zambian prisons, we conducted a mixed-method study, including: facility assessments and in-depth interviews with 246 prisoners and 30 prison officers at six Zambian prisons; a review of Zambian legislation and policy governing prisons and the criminal justice system; and 46 key informant interviews with government and non-governmental organization officials and representatives of international agencies and donors. Results The facility assessments, in-depth interviews and key informant interviews found serious barriers to HIV and TB prevention and treatment, and extended pre-trial detention that contributed to overcrowded conditions. Disparities both between prisons and among different categories of prisoners within prisons were noted, with juveniles, women, pre-trial detainees and immigration detainees significantly less likely to access health services. Conclusions Current conditions and the lack of available medical care in Zambia's prisons violate human rights protections and threaten prisoners' health. In order to protect the health of prisoners, prison-based health services, linkages to community-based health care, general prison conditions and failures of the criminal justice system that exacerbate overcrowding must be immediately improved. International donors should work with the Zambian government to support prison and justice system reform and ensure that their provision of funding in such areas as health services respect human rights standards, including non-discrimination. Human rights protections against torture and cruel, inhuman or degrading treatment, and criminal justice system rights, are
Vernooij, E.; Mehlo, M.; Hardon, A.; Reis, R.
This article explores how notions of the individual and population are evoked in two ongoing HIV treatment as prevention (TasP) implementation studies in Swaziland. By contrasting policy discourses with lived kinship experiences of people living with HIV, we seek to understand how TasP unfolds in th
Ankomah, Augustine; Ganle, John Kuumuori; Lartey, Margaret Yaa; Kwara, Awewura; Nortey, Priscilla Awo; Okyerefo, Michael Perry Kweku; Laar, Amos Kankponang
Timely and enduring access to antiretroviral therapy (ART) by HIV-infected individuals has been shown to substantially reduce HIV transmission risk, HIV-related morbidity and mortality. However, there is evidence that in addition to limited supply of antiretrovirals (ARVs) and linkage to ART in many low-income countries, HIV+ persons often encounter barriers in accessing ART-related services even in contexts where these services are freely available. In Ghana, limited research evidence exists regarding the barriers HIV+ persons already linked to ART face. This paper explores ART access-related barriers that HIV+ persons linked to care in southern Ghana face. A mixed method study design, involving a cross-sectional survey and qualitative in-depth interviews, was conducted to collect data from four healthcare providers and a total of 540 adult HIV+ persons receiving ART at four treatment centres in Ghana. We used univariate analysis to generate descriptive tabulations for key variables from the survey. Data from qualitative in-depth interviews were thematically analysed. Results from the survey and in-depth interviews were brought together to illuminate the challenges of the HIV+ persons. All (100%) the HIV+ persons interviewed were ARV-exposed and linked to ART. Reasons for taking ARVs ranged from beliefs that they will suppress the HIV virus, desire to maintain good health and prolong life, and desire to prevent infection in unborn children, desire both to avoid death and to become good therapeutic citizens (abide by doctors' advice). Despite this, more than half of the study participants (63.3%) reported seven major factors as barriers hindering access to ART. These were high financial costs associated with accessing and receiving ART (26%), delays associated with receiving care from treatment centres (24%), shortage of drugs and other commodities (23%), stigma (8.8%), fear of side effects of taking ARVs (7.9%), job insecurity arising from regular leave of absence
Full Text Available With wide adoption of Service Computing and Mobile Computing, people tend to invoke services with mobile devices, requiring accurate and real-time feedback from services at any time and any place. Among these services, some are private to limited users and require identity authorization before use; hence secure access control in wireless network should be provided. To address the challenge, in this study, we propose the architecture and protocols of a system of access to private services for mobile clients, which combines the technologies of trusted computing, Diffie-Hellman key agreement protocol, digital certificate, DES data encryption algorithm and twice verification. We further show the implementation of the proposed system, in which we have realized the authentication and authorization of mobile clients and then secure data transfer between mobile clients in the unsafe Internet and private services in the Intranet.
Full Text Available This paper examines the development of the Open Access movement in scholarly communication, with particular attention to some of the rhetorical strategies and policy mechanisms used to promote it to scholars and scientists. Despite the majority of journal publishers’ acceptance of author self-archiving practices, and the minimal time commitment required by authors to successfully self-archive their work in disciplinary or institutional repositories, the majority of authors still by and large avoid participation. The paper reviews the strategies and arguments used for increasing author participation in open access, including the role of open access mandates. We recommend a service-oriented approach towards increasing participation in open access, rather than rhetoric that speculates on the benefits that open access will have on text/data mining innovation. In advocating for open access participation, we recommend focusing on its most universal and tangible purpose: increasing public open (gratis access to the published results of publicly funded research. Researchers require strong institutional support to understand the copyright climate of open access self-archiving, user-friendly interfaces and useful metrics, such as repository usage statistics. We recommend that mandates and well-crafted and responsive author support services at universities will ultimately be required to ensure the growth of open access. We describe the mediated deposit service that was developed to support author self-archiving in Spectrum: Concordia University Research Repository. By comparing the number of deposits of non-thesis materials (e.g. articles and conference presentations that were accomplished through the staff-mediated deposit service to the number of deposits that were author-initiated, we demonstrate the relative significance of this service to the growth of the repository.
Lyn J. Haskins
Full Text Available Background: In South Africa, coverage of services for mothers and babies in the first year of life is suboptimal despite high immunisation coverage over the same time period. Integration of services could improve accessibility of services, uptake of interventions and retention in care.Aim: This study describes provision of services for mothers and babies aged under 1 year.Setting: Primary healthcare clinics in one rural district in KwaZulu-Natal, South Africa.Methods: All healthcare workers on duty and mothers exiting the clinic after attending well-child services were interviewed. Clinics were mapped to show the route through the clinic taken by mother–baby pairs receiving well-child services, where these services were provided and by whom.Results: Twelve clinics were visited; 116 health workers and 211 mothers were interviewed. Most clinics did not provide comprehensive services for mothers and children. Challenges of structural layout and deployment of equipment led to fragmented services provided by several different health workers in different rooms. Well-child services were frequently provided in public areas of the clinic or with other mothers present. In some clinics mothers and babies did not routinely see a professional nurse. In all clinics HIV-positive mothers followed a different route. Enrolled nurses led the provision of well-child services but did not have skills and training to provide comprehensive care.Conclusions: Fragmentation of clinic services created barriers in accessing a comprehensive package of care resulting in missed opportunities to provide services. Greater integration of services alongside immunisation services is needed.
Skovdal, Morten; Wringe, Alison; Seeley, Janet
Objectives: This article considers the potential of ‘theories of practice’ for studying and understanding varied (dis)engagement with HIV care and treatment services and begins to unpack the assemblage of elements and practices that shape the nature and duration of individuals’ interactions with ...
Carlos E. Figueroa Castro
Full Text Available Poor immune status, the use of a vascular access different from an AV fistula, and intravenous drug use (IDU may favor increased rates of vascular access infections among HIV infected patients on hemodialysis. Staphylococcus spp. and Streptococcus spp. are the main cause of these infections, but Gram-negative rods and fungi have been found as well. Using an AV fistula when possible, and eliciting a history of IVDU on every visit may prevent this type of infection. When infections are present, coverage for both Gram-positive and negative organisms is recommended. Additional studies specifically addressing the issue of vascular access infection in HIV infected patients are required.
U.S. Environmental Protection Agency — This EnviroAtlas web service includes maps that illustrate factors affecting transit accessibility, and indicators of accessibility. Accessibility measures how...
Pulerwitz, J; Michaelis, A P; Lippman, S A; Chinaglia, M; Díaz, J
HIV-related stigma and discrimination (S&D) have been shown to impede prevention, care and treatment. Yet, few quantitative studies have tested the associations between stigma, service utilization and status disclosure, especially in countries with concentrated HIV epidemics. Surveys, administered to a random sample of 1,775 truck drivers crossing Southern borders in Brazil, included items on multiple conceptual domains of S&D, such as fear of casual contact and blame towards people living with HIV/AIDS. Pearson's chi-square tests and logistic regression were used to examine correlations. Less stigma (both individual items and grouped as a scale) was significantly correlated with VCT use (pHIV-positive test results (p=0.013). Findings indicate that stigma is an important barrier to HIV testing and disclosure among truck drivers in Southern Brazil. Learning more about stigma is important given the growing assertions that testing is a 'critical gateway' to HIV prevention and treatment. As access to HIV testing and treatment improves, providers increasingly need to understand and address how stigma acts as a barrier to services.
Background In the current context of diversity and coexistence of HIV testing approaches, limited information exists on test recipient’s views of HIV testing services and programme attributes that could ease the testing process and make it more appealing for at risk individuals who don’t know their HIV status. This study analyzed ratings given to different testing sites and programme characteristics that might facilitate testing. Methods We analyzed data from 3120 persons attending a mobile HIV testing programme located on a central street in the gay district of Madrid. Results 64% were men (of which, 55% had had sex with other men), 59.5% were <30 years, 35.4% foreigners, 50.6% had a university degree,71.7% a regular employment, 59.3% reported multiple partners and inconsistent condom use and 56.5% had been tested for HIV. Non Governmental Organizations and specific HIV/STI centres received the maximum rating from over 60% of participants, followed by self-testing (38.9%). Pharmacies (20.8%) and hospital emergency departments (14.2%) were the worst valued testing sites. Over 80% gave the highest rating to having immediate test results, not needing a previous appointment, and free testing, while less than 50% gave the maximum rating to privacy and anonymity. Conclusions HIV testing services that don’t require an appointment, based on free tests with rapid results are most valued by a young, not socially marginalized but high risk sexual exposure population. On the contrary, issues traditionally highly valued by health care providers or AIDS social organizations (privacy and anonymity) are much less valued. PMID:23987230
Dangerfield, Derek T; Gravitt, Patti; Rompalo, Anne M; Yap, Ivan; Tai, Raymond; Lim, Sin H
In Malaysia, homosexuality is illegal; little is known about access to HIV prevention services among Malaysian men who have sex with men (MSM). We analysed PT Foundation outreach data to describe the profiles among MSM who accessed PT Foundation services and to examine factors associated with being aware of PT Foundation and having visited the organization. A survey was administered during weekly outreach throughout Kuala Lumpur from March-December 2012. Pearson's Chi square tests were used to compare demographic and behavioural characteristics of participants who were and were not aware of the PT Foundation. Binary logistic regression was used to identify correlates of MSM visiting the PT Foundation among those who had heard of the organization. Of 614 MSM, this study found significantly higher awareness of the PT Foundation among MSM who perceived they had "good" HIV knowledge (p = .026) and participants who reported always using condoms (p = .009). MSM who reported being paid for sex were 2.81 times as likely to visit the PT Foundation compared to men who did not. A subgroup of MSM known to be at high risk for HIV infection is accessing prevention services. Future studies should uncover motivations and barriers of accessing these services among MSM in Malaysia.
Ryder, Nathan; McNulty, Anna M
Confidentiality concerns are often described as barriers to seeking sexual health care. There has been little research describing the relative importance of confidentiality to clients of sexual health clinics, and whether members of high-risk groups have greater concerns. This study aimed to determine the importance of confidentiality and anonymity to clients of a public sexual health clinic, and determine associations with gender and sexuality. A self-administered questionnaire was offered to consecutive new English-speaking clients in October and November 2007. Participants were asked to describe the reasons for presenting, likelihood of disclosing identifying information, and concern should specific people and agencies become aware of their attendance. Of 350 eligible clients, 270 (77%) participated in the survey. Expert care was included in the top three reasons for choosing a sexual health clinic rather than a general practitioner by over half of participants, while confidentiality and cost were each included in the top three reasons by one-third of respondents respectively. Over 90% of clients reported they were likely to give accurate identifying information to the clinic. Participants were comfortable with disclosure of information to other health-care workers but became increasingly unwilling for information to be shared with services not directly involved in their care. Overall there were few associations with gender or sexuality. Clients choose to attend our clinic for a variety of reasons, with confidentiality and anonymity being of lesser importance than competence and cost. Confidentiality is important to the majority of clients, whereas few desire anonymity. Most clients would accept information being shared with other health services, suggesting that confidentiality may not be a barrier to the use of electronic health records in sexual health clinics.
Amo-Adjei, Joshua; Kumi-Kyereme, Akwasi; Fosuah Amo, Hannah; Awusabo-Asare, Kofi
The need to integrate TB/HIV control programmes has become critical due to the comorbidity regarding these diseases and the need to optimise the use of resources. In developing countries such as Ghana, where public health interventions depend on donor funds, the integration of the two programmes has become more urgent. This paper explores stakeholders' views on the integration of TB/HIV control programmes in Ghana within the remits of contingency theory. With 31 purposively selected informants from four regions, semi-structured interviews and observations were conducted between March and May 2012, and the data collected were analysed using the inductive approach. The results showed both support for and opposition to integration, as well as some of the avoidable challenges inherent in combining TB/HIV control. While those who supported integration based their arguments on clinical synergies and the need to promote the efficient use of resources, those who opposed integration cited the potential increase in workload, the clinical complications associated with joint management, the potential for a leadership crisis, and the "smaller the better" propositions to support their stance. Although a policy on TB/HIV integration exists, inadequate 'political will' from the top management of both programmes has trickled down to lower levels, which has stifled progress towards the comprehensive management of TB/HIV and particularly leading to weak data collection and management structures and unsatisfactory administration of co-trimoxazole for co-infected patients. It is our view that the leadership of both programmes show an increased commitment to protocols involving the integration of TB/HIV, followed by a commitment to addressing the 'fears' of frontline service providers to encourage confidence in the process of service integration.
Joshua A. Itsifinus
Full Text Available AIM: HIV/AIDS is a serious social pathology in public health, developmental and security problem since the productive and reproductive age group is mostly affected. This study was to determine the sero-prevalence of HIV among civilian applicants enrolling into military services of Nigeria army where youths vulnerability to HIV infection is very high. METHOD: A periodic cross sectional study was carried out amongst the civilian applicants undergoing recruitment into the Nigeria Army between January-February and July-August 2005, to determine their HIV status. Samples were collected from the applicants after interview to collect their socio-demographic characteristics. Data were analyzed with the aid of SPSS Version 12 and Chi square statistics was used to test for significance of association at P< 0.05. RESULTS: Out of the 9260 samples collected, 204 (2.2% tested positive for HIV with the highest proportion (73.5% occurring in the 22-25yrs bracket. Infection was detected in both sexes. The mean age of the applicants was 22yrs, with age range of 18-30 yrs and sex ratio of 1:7 (M: F. Age sex-specificity shows aged between 21-24 years have the highest number of HIV-antibody positivity. CONCLUSION: Antibody-positive applicants were identified in all the regions of Nigeria and the prevalence suggests that the epidemiology of transmission is changing both quantitatively and qualitatively because HIV now occurs commonly among young adults in their teens and late 20s and the impact of HIV on the military has grave consequences on the stability of Nigeria. The adoption of routine screening of applicants at point of recruitment, serving and retiring from the military can also be a source of data for understanding the epidemiology of this disease among the civilian and the military but in as HIV counseling and testing is an important continuum of the disease prevention and treatment, there is need to review Nigerian Army HIV and AIDS policy. [TAF Prev Med
Duffy, Malia; Ojikutu, Bisola; Andrian, Soa; Sohng, Elaine; Minior, Thomas; Hirschhorn, Lisa R
Non-communicable diseases (NCD) are a growing cause of morbidity in low-income countries including in people living with human immunodeficiency virus (HIV). Integration of NCD and HIV services can build upon experience with chronic care models from HIV programmes. We describe models of NCD and HIV integration, challenges and lessons learned. A literature review of published articles on integrated NCD and HIV programs in low-income countries and key informant interviews were conducted with leaders of identified integrated NCD and HIV programs. Information was synthesised to identify models of NCD and HIV service delivery integration. Three models of integration were identified as follows: NCD services integrated into centres originally providing HIV care; HIV care integrated into primary health care (PHC) already offering NCD services; and simultaneous introduction of integrated HIV and NCD services. Major challenges identified included NCD supply chain, human resources, referral systems, patient education, stigma, patient records and monitoring and evaluation. The range of HIV and NCD services varied widely within and across models. Regardless of model of integration, leveraging experience from HIV care models and adapting existing systems and tools is a feasible method to provide efficient care and treatment for the growing numbers of patients with NCDs. Operational research should be conducted to further study how successful models of HIV and NCD integration can be expanded in scope and scaled-up by managers and policymakers seeking to address all the chronic care needs of their patients. © 2017 John Wiley & Sons Ltd.
Structural changes in retail banking markets and development of remote access technologies have reduced the number of bank branches in many developed countries. That makes close-downs of bank branches and service accessibility in rural/peripheral regions interesting topics of public discussion. This paper uses an empirical entry approach in order to analyze whether the peripheral regions have suffered from the development branch networks in general, or are some specific regions faced more clo...
Dechristopher, Brian A.; Loy, Brian A.; Marsden, Matthew D.; Schrier, Adam J.; Zack, Jerome A.; Wender, Paul A.
Bryostatin is a unique lead in the development of potentially transformative therapies for cancer, Alzheimer's disease and the eradication of HIV/AIDS. However, the clinical use of bryostatin has been hampered by its limited supply, difficulties in accessing clinically relevant derivatives, and side effects. Here, we address these problems through the step-economical syntheses of seven members of a new family of designed bryostatin analogues using a highly convergent Prins-macrocyclization strategy. We also demonstrate for the first time that such analogues effectively induce latent HIV activation in vitro with potencies similar to or better than bryostatin. Significantly, these analogues are up to 1,000-fold more potent in inducing latent HIV expression than prostratin, the current clinical candidate for latent virus induction. This study provides the first demonstration that designed, synthetically accessible bryostatin analogues could serve as superior candidates for the eradication of HIV/AIDS through induction of latent viral reservoirs in conjunction with current antiretroviral therapy.
Jones, Louisa; Akugizibwe, Paula; Clayton, Michaela; Amon, Joseph J; Sabin, Miriam Lewis; Bennett, Rod; Stegling, Christine; Baggaley, Rachel; Kahn, James G; Holmes, Charles B; Garg, Navneet; Obermeyer, Carla Makhlouf; Mack, Christina DeFilippo; Williams, Phoebe; Smyth, Caoimhe; Vitoria, Marco; Crowley, Siobhan; Williams, Brian; McClure, Craig; Granich, Reuben; Hirnschall, Gottfried
Expanding access to antiretroviral therapy (ART) has both individual health benefits and potential to decrease HIV incidence. Ensuring access to HIV services is a significant human rights issue and successful programmes require adequate human rights protections and community support. However, the cost of specific human rights and community support interventions for equitable, sustainable and non-discriminatory access to ART are not well described. Human rights and community support interventions were identified using the literature and through consultations with experts. Specific costs were then determined for these health sector interventions. Population and epidemic data were provided through the Statistics South Africa 2009 national mid-year estimates. Costs of scale up of HIV prevention and treatment were taken from recently published estimates. Interventions addressed access to services, minimising stigma and discrimination against people living with HIV, confidentiality, informed consent and counselling quality. Integrated HIV programme interventions included training for counsellors, ‘Know Your Rights’ information desks, outreach campaigns for most at risk populations, and adherence support. Complementary measures included post-service interviews, human rights abuse monitoring, transportation costs, legal assistance, and funding for human rights and community support organisations. Other essential non-health sector interventions were identified but not included in the costing framework. The annual costs for the human rights and community support interventions are United States (US) $63.8 million (US $1.22 per capita), representing 1.5% of total health sector HIV programme costs. Respect for human rights and community engagement can be understood both as an obligation of expanded ART programmes and as a critically important factor in their success. Basic rights-based and community support interventions constitute only a small percentage of overall
Jones, Louisa; Akugizibwe, Paula; Clayton, Michaela; Amon, Joseph J; Sabin, Miriam Lewis; Bennett, Rod; Stegling, Christine; Baggaley, Rachel; Kahn, James G; Holmes, Charles B; Garg, Navneet; Obermeyer, Carla Makhlouf; Mack, Christina DeFilippo; Williams, Phoebe; Smyth, Caoimhe; Vitoria, Marco; Crowley, Siobhan; Williams, Brian; McClure, Craig; Granich, Reuben; Hirnschall, Gottfried
Expanding access to antiretroviral therapy (ART) has both individual health benefits and potential to decrease HIV incidence. Ensuring access to HIV services is a significant human rights issue and successful programmes require adequate human rights protections and community support. However, the cost of specific human rights and community support interventions for equitable, sustainable and non-discriminatory access to ART are not well described. Human rights and community support interventions were identified using the literature and through consultations with experts. Specific costs were then determined for these health sector interventions. Population and epidemic data were provided through the Statistics South Africa 2009 national mid-year estimates. Costs of scale up of HIV prevention and treatment were taken from recently published estimates. Interventions addressed access to services, minimising stigma and discrimination against people living with HIV, confidentiality, informed consent and counselling quality. Integrated HIV programme interventions included training for counsellors, 'Know Your Rights' information desks, outreach campaigns for most at risk populations, and adherence support. Complementary measures included post-service interviews, human rights abuse monitoring, transportation costs, legal assistance, and funding for human rights and community support organisations. Other essential non-health sector interventions were identified but not included in the costing framework. The annual costs for the human rights and community support interventions are United States (US) $63.8 million (US $1.22 per capita), representing 1.5% of total health sector HIV programme costs. Respect for human rights and community engagement can be understood both as an obligation of expanded ART programmes and as a critically important factor in their success. Basic rights-based and community support interventions constitute only a small percentage of overall programmes
U.S. Department of Health & Human Services — The Find Ryan White HIV/AIDS Medical Care Providers tool is a locator that helps people living with HIV/AIDS access medical care and related services. Users can...
Full Text Available ABSTRACTThis article aims to consider some relevant challenges to the provision of "new prevention technologies" in health services in a scenario where the "advances" in the global response to AIDS control are visible. We take as material for analysis the information currently available on the HIV post-exposure prophylaxis (PEP and pre-exposure prophylaxis (PrEP, treatment as prevention (TASP and over the counter. The methodology consisted of the survey and analysis of the Biblioteca Virtual em Saúde (BVS: MEDLINE, LILACS, WHOLIS, PAHO, SciELO articles that addressed the issue of HIV prevention and care in the context of so-called new prevention technologies. The results of the studies show that there is assistance on the ground of clinics for the treatment of disease responses, but there are several challenges related to the sphere of prevention. The articles list some challenges regarding to management, organization of services and the attention given by health professionals to users. The current context shows evidence of the effectiveness of antiretroviral therapy in reducing the risk of HIV transmission, but the challenges for the provision of preventive technologies in health services permeate health professionals and users in their individual dimensions and health services in organizational and structural dimension. Interventions should be made available in a context of community mobilization; there should be no pressure on people to make HIV testing, antiretroviral treatment or for prevention. In the management is responsible for the training of health professionals to inform, clarify and make available to users, partners and family information about the new antiretroviral use strategies.
Maksud, Ivia; Fernandes, Nilo Martinez; Filgueiras, Sandra Lucia
This article aims to consider some relevant challenges to the provision of "new prevention technologies" in health services in a scenario where the "advances" in the global response to AIDS control are visible. We take as material for analysis the information currently available on the HIV post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP), treatment as prevention (TASP) and over the counter. The methodology consisted of the survey and analysis of the Biblioteca Virtual em Saúde (BVS: MEDLINE, LILACS, WHOLIS, PAHO, SciELO) articles that addressed the issue of HIV prevention and care in the context of so-called new prevention technologies. The results of the studies show that there is assistance on the ground of clinics for the treatment of disease responses, but there are several challenges related to the sphere of prevention. The articles list some challenges regarding to management, organization of services and the attention given by health professionals to users. The current context shows evidence of the effectiveness of antiretroviral therapy in reducing the risk of HIV transmission, but the challenges for the provision of preventive technologies in health services permeate health professionals and users in their individual dimensions and health services in organizational and structural dimension. Interventions should be made available in a context of community mobilization; there should be no pressure on people to make HIV testing, antiretroviral treatment or for prevention. In the management is responsible for the training of health professionals to inform, clarify and make available to users, partners and family information about the new antiretroviral use strategies.
Cabral, Cristiane da Silva; do Lago, Tania di Giacomo; Pinho, Adriana de Araujo
differences regarding the impact of HIV infection at sterilization are observed depending on the timing and the type of sterilization procedure. The probability of obtaining an interval sterilization is significantly lower for WLHIV compared to those not living with HIV. The reverse occurs regarding postpartum sterilization. Although sterilization is mainly performed in conjunction with caesarean section in Brazil, it is evident that caesarean sections are not the sole factor increasing the risk of sterilization among WLHIV. Conclusion The results indicate barriers in the access to services offering interval sterilization for WLHIV and certain facilitation in obtaining the procedure in conjunction with caesarean section. Health policy makers at local and national levels should promote institutional changes in order to facilitate access to interval sterilization and to confront the sensitive discussion of WLHIV’s eligibility for postpartum sterilization. It is also urgent to increase access to a wider range of contraceptive methods for WLHIV and promote dual method protection strategies. Moreover, since condom use may decrease in the future in the context of the preventive effect of antiretroviral therapy, promoting dual methods will expand the choices regarding the reproductive rights of women living with HIV. PMID:27812146
Andrew D Pinto
Full Text Available Introduction: The decentralization of HIV services has been shown to improve equity in access to care for the rural poor of sub-Saharan Africa. This study aims to contribute to our understanding of the impact of decentralization on costs borne by patients. Such information is valuable for economic evaluations of anti-retroviral therapy programmes that take a societal perspective. We compared costs reported by patients who received care in an urban centralized programme to those in the same district who received care through rural decentralized care (DC. Methods: A cross-sectional survey on patient characteristics and costs associated with accessing HIV care was conducted, in May 2010, on 120 patients in centralized care (CC at a tertiary referral hospital and 120 patients in DC at five rural health centres in Zomba District, Malawi. Differences in costs borne by each group were compared using χ2 and t-tests, and a regression model was developed to adjust for confounders, using bootstrapping to address skewed cost data. Results: There was no significant difference between the groups with respect to sex and age. However, there were significant differences in socio-economic status, with higher educational attainment (p<0.001, personal income (p=0.007 and household income per person (p=0.005 in CC. Travel times were similar (p=0.65, as was time waiting at the clinic (p=0.63 and total time spent seeking care (p=0.65. There was a significant difference in travel-related expenses (p<0.001 related to the type of travel participants noted that they used. In CC, 60% of participants reported using a mini-bus to reach the clinic; in DC only 4% reported using a mini-bus, and the remainder reported travelling on foot or by bicycle. There were no significant differences between the groups in the amount of lost income reported or other out-of-pocket costs. Approximately 91 Malawi Kwacha (95% confidence intervals: 1–182 MKW or US$0.59 represents the adjusted
Matthew F Chersich
Full Text Available Introduction: Virtually no African country provides HIV prevention services in sex work settings with an adequate scale and intensity. Uncertainty remains about the optimal set of interventions and mode of delivery. Methods: We systematically reviewed studies reporting interventions for reducing HIV transmission among female sex workers in sub-Saharan Africa between January 2000 and July 2011. Medline (PubMed and non-indexed journals were searched for studies with quantitative study outcomes. Results: We located 26 studies, including seven randomized trials. Evidence supports implementation of the following interventions to reduce unprotected sex among female sex workers: peer-mediated condom promotion, risk-reduction counselling and skills-building for safer sex. One study found that interventions to counter hazardous alcohol-use lowered unprotected sex. Data also show effectiveness of screening for sexually transmitted infections (STIs and syndromic STI treatment, but experience with periodic presumptive treatment is limited. HIV testing and counselling is essential for facilitating sex workers’ access to care and antiretroviral treatment (ART, but testing models for sex workers and indeed for ART access are little studied, as are structural interventions, which create conditions conducive for risk reduction. With the exception of Senegal, persistent criminalization of sex work across Africa reduces sex workers’ control over working conditions and impedes their access to health services. It also obstructs health-service provision and legal protection. Conclusions: There is sufficient evidence of effectiveness of targeted interventions with female sex workers in Africa to inform delivery of services for this population. With improved planning and political will, services – including peer interventions, condom promotion and STI screening – would act at multiple levels to reduce HIV exposure and transmission efficiency among sex workers
Leal Rocha, Lyana; Vieira de Lima Saintrain, Maria; Pimentel Gomes Fernandes Vieira-Meyer, Anya
According to the World Health Organization, one in every 10 people has a disability, and more than two-thirds of them do not receive any type of oral dental care. The Brazilian Constitution of 1988 guarantees all civilians including disabled people the right to healthcare, shaping the guidelines of the Brazilian National Health Care System (Sistema Único de Saúde--SUS). However, there is limited information about the true accessibility of dental services. This study evaluated the accessibility of public dental services to persons with disabilities in Fortaleza, Ceará, which has the third highest disability rate in Brazil. A cross-sectional quantitative study using structured questionnaires was administered to dentists (n = 89) and people with disabilities (n = 204) to evaluate the geographical, architectural, and organizational accessibility of health facilities, the communication between professionals and patients with disabilities, the demand for dental services, and factors influencing the use of dental services by people with motor, visual, and hearing impairments. 43.1% of people with disabilities do not recognize their service as a priority of Basic Health Units (BHU), 52.5% do not usually seek dental care, and of those who do (n = 97), 76.3% find it difficult to receive care and 84.5% only seek care on an emergency basis. Forty-five percent are unaware of the services offered in the BHU. Of the dentists, 56.2% reported difficulty in communicating with deaf patients, and 97.8% desired interpreters stationed in the BHU. People with disabilities gave better accessibility ratings than dentists (p = 0.001). 37.3% of the patients and 43.8% of dentists reported inadequate physical access infrastructure (including doors, hallways, waiting rooms, and offices). Dentists (60%) reported unsafe environments and transportation difficulties as geographical barriers, while most people with disabilities did not report noticing these barriers. While access to dental
Sangita V Patel
Full Text Available Background: Human immunodeficiency virus (HIV disclosure offers important benefits to people living with HIV/AIDS. However, fear of discrimination, blame, and disruption of family relationships can make disclosure a difficult decision. Barriers to HIV disclosure are influenced by the particular culture within which the individuals live. Although many studies have assessed such barriers in the U.S., very few studies have explored the factors that facilitate or prevent HIV disclosure in India. Understanding these factors is critical to the refinement, development, and implementation of a counseling intervention to facilitate disclosure. Materials and Methods: To explore these factors, we conducted 30 in-depth interviews in the local language with HIV- positive individuals from the Integrated Counselling and Testing Centre in Gujarat, India, assessing the experiences, perceived barriers, and facilitators to disclosure. To triangulate the findings, we conducted two focus group discussions with HIV medical and non-medical service providers, respectively. Results: Perceived HIV-associated stigma, fear of discrimination, and fear of family breakdown acted as barriers to HIV disclosure. Most people living with HIV/AIDS came to know of their HIV status due to poor physical health, spousal HIV-positive status, or a positive HIV test during pregnancy. Some wives only learned of their husbands′ HIV positive status after their husbands died. The focus group participants confirmed similar findings. Disclosure had serious implications for individuals living with HIV, such as divorce, maltreatment, ostracism, and decisions regarding child bearing. Interpretation and Conclusion: The identified barriers and facilitators in the present study can be used to augment training of HIV service providers working in voluntary counseling and testing centers in India.
Zietlow, D. W.; Molnar, C.; Meertens, C. M.; Phillips, D. A.; Bartel, B. A.; Ertz, D. J.
UNAVCO, a university-governed consortium that enables geodetic research and education, is developing and implementing new web services to standardize and enhance access to geodetic data for an ever-growing community of users. This simple and easy to use tool gives both experienced and novice users access to all data and products archived at UNAVCO through a uniform interface regardless of data type and structure. UNAVCO data product types include GPS station position time series, velocity estimates and metadata, as well as meteorological time series, and borehole geophysical data and metadata including strain, seismic, and tilt time series. Users access data through a request URL or through the Swagger user interface (UI). The Swagger UI allows users to easily learn about the web services and provides users the ability to test the web services in their web browser. Swagger UI also provides documentation of the web services' URLs and query parameters. With this documentation users can see the valid query parameters for each web service to assist in documentation for both the developers and the users.Output from the web services is currently in a standard comma-separated (CSV) format that can then be used in other processing and/or visualization programs. The web services are being standardized so that all CSV formats will follow the GeoCSV specification. Other formats will be available such as GeoJSON and time series xml since not all data are well represented by the CSV format. The UNAVCO web services are written using Python along with the Flask microframework. This allows quick development and the ability to easily implement new services. Future services are being planned to allow users to access metadata from any station with data available directly or indirectly from the UNAVCO website. In collaboration with the UNAVCO Student Internship Program (USIP), we developed a short video demonstrating how to use the web services tool to assist new users and the broader
in a tertiary hospital in Nigeria. METHODS ... Cost Burden for Accessing Pediatric Emergency Services - Ogaji DS, et al. Common ... health care outstrips supply in public domain, patients are ... Akpor Local Government Area of Rivers State,. Nigeria. .... Work in private sector. Work in .... Some of them where missed out as the ...
Roy, R.; Manhoudt, Gert; van Etten, Wim
We discuss service delivery aspects in a reconfigurable photonic access network. The network is viewed as a stack of logical PONs in which a DWDM overlay is used over TDM PONs operating in their native format. The use of optical routers in the network allows for a dynamic change in the network topol
Gowling, Sarah; Persson, Jennie; Holt, Genevieve; Ashbourne, Sue; Bloomfield, James; Shortland, Hannah; Bate, Clare
IAPT (Improving Access to Psychological Therapies) is a national programme aimed at increasing availability of evidence based psychological therapies in the NHS. IAPT is primarily for people who have mild to moderate, common mental health difficulties such as depression, anxiety, phobias and post traumatic stress disorder (PTSD). The programme seeks to use the least intrusive method of care possible to treat people at the time when it will be of most help to them. Individuals are able to self-refer into most IAPT services or alternatively can request to be referred by their GP or other services in the community. Richmond Wellbeing Service (RWS) is one such IAPT Service and this research is based on our work to promote accessibility of the service to one of the harder to reach population groups - older adults. We know that IAPT services could have a positive impact on older adults as it is believed on average, 25% of over 65 year olds face common mental health problems. However, only a third of these people discuss this with their GP and so are less likely to be referred to an IAPT Service. In relation to the above, this project was designed to look at increasing access for older adults into Richmond Wellbeing Service (RWS) specifically to improve access to the RWS by older adults by 100. The overall goal was to increase older adult (65+) referral rates by 20% over a year, in raw number this would translate to an increase of 100 over a year period, and in percentage terms an average of 8% of total referrals. Results yielded an increase of 39 referrals between baseline and test period. The majority of this increase had occurred in the final five months of the projects duration(31). Interestingly the number of older adults in the older age band (85+) almost doubled within this period (from 12 to 21). In total, in percentage terms this translates to an an increase of OA referrals from 6% up to 6.7%, as above we are aiming for 8% or an additional increase of 61 patients
Dec 29, 2011 ... Nigerian Journal of Clinical Practice • Oct-Dec 2012 • Vol 15 • Issue 4. Original Article. Abstract ... evidence of reducing HIV transmission, limited technical and financial ... all over Nigeria. Major religious groups are Islam, ..... among undergraduates in a polytechnic in southeast Nigeria. Niger J Med. 2006 ...
Full Text Available Background: Tamil Nadu comes under group I high-prevalence state, with <1% prevalence of HIV infection in ante-natal women but above 5% prevalence in high-risk group. One of the ways to control HIV/AIDS in India is through prevention of parent to child transmission (PPTCT, the success of which lies in the utilization of services. Materials and Methods: A descriptive qualitative study was conducted to explore the status of utilization of PPTCT services by rural HIV-positive mothers, in the Gingee Block of Villupuram district, Tamil Nadu. All the mothers who tested positive between June 2006 and May 2010 were interviewed in-depth using an interview guide. Results: There were 21 HIV-positive mothers during this period, 19 of whom gave consent for the study. Thirteen out of 19 mothers (68% received Nevirapine prophylaxis, while 15 out of 20 infants born to these mothers (75% received Nevirapine syrup. During the study period, it was found that 61% of the mothers were not compliant to antiretroviral therapy (ART. Conclusion: Poor access to the ART centers was reflected in majority of the cases (79%. There is a pressing need to improve access to quality PPTCT services especially during the intranatal period.
Bach Xuan Tran
Full Text Available Methadone maintenance treatment (MMT reduces HIV risk behaviors and improves access to HIV-related services among drug users. In this study, we assessed the uptake and willingness of MMT patients to refer HIV testing and counseling (HTC service to their sexual partners and relatives.Health status, HIV-related risk behaviors, and HTC uptake and referrals of 1,016 MMT patients in Hanoi and Nam Dinh were investigated. Willingness to pay (WTP for HTC was elicited using a contingent valuation technique. Interval and logistic regression models were employed to determine associated factors.Most of the patients (94.2% had received HTC, 6.6 times on average. The proportion of respondents willing to refer their partners, their relatives and to be voluntary peer educators was 45.7%, 35.3%, and 33.3%, respectively. Attending MMT integrated with HTC was a facilitative factor for HTC uptake, greater WTP, and volunteering as peer educators. Older age, higher education and income, and HIV positive status were positively related to willingness to refer partners or relatives, while having health problems (mobility, usual care, pain/discomfort was associated with lower likelihood of referring others or being a volunteer. Over 90% patients were willing to pay an average of US $17.9 for HTC service.The results highlighted the potential role of MMT patients as referrers to HTC and voluntary peer educators. Integrating HIV testing with MMT services and applying users' fee are potential strategies to mobilize resources and encourage HIV testing among MMT patients and their partners.
Elaine S. Pires Araujo
Full Text Available OBJECTIVES: To describe the access to the interventions for the prevention of Human Immunodeficiency Virus (HIV mother to child transmission and mother to child transmission rates in the outskirts of Rio de Janeiro, from 1999 to 2009. METHODS: This is a retrospective cohort study. Prevention of HIV mother to child transmission interventions were accessed and mother to child transmission rates were calculated. RESULTS: The study population is young (median: 26 years; interquartile range: 22.0-31.0, with low monthly family income (40.4% up to one Brazilian minimum wage and schooling (62.1% less than 8 years. Only 47.1% (n = 469 knew the HIV status of their partner; of these women, 39.9% had an HIV-seronegative partner. Among the 1259 newborns evaluated, access to the antenatal, intrapartum and postpartum prevention of HIV mother to child transmission components occurred in 59.2%, 74.2%, and 97.5% respectively; 91.0% of the newborns were not breastfed. Overall 52.7% of the newborns have benefited from all the recommended interventions. In subsequent pregnancies (n = 289, 67.8% of the newborns received the full package of interventions. The overall rate of HIV vertical transmission was 4.7% and the highest annual rate occurred in 2005 (7.4%, with no definite trend in the period. CONCLUSIONS: Access to the full package of interventions for the prevention of HIV vertical transmission was low, with no significant trend of improvement over the years. The vertical transmission rates observed were higher than those found in reference services in the municipality of Rio de Janeiro and in the richest regions of the country.
Elizabeth K. Harrington
Full Text Available Despite increasing efforts to address the reproductive health needs of people living with HIV, a high unmet need for contraception exists among HIV+ women in sub-Saharan Africa. This study explores the fertility intentions and family planning (FP preferences of Kenyan women accessing HIV treatment. We conducted 30 semistructured interviews and qualitatively analyzed the data with a grounded theory approach. Fears of premature death, financial hardship, and perinatal HIV transmission emerged as reasons for participants’ desire to delay/cease childbearing. Participants strongly identified FP needs, yet two-thirds were using male condoms alone or no modern method of contraception. Women preferred the HIV clinic as the site of FP access for reasons of convenience, provider expertise, and a sense of belonging, though some had privacy concerns. Our findings support the acceptability of integrated FP and HIV services. Efforts to empower women living with HIV to prevent unintended pregnancies must expand access to contraceptive methods, provide confidential services, and take into account women's varied reproductive intentions.
Thin Zaw, Phyu Phyu; Liabsuetrakul, Tippawan; Htay, Thien Thien; McNeil, Edward
Inequity of accessibility to and utilization of reproductive health (RH) services among youths is a global concern, especially in resource-limited areas. The level of inequity also varies by cultural and socio-economic contexts. To tailor RH services to the needs of youths, relevant solutions are required. This study aimed to assess baseline information on access to and utilization of RH services and unmet needs among youths living in resource-limited, suburban communities of Mandalay City, Myanmar. A community-based, cross-sectional study was conducted in all resource-limited, suburban communities of Mandalay City, Myanmar. A total of 444 randomly selected youths aged between 15 and 24 years were interviewed for three main outcomes, namely accessibility to and utilization of RH services and youth's unmet needs for these services. Factors associated with these outcomes were determined using multivariate logistic regression. Although geographical accessibility was high (79.3%), financial accessibility was low (19.1%) resulting in a low overall accessibility (34.5%) to RH services. Two-thirds of youths used some kind of RH services at least once in the past. Levels of unmet needs for sexual RH information, family planning, maternal care and HIV testing were 62.6%, 31.9%, 38.7% and 56.2%, respectively. Youths living in the south or south-western suburbs, having a deceased parent, never being married or never exposed to mass media were less likely to access RH services. Being a young adult, current student, working as a waste recycler, having ever experienced a sexual relationship, ever being married, ever exposed to mass media, having a high knowledge of RH services and providers or a high level of accessibility to RH services significantly increased the likelihood of utilization of those services. In addition to youths' socio-demographic characteristics, exposure to mass media, norm of peer exposure and knowledge on types of providers and services significantly
Thin Zaw Phyu Phyu
Full Text Available Abstract Background Inequity of accessibility to and utilization of reproductive health (RH services among youths is a global concern, especially in resource-limited areas. The level of inequity also varies by cultural and socio-economic contexts. To tailor RH services to the needs of youths, relevant solutions are required. This study aimed to assess baseline information on access to and utilization of RH services and unmet needs among youths living in resource-limited, suburban communities of Mandalay City, Myanmar. Methods A community-based, cross-sectional study was conducted in all resource-limited, suburban communities of Mandalay City, Myanmar. A total of 444 randomly selected youths aged between 15 and 24 years were interviewed for three main outcomes, namely accessibility to and utilization of RH services and youth's unmet needs for these services. Factors associated with these outcomes were determined using multivariate logistic regression. Results Although geographical accessibility was high (79.3%, financial accessibility was low (19.1% resulting in a low overall accessibility (34.5% to RH services. Two-thirds of youths used some kind of RH services at least once in the past. Levels of unmet needs for sexual RH information, family planning, maternal care and HIV testing were 62.6%, 31.9%, 38.7% and 56.2%, respectively. Youths living in the south or south-western suburbs, having a deceased parent, never being married or never exposed to mass media were less likely to access RH services. Being a young adult, current student, working as a waste recycler, having ever experienced a sexual relationship, ever being married, ever exposed to mass media, having a high knowledge of RH services and providers or a high level of accessibility to RH services significantly increased the likelihood of utilization of those services. In addition to youths’ socio-demographic characteristics, exposure to mass media, norm of peer exposure and knowledge
Ajuwon, Ademola J; Titiloye, Musibau; Oshiname, Frederick; Oyewole, Oyediran
AIDS is a major public health problem in Nigeria. HIV counseling and testing (HCT) service is an important component of prevention and control programs. Little information is available about young persons' knowledge and use of HCT services in Nigeria. This study assessed knowledge of HIV/AIDS and use of HCT services among secondary school students and apprentices in Ibadan, Nigeria. Data were collected through 16 focus group discussions (FGD) and administration of a 36-item questionnaire to 1,281 randomly selected male and female secondary school students and apprentices aged 15-25 years. The respondents consisted of 54% apprentices and 46% students. Although virtually all respondents were aware of AIDS, only 15.8% of the sample had heard about HCT. Of those who were aware of HCT, 30.1% knew where to access the service. Students had superior knowledge of HCT than apprentices. Only 7% of those aware of HCT had ever taken the test. The percentage of those who had reportedly taken the test ranged from 11.3% of female apprentices to 6.3% of male students, 5.3% of female students, and 5.2% of male apprentices. The barriers identified by FGD participants to use of HCT services are fear of stigmatization, perceived exorbitant cost of testing, lack of knowledge of where HCT service are available, and belief that HCT is meant for only sexually active persons. However, 82.6% of the entire sample expressed the willingness to take HCT if it is provided free of charge, and there is a guarantee of confidentiality of results. Young persons have limited knowledge of HCT and under-utilize this service. Establishment of new HCT centers, promotion activities using the media, and peer education are recommended to increase uptake of this service among young persons in Nigeria.
Portia C Mutevedzi
Full Text Available BACKGROUND: The association of HIV with chronic morbidity and inflammatory markers (cytokines in older adults (50+years is potentially relevant for clinical care, but data from African populations is scarce. OBJECTIVE: To examine levels of chronic morbidity by HIV and ART status in older adults (50+years and subsequent associations with selected pro-inflammatory cytokines and body mass index. METHODS: Ordinary, ordered and generalized ordered logistic regression techniques were employed to compare chronic morbidity (heart disease (angina, arthritis, stroke, hypertension, asthma and diabetes and cytokines (Interleukins-1 and -6, C-Reactive Protein and Tumor Necrosis Factor-alpha by HIV and ART status on a cross-sectional random sample of 422 older adults nested within a defined rural South African population based demographic surveillance. RESULTS: Using a composite measure of all morbidities, controlling for age, gender, BMI, smoking and wealth quintile, HIV-infected individuals on ART had 51% decreased odds (95% CI:0.26-0.92 of current morbidity compared to HIV-uninfected. In adjusted regression, compared to HIV-uninfected, the proportional odds (aPOR of having elevated inflammation markers of IL6 (>1.56 pg/mL was nearly doubled in HIV-infected individuals on (aPOR 1.84; 95%CI: 1.05-3.21 and not on (aPOR 1.94; 95%CI: 1.11-3.41 ART. Compared to HIV-uninfected, HIV-infected individuals on ART had >twice partial proportional odds (apPOR=2.30;p=0.004 of having non-clinically significant raised hsCRP levels(>1 ug/mL; ART-naïve HIV-infected individuals had >double apPOR of having hsCRP levels indicative of increased heart disease risk(>3.9 ug/mL;p=0.008. CONCLUSIONS: Although HIV status was associated with increased inflammatory markers, our results highlight reduced morbidity in those receiving ART and underscore the need of pro-actively extending these services to HIV-uninfected older adults, beyond mere provision at fixed clinics. Providing
Eleri, Ewah Otu; Ugwu, Okechukwu; Onuvae, Precious
Nigeria experiences a remarkable paradox -- the abundance of energy resources and widespread energy poverty. Only about 40% of the population has access to the country’s grid electricity. About 72% of the population depends on traditional fuelwood for cooking. Despite this, government financing of energy services that benefits majority of Nigeria’s population has been grossly inadequate. Private sector investments and donor support have not fared better. This paper examines the current level of energy poverty in Nigeria. It analyses the level of government, private sector and donor funding for energy services that benefit the poor. It further reviews international best practices in expanding access for pro poor energy services. The paper finds a significant decline in political interest for expanding electricity services to rural areas. Even though ambitious policy reforms have commenced, agreed programmes are not implemented effectively. Not only are investments in rural electrification in decline, there is no history of annual budgeting for cooking energy programmes. The paper recommends a number of action points for expanding access to energy services that benefit the poor. These include the development and launching of a new national rural electrification strategy; establishment of a national cooking energy programme; and the development of clear policy incentives to support private sector investment in energy services for the poor. It calls on the Nigerian Central Bank of Nigeria to set aside 10% of the existing power intervention fund for pro poor energy financing; and the Nigerian Electricity Regulatory Commission to establish a clear framework for the utilization of the Consumer Assistance Fund. Other recommendations include the use of a proportion of the Ecological Fund to finance cooking energy; establishment of a donor’s platform on pro poor energy; and the mobilization of civil society in providing community-level energy services.
Guise, Andy; Rhodes, Tim; Ndimbii, James; Ayon, Sylvia; Nnaji, Obiora
People who inject drugs (PWID) experience a range of barriers to HIV treatment and care access. The Kenyan government and community-based organisations have sought to develop HIV care for PWID. A principal approach to delivery in Kenya is to provide care from clinics serving the general population and for this to be linked to support from community-based organisations providing harm reduction outreach. This study explores accounts of PWID accessing care in Kenya to identify care barriers and facilitators. PWID accounts were collected within a qualitative longitudinal study. In-depth interviews with PWID living with HIV (n = 44) are combined with interviews with other PWID, care providers and community observation. Results show that some PWID are able to access care successfully, whilst other PWID report challenges. The results focus on three principal themes to give insights into these experiences: the hardship of addiction and the costs of care, the silencing of HIV in the community and then discrimination and support in the clinic. Some PWID are able to overcome, often with social and outreach support, barriers to clinic access; for others, the challenges of addiction, hardship, stigma and discrimination are too constraining. We discuss how clinics serving the general population could be further adapted to increase access. Clinic-based care, even with community links, may, however, be fundamentally challenging for some PWID to access. Additional strategies to develop stand-alone care for PWID and also decentralise HIV treatment and care to community settings and involve peers in delivery should be considered.
Full Text Available The number and power of administrator services has been growing lately. In order to perform their job, administrators acquire rights to access user data such as names, addresses, occupations, passwords and so on. The maintenance of user accounts is designed in a manner so that consumers are protected in a situation like this - administrators cannot access anyuser passwords if auser has changed it during the registration process. However, to carry out his normal activities, anadministrator canchange the current user password, even if he does not know it. This situation requires special measures to be taken by company’s management to protect their employees’ data.
Hontelez, J.A.; Lurie, M.N.; Barnighausen, T.; Bakker, R.; Baltussen, R.; Tanser, F.; Hallett, T.B.; Newell, M.L.; Vlas, S.J. de
BACKGROUND: Expanded access to antiretroviral therapy (ART) using universal test and treat (UTT) has been suggested as a strategy to eliminate HIV in South Africa within 7 y based on an influential mathematical modeling study. However, the underlying deterministic model was criticized widely, and ot
J.A.C. Hontelez (Jan); M.N. Lurie (Mark N.); T. Bärnighausen (Till); R. Bakker (Roel); R.M.P.M. Baltussen (Rob); F. Tanser (Frank); T.B. Hallett (Timothy); M.-L. Newell (Marie-Louise); S.J. de Vlas (Sake)
textabstractBackground:Expanded access to antiretroviral therapy (ART) using universal test and treat (UTT) has been suggested as a strategy to eliminate HIV in South Africa within 7 y based on an influential mathematical modeling study. However, the underlying deterministic model was criticized wid
J.A.C. Hontelez (Jan); M.N. Lurie (Mark N.); T. Bärnighausen (Till); R. Bakker (Roel); R.M.P.M. Baltussen (Rob); F. Tanser (Frank); T.B. Hallett (Timothy); M.L. Newell (Marie Louise); S.J. de Vlas (Sake)
textabstractBackground: Expanded access to antiretroviral therapy (ART) using universal test and treat (UTT) has been suggested as a strategy to eliminate HIV in South Africa within 7 y based on an influential mathematical modeling study. However, the underlying deterministic model was criticized wi
Riggs, Elisha; Davis, Elise; Gibbs, Lisa; Block, Karen; Szwarc, Jo; Casey, Sue; Duell-Piening, Philippa; Waters, Elizabeth
Often new arrivals from refugee backgrounds have experienced poor health and limited access to healthcare services. The maternal and child health (MCH) service in Victoria, Australia, is a joint local and state government operated, cost-free service available to all mothers of children aged 0-6 years. Although well-child healthcare visits are useful in identifying health issues early, there has been limited investigation in the use of these services for families from refugee backgrounds. This study aims to explore experiences of using MCH services, from the perspective of families from refugee backgrounds and service providers. We used a qualitative study design informed by the socioecological model of health and a cultural competence approach. Two geographical areas of Melbourne were selected to invite participants. Seven focus groups were conducted with 87 mothers from Karen, Iraqi, Assyrian Chaldean, Lebanese, South Sudanese and Bhutanese backgrounds, who had lived an average of 4.7 years in Australia (range one month-18 years). Participants had a total of 249 children, of these 150 were born in Australia. Four focus groups and five interviews were conducted with MCH nurses, other healthcare providers and bicultural workers. Four themes were identified: facilitating access to MCH services; promoting continued engagement with the MCH service; language challenges; and what is working well and could be done better. Several processes were identified that facilitated initial access to the MCH service but there were implications for continued use of the service. The MCH service was not formally notified of new parents arriving with young children. Pre-arranged group appointments by MCH nurses for parents who attended playgroups worked well to increase ongoing service engagement. Barriers for parents in using MCH services included access to transportation, lack of confidence in speaking English and making phone bookings. Service users and providers reported that
Stackpool-Moore, Lucy; Bajpai, Divya; Caswell, Georgina; Crone, Tyler; Dewar, Fleur; Gray, Greg; Kyendikuwa, Allen; Mellin, Julie; Miller, Andrew; Morgan, Felicity; Orza, Luisa; Stevenson, Jacqui; Westerhof, Nienke; Wong, Felicia; Yam, Eileen; Zieman, Brady
Sexual health and access to services are a pressing need for young people. This article introduces Link Up, a 3-year project in three African and two Asian countries, to enable and scale up access to integrated HIV services and sexual and reproductive health and rights for marginalized young people. The young people we worked with in this project included young men who have sex with men, young sex workers, young people who use drugs, young transgender people, young homeless people, and other vulnerable young people. The research and programmatic activities of Link Up, as illustrated in this Supplement, have highlighted the importance of recognizing and engaging with diversity among young people to improve access to services and outcomes protecting their health and human rights. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Gari, Sara; Doig-Acuña, Camilo; Smail, Tino; Malungo, Jacob R S; Martin-Hilber, Adriane; Merten, Sonja
The role of socio-cultural factors in influencing access to HIV/AIDS treatment, care and support is increasingly recognized by researchers, international donors and policy makers. Although many of them have been identified through qualitative studies, the evidence gathered by quantitative studies has not been systematically analysed. To fill this knowledge gap, we did a systematic review of quantitative studies comparing surveys done in high and low income countries to assess the extent to which socio-cultural determinants of access, identified through qualitative studies, have been addressed in epidemiological survey studies. Ten electronic databases were searched (Cinahl, EMBASE, ISI Web of Science, IBSS, JSTOR, MedLine, Psyinfo, Psyindex and Cochrane). Two independent reviewers selected eligible publications based on the inclusion/exclusion criteria. Meta-analysis was used to synthesize data comparing studies between low and high income countries. Thirty-four studies were included in the final review, 21 (62%) done in high income countries and 13 (38%) in low income countries. In low income settings, epidemiological research on access to HIV/AIDS services focused on socio-economic and health system factors while in high income countries the focus was on medical and psychosocial factors. These differences depict the perceived different barriers in the two regions. Common factors between the two regions were also found to affect HIV testing, including stigma, high risk sexual behaviours such as multiple sexual partners and not using condoms, and alcohol abuse. On the other hand, having experienced previous illness or other health conditions and good family communication was associated with adherence to ART uptake. Due to insufficient consistent data, a meta-analysis was only possible on adherence to treatment. This review offers evidence of the current challenges for interdisciplinary work in epidemiology and public health. Quantitative studies did not
Stephanie A Nixon
Full Text Available Introduction: Despite the emerging body of literature on increased vulnerability to HIV among people with disabilities (PWDs, there is a dearth of evidence related to experiences of PWDs who have become HIV-positive. This priority was identified by a disability advocacy organization in Lusaka, Zambia, where the prevalence of HIV and of disability is each approximately 15%. The purpose of this study was to explore perceptions and experiences of HIV-related health services for PWDs who are also living with HIV in Lusaka, Zambia. Methods: This qualitative, interpretive study involved in-depth, semi-structured, one-on-one interviews with two groups of participants in Lusaka, Zambia: 21 PWDs who had become HIV-positive, and 11 people working in HIV and/or disability. PWDs had physical, hearing, visual and/or intellectual impairments. Interviews were conducted in English, Nyanja, Bemba or Zambian sign language. Descriptive and thematic analyses were conducted by a multidisciplinary, international research team. Results: Participants described their experiences with HIV-related health services in terms of the challenges they faced. In particular, they encountered three main challenges while seeking care and treatment: (1 disability-related discrimination heightened when seeking HIV services, (2 communication barriers and related concerns with confidentiality, and (3 movement and mobility challenges related to seeking care and collecting antiretroviral therapy. These experiences were further shaped by participants’ profound concerns about poverty and unmet basic needs. Discussion: This study demonstrates how PWDs who are HIV-positive have the same HIV care, treatment and support needs as able-bodied counterparts, but face avoidable barriers to care. Many challenges mirror concerns identified with HIV prevention, suggesting that efforts to promote inclusion and reduce stigma could have widespread benefits. Conclusions: Despite the growing body of
Srirama, Satish Narayana
It is now feasible to host basic web services on a smart phone due to the advances in wireless devices and mobile communication technologies. While the applications are quite welcoming, the ability to provide secure and reliable communication in the vulnerable and volatile mobile ad-hoc topologies is vastly becoming necessary. The paper mainly addresses the details and issues in providing secured communication and access control for the mobile web service provisioning domain. While the basic message-level security can be provided, providing proper access control mechanisms for the Mobile Host still poses a great challenge. This paper discusses details of secure communication and proposes the distributed semantics-based authorization mechanism.
Full Text Available Abstract Background Assessment of physical access to health services is extremely important for planning. Complex methods that incorporate data inputs from road networks and transport systems are used to assess physical access to healthcare in industrialised countries. However, such data inputs hardly exist in many developing countries. Straight-line distances between the service provider and resident population are easily obtained but their relationship with driving distance and travel time is unclear. This study aimed to investigate the relationship between different measures of physical access, including straight-line distances, road distances and travel time and the impact of these measures on the vaccination of children in Yemen. Methods Coordinates of houses and health facilities were determined by GPS machine in Urban and rural areas in Taiz province, Yemen. Road distances were measured by an odometer of a vehicle driven from participants' houses to the nearest health centre. Driving time was measured using a stop-watch. Data on children's vaccination were collected by personal interview and verified by inspecting vaccination cards. Results There was a strong correlation between straight-line distances, driving distances and driving time (straight line distances vs. driving distance r = 0.92, p Conclusion Straight-line distances, driving distances and driving time are strongly linked and associated with vaccination uptake. Straight-line distances can be used to assess physical access to health services where data inputs on road networks and transport are lacking. Impact of physical access is clear in Yemen, highlighting the need for efforts to target vaccination and other preventive healthcare measures to children who live away from health facilities.
van Laren, Linda
In South Africa, the HIV&AIDS education policy documents indicate opportunities for integration across disciplines/subjects. There are different interpretations of integration/inclusion and mainstreaming HIV&AIDS education, and numerous levels of integration. Integration ensures that learners experience the disciplines/subjects as being linked and related, and integration is required to support and expand the learners' opportunities to attain skills, acquire knowledge and develop attitudes and values across the curriculum. This study makes use of self-study methodology where I, a teacher educator, aim to improve my practice through including HIV&AIDS statistics in Mathematics Education. This article focuses on how I used HIV&AIDS statistics to facilitate pre-service teacher reflection and introduce them to integration of HIV&AIDS education across the curriculum. After pre-service teachers were provided with HIV statistics, they drew a pie chart which graphically illustrated the situation and reflected on issues relating to HIV&AIDS. Three themes emerged from the analysis of their reflections. The themes relate to the need for further HIV&AIDS education, the changing pastoral role of teachers and the changing context of teaching. This information indicates that the use of statistics is an appropriate means of initiating the integration of HIV&AIDS education into the academic curriculum.
... Under the Ryan White HIV/AIDS Program AGENCY: Health Resources and Services Administration (HRSA... care services for persons living with HIV/AIDS, including primary adult HIV medical care, adult... the Ryan White HIV/AIDS Program through a contractual agreement with the Comprehensive Care...
Campo-Arias, Adalberto; Oviedo, Heidi Celina; Herazo, Edwin
The perceived stigma represents a sociocultural barrier to access mental health services and prevents individuals who meet criteria for a mental disorder the possibility of receiving comprehensive and integred care. To update institutional mechanisms by which stigma related to mental disorders, perceived and perpetrated, acts as a barrier to mental health access. Stigma as a barrier to access to mental health services is due to a reduction in service requests, the allocation of limited resources to mental health, the systematic process of impoverishment of the people who suffer a mental disorder, increased risk of crime, and implications in contact with the legal system, and the invisibility of the vulnerability of these people. Structured awareness and education programs are needed to promote awareness about mental disorders, promote community-based psychosocial rehabilitation, and reintegration into productive life process. In Colombia, the frequency and variables associated with the stigma of mental disorders needs to be studied. This knowledge will enable the implementation of measures to promote the social and labor inclusion of people who meet the criteria for mental disorders. Copyright © 2014 Asociación Colombiana de Psiquiatría. All rights reserved.
Full Text Available Introduction: HIV-affected women and couples often desire children and many accept HIV risk in order to attempt pregnancy and satisfy goals for a family. Risk reduction strategies to mitigate sexual and perinatal HIV transmission include biomedical and behavioural approaches. Current efforts to integrate HIV and reproductive health services offer prime opportunities to incorporate strategies for HIV risk reduction during pregnancy attempts. Key client and provider values about services to optimize pregnancy in the context of HIV risk provide insights for the design and implementation of large-scale “safer conception” programmes. Discussion: Through our collective experience and discussions at a multi-disciplinary international World Health Organization–convened workshop to initiate the development of guidelines and an algorithm of care to support the delivery of services for HIV-affected women and couples attempting pregnancy, we identified four values that are key to the implementation of these programmes: (1 understanding fertility care and an ability to identify potential fertility problems; (2 providing equity of access to resources enabling informed decision-making about reproductive choices; (3 creating enabling environments that reduce stigma associated with HIV and infertility; and (4 creating enabling environments that encourage disclosure of HIV status and fertility status to partners. Based on these values, recommendations for programmes serving HIV-affected women and couples attempting pregnancy include the following: incorporation of comprehensive reproductive health counselling; training to support the transfer and exchange of knowledge between providers and clients; care environments that reduce the stigma of childbearing among HIV-affected women and couples; support for safe and voluntary disclosure of HIV and fertility status; and increased efforts to engage men in reproductive decision-making at times that align with
Ghose, Toorjo; Boucicaut, Edner; King, Charles; Doyle, Andrea; Shubert, Virginia
In this research we examined how the conditions of Haiti's tent communities, inhabited by those displaced by the January 10, 2010, earthquake, shaped access and adherence to highly active antiretroviral treatment (HAART) for Haitians with HIV. Conditions in the encampments were marked by unhygienic and cramped living spaces, exposure to the elements, a lack of privacy, unavailability of food and clean water, and a dependence on poorly functioning aid agencies. These conditions shaped access and adherence to HAART by (a) exacerbating the stigma of being HIV positive and undermining mental health; (b) presenting logistical challenges to accessing medical care, storing pills, and ingesting them safely and privately; and (c) sustaining a political economy of aid characterized by unequal treatment in major HAART-dispensing centers, unequal circulation of international funds, and the emergence of alternative medical institutions within encampments that could improve future treatment. Policy and intervention implications are discussed.
Legido-Quigley, Helena; Montgomery, Catherine M; Khan, Palwasha; Atun, Rifat; Fakoya, Ade; Getahun, Haileyesus; Grant, Alison D
Given the imperative to scale up integrated tuberculosis (TB) and HIV services in settings where both are of major public health importance, we aimed to synthesise knowledge concerning implementation of TB/HIV service integration. Systematic review of studies describing a strategy to facilitate TB and HIV service integration, searching 15 bibliographic databases including Medline, Embase and the Cochrane library; and relevant conference abstracts. Sixty-three of 1936 peer-reviewed articles and 70 of 170 abstracts met our inclusion criteria. We identified five models: entry via TB service, with referral for HIV testing and care; entry via TB service, on-site HIV testing, and referral for HIV care; entry via HIV service with referral for TB screening and treatment; entry via HIV service, on-site TB screening, and referral for TB diagnosis and treatment; and TB and HIV services provided at a single facility. Referral-based models are most easily implemented, but referral failure is a key risk. Closer integration requires more staff training and additional infrastructure (e.g. private space for HIV counselling; integrated records). Infection control is a major concern. More integrated models hold potential efficiencies from both provider and user perspective. Most papers report 'outcomes' (e.g. proportion of TB patients tested for HIV); few report downstream 'impacts' such as outcomes of TB treatment or antiretroviral therapy. Very few studies address the perspectives of service users or staff, or costs or cost-effectiveness. While scaling up integrated services, robust comparisons of the impacts of different models are needed using standardised outcome measures. © 2012 Blackwell Publishing Ltd.
Itano, Michelle S; Bleck, Marina; Johnson, Daniel S; Simon, Sanford M
Human immunodeficiency virus (HIV)-1 infection and the associated disease AIDS are a major cause of human death worldwide with no vaccine or cure available. The trafficking of HIV-1 RNAs from sites of synthesis in the nucleus, through the cytoplasm, to sites of assembly at the plasma membrane are critical steps in HIV-1 viral replication, but are not well characterized. Here we present a broadly accessible microscopy method that captures multiple focal planes simultaneously, which allows us to image the trafficking of HIV-1 genomic RNAs with high precision. This method utilizes a customization of a commercial multichannel emission splitter that enables high-resolution 3D imaging with single-macromolecule sensitivity. We show with high temporal and spatial resolution that HIV-1 genomic RNAs are most mobile in the cytosol, and undergo confined mobility at sites along the nuclear envelope and in the nucleus and nucleolus. These provide important insights regarding the mechanism by which the HIV-1 RNA genome is transported to the sites of assembly of nascent virions.
Baughman, Martin L. [Texas Univ., Electrical and Computer Engineering Dept., Austin, TX (United States)
This paper describes the reorganization of the electricity industry within the Electric Reliability Council of Texas (ERCOT) and the system of administration and pricing of transmission of services that has been adopted and was placed into service in ERCOT starting January 1, 1997. Included is a summary of the physical and geographical ownership of the Texas system, with information on the mix of fuels and generation ownership patterns, and ownership of the transmission grid. How the electricity industry is being restructured within the interconnection to provide for open-access transmission is discussed, including discussion of the services that will be provided by the transmission segment of the industry, who is responsible for providing them, how they will be priced, and the role of the Independent System Operator (ISO). (author)
Full Text Available Introduction: Recent international guidelines call for expanded access to triple-drug antiretroviral therapy (ART in HIV-positive women during pregnancy and postpartum. However, high levels of non-adherence and/or disengagement from care may attenuate the benefits of ART for HIV transmission and maternal health. We examined the frequency and predictors of disengagement from care among women initiating ART during pregnancy in Cape Town, South Africa. Methods: We used routine medical records to follow-up pregnant women initiating ART within prevention of mother-to-child transmission of HIV services in Cape Town, South Africa. Outcomes assessed through six months postpartum were (1 disengagement (no attendance within 56 days of a scheduled visit and (2 missed visits (returning to care 14–56 days late for a scheduled visit. Results: A total of 358 women (median age, 28 years; median gestational age, 26 weeks initiated ART during pregnancy. By six months postpartum, 24% of women (n=86 had missed at least one visit and an additional 32% (n=115 had disengaged from care; together, 49% of women had either missed a visit or had disengaged by six months postpartum. Disengagement was more than twice as frequent postpartum compared to in the antenatal period (6.2 vs. 2.4 per 100 woman-months, respectively; p<0.0001. In a proportional hazards model, later gestational age at initiation (HR: 1.04; 95% CI: 1.00–1.07; p=0.030 and being newly diagnosed with HIV (HR: 1.57; 95% CI: 1.07–2.33; p=0.022 were significant predictors of disengagement after adjusting for patient age, starting CD4 cell count and site of ART initiation. Conclusions: These results demonstrate that missed visits and disengagement from care occur frequently, particularly post-delivery, among HIV-positive women initiating ART during pregnancy. Women who are newly diagnosed with HIV may be particularly vulnerable and there is an urgent need for interventions both to promote retention
Dirk von Suchodoletz
Full Text Available The changing world of IT services opens the chance to more tightly integrate digital long-term preservation into systems, both for commercial and end users. The emergence of cloud offerings re-centralizes services, and end users interact with them remotely through standardized (web-client applications on their various devices. This offers the chance to use partially the same concepts and methods to access obsolete computer environments and allows for more sustainable business processes. In order to provide a large variety of user-friendly remote emulation services, especially in combination with authentic performance and user experience, a distributed system model and architecture is required, suitable to run as a cloud service, allowing for the specialization both of memory institutions and third party service providers.The shift of the usually non-trivial task of the emulation of obsolete software environments from the end user to specialized providers can help to simplify digital preservation and access strategies. Besides offering their users better access to their holdings, libraries and archives may gain new business opportunities to offer services to a third party, such as businesses requiring authentic reproduction of digital objects and processes for legal reasons. This paper discusses cloud concepts as the next logical step for accessing original digital material. Emulation-as-a-Service (EaaS fills the gap between the successful demonstration of emulation strategies as a long term access strategy and it’s perceived availability and usability. EaaS can build upon the ground of research and prototypical implementations of previous projects, and reuse well established remote access technology.In this article we develop requirements and a system model, suitable for a distributed environment. We will discuss the building blocks of the core services as well as requirements regarding access management. Finally, we will try to present a
Ma, Fuchang; Lv, Fan; Xu, Peng; Zhang, Dapeng; Meng, Sining; Ju, Lahong; Jiang, Huihui; Ma, Liping; Sun, Jiangping; Wu, Zunyou
The growing number of people living with HIV/AIDS (PLWHA) in China points to an increased need for case management services of HIV/AIDS. This study sought to explore the challenges and enablers in shifting the HIV/AIDS case management services from Centers for Disease Control and Prevention (CDCs) to Community Health Service Centers (CHSCs) in urban China. A qualitative method based on the Health Policy Triangle (HPT) framework was employed to gain in-depth insights into four elements of the task shifting strategy. This included a review on published literature and health policy documents, 15 focus group discussions (FGDs) and 30 in-depth interviews (IDIs) with four types of key actors from three cities in China. A total of 78 studies and 17 policy files at the national, municipal and local levels were obtained and reviewed comprehensively. Three semi-structured interview guides were used to explore key actors' views on shifting the HIV/AIDS case management services to CHSCs. It is necessary and feasible for CHSCs to engage in case management services for PLWHA in local communities. The increasing number of PLWHA and shortage of qualified health professionals in CDCs made shifting case management services downwards to CHSCs an urgent agenda. CHSCs' wide distribution, technical capacity, accessibility and current practice enabled them to carry out case management services for PLWHA. However our findings indicated several challenges in this task shifting process. Those challenges included lack of specific policy and stable financial support for CHSCs, inadequate manpower, relatively low capacity for health service delivery, lack of coordination among sectors, PLWHA's fear for discrimination and privacy disclosure in local communities, which may compromise the effectiveness and sustainability of those services. Shifting the HIV/AIDS case management services from CDCs to CHSCs is a new approach to cope with the rising number of PLWHA in China, but it should be
Niniek Lely Pratiwi
Full Text Available Background: The MDG target to increase maternal health will be achieved when 50% of maternal deaths can be prevented through improvment the coverage of K1, K4, to make sure that midwife stay in the village improve the delivery by health workers in health facilities, increase coverage long-term contraceptive methods participant as well as family and community empowerment in health. Methods: This study is a further analysis of Riskesdas in 2010 to assess how big the accessibility of services in family planning in Indonesia. Results: Women of 3–4 children in rural greater and prevalence (27.1% compared to women who live in urban areas (25.0%. The main reason of not using contraception mostly because they want to have children 27.0% in urban, 28.2% rural whereas, the second reason is the fear of side effects 23.1% in urban, 16.5% rural. There is 10% of respondent did not use contraceptives, because they did not need it. Health seeking behavior of pregnant women with family planning work status has a significant relationship (prevalence ratio 1.073. The jobless mothers has better access to family planning services compared to working mother. Conclusions: Accessibility of family planning services is inadequate, because not all rural ‘Poskesdes’ equipped with infrastructure and family planning devices, a lack of knowledge of family planning in rural areas. Health seeking behavior of family planning services is mostly to the midwives, the scond is to community health centers and than polindes, ‘poskesdes’ as the ranks third.
Hung, Anna; Pradel, Françoise
To examine approaches being used to evaluate and improve quality of HIV clinical services we searched the MEDLINE, Cochrane Library collection, EMBASE, Global Health, and Web of Science databases for articles and abstracts focused on evaluating or improving quality of HIV clinical services. We extracted country income level, targeted clinical services, and quality evaluation approaches, data sources, and criteria. Fifty journal articles and 46 meeting abstracts were included. Of the 96 studies reviewed, 65% were programme evaluations, 71% focused on low- and middle-income countries, and 65% focused on antiretroviral therapy services. With regard to quality, 45% used a quality improvement model or programme, 13% set a quality threshold, and 51% examined patient records to evaluate quality. No studies provided a definition for quality HIV care. Quality assurance and improvement of HIV clinical services is increasingly important. This review highlights gaps in knowledge for future research, and may also help countries and programmes develop their HIV care quality improvement frameworks.
Abstract HIV was first described as a "long-wave event" in 1990, well before the advent of antiretroviral therapy (ART). The pandemic was then seen as involving three curves: an HIV curve, an AIDS curve and a curve representing societal impact. Since the mid-2000's, free public delivery of life-saving ART has begun shifting HIV from a terminal disease to a chronic illness for those who can access and tolerate the medications. This increasing chronicity prompts revisiting HIV as a long-wave ev...
This statement explores the ethical considerations surrounding the provision of fertility services to transgender individuals and concludes that denial of access to fertility services is not justified.
Formica, Andrea; The ATLAS collaboration
Usage of Conditions Data in ATLAS is extensive for offline reconstruction and analysis (for example: alignment, calibration, data quality). The system is based on the LCG Conditions Database infrastructure, with read and write access via an ad hoc C++ API (COOL), a system which was developed before Run 1 data taking began. The infrastructure dictates that the data is organized into separate schemas (assigned to subsystems/groups storing distinct and independent sets of conditions), making it difficult to access information from several schemas at the same time. We have thus created PL/SQL functions containing queries to provide content extraction at multi-schema level. The PL/SQL API has been exposed to external clients by means of an intermediate java application server (JBoss), where an application delivering access to the DB via RESTful services has been deployed. The services allow navigation over multiple schema content, via simple URLs. The queried data can be retrieved either in XML or JSON formats, vi...
Formica, Andrea; Gallas, E. J.
Usage of condition data in ATLAS is extensive for offline reconstruction and analysis (e.g. alignment, calibration, data quality). The system is based on the LCG Conditions Database infrastructure, with read and write access via an ad hoc C++ API (COOL), a system which was developed before Run 1 data taking began. The infrastructure dictates that the data is organized into separate schemas (assigned to subsystems/groups storing distinct and independent sets of conditions), making it difficult to access information from several schemas at the same time. We have thus created PL/SQL functions containing queries to provide content extraction at multi-schema level. The PL/SQL API has been exposed to external clients by means of a Java application providing DB access via REST services, deployed inside an application server (JBoss WildFly). The services allow navigation over multiple schemas via simple URLs. The data can be retrieved either in XML or JSON formats, via simple clients (like curl or Web browsers).
Formica, Andrea; The ATLAS collaboration
Usage of Conditions Data in ATLAS is extensive for offline reconstruction and analysis (e.g.: alignment, calibration, data quality). The system is based on the LCG Conditions Database infrastructure, with read and write access via an ad hoc C++ API (COOL), a system which was developed before Run 1 data taking began. The infrastructure dictates that the data is organized into separate schemata (assigned to subsystems/groups storing distinct and independent sets of conditions), making it difficult to access information from several schemata at the same time. We have thus created PL/SQL functions containing queries to provide content extraction at multi-schema level. The PL/SQL API has been exposed to external clients by means of a Java application providing DB access via RESTful services, deployed inside an application server (JBoss WildFly). The services allow navigation over multiple schemata via simple URLs. The data can be retrieved either in XML or JSON formats, via simple clients (like curl or Web browser...
Usage of condition data in ATLAS is extensive for offline reconstruction and analysis (e.g. alignment, calibration, data quality). The system is based on the LCG Conditions Database infrastructure, with read and write access via an ad hoc C++ API (COOL), a system which was developed before Run 1 data taking began. The infrastructure dictates that the data is organized into separate schemas (assigned to subsystems/groups storing distinct and independent sets of conditions), making it difficult to access information from several schemas at the same time. We have thus created PL/SQL functions containing queries to provide content extraction at multi-schema level. The PL/SQL API has been exposed to external clients by means of a Java application providing DB access via REST services, deployed inside an application server (JBoss WildFly). The services allow navigation over multiple schemas via simple URLs. The data can be retrieved either in XML or JSON formats, via simple clients (like curl or Web browsers).
Rizkalla, Christine; Bauman, Laurie J; Avner, Jeffrey R
As embarrassment is a known obstacle to condom acquisition, selling condoms from physically inaccessible places that require personnel assistance constitutes a barrier to access. This study investigates the extent of this barrier in the Bronx, a high HIV/STI prevalence county of New York. 75 of 320 listed Bronx pharmacies were sampled via computer randomization. Investigators coded condom placement and physical accessibility within these pharmacies and 140 surrounding stores. 91% of sites sold condoms. In 82%, condoms could not be accessed without assistance. Condoms were physically inaccessible in venues most encountered in the community: grocery stores versus pharmacies (OR=15; 95% CI, 5-48), independent versus chain pharmacies (OR=32; 95% CI, 6-235). They were physically inaccessible more in the lowest SES/highest HIV prevalence areas versus the highest SES/lowest HIV prevalence areas (OR = 4.3, 95% CI, 1.1-17). Findings can inform efforts to increase accessibility of condoms, distribute condoms in alternative settings, and prompt similar investigations in other high-risk communities.
Full Text Available As embarrassment is a known obstacle to condom acquisition, selling condoms from physically inaccessible places that require personnel assistance constitutes a barrier to access. This study investigates the extent of this barrier in the Bronx, a high HIV/STI prevalence county of New York. 75 of 320 listed Bronx pharmacies were sampled via computer randomization. Investigators coded condom placement and physical accessibility within these pharmacies and 140 surrounding stores. 91% of sites sold condoms. In 82%, condoms could not be accessed without assistance. Condoms were physically inaccessible in venues most encountered in the community: grocery stores versus pharmacies (OR=15; 95% CI, 5–48, independent versus chain pharmacies (OR=32; 95% CI, 6–235. They were physically inaccessible more in the lowest SES/highest HIV prevalence areas versus the highest SES/lowest HIV prevalence areas (OR = 4.3, 95% CI, 1.1–17. Findings can inform efforts to increase accessibility of condoms, distribute condoms in alternative settings, and prompt similar investigations in other high-risk communities.
Full Text Available The flexibility of the MOOC service allows students to learn at their own time, place and pace, enhancing continuous communication and interaction between all participants in knowledge and community building. This model especially benefits people with disabilities, which can improve therefore their level of employability and social inclusion, reaching a better quality of life. Unfortunately the access to MOOC platforms present severe barriers: there is a lack of accessibility on the learning resources, the communicating tools and personalized user interfaces. All these issues add extra difficulties such as the need to develop specific digital or even social skills for students with functional diversity. In this context, MOOCs are leading a revolutionary computer and mobile-based scenario along with social technologies that will emerge new kinds of learning applications that enhance communication and collaboration processes. For that reason, this paper describes the need for designing an information model and related specifications to support a new strategy for delivering accessible MOOC courses to learners with special needs, in terms of their preferences and context of use based on a particular application profile. This user profile’s design is based on standard metadata schemas, data that provides information about other data, regarding the achievement of accessibility from content to user preferences.
Full Text Available Cloud computing is a set of resources and services offered by Internet. It provides all kinds of services for end user. One of the most important services provided by cloud computing is an Email (Data Storage and File Sharing. Employees or any Committee of Institution are very interested in sharing documents with group members. There is possibility of creating one group to share information with all. So, in everybody’s registered email id, they will get notification for it. Here, everybody have their own mail id. In this research paper, a model is discussed which allow one email id and two users sharing same Email id. This mechanism is like Joint access of single bank account between two members.
Full Text Available Introduction. HIV in Serbia is most often transmitted through sexual contact, and therefore numerous prevention activities are geared towards sex workers (SW. Objective. To analyze the differences in knowledge, attitudes and risky behaviour between indoor and street SW in Belgrade; to examine the accessibility of health services to this vulnerable group. Methods. In this behavioural cross-sectional study, 113 street and 78 indoor SW were included. The sampling method used was snowball samples. Data were gathered through structured questionnaires. Results. Around 15% of respondents used drugs intravenously. Around 60% of SW used a condom during the last sexual intercourse with their private partner, and around 90% with a commercial partner. Indoor SW had lower levels of education more often than outdoor SW, and they used marijuana, sedatives and painkillers on a daily basis. A significantly higher number of indoor SW were informed about HIV, HBV and HCV testing, and that the risk for HIV infection is not lower if a condom is used exclusively for vaginal sex. Indoor SW reported using health services and testing and counseling for HIV, HBV and HCV more frequently than outdoor SW. Outdoor SW had significantly more sex partners in the previous month than indoor SW. Indoor SW recognized more frequently that providing sex services posed a higher risk for HIV infection. Conclusion. The results of this research study show that even though outdoor SW had higher levels of education than indoor SW, their level of knowledge about HIV transmission was lower and they reported more risky behaviour than indoor SW. Data show that both groups reported not taking care of their health.
Singer, Richard; Cardenas, Gabriel; Xavier, Jessica; Jeanty, Yves; Pereyra, Margaret; Rodriguez, Allan; Metsch, Lisa R.
Objectives We examined factors associated with dental anxiety among a sample of HIV primary care patients and investigated the independent association of dental anxiety with oral health care. Methods Cross-sectional data were collected in 2010 from 444 patients attending two HIV primary care clinics in Miami-Dade County, Florida. Corah Dental Anxiety Scores and use of oral health-care services were obtained from all HIV-positive patients in the survey. Results The prevalence of moderate to severe dental anxiety in this sample was 37.8%, while 7.9% of the sample was characterized with severe dental anxiety. The adjusted odds of having severe dental anxiety were 3.962 times greater for females than for males (95% confidence interval [CI] 1.688, 9.130). After controlling for age, ethnicity, gender, education, access to dental care, and HIV primary clinic experience, participants with severe dental anxiety had 69.3% lower adjusted odds of using oral health-care services within the past 12 months (vs. longer than 12 months ago) compared with participants with less-than-severe dental anxiety (adjusted odds ratio = 0.307, 95% CI 0.127, 0.742). Conclusion A sizable number of patients living with HIV have anxiety associated with obtaining needed dental care. Routine screening for dental anxiety and counseling to reduce dental anxiety are supported by this study as a means of addressing the impact of dental anxiety on the use of oral health services among HIV-positive individuals. PMID:22547875
McClarty, Leigh M; Lorway, Robert R; Ramanaik, Satyanarayana; Wylie, John; Becker, Marissa L
The HIV epidemic in the south Indian state of Karnataka disproportionately burdens key populations of men who have sex with men and female sex workers. Despite having successfully reduced HIV incidence among certain key populations through the use of targeted intervention, India's HIV epidemic remains one of its greatest public health issues. The best long-term strategy for managing the global HIV epidemic might involve a preventive vaccine; however, vaccine availability cannot guarantee its accessibility or acceptability. Vaccine recommendations from frontline health service providers have previously been identified as useful strategies to enhance vaccine uptake among target groups. This study used structured interviews to explore frontline health service providers' self-identified likelihood to recommend a future, preventive HIV vaccine to key populations in Karnataka. A modified social ecological model was then used to categorise factors that might prevent health service providers from recommending an HIV vaccine. Overall, 83% of health service providers reported that they would be very likely to recommend an HIV vaccine to men who have sex with men and female sex workers, while less than one-third of participants identified one or more barrier to vaccine recommendation. Intrapersonal, interpersonal, and structural/political factors were most commonly reported to act as potential barriers to future HIV vaccine recommendation among health service providers in Karnataka. This study adds to the limited body of literature focussing on future HIV vaccine acceptability in low- and middle-income countries and highlights some of the several complexities surrounding vaccine acceptability and uptake among key populations in Karnataka. Copyright © 2014 Elsevier Ltd. All rights reserved.
CERN has recently experienced several computer security incidents caused by people opening VPN connections and (unknown to them) allowing malicious software to enter CERN. VPN should be used to connect to CERN only in extreme and exceptional circumstances and it is formally discouraged as a general solution. If incidents continue, the availability of the service will need to be reviewed. Recommended methods of connecting to CERN from the Internet for common functionalities such as e-mail, access to CERN web or file servers and interactive sessions on CERN systems are described at http://cern.ch/security/vpn
The existence of a right to healthcare or, at least, access to healthcare services, is a right that exists in terms of the Bill of Rights in the Constitution of the Republic of South Africa, 1996. This article explores the scope and ambit of the right and its meaning within the context of both of constitutional directives, the duties imposed upon the State to progressively realise the right for its citizens and the practical implications of the right with reference to existing healthcare infrastructure in the Republic of South Africa.
Niu, Lu; Luo, Dan; Liu, Ying; Xiao, Shuiyuan
Objective: The present study was designed to assess the quality of Chinese-language Internet-based information on HIV/AIDS. Methods: We entered the following search terms, in Chinese, into Baidu and Sogou: “HIV/AIDS”, “symptoms”, and “treatment”, and evaluated the first 50 hits of each query using the Minervation validation instrument (LIDA tool) and DISCERN instrument. Results: Of the 900 hits identified, 85 websites were included in this study. The overall score of the LIDA tool was 63.7%; the mean score of accessibility, usability, and reliability was 82.2%, 71.5%, and 27.3%, respectively. Of the top 15 sites according to the LIDA score, the mean DISCERN score was calculated at 43.1 (95% confidence intervals (CI) = 37.7–49.5). Noncommercial websites showed higher DISCERN scores than commercial websites; whereas commercial websites were more likely to be found in the first 20 links obtained from each search engine than the noncommercial websites. Conclusions: In general, the HIV/AIDS related Chinese-language websites have poor reliability, although their accessibility and usability are fair. In addition, the treatment information presented on Chinese-language websites is far from sufficient. There is an imperative need for professionals and specialized institutes to improve the comprehensiveness of web-based information related to HIV/AIDS. PMID:27556475
The role of family planning in achieving safe pregnancy for serodiscordant couples: commentary from the United States government's interagency task force on family planning and HIV service integration.
Mason, Jennifer; Medley, Amy; Yeiser, Sarah; Nightingale, Vienna R; Mani, Nithya; Sripipatana, Tabitha; Abutu, Andrew; Johnston, Beverly; Watts, D Heather
People living with HIV (PLHIV) have the right to exercise voluntary choices about their health, including their reproductive health. This commentary discusses the integral role that family planning (FP) plays in helping PLHIV, including those in serodiscordant relationships, achieve conception safely. The United States (US) President's Emergency Plan for AIDS Relief (PEPFAR) is committed to meeting the reproductive health needs of PLHIV by improving their access to voluntary FP counselling and services, including prevention of unintended pregnancy and counselling for safer conception. Inclusion of preconception care and counselling (PCC) as part of routine HIV services is critical to preventing unintended pregnancies and perinatal infections among PLHIV. PLHIV not desiring a current pregnancy should be provided with information and counselling on all available FP methods and then either given the method onsite or through a facilitated referral process. PLHIV, who desire children should be offered risk reduction counselling, support for HIV status disclosure and partner testing, information on safer conception options to reduce the risk of HIV transmission to the partner and the importance of adhering to antiretroviral treatment during pregnancy and breastfeeding to reduce the risk of vertical transmission to the infant. Integration of PCC, HIV and FP services at the same location is recommended to improve access to these services for PLHIV. Other considerations to be addressed include the social and structural context, the health system capacity to offer these services, and stigma and discrimination of providers. Evaluation of innovative service delivery models for delivering PCC services is needed, including provision in community-based settings. The US Government will continue to partner with local organizations, Ministries of Health, the private sector, civil society, multilateral and bilateral donors, and other key stakeholders to strengthen both the policy and
Kissam, Ed; Dorsey, Holda
This module, which may be used as the basis for a workshop or as a special topic unit in adult basic education or English-as-a-Second-Language (ESL) courses, discusses how to access the formalized human service delivery systems in the United States, which often replace the networks of extended families and friends that immigrants relied on in…
Richard G Parker
Full Text Available Introduction: Critical technological advances have yielded a toolkit of HIV prevention strategies. This literature review sought to provide contextual and historical reflection needed to bridge the conceptual gap between clinical efficacy and community effectiveness (i.e. knowledge and usage of existing HIV prevention options, especially in resource-poor settings. Methods: Between January 2015 and October 2015, we reviewed scholarly and grey literatures to define treatment literacy and health literacy and assess the current need for literacy related to HIV prevention. The review included searches in electronic databases including MEDLINE, PsycINFO, PubMed, and Google Scholar. Permutations of the following search terms were used: “treatment literacy,” “treatment education,” “health literacy,” and “prevention literacy.” Through an iterative process of analyses and searches, titles and/or abstracts and reference lists of retrieved articles were reviewed for additional articles, and historical content analyses of grey literature and websites were additionally conducted. Results and discussion: Treatment literacy was a well-established concept developed in the global South, which was later partially adopted by international agencies such as the World Health Organization. Treatment literacy emerged as more effective antiretroviral therapies became available. Developed from popular pedagogy and grassroots efforts during an intense struggle for treatment access, treatment literacy addressed the need to extend access to underserved communities and low-income settings that might otherwise be excluded from access. In contrast, prevention literacy is absent in the recent surge of new biomedical prevention strategies; prevention literacy was scarcely referenced and undertheorized in the available literature. Prevention efforts today include multimodal techniques, which jointly comprise a toolkit of biomedical, behavioural, and structural
Parker, Richard G; Perez-Brumer, Amaya; Garcia, Jonathan; Gavigan, Kelly; Ramirez, Ana; Milnor, Jack; Terto, Veriano
Introduction Critical technological advances have yielded a toolkit of HIV prevention strategies. This literature review sought to provide contextual and historical reflection needed to bridge the conceptual gap between clinical efficacy and community effectiveness (i.e. knowledge and usage) of existing HIV prevention options, especially in resource-poor settings. Methods Between January 2015 and October 2015, we reviewed scholarly and grey literatures to define treatment literacy and health literacy and assess the current need for literacy related to HIV prevention. The review included searches in electronic databases including MEDLINE, PsycINFO, PubMed, and Google Scholar. Permutations of the following search terms were used: “treatment literacy,” “treatment education,” “health literacy,” and “prevention literacy.” Through an iterative process of analyses and searches, titles and/or abstracts and reference lists of retrieved articles were reviewed for additional articles, and historical content analyses of grey literature and websites were additionally conducted. Results and discussion Treatment literacy was a well-established concept developed in the global South, which was later partially adopted by international agencies such as the World Health Organization. Treatment literacy emerged as more effective antiretroviral therapies became available. Developed from popular pedagogy and grassroots efforts during an intense struggle for treatment access, treatment literacy addressed the need to extend access to underserved communities and low-income settings that might otherwise be excluded from access. In contrast, prevention literacy is absent in the recent surge of new biomedical prevention strategies; prevention literacy was scarcely referenced and undertheorized in the available literature. Prevention efforts today include multimodal techniques, which jointly comprise a toolkit of biomedical, behavioural, and structural/environmental approaches
Full Text Available Introduction: Evidence suggests that people who inject drugs often begin their drug use and injecting practices in adolescence, yet there are limited data available on the HIV epidemic and the responses for this population. The comprehensive package of interventions for the prevention, treatment and care of HIV infection among people who inject drugs first laid out in 2009 (revised in 2012 by World Health Organization, United Nations Office of Drugs and Crime and Joint United Nations Programme on HIV/AIDS, does not consider the unique needs of adolescent and young people. In order to better understand the values and preferences of young people who inject drugs in accessing harm reduction services and support, we undertook a series of community consultations with young people with experience of injecting drugs during adolescence. Methods: Community consultations (4–14 persons were held in 14 countries. Participants were recruited using a combined criterion and maximum variation sampling strategy. Data were analyzed using collaborative qualitative data analysis. Frequency analysis of themes was conducted. Results: Nineteen community consultations were organized with a total of 132 participants. All participants had experienced injecting drugs before the age of 18. They had the following age distribution: 18–20 (37%, 21–25 (48% and 26–30 (15%. Of the participants, 73.5% were male while 25.7% were female, with one transgender participant. Barriers to accessing the comprehensive package included: lack of information and knowledge of services, age restrictions on services, belief that services were not needed, fear of law enforcement, fear of stigma, lack of concern, high cost, lack of outreach, lack of knowledge of HCV/TB and lack of youth friendly services. Conclusions: The consultations provide a rare insight into the lived experiences of adolescents who inject drugs and highlight the dissonance between their reality and current policy and
Rivera-Diaz, Marinilda; Varas-Diaz, Nelson; Reyes-Estrada, Marcos; Suro, Beatriz; Coriano, Doralis
HIV/AIDS stigma continues affecting the provision of health services to people living with HIV/AIDS, as well as their physical and mental well-being. Scientific literature has highlighted the importance of understanding stigma manifestations that surpass one-on-one social interactions. For that reason, social research in Puerto Rico and elsewhere has highlighted the importance of understanding the Socio-Structural Factors (SSF) that foster HIV/AIDS stigma. With the objective of exploring the SSF that influence stigma manifestations related to HIV/AIDS, we conducted 9 focus groups composed by women and men on HIV/AIDS treatment that had experienced social stigma related to the disease. Participants identified SSF that they understood were related to stigma such as a) development of housing projects for people with HIV/AIDS, b) decentralization of health related services, and c) health services administrative protocols that fostered exclusion. Results evidence the importance of addressing SSF when developing stigma related interventions for this population.
Brown, K E; Newby, K; Caley, M; Danahay, A; Kehal, I
Sexual health service access is fundamental to good sexual health, yet interventions designed to address this have rarely been implemented or evaluated. In this article, pilot evaluation findings for a targeted public health behavior change intervention, delivered via a website and web-app, aiming to increase uptake of sexual health services among 13-19-year olds are reported. A pre-post questionnaire-based design was used. Matched baseline and follow-up data were identified from 148 respondents aged 13-18 years. Outcome measures were self-reported service access, self-reported intention to access services and beliefs about services and service access identified through needs analysis. Objective service access data provided by local sexual health services were also analyzed. Analysis suggests the intervention had a significant positive effect on psychological barriers to and antecedents of service access among females. Males, who reported greater confidence in service access compared with females, significantly increased service access by time 2 follow-up. Available objective service access data support the assertion that the intervention may have led to increases in service access. There is real promise for this novel digital intervention. Further evaluation is planned as the model is licensed to and rolled out by other local authorities in the United Kingdom.
Olivier, C; Dykeman, M
Interdisciplinary collaboration can be enhanced through an understanding of the challenges and needs associated with service provision. This study explores the experiences of 192 service providers, with additional comparisons of nurses and social workers. Service providers reported fear of contracting HIV, feeling helpless, problems getting up-to-date information, grief and inadequate referral resources. Except for many more nurses expressing worry about contracting HIV, nurses and social workers shared many of the same problems. In addition, both groups were concerned with the comprehensive health needs of people living with HIV/AIDS. Moreover, they demonstrated shared professional values such as the importance of self-awareness and professional knowledge, positive and non-judgemental attitudes, and non-discriminatory treatment of client groups. This commonality makes nurses and social workers natural allies in responding to the many challenges associated with HIV service provision. Study findings support collaboration in the areas of service delivery, policy development, advocacy and professional development.
Chileshe, Muatale; Bond, Virginia Anne
The vulnerabilities that underlie barriers faced by the rural poor whilst trying to access and adhere to "free" antiretroviral treatment (ART) demand more attention. This paper highlights barriers that poor rural Zambians co-infected with tuberculosis (TB) and HIV and their households faced in accessing ART between September 2006 and July 2007, and accounts for patient outcomes by the end of TB treatment and (more sporadically) beyond October 2009. The analysis draws on findings from wider anthropological fieldwork on the converging impact of TB, HIV and food insecurity, focusing for the purpose of this paper on ethnographic case-studies of seven newly diagnosed TB patients co-infected with HIV and their six households (one household had two TB patients). Economic barriers included being pushed into deeper poverty by managing TB, rural location, absence of any external assistance, and mustering time and extended funds for transport and "special food" during and beyond the end of TB. In the case of death, funeral costs were astronomical. Social barriers included translocation, broken marriages, a sub-ordinate household position, gender relations, denial, TB/HIV stigma and the difficulty of disclosure. Health facility barriers involved understaffing, many steps, lengthy procedures and inefficiencies (lost blood samples, electricity cuts). By the end of TB treatment, outcomes were mixed; two co-infected patients had died, three had started ART and two had yet to start ART. The three on ART underwent a striking transformation in the short term. By October 2009, two more had died and three were doing well. The study advocates nutritional support and other material support (especially transport funds) for co-infected TB patients until ART is accessed and livelihood regained. More prompt diagnosis of TB and reducing steps and increasing the reach of the ART programme in rural areas are also recommended.
Liu, Yu; Sun, Xiaoyun; Qian, Han-Zhu; Yin, Lu; Yan, Zheng; Wang, Lijuan; Jiang, Shulin; Lu, Hongyan; Ruan, Yuhua; Shao, Yiming; Vermund, Sten H; Amico, K Rivet
Diagnosis of HIV is the entry point into the continuum of HIV care; a well-recognized necessary condition for the ultimate prevention of onward transmission. In China, HIV testing rates among men who have sex with men (MSM) are low compared to other high risk subgroups, yet experiences with HIV testing among MSM in China are not well understood. To address this gap and prepare for intervention development to promote HIV testing and rapid linkage to treatment, six focus groups (FGs) were conducted with MSM in Beijing (40 HIV-positive MSM participated in one of four FGs and 20 HIV-negative or status unknown MSM participated in one of two FGs). Major themes reported as challenges to HIV testing included stigma and discrimination related to HIV and homosexuality, limited HIV knowledge, inconvenient clinic times, not knowing where to get a free test, fear of positive diagnosis or nosocomial infection, perceived low service quality, and concerns/doubts about HIV services. Key facilitators included compensation, peer support, professionalism, comfortable testing locations, rapid testing, referral and support after diagnosis, heightened sense of risk through engagement in high-risk behaviors, sense of responsibility to protect self, family and partner support, and publicity via social media. Themes and recommendations were generally consistent across HIV-positive and negative/status unknown groups, although examples of enacted stigma were more prevalent in the HIV-positive groups. Findings from our study provide policy suggestions for how to bolster current HIV prevention intervention efforts to enhance 'test-and-treat' strategies for Chinese MSM.
Underhill, Kristen; Morrow, Kathleen M.; Colleran, Christopher M.; Holcomb, Richard; Operario, Don; Calabrese, Sarah K.; Galárraga, Omar; Mayer, Kenneth H.
Background Pre-exposure prophylaxis (PrEP) is a promising strategy for HIV prevention among men who have sex with men (MSM) and men who engage in sex work. But access will require routine HIV testing and contacts with healthcare providers. This study investigated men’s healthcare and HIV testing experiences to inform PrEP implementation. Methods We conducted 8 focus groups (n = 38) in 2012 and 56 in-depth qualitative interviews in 2013–14 with male sex workers (MSWs) (n = 31) and other MSM (n = 25) in Providence, RI. MSWs primarily met clients in street-based sex work venues. Facilitators asked participants about access to healthcare and HIV/STI testing, healthcare needs, and preferred PrEP providers. Results MSWs primarily accessed care in emergency rooms (ERs), substance use clinics, correctional institutions, and walk-in clinics. Rates of HIV testing were high, but MSWs reported low access to other STI testing, low insurance coverage, and unmet healthcare needs including primary care, substance use treatment, and mental health services. MSM not engaging in sex work were more likely to report access to primary and specialist care. Rates of HIV testing among these MSM were slightly lower, but they reported more STI testing, more insurance coverage, and fewer unmet needs. Preferred PrEP providers for both groups included primary care physicians, infectious disease specialists, and psychiatrists. MSWs were also willing to access PrEP in substance use treatment and ER settings. Conclusions PrEP outreach efforts for MSWs and other MSM should engage diverse providers in many settings, including mental health and substance use treatment, ERs, needle exchanges, correctional institutions, and HIV testing centers. Access to PrEP will require financial assistance, but can build on existing healthcare contacts for both populations. PMID:25386746
Full Text Available Pre-exposure prophylaxis (PrEP is a promising strategy for HIV prevention among men who have sex with men (MSM and men who engage in sex work. But access will require routine HIV testing and contacts with healthcare providers. This study investigated men's healthcare and HIV testing experiences to inform PrEP implementation.We conducted 8 focus groups (n = 38 in 2012 and 56 in-depth qualitative interviews in 2013-14 with male sex workers (MSWs (n = 31 and other MSM (n = 25 in Providence, RI. MSWs primarily met clients in street-based sex work venues. Facilitators asked participants about access to healthcare and HIV/STI testing, healthcare needs, and preferred PrEP providers.MSWs primarily accessed care in emergency rooms (ERs, substance use clinics, correctional institutions, and walk-in clinics. Rates of HIV testing were high, but MSWs reported low access to other STI testing, low insurance coverage, and unmet healthcare needs including primary care, substance use treatment, and mental health services. MSM not engaging in sex work were more likely to report access to primary and specialist care. Rates of HIV testing among these MSM were slightly lower, but they reported more STI testing, more insurance coverage, and fewer unmet needs. Preferred PrEP providers for both groups included primary care physicians, infectious disease specialists, and psychiatrists. MSWs were also willing to access PrEP in substance use treatment and ER settings.PrEP outreach efforts for MSWs and other MSM should engage diverse providers in many settings, including mental health and substance use treatment, ERs, needle exchanges, correctional institutions, and HIV testing centers. Access to PrEP will require financial assistance, but can build on existing healthcare contacts for both populations.
Full Text Available Abstract Background In the face of the dual TB/HIV epidemic, the ProTEST Initiative was one of the first to demonstrate the feasibility of providing collaborative TB/HIV care for people living with HIV (PLWH in poor settings. The ProTEST Initiative facilitated collaboration between service providers. Voluntary counselling and testing (VCT acted as the entry point for services including TB screening and preventive therapy, clinical treatment for HIV-related disease, and home-based care (HBC, and a hospice. This paper estimates the costs of the ProTEST Initiative in two sites in urban Zambia, prior to the introduction of anti-retroviral therapy. Methods Annual financial and economic providers costs and output measures were collected in 2000–2001. Estimates are made of total costs for each component and average costs per: person reached by ProTEST; VCT pre-test counselled, tested and completed; isoniazid preventive therapy started and completed; clinic visit; HBC patient; and hospice admission and bednight. Results Annual core ProTEST costs were (in 2007 US dollars $84,213 in Chawama and $31,053 in Matero. The cost of coordination was 4%–5% of total site costs ($1–$6 per person reached. The largest cost component in Chawama was voluntary counselling and testing (56% and the clinic in Matero (50%, where VCT clients had higher HIV-prevalences and more advanced HIV. Average costs were lower for all components in the larger site. The cost per HBC patient was $149, and per hospice bednight was $24. Conclusion This study shows that coordinating an integrated and comprehensive package of services for PLWH is relatively inexpensive. The lessons learnt in this study are still applicable today in the era of ART, as these services must still be provided as part of the continuum of care for people living with HIV.
Sefhedi, Sheila; Montsi, Mercy; Mpofu, Elias
This exploratory study describes the provision of HIV & AIDS counselling services in Botswana junior secondary schools as perceived by teachers. A total of 45 teachers (age range = 20-55; teaching experience range = 0-21 years) from three schools participated. The participants completed a questionnaire on the types of HIV & AIDS-related…
Full Text Available Abstract Background We investigated the accessibility of reproductive health information and contraceptives in a relatively less developed area of rural central India and assessed the risks facing young unmarried men. Methods This cross-sectional study used both qualitative and quantitative methods. Participants included 38 unmarried rural men in four focus-group discussions and a representative sample of 316 similarly profiled men, aged 17-22 years, in a survey. Information was collected on the men's socioeconomic characteristics; awareness, knowledge, and perceptions of family planning; attitudes toward future contraceptive use; intra-family communication; knowledge about STIs/HIV/AIDS; and access and use of condoms. Content analysis for qualitative information and descriptive analysis for survey data were used to draw conclusions. Results Young unmarried rural Indian men's sexual and reproductive health (SRH knowledge is limited, although the majority is familiar with condoms (99%. The young men identified electronic mass media (67% as the prime source of reproductive health information, yet they lacked detailed knowledge of various contraceptives and felt ignored by health providers, who, they felt, would be capable of providing SRH information through interpersonal communication. Young men are more concerned about avoiding infections and securing sexual pleasure and less concerned about avoiding potential pregnancies. For example, 68% of the young men were aware of condoms and their HIV/AIDS preventive role, but only about two-fifths mentioned condom use to prevent unwanted pregnancies. Although most young men (96% knew where to access a condom, they felt uncomfortable or embarrassed doing so in their own villages or close by because of socio-cultural norms that prevented them from using contraceptives. Very few respondents (4% disclosed using condoms themselves, but 59% said they knew someone from their peer group who had used them
Char, Arundhati; Saavala, Minna; Kulmala, Teija
We investigated the accessibility of reproductive health information and contraceptives in a relatively less developed area of rural central India and assessed the risks facing young unmarried men. This cross-sectional study used both qualitative and quantitative methods. Participants included 38 unmarried rural men in four focus-group discussions and a representative sample of 316 similarly profiled men, aged 17-22 years, in a survey. Information was collected on the men's socioeconomic characteristics; awareness, knowledge, and perceptions of family planning; attitudes toward future contraceptive use; intra-family communication; knowledge about STIs/HIV/AIDS; and access and use of condoms. Content analysis for qualitative information and descriptive analysis for survey data were used to draw conclusions. Young unmarried rural Indian men's sexual and reproductive health (SRH) knowledge is limited, although the majority is familiar with condoms (99%). The young men identified electronic mass media (67%) as the prime source of reproductive health information, yet they lacked detailed knowledge of various contraceptives and felt ignored by health providers, who, they felt, would be capable of providing SRH information through interpersonal communication. Young men are more concerned about avoiding infections and securing sexual pleasure and less concerned about avoiding potential pregnancies. For example, 68% of the young men were aware of condoms and their HIV/AIDS preventive role, but only about two-fifths mentioned condom use to prevent unwanted pregnancies. Although most young men (96%) knew where to access a condom, they felt uncomfortable or embarrassed doing so in their own villages or close by because of socio-cultural norms that prevented them from using contraceptives. Very few respondents (4%) disclosed using condoms themselves, but 59% said they knew someone from their peer group who had used them. Young unmarried men in rural India are underserved with
... under the Ryan White HIV/AIDS Program AGENCY: Health Resources and Services Administration (HRSA), HHS. ACTION: Notice of a non-competitive one-time replacement award from Ryan White HIV/AIDS Program, Part C... replacement award to support comprehensive primary care services for persons living with HIV/AIDS,...
... Under the Ryan White HIV/AIDS Program AGENCY: Health Resources and Services Administration (HRSA), HHS... with HIV/AIDS, including primary medical care, laboratory testing, oral health care, outpatient mental... providing services after March 31, 2010. HRSA's HIV/AIDS Bureau identified the Rural Health Group as...
... Under the Ryan White HIV/AIDS Program AGENCY: Health Resources and Services Administration (HRSA... The Ryan White HIV/AIDS Program to support comprehensive primary care services for persons living with HIV/AIDS, including primary medical care, laboratory testing, oral health care, outpatient...
Jan A C Hontelez
Full Text Available BACKGROUND: Expanded access to antiretroviral therapy (ART using universal test and treat (UTT has been suggested as a strategy to eliminate HIV in South Africa within 7 y based on an influential mathematical modeling study. However, the underlying deterministic model was criticized widely, and other modeling studies did not always confirm the study's finding. The objective of our study is to better understand the implications of different model structures and assumptions, so as to arrive at the best possible predictions of the long-term impact of UTT and the possibility of elimination of HIV. METHODS AND FINDINGS: We developed nine structurally different mathematical models of the South African HIV epidemic in a stepwise approach of increasing complexity and realism. The simplest model resembles the initial deterministic model, while the most comprehensive model is the stochastic microsimulation model STDSIM, which includes sexual networks and HIV stages with different degrees of infectiousness. We defined UTT as annual screening and immediate ART for all HIV-infected adults, starting at 13% in January 2012 and scaled up to 90% coverage by January 2019. All models predict elimination, yet those that capture more processes underlying the HIV transmission dynamics predict elimination at a later point in time, after 20 to 25 y. Importantly, the most comprehensive model predicts that the current strategy of ART at CD4 count ≤350 cells/µl will also lead to elimination, albeit 10 y later compared to UTT. Still, UTT remains cost-effective, as many additional life-years would be saved. The study's major limitations are that elimination was defined as incidence below 1/1,000 person-years rather than 0% prevalence, and drug resistance was not modeled. CONCLUSIONS: Our results confirm previous predictions that the HIV epidemic in South Africa can be eliminated through universal testing and immediate treatment at 90% coverage. However, more realistic
Alemnji, George; Fonjungo, Peter; Van Der Pol, Barbara; Peter, Trevor; Kantor, Rami; Nkengasong, John
Strong laboratory services and systems are critical for delivering timely and quality health services that are vital to reduce patient attrition in the HIV treatment and prevention cascade. However, challenges exist in ensuring effective laboratory health systems strengthening and linkages. In particular, linkages and referrals between laboratory testing and other services need to be considered in the context of an integrated health system that includes prevention, treatment, and strategic information. Key components of laboratory health systems that are essential for effective linkages include an adequate workforce, appropriate point-of-care (POC) technology, available financing, supply chain management systems, and quality systems improvement, including accreditation. In this review, we highlight weaknesses of and gaps between laboratory testing and other program services. We propose a model for strengthening these systems to ensure effective linkages of laboratory services for improved access and retention in care of HIV/AIDS patients, particularly in low- and middle-income countries.
Racher, Frances E; Vollman, Ardene Robinson
Access to health services is a major concern across North America and abroad, with particular salience for the residents of rural and remote areas and the health professionals committed to providing services to them. Intrinsic to this discussion is clarification of the phenomenon of access to health services, a concept that remains nebulous and obscure to consumers, health care providers, and policymakers alike. Multiple understandings of access to health services impedes progress in the development of policy, the creation of programs, and the transformation of health services. Considerable discussion of theory concerning access to health services is articulated in public or community health literature and that of other disciplines; however, limited attention to this topic is apparent in nursing literature. This report articulates definitions, dimensions, and frameworks of access to health services from available literature and existing theory. Further, key points are identified and discussed for consideration in nursing research on the term access and implications for practice.
how this disease had impacted on health service provision in Tanzania from a cost perspective. Methods: The study .... health facilities. While the budget allocated for HIV/ ...... as social marketing, training of trainers and peer and risky groups ...
Choi, Stephanie K Y; Boyle, Eleanor; Cairney, John;
BACKGROUND: Major depression can profoundly impact clinical and quality-of-life outcomes of people living with HIV, and this disease is underdiagnosed and undertreated in many HIV-positive individuals. Here, we describe the prevalence of publicly funded primary and secondary mental health service...... use and antidepressant use, as well as mental health care for depression in accordance with existing Canadian guidelines for HIV-positive patients with depression in Ontario, Canada. METHODS: We conducted a prospective cohort study linking data from the Ontario HIV Treatment Network Cohort Study...... with depression, 493 (50%) patients used mental health services; 182 (18%) used primary services (general practitioners); 176 (18%) used secondary services (psychiatrists); and 135 (14%) used both. Antidepressants were used by 407 (39%) patients. Patients who identified as gay, lesbian, or bisexual, as having low...
Henley, Catherine; Forgwei, Gideon; Welty, Thomas; Golden, Matthew; Adimora, Adaora; Shields, Raymond; Muffih, Pius Tih
Background Partner services (PSs) are a long-standing component of HIV control programs in the United States and some parts of Europe. Small randomized trials suggest that HIV PS can be effective in identifying persons with undiagnosed HIV infection. However, the scalability and effectiveness of HIV PS in low-income countries are unknown. Methods We used data collected from 2009 to 2010 through a large HIV PS program in Cameroon to evaluate HIV PS in a developing country. HIV-positive index cases diagnosed in antenatal care, voluntary counseling and testing, and inpatient facilities were interviewed to collect information on their sexual partners. Partners were contacted via telephone or home visit to notify, test, and enroll those found to be HIV positive in medical care. Results Health advisors interviewed 1462 persons with HIV infection during the evaluation period; these persons provided information about 1607 sexual partners. Health advisors notified 1347 (83.8%) of these partners, of whom 900 (66.8%) were HIV tested. Of partners tested, 451 (50.1%) were HIV positive, of whom 386 (85.6%) enrolled into HIV medical care. An average 3.2 index cases needed to be interviewed to identify 1 HIV case. Conclusions HIV PS can be successfully implemented in a developing country and is highly effective in identifying persons with HIV infection and linking them to care. PMID:24220349
Full Text Available HIV counseling and testing (HCT is a critical gateway to treatment, care, and support services. For pregnant women, it is to access prevention of mother-to-child-transmission (PMTCT services. However, not much has been done to appraise this service from the perspective of the recipients in Nigeria. This study documents the appraisal of the HCT services received at the antenatal care (ANC services in three government hospitals in Ibadan, Nigeria, from the perspectives of pregnant women. Data were collected using focus group discussion guide among purposively selected 40 (21 primigravida and 19 multigravida pregnant women. Observation and inventory checklists were used to collect data on procedures and basic requirements of HCT. Content analysis was used to analyze the data. Participants were neither counseled nor given opportunity to voluntarily participate in HCT services as it was made compulsory before accessing ANC. Test results were reportedly handed over directly to participants without post-test counseling. Observation of HCT procedure showed that guidelines for counseling were not strictly adhered to. Inventory of facilities, staff, and materials revealed inadequate staffing, lack of a dedicated counseling room, and inadequate antiretroviral drugs and test kits. The HCT services as provided for pregnant women are fraught with procedural inadequacies. Training and supervision of health care workers as well as provision of resources are needed to address the situation.
Full Text Available Introduction: HIV-positive (HIV+ temporary residents living in Australia legally are unable to access government subsidized antiretroviral treatment (ART which is provided via Medicare to Australian citizens and permanent residents. Currently, there is no information systematically being collected on non-Medicare eligible HIV+ patients in Australia. The objectives of this study are to describe the population recruited to the Australian HIV Observational Database (AHOD Temporary Residents Access Study (ATRAS and to determine the short- and long-term outcomes of receiving (subsidized optimal ART and the impact on onwards HIV transmission. Methods: ATRAS was established in 2011. Eligible patients were recruited via the AHOD network. Key HIV-related characteristics were recorded at baseline and prospectively. Additional visa-related information was also recorded at baseline, and updated annually. Descriptive statistics were used to describe the ATRAS cohort in terms of visa status by key demographic characteristics, including sex, region of birth, and HIV disease status. CD4 cell count (mean and SD and the proportion with undetectable (<50 copies/ml HIV viral load are reported at baseline, 6 and 12 months of follow-up. We also estimate the proportion reduction of onward HIV transmission based on the reduction in proportion of people with detectable HIV viral load. Results: A total of 180 patients were recruited to ATRAS by June 2012, and by July 2013 39 patients no longer required ART via ATRAS, 35 of whom became eligible for Medicare-funded medication. At enrolment, 63% of ATRAS patients were receiving ART from alternative sources, 47% had an undetectable HIV viral load (<50 copies/ml and the median CD4 cell count was 343 cells/µl (IQR: 222–479. At 12 months of follow-up, 85% had an undetectable viral load. We estimated a 75% reduction in the risk of onward HIV transmission with the improved rate of undetectable viral load. Conclusions: The
Lafort, Yves; Jocitala, Osvaldo; Candrinho, Balthazar; Greener, Letitia; Beksinska, Mags; Smit, Jenni A; Chersich, Matthew; Delva, Wim
In the context of an implementation research project aiming at improving use of HIV and sexual and reproductive health (SRH) services for female sex workers (FSWs), a broad situational analysis was conducted in Tete, Mozambique, assessing if services are adapted to the needs of FSWs. Methods comprised (1) a policy analysis including a review of national guidelines and interviews with policy makers, and (2) health facility assessments at 6 public and 1 private health facilities, and 1 clinic specifically targeting FSWs, consisting of an audit checklist, interviews with 18 HIV/SRH care providers and interviews of 99 HIV/SRH care users. There exist national guidelines for most HIV/SRH care services, but none provides guidance for care adapted to the needs of high-risk women such as FSWs. The Ministry of Health recently initiated the process of establishing guidelines for attendance of key populations, including FSWs, at public health facilities. Policy makers have different views on the best approach for providing services to FSWs-integrated in the general health services or through parallel services for key populations-and there exists no national strategy. The most important provider of HIV/SRH services in the study area is the government. Most basic services are widely available, with the exception of certain family planning methods, cervical cancer screening, services for victims of sexual and gender-based violence, and termination of pregnancy (TOP). The public facilities face serious limitations in term of space, staff, equipment, regular supplies and adequate provider practices. A stand-alone clinic targeting key populations offers a limited range of services to the FSW population in part of the area. Private clinics offer only a few services, at commercial prices. There is a need to improve the availability of quality HIV/SRH services in general and to FSWs specifically, and to develop guidelines for care adapted to the needs of FSWs. Access for FSWs can be
Darin, Kristin M; Scarsi, Kimberly K; Klepser, Donald G; Klepser, Stephanie A; Reeves, Andrew; Young, Maria; Klepser, Michael E
To evaluate consumers' interest in pharmacist-provided human immunodeficiency virus (HIV) screening and to evaluate potential barriers and facilitators to HIV screening in the community pharmacy setting. Cross-sectional survey of adult patients who presented to one of five community (chain and independent) pharmacies from November 2010 to August 2011. Based on 380 usable surveys, 135 (35.8%) participants were interested in pharmacy-based HIV screening. Independent predictors of interest in HIV screening identified in multivariate analysis (reference groups: ages 30 to 49 years old and white, non-Hispanic race) included younger age (18 to 29 years old) (odds ratio [OR], 2.48; 95% confidence interval [CI], 1.31 to 4.71); black, non-Hispanic race (OR, 2.37; CI, 1.40 to 4.03); and other race (OR, 4.58; CI, 1.63 to 12.87). Lack of perceived risk for HIV was the most commonly cited barrier to HIV screening; and free, rapid, or confidential HIV testing were identified as potential facilitators. Interest in pharmacy-based HIV screening was high among participants representing age and race groups disproportionately affected by HIV. Expansion of HIV screening efforts to community pharmacies warrants further consideration.
... priority access service by commercial mobile radio service providers. 64.402 Section 64.402... Policies and procedures for the provision of priority access service by commercial mobile radio service providers. Commercial mobile radio service providers that elect to provide priority access service...
Migrants, refugees, and internally displaced people are vulnerable to HIV because they live in poor areas with little privacy, have different sexual relationships, and lack information about sexual health and services. In response to these problems, HIV prevention and care programs were initiated. The programs include: 1) involving migrant workers as both interviewers and outreach workers to better understand the idea of the migrants per Coordination of Action Research on Mobility and AIDS; 2) improving living conditions; 3) access of migrants to information and services; 4) improving the rights of the people; 5) increasing income; and 6) access to sexual health information that concerns exposure of HIV through different sexual partners.
McGuire, R. E.; Bilitza, D.; Boardsen, S. A.; Candey, R. M.; Chimiak, R.; Cooper, J. F.; Garcia, L. N.; Harris, B. T.; Johnson, R. C.; Kovalick, T. J.; Lal, N.; Leckner, H. A.; Liu, M. H.; Papitashvili, N. E.; Rao, U. R.; Roberts, D. A.; Yurow, R. E.
In its role as a Heliophysics Active Final Archive and in close cooperation with the MMS project and its Science Data Center, the Space Physics Data Facility (SPDF) now serves a full set of public MMS data and QuickLook plots. All SPDF services for this data and all data are available via links from the SPDF home page (http://spdf.gsfc.nasa.gov). SPDF's CDAWeb features MMS Level-2 survey and burst mode data with graphics, listing and data superset/subset functions. These capabilities are available (1) through our html user interface, (2) through calls to our CDAS web services API, and (3) through other interfaces and libraries using the CDAS web services or that otherwise access our holdings including SPDF's Heliophysics Data Portal and several external systems. As context in use of the MMS data, CDAWeb also serves current data from many other current missions. These include the Van Allen Probes 1/2 and the five THEMIS/ARTEMIS spacecraft, as well as e.g. ACE, Cluster 1/2/3/4, DMSP 16/17/18, Geotail, GOES 13/14/15, NOAA/POES 15/16/18/19, MetOP POES 1/2, Stereo A/B, TWINS 1/2, Wind and >120 Ground-Based investigations). This full set of public MMS Level-2 science data and QuickLook plots, and all other public data held by SPDF, are also available for direct file download by HTTP or FTP links from the SPDF home page above. As a reminder, MMS Level-2 data are publicly available about 30 days after data is taken, and QuickLook survey plots are available about a day after data is taken). MMS orbits (current and predictive) are served through SPDF's SSCWeb service and our Java-based interactive 4D Orbit Viewer, also with orbits of many other current missions). Our presentation will discuss recent enhancements to CDAWeb and other services and our plans to support new MMS data products and upcoming heliophysics missions including ICON, GOLD and Solar Probe Plus.
Frey-Wettstein, M; Leder, A; Schütze, M
An inquiry amongst blood transfusion services served to establish at 19 the number of known transfusion associated HIV infections in Switzerland. In 12 cases the transfusion of an anti-HIV positive blood unit could be proven retrospectively, while in 7 cases an HIV-infected blood donor could not be found but the association of the infection with blood transfusion is highly probable by exclusion of other risk factors. All these infections occurred before introduction of anti-HIV screening in Switzerland in November 1985. After this date no new transfusion associated HIV infections have been reported. It is estimated that there are fewer than 170 transfusion associated HIV infections in Switzerland. The probability of infection with AIDS by blood transfusion is less than 1:500,000. Blood transfusion today appears to be as safe as before the emergence of the AIDS epidemic.
... 7 Agriculture 11 2010-01-01 2010-01-01 false RUS standard for service installations at customers... customers access locations. (a) Sections 1755.501 through 1755.510 cover service installations at permanent or mobile home customer access locations. Sections 1755.501 through 1755.510 do not cover service...
Sun, Jing; Boing, Alexandra Crispim; Silveira, Marysabel P T; Bertoldi, Andréa D; Ziganshina, Liliya E; Khaziakhmetova, Veronica N; Khamidulina, Rashida M; Chokshi, Maulik R; McGee, Shelley; Suleman, Fatima
This article illustrates how the BRICS countries have been building their focused leadership, making important high level commitment and national policy changes, and improving their health systems, in addressing the HIV/AIDS epidemics in respective settings. Specific aspects are focused on efforts of creating public provisions to secure universal access to ARVs from the aspects of active responsive system and national program, health system strengthening, fostering local production of ARVs, supply chain management, and information system strengthening. Challenges in each BRICS country are analyzed respectively. The most important contributors to the success of response to HIV/AIDS include: creating legal basis for healthcare as a fundamental human right; political commitment to necessary funding for universal access and concrete actions to secure equal quality care; comprehensive system to secure demands that all people in need are capable of accessing prevention, treatment and care; active community involvement; decentralization of the management system considering the local settings; integration of treatment and prevention; taking horizontal approach to strengthen health systems; fully use of the TRIPS flexibility; and regular monitoring and evaluation to serve evidence based decision making.
..., the current process and timelines used to manage and monitor grant applications makes either of these... waiver request must be signed by the chief elected official or the Project Director, and include the... of a waiver will positively contribute to the grantee's ability to address service needs for HIV/AIDS...
Full Text Available Objective. To investigate barriers and correlates of the use of HIV prevention services and HIV testing behaviors among men who have sex with men in Chongqing. Methods. Three consecutive cross-sectional surveys provided demographic, sexual behavior, HIV/syphilis infection, HIV prevention service, and testing behavior data. Results. Of 1239 participants, 15.4% were infected with HIV, incidence was 12.3 per 100 persons/year (95% CI: 9.2–15.3, 38% of the participants reported ever having unprotected insertive anal sex, 40% ever received free condom/lubricants in the past year, and 27.7% ever obtained free sexually transmitted infection examination/treatment in the past year. Multivariable logistic regression revealed that lower levels of HIV/AIDS related stigmatizing/discriminatory attitudes, full-time jobs, and sex debut with men at a younger age were independently associated with use of free condom/lubricants. Large social networks, higher incomes, and sexual debut with men at a younger age were associated with use of any HIV prevention and HIV testing services. Lower levels of stigmatizing/discriminatory attitudes were also associated with HIV testing. Fearing needles and being unaware of the venues for testing were top barriers for testing service utilization. Conclusion. It is imperative to address HIV/AIDS related stigmatizing/discriminatory attitudes and other barriers while delivering intervention and testing services.
McGrail, Matthew R; Russell, Deborah J; Humphreys, John S
Objective Improving access to primary health care (PHC) remains a key issue for rural residents and health service planners. This study aims to show that how access to PHC services is measured has important implications for rural health service and workforce planning.Methods A more sophisticated tool to measure access to PHC services is proposed, which can help health service planners overcome the shortcomings of existing measures and long-standing access barriers to PHC. Critically, the proposed Index of Access captures key components of access and uses a floating catchment approach to better define service areas and population accessibility levels. Moreover, as demonstrated through a case study, the Index of Access enables modelling of the effects of workforce supply variations.Results Hypothetical increases in supply are modelled for a range of regional centres, medium and small rural towns, with resulting changes of access scores valuable to informing health service and workforce planning decisions.Conclusions The availability and application of a specific 'fit-for-purpose' access measure enables a more accurate empirical basis for service planning and allocation of health resources. This measure has great potential for improved identification of PHC access inequities and guiding redistribution of PHC services to correct such inequities.What is known about the topic? Resource allocation and health service planning decisions for rural and remote health settings are currently based on either simple measures of access (e.g. provider-to-population ratios) or proxy measures of access (e.g. standard geographical classifications). Both approaches have substantial limitations for informing rural health service planning and decision making.What does this paper add? The adoption of a new improved tool to measure access to PHC services, the Index of Access, is proposed to assist health service and workforce planning. Its usefulness for health service planning is
Full Text Available Abstract Background Well-documented shortages of health care workers in sub-Saharan Africa are exacerbated by the increased human resource demands of rapidly expanding HIV care and treatment programmes. The successful continuation of existing programmes is threatened by health care worker burnout and HIV-related illness. Methods From March to June 2007, we studied occupational burnout and utilization of HIV services among health providers in the Lusaka public health sector. Providers from 13 public clinics were given a 36-item, self-administered questionnaire and invited for focus group discussions and key-informant interviews. Results Some 483 active clinical staff completed the questionnaire (84% response rate, 50 staff participated in six focus groups, and four individuals gave interviews. Focus group participants described burnout as feeling overworked, stressed and tired. In the survey, 51% reported occupational burnout. Risk factors were having another job (RR 1.4 95% CI 1.2–1.6 and knowing a co-worker who left in the last year (RR 1.6 95% CI 1.3–2.2. Reasons for co-worker attrition included: better pay (40%, feeling overworked or stressed (21%, moving away (16%, death (8% and illness (5%. When asked about HIV testing, 370 of 456 (81% reported having tested; 240 (50% tested in the last year. In contrast, discussion groups perceived low testing rates. Both discussion groups and survey respondents identified confidentiality as the prime reason for not undergoing HIV testing. Conclusion In Lusaka primary care clinics, overwork, illness and death were common reasons for attrition. Programmes to improve access, acceptability and confidentiality of health care services for clinical providers and to reduce workplace stress could substantially affect workforce stability.
Full Text Available Background and purpose: Pharmacetical care has been shifted from product or drug oriented paradigm into patient oriented to ensure that every custumer will be able get the most effective medication. This research aimed was to explore the relationship between pharmaceutical services and satisfaction of customers accessing the pharmacy services in Denpasar. Methods: This research was analytic study using cross sectional design. The sample consists of 116 customers taken from 20 pharmacies at Denpasar. Data was collected using self-administered questionnaires. Data was analyzed using logistic regression. Results: The analysis indicated that the level of customer satisfaction was 46.55%. There was a significant relationship between pharmacy appearance (OR=12.819, 95%CI: 2.791-58.870, drug information services (OR=16.157, 95%CI: 3.279-79.620, the availability of drugs (OR=6.811, 95%CI: 1.571-29.460, and speed of service (OR=43.432, 95%CI: 7.197-262.095 with satisfaction levels of customers. Conclusion: It is recommended that there is an upgrade of facilities in order to enhance customer satisfaction including an increase in staff numbers attending to customers that are able to provide adequate information so as to optimize service provision. Keywords: pharmaceutical services, customer satisfaction, pharmacy, Denpasar
Full Text Available Long Thanh Nguyen,1 Bach Xuan Tran,2 Cuong Tuan Tran,1 Huong Thi Le,1 Son Van Tran1 1Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam; 2Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam Introduction: Antiretroviral treatment (ART services are estimated to account for 30% of the total resources needed for human immunodeficiency virus (HIV/acquired immunodeficiency syndrome (AIDS control and prevention in Vietnam during the 2011–2020 timeframe. With international funding decreasing, determining the total cost of HIV/AIDS treatment is necessary in order to develop a master plan for the transition of ART services delivery and management. We analyzed the costs of HIV/AIDS treatment paid by both HIV programs and patients in a central outpatient clinic, and we explored factors associated with the capacity of patients to pay for this service. Methods: Patients (n=315 receiving ART in the Department of Infectious Diseases at Bach Mai Hospital, Hanoi, Vietnam, were interviewed. Patient records and expenses were reviewed. Results: The total cost of ART per patient was US$611 (75% from health care providers, 25% from patients or their families. The cost of a second-line regimen was found to be 2.7 times higher than the first-line regimen cost. Most outpatients (73.3% were able to completely pay for all of their ART expenses. Capacity to pay for ART was influenced by five factors, including marital status, distance from house to clinic, patient's monthly income, household economic condition, and health insurance status. Most of the patients (84.8% would have been willing to pay for health insurance if a copayment scheme for ART were to be introduced. Conclusion: This study provides evidence on payment capacity of HIV/AIDS patients in Vietnam and supplies information on ART costs from both provider and patient perspectives. In particular, results from this study suggest that earlier access to ART
The present paper discusses the importance, objectives and major developments in open access initiatives. It further examines the specific use of digital information services including the digital reference service. The paper also highlights the various steps taken in this direction at the Central Library of IIT Madras.
Full Text Available In this paper we tackle the mobility issue in IP Multimedia Subsystem (IMS. Although IMS was designedto integrate different access networks, mobility management among these networks is still unresolved. We propose a novel hybrid mobility management scheme, based on tight cooperation between fast handovers for mobile IPv6 (FMIPv6 and session initiation protocol (SIP to ensure an uninterrupted real-time service. Moreover, the new Media Independent Handover (MIH service is integrated into IMS architecture in order to perform intelligent and accurate horizontal and vertical handovers. We investigate two handover cases: selected handover and forced handover. Selected handover takes place when user equipment (UE is connected to the network via two interfaces at the same time and decides to upgrade the quality of its connection following a given criterion (i.e. cost, bandwidth…etc without having any difficulty in the previous link. As far as forced handover is concerned, it occurs when thesignal reaches a critical level and UE is forced to make a handover in order to maintain the ongoing communication. This case is managed in two phases. The first one or the fast phase is handled by FMIPv6 protocol to preserve as soon as possible packets of the ongoing communication. The second one or the slow phase is handled by SIP protocol to optimize packet delivery route. By doing so, we exploit the benefits of both network layer and application mobility protocols to ensure a continuous session over the two networks without imposing new elements to the network. Through a comparison with other mobility mechanisms, we show in the analytic analysis that our hybrid scheme presents better results in terms of handover latency and packet loss.
Full Text Available A qualitative assessment was made of service provider and user perceptions of the quality of integrated reproductive health services established through a pilot intervention in Cambodia. The intervention aimed to promote pregnant women's HIV testing and general utilization of reproductive health facilities as well as improve the follow-up of HIV-positive women and exposed infants through strengthened referral and operational linkages amongst health facilities/services and community-based support interventions for PLHIV. The study was conducted in one operational district where the intervention was piloted and for comparative purposes in a district where integrated services had yet to be implemented. Service providers in the pilot district reported improved collaboration and coordination of services, more effective referral, and the positive impact of improved proximity of HIV testing through integrated local level facilities. Community-based support teams for PLHIV embraced their expanded role, were valued by families receiving their assistance, and were understood to have had an important role in referral, PMTCT follow-up and countering PLHIV stigmatization; findings which underscore the potential role of community support in integrated service provision. Challenges identified included stigmatization of PLHIV by health staff at district hospital level and a lack of confidence amongst non-specialized health staff when managing deliveries by HIV-positive women, partly due to fear of HIV transmission.
Linda van Laren
Full Text Available Since 1999, many South African education policy documents have mandated integration of HIV & AIDS education in learning areas/disciplines. Policy document research has shown that although South African politicians and managers have produced volumes of eloquent and compelling legislation regarding provision for HIV & AIDS education, little of this is translated into action. The impact of HIV & AIDS permeates the social, economic and political arenas in South Africa. Integration of HIV & AIDS education across disciplines can serve as a strategy to further the ideals of social justice. This paper focuses on how integration in the teaching and learning of Mathematics Education provides opportunities to take action for social justice. The inquiry explores the following question: How can the myth that there is 'nothing we can do' about HIV & AIDS, which is linked to social justice issues, be addressed through integration of HIV & AIDS education in Mathematics pre-service teacher education? Drawing on self-study, the work of a Mathematics teacher educator who worked with pre-service teachers to integrate HIV & AIDS education at a higher education institution is described. By considering integration of HIV & AIDS education in Mathematics Education and taking action it is possible to develop strategies which directly relate to social justice.
Thanh Duong Cong
Full Text Available Abstract Background Seeking and utilisation of HIV prevention, treatment, care, and support services for people living with HIV is often hampered by HIV-related stigma. The study aimed to explore the perceptions and experiences regarding treatment, care, and support amongst people living with HIV in Viet Nam, where the HIV epidemic is concentrated among injecting drug users, sex workers, and men who have sex with men. Methods In-depth interviews and focus group discussions were conducted during September 2007 in 6 districts in Hai Phong with a very high HIV prevalence among injecting drug users. The information obtained was analysed and merged within topic areas. Illustrative quotes were selected. Results Stigma and discrimination against people living with HIV in the community and healthcare settings was commonly reported, and substantially hampered the seeking and the utilisation of HIV-related services. The informants related the high level of stigma to the way the national HIV preventive campaigns played on fear, by employing a “scare tactic” mainly focusing on drug users and sex workers, who were defined as “social evils” in the anti-drug and anti-prostitution policy. There was a strong exclusion effect caused by the stigma, with serious implications, such as loss of job opportunities and isolation. The support and care provided by family members was experienced as vital for the spirit and hope for the future among people living with HIV. Conclusions A comprehensive care and support programme is needed. The very high levels of stigma experienced seem largely to have been created by an HIV preventive scare tactic closely linked to the “social evil“ approach in the national policy on drug and prostitution. In order to reduce the stigma and create more effective interventions, this tactic will have to be replaced with approaches that create better legal and policy environments for drug users and sex workers.
Full Text Available BACKGROUND: Food insecurity is associated with poor nutritional and clinical outcomes among people living with HIV/AIDS. Few studies investigate the link between food insecurity, dietary diversity and health-related quality of life among people living with HIV/AIDS. OBJECTIVE: We investigated whether household food access and individual dietary diversity are associated with health-related quality of life among people living with HIV/AIDS in Uganda. METHODS: We surveyed 902 people living with HIV/AIDS and their households from two clinics in Northern Uganda. Health-related quality of life outcomes were assessed using the Medical Outcomes Study (MOS-HIV Survey. We performed multivariate regressions to investigate the relationship between health-related quality of life, household food insecurity and individual dietary diversity. RESULTS: People living with HIV/AIDS from severe food insecurity households have mean mental health status scores that are 1.7 points lower (p<.001 and physical health status scores that are 1.5 points lower (p<.01. Individuals with high dietary diversity have mean mental health status scores that were 3.6 points higher (p<.001 and physical health status scores that were 2.8 points higher (p<.05. CONCLUSIONS: Food access and diet quality are associated with health-related quality of life and may be considered as part of comprehensive interventions designed to mitigate psychosocial consequences of HIV.
Full Text Available Abstract Background Admissions for Ambulatory Care Sensitive Conditions (ACSCs are considered preventable admissions, because they are unlikely to occur when good preventive health care is received. Thus, high rates of admissions for ACSCs among the elderly (persons aged 65 or above who qualify for Medicare health insurance are signals of poor preventive care utilization. The relevant geographic market to use in studying these admission rates is the primary care physician market. Our conceptual model assumes that local market conditions serving as interventions along the pathways to preventive care services utilization can impact ACSC admission rates. Results We examine the relationships between market-level supply and demand factors on market-level rates of ACSC admissions among the elderly residing in the U.S. in the late 1990s. Using 6,475 natural markets in the mainland U.S. defined by The Health Resources and Services Administration's Primary Care Service Area Project, spatial regression is used to estimate the model, controlling for disease severity using detailed information from Medicare claims files. Our evidence suggests that elderly living in impoverished rural areas or in sprawling suburban places are about equally more likely to be admitted for ACSCs. Greater availability of physicians does not seem to matter, but greater prevalence of non-physician clinicians and international medical graduates, relative to U.S. medical graduates, does seem to reduce ACSC admissions, especially in poor rural areas. Conclusion The relative importance of non-physician clinicians and international medical graduates in providing primary care to the elderly in geographic areas of greatest need can inform the ongoing debate regarding whether there is an impending shortage of physicians in the United States. These findings support other authors who claim that the existing supply of physicians is perhaps adequate, however the distribution of them across
Farber, Eugene W; Lamis, Dorian A; Shahane, Amit A; Campos, Peter E
Human immunodeficiency virus (HIV) stigma represents a significant source of stress among individuals living with HIV disease, prompting interest in research to identify factors that may help to ameliorate the stress burden associated with HIV stigma. Consistent with this research line, the current study was conducted as a cross-sectional investigation examining associations between positive global personal meaning, social support, and perceived HIV stigma. Global personal meaning refers to beliefs and aspirations through which one ascribes value and purpose in living. The study sample was comprised of individuals living with HIV disease who presented for an initial visit in a specialty HIV mental health services program. In bivariate analyses, social support was negatively correlated with multidimensional aspects of HIV stigma that included distancing, blaming, and discrimination stigma, whereas personal meaning was negatively associated only with blaming stigma. In further analyses using structural equation modeling, social support significantly mediated the association between personal meaning and both distancing and blaming stigma. Interactions between positive personal meaning and social support may be useful to consider in future research on psychological resource factors and HIV stigma. Understanding these interactions may also inform clinical efforts to address HIV stigma concerns.
Tschirhart, Naomi; Kabanga, Lucky; Nichols, Sue
This paper examines the convergence of HIV/AIDS and the social processes through which women access customary land in rural Malawi. Data were collected from focus group discussions with women in patrilineal and matrilineal communities. Women's land tenure is primarily determined through kinship group membership, customary inheritance practices and location of residence. In patrilineal communities, land is inherited through the male lineage and women access land through relationships with male members who are the rightful heirs. Conversely in matrilineal matrilocal communities, women as daughters directly inherit the land. This research found that in patrilineal communities, HIV/AIDS, gendered inequalities embedded in customary inheritance practices and resource shortages combine to affect women's access to land. HIV/AIDS may cause the termination of a woman's relationship with the access individual due to stigma or the individual's death. Termination of such relationships increases tenure insecurity for women accessing land in a community where they do not have inheritance rights. In contrast to the patrilineal patrilocal experience, research on matrilineal matrilocal communities demonstrates that where women are the inheritors of the land and have robust land tenure rights, they are not at risk of losing their access to land due to HIV/AIDS.
The HIV/AIDS epidemic continues to be a critical public health issue in the United States, where an estimated 1.2 million individuals live with HIV infection. Viral suppression is one of the primary public health goals for People Living with HIV/AIDS (PLWHA). A crucial component of this goal involves adequate access to health care, specifically anti-retroviral HIV medications. The enactment of the Affordable Care Act (ACA) in 2010 raised hopes for millions of PLWHA without access to health care coverage. High cost-sharing requirements enacted by health plans place a financial burden on PLWHA who need ongoing access to these life-saving medications. Plighted with poverty, Detroit, Michigan, is a center of attention for examining the financial burden of HIV medications on PLWHA under the new health plans. From November 2014 to January 2015, monthly out-of-pocket costs and medication utilization requirements for 31 HIV medications were examined for the top 12 insurance carriers offering Qualified Health Plans on Michigan's Health Insurance Marketplace Exchange. The percentage of medications requiring quantity limits and prior authorization were calculated. The average monthly out-of-pocket cost per person ranged from $12 to $667 per medication. Three insurance carriers placed all 31 HIV medications on the highest cost-sharing tier, charging 50% coinsurance. High out-of-pocket costs and medication utilization restrictions discourage PLWHA from enrolling in health plans and threaten interrupted medication adherence, drug resistance, and increased risk of viral transmission. Health plans inflicting high costs and medication restrictions violate provisions of the ACA and undermine health care quality for PLWHA. (Population Health Management 2016;19:272-278).
Full Text Available CD4 cell count measurement remains an important diagnostic tool for HIV care in developing countries. Insufficient laboratory capacity in rural Sub-Saharan Africa is frequently mentioned but data on the impact at an individual patient level are lacking. Urban-rural discrepancies in CD4 testing have not been quantified to date. Such evidence is crucial for public health planning and to justify new yet more expensive diagnostic procedures that could circumvent access constraints in rural areas.To compare CD4 testing among rural and urban HIV patients during the first year of treatment.Records from 2,145 HIV positive adult patients from a Médecins sans Frontières (Doctors without Borders HIV project in Beitbridge, Zimbabwe, during 2011 and 2012 were used for a retrospective cohort analysis. Covariate-adjusted risk ratios were calculated to estimate the effects of area of residence on CD4 testing at treatment initiation, six and 12 months among rural and urban patients.While the proportion of HIV patients returning for medical consultations at six and 12 months decreased at a similar rate in both patient groups, CD4 testing during consultations dropped to 21% and 8% for urban, and 2% and 1% for rural patients at six and 12 months, respectively. Risk ratios for missing CD4 testing were 0.8 (95% CI 0.7-0.9, 9.2 (95% CI 5.5-15.3, and 7.6 (95% 3.7-17.1 comparing rural versus urban patients at treatment initiation, six and 12 months, respectively.CD4 testing was low overall, and particularly poor in rural patients. Difficulties with specimen transportation were probably a major factor underlying this difference and requires new diagnostic approaches. Our findings point to severe health system constraints in providing CD4 testing overall that need to be addressed if effective monitoring of HIV patients is to be achieved, whether by alternative CD4 diagnostics or newly-recommended routine viral load testing.
Hu, Ruishan; Dong, Suocheng; Zhao, Yonghong; Hu, Hao; Li, Zehong
There is a great health services disparity between urban and rural areas in China. The percentage of people who are unable to access health services due to long travel times increases. This paper takes Donghai County as the study unit to analyse areas with physician shortages and characteristics of the potential spatial accessibility of health services. We analyse how the unequal health services resources distribution and the New Cooperative Medical Scheme affect the potential spatial accessibility of health services in Donghai County. We also give some advice on how to alleviate the unequal spatial accessibility of health services in areas that are more remote and isolated. The shortest traffic times of from hospitals to villages are calculated with an O-D matrix of GIS extension model. This paper applies an enhanced two-step floating catchment area (E2SFCA) method to study the spatial accessibility of health services and to determine areas with physician shortages in Donghai County. The sensitivity of the E2SFCA for assessing variation in the spatial accessibility of health services is checked using different impedance coefficient valuesa. Geostatistical Analyst model and spatial analyst method is used to analyse the spatial pattern and the edge effect of potential spatial accessibility of health services. The results show that 69% of villages have access to lower potential spatial accessibility of health services than the average for Donghai County, and 79% of the village scores are lower than the average for Jiangsu Province. The potential spatial accessibility of health services diminishes greatly from the centre of the county to outlying areas. Using a smaller impedance coefficient leads to greater disparity among the villages. The spatial accessibility of health services is greater along highway in the county. Most of villages are in underserved health services areas. An unequal distribution of health service resources and the reimbursement policies of the
Hu, Ruishan; Dong, Suocheng; Zhao, Yonghong; Hu, Hao; Li, Zehong
Introduction There is a great health services disparity between urban and rural areas in China. The percentage of people who are unable to access health services due to long travel times increases. This paper takes Donghai County as the study unit to analyse areas with physician shortages and characteristics of the potential spatial accessibility of health services. We analyse how the unequal health services resources distribution and the New Cooperative Medical Scheme affect the potential sp...
Essajee, Shaffiq; Bhairavabhotla, Ravikiran; Penazzato, Martina; Kiragu, Karusa; Jani, Ilesh; Carmona, Sergio; Rewari, Bharat; Kiyaga, Charles; Nkengasong, John; Peter, Trevor
Investment to scale-up early infant diagnosis (EID) of HIV has increased substantially in the last decade. This investment includes physical infrastructure, equipment, human resources, and specimen transportation systems as well as specialized mechanisms to deliver laboratory results to clinics. The Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive, as well as related international initiatives to prevent mother-to-child transmission of HIV and treat children living with HIV have been important drivers of this scale-up by mobilizing resources, creating advocacy, developing normative recommendations, and providing direct technical support to countries through the global community of international stakeholders. As a result, the number of early infant diagnosis tests performed annually has increased 10-fold between 2005 and 2015, and many thousands of infants are now receiving life-saving antiretroviral therapy because of this improved access. Despite these efforts and many success stories, timely infant diagnosis remains a challenge in many Global Plan countries. The most recent data (from the end of 2015) suggest a large variation in access. Some countries report that almost 90% of HIV-exposed infants are being tested; others report that the level of access has stagnated at 30%. Still, just over half of all exposed infants in Global Plan countries receive a test in the first 2 months of life. We discuss the key factors that are responsible for this scale-up of diagnostic capacity, highlight some of the challenges that have hampered progress, and describe priorities for the future that can help maintain momentum to achieve true universal access to HIV testing for children.
Gonsalves, Gregg S; Crawford, Forrest W; Cleary, Paul D; Kaplan, Edward H; Paltiel, A David
Public health agencies suggest targeting "hotspots" to identify individuals with undetected HIV infection. However, definitions of hotspots vary. Little is known about how best to target mobile HIV testing resources. We conducted a computer-based tournament to compare the yield of 4 algorithms for mobile HIV testing. Over 180 rounds of play, the algorithms selected 1 of 3 hypothetical zones, each with unknown prevalence of undiagnosed HIV, in which to conduct a fixed number of HIV tests. The algorithms were: 1) Thompson Sampling, an adaptive Bayesian search strategy; 2) Explore-then-Exploit, a strategy that initially draws comparable samples from all zones and then devotes all remaining rounds of play to HIV testing in whichever zone produced the highest observed yield; 3) Retrospection, a strategy using only base prevalence information; and; 4) Clairvoyance, a benchmarking strategy that employs perfect information about HIV prevalence in each zone. Over 250 tournament runs, Thompson Sampling outperformed Explore-then-Exploit 66% of the time, identifying 15% more cases. Thompson Sampling's superiority persisted in a variety of circumstances examined in the sensitivity analysis. Case detection rates using Thompson Sampling were, on average, within 90% of the benchmark established by Clairvoyance. Retrospection was consistently the poorest performer. We did not consider either selection bias (i.e., the correlation between infection status and the decision to obtain an HIV test) or the costs of relocation to another zone from one round of play to the next. Adaptive methods like Thompson Sampling for mobile HIV testing are practical and effective, and may have advantages over other commonly used strategies.
Full Text Available Abstract Background In South Africa the need to integrate HIV, TB and STI programmes has been recognised at a policy and organisation level; the challenge is now one of translating policies into relevant actions and monitoring implementation to ensure that the anticipated benefits of integration are achieved. In this research, set in public primary care services in Cape Town, South Africa, we set out to determine how middle level managers could be empowered to monitor the implementation of an effective, integrated HIV/TB/STI service. Methods A team of managers and researchers designed an evaluation tool to measure implementation of key components of an integrated HIV/TB/STI package with a focus on integration. They used a comprehensive health systems framework based on conditions for programme effectiveness and then identified and collected tracer indicators. The tool was extensively piloted in two rounds involving 49 clinics in 2003 and 2004 to identify data necessary for effective facility-level management. A subsequent evaluation of 16 clinics (2 per health sub district, 12% of all public primary care facilities was done in February 2006. Results 16 clinics were reviewed and 635 records sampled. Client access to HIV/TB/STI programmes was limited in that 50% of facilities routinely deferred clients. Whilst the physical infrastructure and staff were available, there was problem with capacity in that there was insufficient staff training (for example, only 40% of clinical staff trained in HIV care. Weaknesses were identified in quality of care (for example, only 57% of HIV clients were staged in accordance with protocols and continuity of care (for example, only 24% of VCT clients diagnosed with HIV were followed up for medical assessment. Facility and programme managers felt that the evaluation tool generated information that was useful to manage the programmes at facility and district level. On the basis of the results facility managers drew
Rodriguez, Juan Carlos; Meyer, Kristin; Merry, Brian
Library public services staff have primarily focused on providing services through interactions with their users. Although service quality and customer satisfaction are important in the delivery of these services, the emphasis and nature of the work have often been influenced by a library-centric philosophy rather than a user-centric philosophy.…
Lee, Leslie A.; Wu, Michelle M.
Access services is not unique in its need for effective personnel management. A review of the literature indicates that there are many publications on or relating to library personnel administration; however, relatively few of them are dedicated to the narrow topic of access services. As such, this review encompasses literature that is general to…
to networks). In contexts of displacement access to basic services is formally regulated by one’s status (e.g. as refugee or national citizen) and by physical location (e.g. in settlements/camps or urban areas). The paper discusses what role religious institutions play when access to services provided...
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Binti Othman, Maisara; Zhang, Xu; Jensen, Jesper Bevensee
The usability of carrierless amplitude and phase (CAP) modulation dimensions for service and user allocation for WDM optical access is experimentally demonstrated in a 2X2D-ODMA configuration.......The usability of carrierless amplitude and phase (CAP) modulation dimensions for service and user allocation for WDM optical access is experimentally demonstrated in a 2X2D-ODMA configuration....
Radigan, Marleen; Wang, Rui; Chen, Yu; Xiang, Jiani
Access to peer advocates is increasingly available to youth and their caregivers who are receiving services in the public mental health system. This study examines associations between reported access to a youth or family advocate and perceptions of satisfaction with mental health services. A cross-sectional survey of youth (N = 768) and caregivers (N = 1,231) who utilized public mental health services in New York State in 2012 was conducted. The survey includes items on access to youth or family advocates and degree of satisfaction with mental health services. A greater proportion of youth or caregivers with access to peer advocates compared to those without access responded positively on the satisfaction domains of access to services, appropriateness of services, participation in services and overall/global satisfaction. Access to peer advocates was also positively associated with agreement on the psychotropic medication comprehension domain for youth and on perceptions of child functioning and social connectedness for caregivers compared to those without access. This study adds to the growing understanding of the important role peer advocates play in engaging youth with mental health needs and their caregivers in mental health services.
Jetton, Lora Lennertz; Bailey, Alberta S.
This article updates a previous article published in 1992 that described the role of the access services manager in policy formation. Since that time, the access services department and mission has matured and evolved to a prominent position within the library organization. Technological changes and innovation in the marketplace of wired and…
Kersaint, Gladis; Dogbey, James; Barber, Jeff; Kephart, David
This study investigated outcomes (achievement, attitude, and retention) of college algebra students who had access to an online tutoring resource using a pre-posttest control group design. Students in the experimental groups were provided access to an online tutoring service unlike the students in the control group. Both groups had access to other…
Olsen, Rasmus Løvenstein; Schwefel, Hans-Peter; Hansen, Martin Bøgsted
Remote access to dynamically changing information elements is a required functionality for various network services, including routing and instances of context-sensitive networking. Three fundamentally different strategies for such access are investigated in this paper: (1) a reactive approach......, network delay characterization) and specific requirements on mismatch probability, traffic overhead, and access delay. Finally, the analysis is applied to the use-case of context-sensitive service discovery....
Rosa E. Lillo
Full Text Available We examine the service mechanism of two queueing models with two units in tandem. In the first model, customers who complete service in Unit 1 must wait in an intermediate buffer until the ongoing service in Unit II ends. In the second model, jobs can be pre-positioned in an intermediate buffer to await service in Unit II. Under the assumption of phase-type service times, the steady-state regime of the service system is studied in detail.
Van Thu Nguyen
Full Text Available Currently, HIV testing and counseling (HTC services in Vietnam are primarily funded by international sources. However, international funders are now planning to withdraw their support and the Government of Vietnam (GVN is seeking to identify domestic funding and generate client fees to continue services. A clear understanding of the cost to sustain current HTC services is becoming increasingly important to facilitate planning that can lead to making HTC and other HIV services more affordable and sustainable in Vietnam. The objectives of this analysis were to provide a snapshot of current program costs to achieve key program outcomes including 1 testing and identifying PLHIV unaware of their HIV status and 2 successfully enrolling HIV (+ clients in care.We reviewed expenditure data reported by 34 HTC sites in nine Vietnamese provinces over a one-year period from October 2012 to September 2013. Data on program outcomes were extracted from the HTC database of 42,390 client records. Analysis was carried out from the service providers' perspective.The mean expenditure for a single client provided HTC services (testing, receiving results and referral for care/treatment was US $7.6. The unit expenditure per PLHIV identified through these services varied widely from US $22.8 to $741.5 (median: $131.8. Excluding repeat tests, the range for expenditure to newly diagnose a PLHIV was even wider (from US $30.8 to $1483.0. The mean expenditure for one successfully referred HIV client to care services was US $466.6. Personnel costs contributed most to the total cost.Our analysis found a wide range of expenditures by site for achieving the same outcomes. Re-designing systems to provide services at the lowest feasible cost is essential to making HIV services more affordable and treatment for prevention programs feasible in Vietnam. The analysis also found that understanding the determinants and reasons for variance in service costs by site is an important
Fogarty Kieran J
Full Text Available Abstract Background From 2000–2002, the Centers for Disease Control and Prevention (CDC funded a study that was designed to improve the information available to program planners about the geographic distribution of CDC-funded HIV prevention services provided by community-based organizations (CBOs. Program managers at CDC recognized the potential of a geographic information system (GIS to organize and analyze information about HIV prevention services and they made GIS a critical component of the study design. The primary objective of this study was to construct a national, geographically-referenced database of HIV prevention services provided by CDC-funded CBOs. We designed a survey instrument to collect information about the geographic service areas where CBOs provided HIV prevention services, then collected data from CBOs that received CDC funding for these services during fiscal year 2000. We developed a GIS database to link questionnaire responses with GIS map layers in a manner that would incorporate overlapping geographies, risk populations and prevention services. We collected geographic service area data in two formats: 1 geopolitical boundaries and 2 geographic distance. Results The survey response rate was 70.3%, i.e. 1,020 of 1,450 community-based organizations responded. The number of HIV prevention programs administered by each CBO ranged from 1 to 23. The survey provided information about 3,028 prevention programs, including descriptions of intervention types, risk populations, race and ethnicity, CBO location and geographic service area. We incorporated this information into a large GIS database, the HIV Prevention Services Database. The use of geopolitical boundaries provided more accurate results than geographic distance. The use of a reference map with the questionnaire improved completeness, accuracy and precision of service area data. Conclusion The survey instrument design and database development procedures that we used
Full Text Available Abstract Background The North-east Indian states of Manipur and Nagaland consistently report relatively high HIV prevalence. The targeted HIV prevention interventions in these two states are mostly delivered by non-government organizations (NGOs, and prevention of HIV transmission by injecting drug use is their main focus. Most injecting drug users (IDUs are male, and the services are primarily tailored to meet their needs, which are not necessarily the same as those for women. This qualitative study describes the health service needs of women who use drugs and alcohol in Manipur and Nagaland, with the goal of identifying strategies and activities that can be implemented by NGOs wanting to improve their reach among vulnerable women. Methods In 2009-10, semi-structured in-depth interviews were conducted with 27 key informants and nine focus group discussions (FGDs with women who use drugs and alcohol, and two FGDs with male IDUs. The thematic areas covered included: the context of female drug and alcohol use; drug and alcohol use patterns; HIV risk behaviours; barriers and facilitators of service use; perceived health needs; and expressed health service needs. The data were recorded, transcribed, translated and thematically analysed. Results The most problematic substance for women from Nagaland was alcohol, and for women from Manipur it was heroin. The most commonly identified health problems were primarily related to the women’s drug and alcohol use, reproductive health and mental health. Other problems of major concern included social exclusion, violence, children’s welfare, and financial difficulties. The expressed service needs of these women were women-only integrated health services, women-only detoxification and rehabilitation services, mental health services, desensitization of mainstream health workers, free access to medicines, assistance to meet basic needs, and a safe place for engaging in sex work. Conclusion The expressed
Behel, Stephanie K; MacKellar, Duncan A; Valleroy, Linda A; Secura, Gina M; Bingham, Trista; Celentano, David D; Koblin, Beryl A; Lalota, Marlene; Shehan, Douglas; Torian, Lucia V
We investigated whether there were racial/ethnic differences among young men who have sex with men (MSM) in their use of, perceived importance of, receipt of, and satisfaction with HIV prevention services received at health care providers (HCP) and HIV test providers (HTP) that explain racial disparities in HIV prevalence. Young men, aged 23 to 29 years, were interviewed and tested for HIV at randomly sampled MSM-identified venues in six U.S. cities from 1998 through 2000. Analyses were restricted to five U.S. cities that enrolled 50 or more black or Hispanic MSM. Among the 2,424 MSM enrolled, 1,522 (63%) reported using a HCP, and 1,268 (52%) reported having had an HIV test in the year prior to our interview. No racial/ethnic differences were found in using a HCP or testing for HIV. Compared with white MSM, black and Hispanic MSM were more likely to believe that HIV prevention services are important [respectively, AOR, 95% confidence interval (CI): 3.0, 1.97 to 4.51 and AOR, 95% CI: 2.7, 1.89 to 3.79], and were more likely to receive prevention services at their HCP (AOR, 95% CI: 2.5, 1.72 to 3.71 and AOR, 95% CI: 1.7, 1.18 to 2.41) and as likely to receive counseling services at their HTP. Blacks were more likely to be satisfied with the prevention services received at their HCP (AOR, 95% CI: 1.7, 1.14 to 2.65). Compared to white MSM, black and Hispanic MSM had equal or greater use of, perceived importance of, receipt of, and satisfaction with HIV prevention services. Differential experience with HIV prevention services does not explain the higher HIV prevalence among black and Hispanic MSM.
Full Text Available Abstract Background This cross-sectional study assessed factors affecting access to antiretroviral therapy (ART among HIV-positive women from the prevention of mother to child transmission HIV programme in Chitungwiza, Zimbabwe. Methods Data were collected between June and August 2008. HIV-positive women attending antenatal clinics who had been referred to the national ART programme from January 2006 until December 2007 were surveyed. The questionnaire collected socio-demographic data, treatment-seeking behaviours, and positive or negative factors that affect access to HIV care and treatment. Results Of the 147 HIV-positive women interviewed, 95 (65% had registered with the ART programme. However, documentation of the referral was noted in only 23 (16% of cases. Of the 95 registered women, 35 (37% were receiving ART; 17 (18% had not undergone CD4 testing. Multivariate analysis revealed that participants who understood the referral process were three times more likely to access HIV care and treatment (OR = 3.21, 95% CI 1.89-11.65 and participants enrolled in an HIV support group were twice as likely to access care and treatment (OR = 2.34, 95% CI 1.13-4.88. Those living with a male partner were 60% less likely to access care and treatment (OR = 0.40, 95% CI 0.16-0.99. Participants who accessed HIV care and treatment faced several challenges, including long waiting times (46%, unreliable access to laboratory testing (35% and high transport costs (12%. Of the 147 clients surveyed, 52 (35% women did not access HIV care and treatment. Barriers included perceived long queues (50%, competing life priorities, such as seeking food or shelter (33% and inadequate referral information (15%. Conclusions Despite many challenges, the majority of participants accessed HIV care. Development of referral tools and decentralization of CD4 testing to clinics will improve access to ART. Psychosocial support can be a successful entry point to encourage client referral
Wolfswinkel, R.N. van
In the current broadband market there are many new developments regarding both services and the broadband infrastructures carrying those services. This paper will address what the requirements of services are towards broadband networks. The focus will be on the requirements of triple play related se
Fronczak, Nancy; Oyediran, Kola' A; Mullen, Stephanie; Kolapo, Usman M
Decentralizing health services, including those for HIV prevention and treatment, is one strategy for maximizing the use of limited resources and expanding treatment options; yet few methods exist for systematically identifying where investments for service expansion might be most effective, in terms of meeting needs and rapid availability of improved services. The Nigerian Government, the United States Government under the President's Emergency Plan for AIDS Relief (PEPFAR) program and other donors are expanding services for prevention of mother-to-child transmission (PMTCT) of HIV to primary health care facilities in Nigeria. Nigerian primary care facilities vary greatly in their readiness to deliver HIV/AIDS services. In 2012, MEASURE Evaluation assessed 268 PEPFAR-supported primary health care facilities in Nigeria and developed a systematic method for prioritizing these facilities for expansion of PMTCT services. Each assessed facility was scored based on two indices with multiple, weighted variables: one measured facility readiness to provide PMTCT services, the other measured local need for the services and feasibility of expansion. These two scores were compiled and the summary score used as the basis for prioritizing facilities for PMTCT service expansion. The rationale was that using need and readiness to identify where to expand PMTCT services would result in more efficient allocation of resources. A review of the results showed that the indices achieved the desired effect-that is prioritizing facilities with high need even when readiness was problematic and also prioritizing facilities where rapid scale-up was feasible. This article describes the development of the two-part index and discusses advantages of using this approach when planning service expansion. The authors' objective is to contribute to development of methodologies for prioritizing investments in HIV, as well as other public health arenas, that should improve cost-effectiveness and
DiStefano, Anthony S; Hubach, Randolph D
This article examines what measures health care and social service providers take to address intersections between various forms of violence and HIV/AIDS in the delivery of services to their clients/patients. We operated within an organizationallinteractional uncertainty theoretical framework and analyzed qualitative interview data from 30 providers offering services related to violence or HIV/AIDS in the San Francisco Bay Area. We found that providers used several strategies to mitigate crossover risk, but they enacted these measures on a case-by-case basis and tended not to follow a dedicated and complete protocol with every client/patient. We also identify nine factors that affected providers' capacity to discern and effectively address violence-HIV/AIDS intersections, present providers' descriptions of their needs in terms of addressing crossover risk, and discuss implications for interventions.
Bukenya, Dominic; Wringe, Alison; Moshabela, Mosa
Objective: To explore barriers and facilitators to accessing postdiagnosis HIV care in five sub-Saharan African countries. Methods: In-depth interviews were conducted with 77 people living with HIV (PLHIV) in pre-antiretroviral therapy care or not-yet-in care and 46 healthcare workers. Participan...
An integrated tiered service delivery model (ITSDM based on local CD4 testing demands can improve turn-around times and save costs whilst ensuring accessible and scalable CD4 services across a national programme.
Deborah K Glencross
Full Text Available The South African National Health Laboratory Service (NHLS responded to HIV treatment initiatives with two-tiered CD4 laboratory services in 2004. Increasing programmatic burden, as more patients access anti-retroviral therapy (ART, has demanded extending CD4 services to meet increasing clinical needs. The aim of this study was to review existing services and develop a service-model that integrated laboratory-based and point-of-care testing (POCT, to extend national coverage, improve local turn-around/(TAT and contain programmatic costs.NHLS Corporate Data Warehouse CD4 data, from 60-70 laboratories and 4756 referring health facilities was reviewed for referral laboratory workload, respective referring facility volumes and related TAT, from 2009-2012.An integrated tiered service delivery model (ITSDM is proposed. Tier-1/POCT delivers CD4 testing at single health-clinics providing ART in hard-to-reach areas (350-1500 tests/day, serving ≥ 200 health-clinics. Tier-6 provides national support for standardisation, harmonization and quality across the organization.The ITSDM offers improved local TAT by extending CD4 services into rural/remote areas with new Tier-3 or Tier-2/POC-Hub services installed in existing community laboratories, most with developed infrastructure. The advantage of lower laboratory CD4 costs and use of existing infrastructure enables subsidization of delivery of more expensive POC services, into hard-to-reach districts without reasonable access to a local CD4 laboratory. Full ITSDM implementation across 5 service tiers (as opposed to widespread implementation of POC testing to extend service can facilitate sustainable 'full service coverage' across South Africa, and save>than R125 million in HIV/AIDS programmatic costs. ITSDM hierarchical parental-support also assures laboratory/POC management, equipment maintenance, quality control and on-going training between tiers.
Akinci, Fevzi; Healey, Bernard J
Using the concept of social marketing, this study examined the determinants of access to primary health care services in order to better understand the perceived access problems and unmet service needs of an entire city in Northeastern Pennsylvania. Consistent with previous research, lack of access to health insurance coverage represents an important financial barrier to access to health care services in this community. This study also highlights the role of perceived need in explaining the presence or absence of a physician consultation.While increased attention to access issues at the national level is important, there also needs to be more emphasis on collecting local data for local decision-making regarding access issues.
Kakaire, Tom; Schlech, Walter; Coutinho, Alex; Brough, Richard; Parkes-Ratanshi, Rosalind
Whilst multi-lateral funding for HIV/AIDS dramatically increased from 2004 to 2008, it has largely plateaued in the last 8 years. Across sub-Saharan Africa, up to 20 % of total spending on health is used for HIV services, and of this over 85 % is estimated to come from international funding rather than in-country sources. In Uganda, the fiscal liability to maintain services for all those who are currently receiving it is estimated to be as much as 3 % of Gross Domestic Product (GDP). In order to meet the growing need of increased patient numbers and further ART coverage the projected costs of comprehensive HIV care and treatment services will increase substantially. Current access to HIV care includes free at point of delivery (provided by Ministry of Health clinics), as well as out-of-pocket financing and health insurance provided care at private for- and not for- profit facilities. The HIV response is funded through Ugandan Ministry of Health national budget allocations, as well as multilateral donations such as the President's Emergency Plan for AIDS in Africa (PEPFAR) and Global Fund (GF) and other international funders. We are concerned that current funding mechanism for HIV programs in Uganda may be difficult to sustain and as service providers we are keen to explore ways in which provide lifelong HIV care to as many people living with HIV (PLHIV) as possible. Until such time as the Ugandan economy can support universal, state-supported, comprehensive healthcare, bridging alternatives must be considered. We suggest that offering patients with the sufficient means to assume some of the financial burden for their care in return for more convenient services could be one component of increasing coverage and sustaining services for those living with HIV.
Austen, Sally; McGrath, Melissa
Long-distance travel to provide mental health services for deaf people has implications for efficiency, safety, and equality of service. However, uptake of Telemental Health (TMH) has been slow in both deaf and general mental health services. A quantitative study was used to investigate access to TMH and whether staff confidence, experience, or…
... information services. 54.621 Section 54.621 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED... § 54.621 Access to advanced telecommunications and information services. (a) Twenty-five percent of the... service support equal to 50 percent of the monthly cost of advanced telecommunications and...
Grace, C J; Soons, K R; Kutzko, D; Alston, W K; Ramundo, M
The incidence of human immunodeficiency virus (HIV) infection is increasing rapidly in rural areas of the United States. Barriers to health-care delivery for this patient population include the complexity of this rapidly changing field, inexperienced rural physicians, long travel distances to receive expert care, lack of psychosocial support systems, and concerns about confidentiality. Models of HIV care for rural areas have not been developed that remove these barriers. We present the philosophy, structure, implementation, and services of a model of care in Vermont that is designed to remove many of these barriers and bring HIV expertise into the rural areas of the state. Three HIV specialty clinics have been developed in regional hospitals throughout the state. The clinic team includes an HIV-trained nurse practitioner and social worker from the hospital, a client consultant from the regional AIDS service organization, and an infectious disease specialist who travels to each of the clinics monthly. Patient care will be centralized in these regionally located clinics. The dispersion of HIV care among numerous and inexperienced rural providers will be obviated. Confidentiality will be emphasized within the hospital environment. The model has the potential to provide a complete continuum of medical care and psychosocial case management, integrate patient care and regional provider education, and increase community awareness. Patients will be able to receive their care in their own community, avoiding long travel distances. This may encourage patients to seek care earlier in their illness. The model may be adaptable to other rural areas of the United States.
Claessens, S.; Honohan, P.; Rojas-Suarez, L.
Despite the rapid growth in finance worldwide over the past quarter-century — now interrupted by the global financial crisis — many low-income households and small firms remain excluded from access to many financial services, especially in developing countries. While traditionally seen by many
Objective The present study looked at the views of people directly involved in the entry process for community health counselling using the frame of the health access literature. The concurrence of system participants' views with the access literature highlights access issues, particularly for people who are vulnerable or disadvantaged. The paper privileges the voices of the system participants, inviting local health services to consider using participatory design to improve access at the entry point.Methods People involved in the entry process for community health counselling explored the question, 'What, for you, are the features of a good intake system?' They also commented on themes identified during pilot interviews. These were thematically analysed for each participant group by the researcher to develop a voice for each stakeholder group.Results People accessing the service could be vulnerable and the entry process failed to take that into account. People directly involved in the counselling service entry system, system participants, consisted of: professionals referring in, people seeking services and reception staff taking first enquiries. They shared substantially the same concerns as each other. The responses from these system participants are consistent with the international literature on access and entry into health services.Conclusion Participatory service design could improve primary healthcare service entry at the local level. Canvassing the experiences of system participants is important for delivering services to those who have the least access and, in that way, could contribute to health equity.What is known about the topic? People with the highest health needs receive the fewest services. Health inequality is increasing.What does this paper add? System participants can provide advice consistent with the academic research literature that is useful for improving service entry at the local level.What are the implications for practitioners
Bendycki, N; Zeroske, J
Marketing plans that do not include an analysis of customer service, access and capacity issues are incomplete documents. Unresolved customer service, access and capacity issues can undermine an otherwise well-designed marketing plan. The medical and administrative leadership of the group practice or clinical department must work together to identify customer service, access and capacity issues which are affecting the practice's ability to respond to the needs of the marketplace. Someone with marketing expertise can provide valuable input to this process. The resulting solutions need to be developed which are realistic and in keeping with the general marketing direction of the practice.
Liu, Hong; Dittmann, Lars; Gliese, Ulrik Bo
The furture broadband wireless asynchronous transfer mode (ATM) networks must provide seamless extension of multimedia services from the wireline ATM networks. This requires an effecient wireless access protocol to fulfill varying Quality-og-Service (QoS) requirements for multimedia applications....... In this paper, we propose a multiple access protocol using centralized and distributed channel access control techniques to provide QoS guarantees for multimedia services by taking advantage of the characteristics of different kinds of ATM traffics. Multimedia traffic, including constant bit rate (CBR...
Sutton, Stuart A.
Explores the development of the ERIC (Educational Resources Information Center) dataset and the relationship between that dataset and the disparate services that have emerged as a result of the Internet and the Web. Discusses the technical infrastructure; database content; services and resources; creating a unified knowledge base; and metadata…
Medical-Centre, Keffi, Nasarawa-State, Nigeria. Patients were selected by ... satisfaction with various aspects of services; reception/registration (65.3%), waiting time (57.4%), doctors' consultation (70.5%), prescribed drugs (55.3%), laboratory services (71.6%) .... scale response, using an evaluation system developed.
Full Text Available The paper provides an evaluation of recent experience in South Africa with two service designs for transport dedicated to disabled users. The designs – a Dial-a-Ride system and a fixed-route, fixed-schedule system operating on the “service route...
Cook, A.S. [Power Technologies, Inc., Brisbane (Australia); Merrill, H.M. [Power Technologies, Inc., Schenectady, NY (United States)
Utilities functioning in a competitive electricity market are required to provide unbundled services. This paper describes how to make unbundled transmission services available in a competitive electricity market. Methods are presented for developing the long-run marginal cost of transmission and for pricing stand-by and top-up electricity supply. The methods are illustrated with case studies based on current data.
Huffer, E.; Hertz, J.; Kusterer, J.
The corpus of Earth Science data products at the Atmospheric Science Data Center at NASA's Langley Research Center comprises a widely heterogeneous set of products, even among those whose subject matter is very similar. Two distinct data products may both contain data on the same parameter, for instance, solar irradiance; but the instruments used, and the circumstances under which the data were collected and processed, may differ significantly. Understanding the differences is critical to using the data effectively. Data distribution services must be able to provide prospective users with enough information to allow them to meaningfully compare and evaluate the data products offered. Semantic technologies - ontologies, triple stores, reasoners, linked data - offer functionality for addressing this issue. Ontologies can provide robust, high-fidelity domain models that serve as common schema for discovering, evaluating, comparing and integrating data from disparate products. Reasoning engines and triple stores can leverage ontologies to support intelligent search applications that allow users to discover, query, retrieve, and easily reformat data from a broad spectrum of sources. We argue that because of the extremely complex nature of scientific data, data distribution systems should wholeheartedly embrace semantic technologies in order to make their data accessible to a broad array of prospective end users, and to ensure that the data they provide will be clearly understood and used appropriately by consumers. Toward this end, we propose a distribution system in which formal ontological models that accurately and comprehensively represent the ASDC's data domain, and fully leverage the expressivity and inferential capabilities of first order logic, are used to generate graph-based representations of the relevant relationships among data sets, observational systems, metadata files, and geospatial, temporal and scientific parameters to help prospective data consumers
Pottie, Kevin; Medu, Olanrewaju; Welch, Vivian; Dahal, Govinda P; Tyndall, Mark; Rader, Tamara; Wells, George
To assess the effects of rapid voluntary counselling and testing (VCT) for HIV on HIV incidence and uptake of HIV/AIDS services in people at high risk for HIV exposure. Cochrane systematic review and meta-analysis. We searched PubMed, EMBASE, AIDSearch, LILACS, Global Health, Medline Africa, PsychInfo, CINAHL, Cochrane CENTRAL, Cochrane HIV/AIDS Group Specialized Register and grey literature from 1 January 2001 to 5 June 2014 without language restriction. We included controlled studies that compared rapid VCT with conventional testing among people at risk for HIV exposure. Two reviewers extracted data. We used Cochrane risk of bias tool and GRADE criteria: risk of bias, inconsistency, indirectness, imprecision and publication bias. For observational studies we used the Newcastle-Ottawa Scale. We used the PRISMA-Equity reporting guideline. From 2441 articles, we included 8 randomised controlled trials and 5 observational studies. Rapid VCT was associated with a threefold increase in HIV-testing uptake (relative risk (RR)=2.95 95% CI 1.69 to 5.16) and a twofold increase in the receipt of test results (RR=2.14, 95% CI 1.08 to 4.24). Women accepted testing more often than men in rapid VCT arm, but no differences in effect for age or socioeconomic status. Observational studies also showed rapid VCT led to higher rates of uptake of testing. Heterogeneity was high. A cluster-randomised trial reported an 11% reduction in HIV incidence in intervention communities (RR=0.89, 95% CI=0.63 to 1.24) over 3 years trial. Rapid VCT in health facilities and communities was associated with a large increase in HIV-testing uptake and receipt of results. This has implications for WHO guidelines. The routine use of rapid VCT may also help avoid human rights violations among marginalised populations where testing may occur without informed consent and where existing stigma may create barriers to testing. Published by the BMJ Publishing Group Limited. For permission to use (where not
Abstract Background Considerable attention has been given by policy makers and researchers to the human resources for health crisis in Africa. However, little attention has been paid to quantifying health facility-level trends in health worker numbers, distribution and workload, despite growing demands on health workers due to the availability of new funds for HIV\\/AIDS control scale-up. This study analyses and reports trends in HIV and non-HIV ambulatory service workloads on clinical staff in urban and rural district level facilities. Methods Structured surveys of health facility managers, and health services covering 2005-07 were conducted in three districts of Zambia in 2008 (two urban and one rural), to fill this evidence gap. Intra-facility analyses were conducted, comparing trends in HIV and non-HIV service utilisation with staff trends. Results Clinical staff (doctors, nurses and nurse-midwives, and clinical officers) numbers and staff population densities fell slightly, with lower ratios of staff to population in the rural district. The ratios of antenatal care and family planning registrants to nurses\\/nurse-midwives were highest at baseline and increased further at the rural facilities over the three years, while daily outpatient department (OPD) workload in urban facilities fell below that in rural facilities. HIV workload, as measured by numbers of clients receiving antiretroviral treatment (ART) and prevention of mother to child transmission (PMTCT) per facility staff member, was highest in the capital city, but increased rapidly in all three districts. The analysis suggests evidence of task sharing, in that staff designated by managers as ART and PMTCT workers made up a higher proportion of frontline service providers by 2007. Conclusions This analysis of workforce patterns across 30 facilities in three districts of Zambia illustrates that the remarkable achievements in scaling-up HIV\\/AIDS service delivery has been on the back of sustained non-HIV
Full Text Available Abstract Background Considerable attention has been given by policy makers and researchers to the human resources for health crisis in Africa. However, little attention has been paid to quantifying health facility-level trends in health worker numbers, distribution and workload, despite growing demands on health workers due to the availability of new funds for HIV/AIDS control scale-up. This study analyses and reports trends in HIV and non-HIV ambulatory service workloads on clinical staff in urban and rural district level facilities. Methods Structured surveys of health facility managers, and health services covering 2005-07 were conducted in three districts of Zambia in 2008 (two urban and one rural, to fill this evidence gap. Intra-facility analyses were conducted, comparing trends in HIV and non-HIV service utilisation with staff trends. Results Clinical staff (doctors, nurses and nurse-midwives, and clinical officers numbers and staff population densities fell slightly, with lower ratios of staff to population in the rural district. The ratios of antenatal care and family planning registrants to nurses/nurse-midwives were highest at baseline and increased further at the rural facilities over the three years, while daily outpatient department (OPD workload in urban facilities fell below that in rural facilities. HIV workload, as measured by numbers of clients receiving antiretroviral treatment (ART and prevention of mother to child transmission (PMTCT per facility staff member, was highest in the capital city, but increased rapidly in all three districts. The analysis suggests evidence of task sharing, in that staff designated by managers as ART and PMTCT workers made up a higher proportion of frontline service providers by 2007. Conclusions This analysis of workforce patterns across 30 facilities in three districts of Zambia illustrates that the remarkable achievements in scaling-up HIV/AIDS service delivery has been on the back of
Walsh, Aisling; Ndubani, Phillimon; Simbaya, Joseph; Dicker, Patrick; Brugha, Ruairí
Considerable attention has been given by policy makers and researchers to the human resources for health crisis in Africa. However, little attention has been paid to quantifying health facility-level trends in health worker numbers, distribution and workload, despite growing demands on health workers due to the availability of new funds for HIV/AIDS control scale-up. This study analyses and reports trends in HIV and non-HIV ambulatory service workloads on clinical staff in urban and rural district level facilities. Structured surveys of health facility managers, and health services covering 2005-07 were conducted in three districts of Zambia in 2008 (two urban and one rural), to fill this evidence gap. Intra-facility analyses were conducted, comparing trends in HIV and non-HIV service utilisation with staff trends. Clinical staff (doctors, nurses and nurse-midwives, and clinical officers) numbers and staff population densities fell slightly, with lower ratios of staff to population in the rural district. The ratios of antenatal care and family planning registrants to nurses/nurse-midwives were highest at baseline and increased further at the rural facilities over the three years, while daily outpatient department (OPD) workload in urban facilities fell below that in rural facilities. HIV workload, as measured by numbers of clients receiving antiretroviral treatment (ART) and prevention of mother to child transmission (PMTCT) per facility staff member, was highest in the capital city, but increased rapidly in all three districts. The analysis suggests evidence of task sharing, in that staff designated by managers as ART and PMTCT workers made up a higher proportion of frontline service providers by 2007. This analysis of workforce patterns across 30 facilities in three districts of Zambia illustrates that the remarkable achievements in scaling-up HIV/AIDS service delivery has been on the back of sustained non-HIV workload levels, increasing HIV workload and stagnant
Full Text Available The aim of the study was to explore the patterns of dental health services access in children under twelve years of age in Peru. Data from 25,285 children under 12 years who participated in the Demographic and Family Health Survey of 2014 were reviewed. An exploratory spatial analysis was performed to project the proportions of children with access to dental health services, according to national regions, type of health service and urban or rural place of residence. The results show that of the total sample, 26.7% had access to dental health services in the last six months, 39.6% belonged to the age group 0-4 years, 40.6% lived in the Andean region and 58.3% lived in urban areas. The regions of Huancavelica, Apurimac, Ayacucho, Lima and Pasco had the highest percentages of access nationwide. In conclusion, there is low access to dental health services in the population under 12 years of age in Peru. The spatial distribution of access to dental health services allows regions to be identified and grouped according to similar access patterns, in order to better focus public health actions.
Ventelou, Bruno; Arrighi, Yves; Greener, Robert; Lamontagne, Erik; Carrieri, Patrizia; Moatti, Jean-Paul
Previous economic literature on the cost-effectiveness of antiretroviral treatment (ART) programs has been mainly focused on the microeconomic consequences of alternative use of resources devoted to the fight against the HIV pandemic. We rather aim at forecasting the consequences of alternative scenarios for the macroeconomic performance of countries. We used a micro-simulation model based on individuals aged 15-49 selected from nationally representative surveys (DHS for Cameroon, Tanzania and Swaziland) to compare alternative scenarios : 1-freezing of ART programs to current levels of access, 2- universal access (scaling up to 100% coverage by 2015, with two variants defining ART eligibility according to previous or current WHO guidelines). We introduced an "artificial" ageing process by programming methods. Individuals could evolve through different health states: HIV negative, HIV positive (with different stages of the syndrome). Scenarios of ART procurement determine this dynamics. The macroeconomic impact is obtained using sample weights that take into account the resulting age-structure of the population in each scenario and modeling of the consequences on total growth of the economy. Increased levels of ART coverage result in decreasing HIV incidence and related mortality. Universal access to ART has a positive impact on workers' productivity; the evaluations performed for Swaziland and Cameroon show that universal access would imply net cost-savings at the scale of the society, when the full macroeconomic consequences are introduced in the calculations. In Tanzania, ART access programs imply a net cost for the economy, but 70% of costs are covered by GDP gains at the 2034 horizon, even in the extended coverage option promoted by WHO guidelines initiating ART at levels of 350 cc/mm(3) CD4 cell counts. Universal Access ART scaling-up strategies, which are more costly in the short term, remain the best economic choice in the long term. Renouncing or
Grut, Lisbet; Sanudi, Lifah; Braathen, Stine Hellum; Jürgens, Thomas; Eide, Arne H
Tuberculosis occurs in all populations, but with higher prevalence in poor contexts. Vulnerable groups, including individuals with disability, run a particular risk due to poorer access to information and health services. Studying access to tuberculosis services for vulnerable groups in poor contexts may provide useful insight into the quality of such services in low-income contexts. This article aims to present a contextual understanding of access to tuberculosis services for people with disabilities in one district in southern Malawi. A qualitative method with semi-structured interviews and site observations was applied. In all, 89 participants were interviewed: 47 persons with disability, 11 parents/guardians of youths with disability, and the remaining 31 comprising eight health workers, four community rehabilitation assistants and volunteers, and 19 leaders in the community.Our main findings are that lack of information and knowledge, and considerable confusion related to tuberculosis, its cause and how to protect oneself, are major barrier to accessing services. Disease awareness and personal risk perception are key factors in this regard. Further findings concerns the pathways to tuberculosis related health services, in particular having a test and completing the treatment. The combination of lack of knowledge and barriers in accessing tests implies substantial availability and access problems.It is of importance to understand the combined impact of individual, social, contextual, and systems barriers to fully address the complexity of accessing tuberculosis services for vulnerable groups in poor populations. Lack of disability specific strategies in the local health services may be part of the reason why individuals with disability to not access such services.
Full Text Available Tuberculosis occurs in all populations, but with higher prevalence in poor contexts. Vulnerable groups, including individuals with disability, run a particular risk due to poorer access to information and health services. Studying access to tuberculosis services for vulnerable groups in poor contexts may provide useful insight into the quality of such services in low-income contexts. This article aims to present a contextual understanding of access to tuberculosis services for people with disabilities in one district in southern Malawi. A qualitative method with semi-structured interviews and site observations was applied. In all, 89 participants were interviewed: 47 persons with disability, 11 parents/guardians of youths with disability, and the remaining 31 comprising eight health workers, four community rehabilitation assistants and volunteers, and 19 leaders in the community.Our main findings are that lack of information and knowledge, and considerable confusion related to tuberculosis, its cause and how to protect oneself, are major barrier to accessing services. Disease awareness and personal risk perception are key factors in this regard. Further findings concerns the pathways to tuberculosis related health services, in particular having a test and completing the treatment. The combination of lack of knowledge and barriers in accessing tests implies substantial availability and access problems.It is of importance to understand the combined impact of individual, social, contextual, and systems barriers to fully address the complexity of accessing tuberculosis services for vulnerable groups in poor populations. Lack of disability specific strategies in the local health services may be part of the reason why individuals with disability to not access such services.
Grut, Lisbet; Sanudi, Lifah; Braathen, Stine Hellum; Jürgens, Thomas; Eide, Arne H.
Tuberculosis occurs in all populations, but with higher prevalence in poor contexts. Vulnerable groups, including individuals with disability, run a particular risk due to poorer access to information and health services. Studying access to tuberculosis services for vulnerable groups in poor contexts may provide useful insight into the quality of such services in low-income contexts. This article aims to present a contextual understanding of access to tuberculosis services for people with disabilities in one district in southern Malawi. A qualitative method with semi-structured interviews and site observations was applied. In all, 89 participants were interviewed: 47 persons with disability, 11 parents/guardians of youths with disability, and the remaining 31 comprising eight health workers, four community rehabilitation assistants and volunteers, and 19 leaders in the community.Our main findings are that lack of information and knowledge, and considerable confusion related to tuberculosis, its cause and how to protect oneself, are major barrier to accessing services. Disease awareness and personal risk perception are key factors in this regard. Further findings concerns the pathways to tuberculosis related health services, in particular having a test and completing the treatment. The combination of lack of knowledge and barriers in accessing tests implies substantial availability and access problems.It is of importance to understand the combined impact of individual, social, contextual, and systems barriers to fully address the complexity of accessing tuberculosis services for vulnerable groups in poor populations. Lack of disability specific strategies in the local health services may be part of the reason why individuals with disability to not access such services. PMID:25830950
Dourado, Inês; MacCarthy, Sarah; Lima, Carlos; Veras, Maria Amélia; Kerr, Ligia; de Brito, Ana Maria; Gruskin, Sofia
Despite the known benefits of early treatment initiation for individual morbidity and mortality, as well as for reducing the risk of transmission, late presentation (LP) to HIV/AIDS services remains a major concern in many countries. There is little information on LP from middle- and low-income countries and studies that do evaluate LP commonly disaggregate data by sex. It is rare, however, for researchers to further disaggregate the data by pregnancy status so it remains unclear if pregnancy status modifies the effects associated with sex. The study was conducted at the only State Reference Center for HIV/AIDS in Salvador, Brazil's third largest city. LP was defined as a patient accessing services with a CD4 difference between men and nonpregnant women (APR 1.04; 95%CI 0.92-1.19), but the APR of LP for nonpregnant women was 53% less than men (APR 0.47; 95%CI 0.33-0.68). These results highlight the importance of analyzing data disaggregated not only by sex but also by pregnancy status to accurately identify the risk factors associated with LP so that programs and policies can effectively and efficiently address LP in Brazil and beyond.
Juliana Pires Ribeiro
Full Text Available The objective of this study was to evaluate accessibility to primary health care services in the state of Goiás. A descriptive cross-sectional study was conducted based on secondary data from the National Program to Improve Access to and Quality of Primary Health Care. The study sample was composed of health professionals from 1,216 primary health care units. Results showed that 68.5% of the health units miss a screening room, thus considerably damaging prompt decision-making by professionals. The lack of medical offices in 2% of the sites hinders the primary health care services accessibility in Goiás. As regards opening hours and work shifts, 86% of the units are open five days a week in eight-hour shifts, which does not favor accessibility for users. This study confirms the lack of accessibility to health services and the need for additional investments to strengthen primary health care.
Plante, Raymond; Harrison, Paul; Tody, Doug
An application that queries or consumes descriptions of VO resources must be able to recognize a resource's support for standard IVOA protocols. This specification describes how to describe a service that supports any of the four fundamental data access protocols -- Simple Cone Search (SCS), Simple Image Access (SIA), Simple Spectral Access (SSA), Simple Line Access (SLA) -- using the VOResource XML encoding standard. A key part of this specification is the set of VOResource XML extension schemas that define new metadata that are specific to those protocols. This document describes in particular rules for describing such services within the context of IVOA Registries and data discovery as well as the VO Standard Interface (VOSI) and service self-description. In particular, this document spells out the essential markup needed to identify support for a standard protocol and the base URL required to access the interface that supports that protocol.
... telephone companies involved in a merger or acquisition. (1) Notwithstanding the requirements of § 69.3(e)(9... resulting from the merger or acquisition of telephone properties are to be made effective on the next annual access tariff filing effective date following consummation of the merger or acquisition transaction,...
Full Text Available Seamless handover across different access technologies is very important in the future wireless networks. To optimize vertical handover in heterogeneous networks, IEEE 802.21 standard defines Media Independent Handover (MIH services. The MIH services can be a new target to attackers, which will be the main concern for equipment vendors and service providers. In this paper, we focus specifically on security of Media Independent Information Service (MIIS and present a new access authentication scheme with user anonymity for MIIS. The protocol can be used to establish a secure channel between the mobile node and the information server. Security and performance of the protocol are also analyzed in this paper.
Full Text Available Integrating reproductive health (RH with HIV care is a policy priority in high HIV prevalence settings, despite doubts surrounding its feasibility and varying evidence of effects on health outcomes. The process and outcomes of integrated RH-HIV care were investigated in Swaziland, through a comparative case study of four service models, ranging from fully integrated to fully stand-alone HIV services, selected purposively within one town. A client exit survey (n=602 measured integrated care received and unmet family planning (FP needs. Descriptive statistics were used to assess the degree of integration per clinic and client demand for services. Logistic regression modelling was used to test the hypothesis that clients at more integrated sites had lower unmet FP needs than clients in a stand-alone site. Qualitative methods included in-depth interviews with clients and providers to explore contextual factors influencing the feasibility of integrated RH-HIV care delivery; data were analysed thematically, combining deductive and inductive approaches. Results demonstrated that clinic models were not as integrated in practice as had been claimed. Fragmentation of HIV care was common. Services accessed per provider were no higher at the more integrated clinics compared to stand-alone models (p>0.05, despite reported demand. While women at more integrated sites received more FP and pregnancy counselling than stand-alone models, they received condoms (a method of choice less often, and there was no statistical evidence of difference in unmet FP needs by model of care. Multiple contextual factors influenced integration practices, including provider de-skilling within sub-specialist roles; norms of task-oriented routinised HIV care; perceptions of heavy client loads; imbalanced client-provider interactions hindering articulation of RH needs; and provider motivation challenges. Thus, despite institutional support, factors related to the social context of
Church, Kathryn; Wringe, Alison; Lewin, Simon; Ploubidis, George B.; Fakudze, Phelele; Mayhew, Susannah H.
Integrating reproductive health (RH) with HIV care is a policy priority in high HIV prevalence settings, despite doubts surrounding its feasibility and varying evidence of effects on health outcomes. The process and outcomes of integrated RH-HIV care were investigated in Swaziland, through a comparative case study of four service models, ranging from fully integrated to fully stand-alone HIV services, selected purposively within one town. A client exit survey (n=602) measured integrated care received and unmet family planning (FP) needs. Descriptive statistics were used to assess the degree of integration per clinic and client demand for services. Logistic regression modelling was used to test the hypothesis that clients at more integrated sites had lower unmet FP needs than clients in a stand-alone site. Qualitative methods included in-depth interviews with clients and providers to explore contextual factors influencing the feasibility of integrated RH-HIV care delivery; data were analysed thematically, combining deductive and inductive approaches. Results demonstrated that clinic models were not as integrated in practice as had been claimed. Fragmentation of HIV care was common. Services accessed per provider were no higher at the more integrated clinics compared to stand-alone models (p>0.05), despite reported demand. While women at more integrated sites received more FP and pregnancy counselling than stand-alone models, they received condoms (a method of choice) less often, and there was no statistical evidence of difference in unmet FP needs by model of care. Multiple contextual factors influenced integration practices, including provider de-skilling within sub-specialist roles; norms of task-oriented routinised HIV care; perceptions of heavy client loads; imbalanced client-provider interactions hindering articulation of RH needs; and provider motivation challenges. Thus, despite institutional support, factors related to the social context of care inhibited
Full Text Available Abstract This study is based on a large-scale household survey and in-depth interviews of key informants that was conducted in villages in three counties of two provinces in China. We assess the new decentralized service provision system for people living with HIV/AIDS in rural populations in China. Since 2003, new social assistance schemes, and, more importantly, decentralization of routine treatment and care to community health stations, were progressively implemented in rural areas most affected by the HIV/AIDS epidemic. Though some problems remain, such as persistent discrimination towards infected patients and the lack of sufficient training of medical staff, the new decentralized pattern of service provision has lowered barriers to health access and alleviated economic pressure on affected households.
Oshita, Kazuki; Arakawa, Kazuharu; Tomita, Masaru
The availability of bioinformatics web-based services is rapidly proliferating, for their interoperability and ease of use. The next challenge is in the integration of these services in the form of workflows, and several projects are already underway, standardizing the syntax, semantics, and user interfaces. In order to deploy the advantages of web services with locally installed tools, here we describe a collection of proxy client tools for 42 major bioinformatics web services in the form of European Molecular Biology Open Software Suite (EMBOSS) UNIX command-line tools. EMBOSS provides sophisticated means for discoverability and interoperability for hundreds of tools, and our package, named the Keio Bioinformatics Web Service (KBWS), adds functionalities of local and multiple alignment of sequences, phylogenetic analyses, and prediction of cellular localization of proteins and RNA secondary structures. This software implemented in C is available under GPL from http://www.g-language.org/kbws/ and GitHub repository http://github.com/cory-ko/KBWS. Users can utilize the SOAP services implemented in Perl directly via WSDL file at http://soap.g-language.org/kbws.wsdl (RPC Encoded) and http://soap.g-language.org/kbws_dl.wsdl (Document/literal).
Full Text Available Abstract The availability of bioinformatics web-based services is rapidly proliferating, for their interoperability and ease of use. The next challenge is in the integration of these services in the form of workflows, and several projects are already underway, standardizing the syntax, semantics, and user interfaces. In order to deploy the advantages of web services with locally installed tools, here we describe a collection of proxy client tools for 42 major bioinformatics web services in the form of European Molecular Biology Open Software Suite (EMBOSS UNIX command-line tools. EMBOSS provides sophisticated means for discoverability and interoperability for hundreds of tools, and our package, named the Keio Bioinformatics Web Service (KBWS, adds functionalities of local and multiple alignment of sequences, phylogenetic analyses, and prediction of cellular localization of proteins and RNA secondary structures. This software implemented in C is available under GPL from http://www.g-language.org/kbws/ and GitHub repository http://github.com/cory-ko/KBWS. Users can utilize the SOAP services implemented in Perl directly via WSDL file at http://soap.g-language.org/kbws.wsdl (RPC Encoded and http://soap.g-language.org/kbws_dl.wsdl (Document/literal.
... From the Federal Register Online via the Government Publishing Office ENVIRONMENTAL PROTECTION AGENCY Access to Confidential Business Information by Chemical Abstract Services AGENCY: Environmental Protection Agency (EPA). ACTION: Notice. SUMMARY: EPA expects to authorize its contractor, Chemical...
.... It provides data on the use of basic financial services by households and firms across a sample of countries, assesses the desirability of universal access, and provides an overview of the macro...
Full Text Available Recent advances in information communication technology and software have enabled mobile terminals to employ various capabilities as a smartphone. They adopt multiple interfaces for wireless communication and run as a portable computer. Mobile services are also transferred from voice to data. Mobile terminals can access Internet for data services anytime anywhere. By using location-based information, improved mobile services are enabled in heterogeneous networks. In the mobile service environment, it is required that mobile terminals should efficiently use wireless network resources. In addition, because video stream becomes a major service among the data services of mobile terminals in heterogeneous networks, the necessity of the efficient network access control for heterogeneous wireless networks is raised as an important topic. That is, quality of services of the location-based video stream is determined by the network access control. Therefore, this paper proposes a novel network access control in the heterogeneous wireless networks. The proposed method estimates the network status with Naïve Bayesian Classifier and performs network access control according to the estimated network status. Thus, it improves data transmission efficiency to satisfy the quality of services. The efficiency of the proposed method is validated through the extensive computer simulation.
U.S. Department of Health & Human Services — NAHDAP acquires, preserves and disseminates data relevant to drug addiction and HIV research. By preserving and making available an easily accessible library of...
Rocha, Thiago Augusto Hernandes; da Silva, Núbia Cristina; Amaral, Pedro Vasconcelos; Barbosa, Allan Claudius Queiroz; Rocha, João Victor Muniz; Alvares, Viviane; de Almeida, Dante Grapiuna; Thumé, Elaine; Thomaz, Erika Bárbara Abreu Fonseca; de Sousa Queiroz, Rejane Christine; de Souza, Marta Rovery; Lein, Adriana; Lopes, Daniel Paulino; Staton, Catherine A; Vissoci, João Ricardo Nickenig; Facchini, Luiz Augusto
Unequal distribution of emergency care services is a critical barrier to be overcome to assure access to emergency and surgical care. Considering this context it was objective of the present work analyze geographic access barriers to emergency care services in Brazil. A secondary aim of the study is to define possible roles to be assumed by small hospitals in the Brazilian healthcare network to overcome geographic access challenges. The present work can be classified as a cross-sectional ecological study. To carry out the present study, data of all 5843 Brazilian hospitals were categorized among high complexity centers and small hospitals. The geographical access barriers were identified through the use of two-step floating catchment area method. Once concluded the previous step an evaluation using the Getis-Ord-Gi method was performed to identify spatial clusters of municipalities with limited access to high complexity centers but well covered by well-equipped small hospitals. The analysis of accessibility index of high complexity centers highlighted large portions of the country with nearly zero hospital beds by inhabitant. In contrast, it was possible observe a group of 1595 municipalities with high accessibility to small hospitals, simultaneously with a low coverage of high complexity centers. Among the 1595 municipalities with good accessibility to small hospitals, 74% (1183) were covered by small hospitals with at least 60% of minimum emergency service requirements. The spatial clusters analysis aggregated 589 municipalities with high values related to minimum emergency service requirements. Small hospitals in these 589 cities could promote the equity in access to emergency services benefiting more than eight million people. There is a spatial disequilibrium within the country with prominent gaps in the health care network for emergency services. Taking this challenge into consideration, small hospitals could be a possible solution and foster equity in access
... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Access to information and translation... Trafficking in Persons § 1100.33 Access to information and translation services for victims of severe forms of... reasonable access to translation services and/or oral interpreter services in the event the victim is...
Without a birth certificate, no identity card can be issued and without identity card, there is no access to formal financial services. This link seems to be trivial in industrialized countries, where the ability of the individual to participate in economic life is rarely hindered by a lack of identification. In many developing countries, however, access to financial services is often denied, because potential customers cannot be identified based upon official identity documents-a basic due d...
Full Text Available Abstract Background Access to health care can be described along four dimensions: geographic accessibility, availability, financial accessibility and acceptability. Geographic accessibility measures how physically accessible resources are for the population, while availability reflects what resources are available and in what amount. Combining these two types of measure into a single index provides a measure of geographic (or spatial coverage, which is an important measure for assessing the degree of accessibility of a health care network. Results This paper describes the latest version of AccessMod, an extension to the Geographical Information System ArcView 3.×, and provides an example of application of this tool. AccessMod 3 allows one to compute geographic coverage to health care using terrain information and population distribution. Four major types of analysis are available in AccessMod: (1 modeling the coverage of catchment areas linked to an existing health facility network based on travel time, to provide a measure of physical accessibility to health care; (2 modeling geographic coverage according to the availability of services; (3 projecting the coverage of a scaling-up of an existing network; (4 providing information for cost effectiveness analysis when little information about the existing network is available. In addition to integrating travelling time, population distribution and the population coverage capacity specific to each health facility in the network, AccessMod can incorporate the influence of landscape components (e.g. topography, river and road networks, vegetation that impact travelling time to and from facilities. Topographical constraints can be taken into account through an anisotropic analysis that considers the direction of movement. We provide an example of the application of AccessMod in the southern part of Malawi that shows the influences of the landscape constraints and of the modes of transportation on
Poljski, Carolyn; Quiazon, Regina; Tran, Chau
Drawing on the research and advocacy work being conducted by the Multicultural Centre for Women's Health (MCWH), a national community-based organization in Victoria, Australia, the paper analyzes female international students' experiences with accessing sexual and reproductive health information and services. Accessibility of sexual and…
Wray, Christina C.
Providing accessible library services and instruction to distance users with disabilities can seem daunting. This article, which grew out of a webinar presented by the author to the Health Science Special Interest Group of ACRL, provides practical strategies to help content creators utilize built-in accessibility features and provides a resources…
T.A. Nguyen; P. Oosterhoff; P.N. Yen; P. Wright; A. Hardon
HIV prevention within maternal-child health services has increased in many developing countries, but many HIV-infected women in developing countries still receive insufficient postnatal care. This study explored the experience of 30 HIV-infected women in Vietnam in accessing HIV-related postnatal ca
Fonjungo, Peter N; Boeras, Debrah I; Zeh, Clement; Alexander, Heather; Parekh, Bharat S; Nkengasong, John N
Access to point-of-care testing (POCT) improves patient care, especially in resource-limited settings where laboratory infrastructure is poor and the bulk of the population lives in rural settings. However, because of challenges in rolling out the technology and weak quality assurance measures, the promise of human immunodeficiency virus (HIV)-related POCT in resource-limited settings has not been fully exploited to improve patient care and impact public health. Because of these challenges, the Joint United Nations Programme on HIV/AIDS (UNAIDS), in partnership with other organizations, recently launched the Diagnostics Access Initiative. Expanding HIV programs, including the "test and treat" strategies and the newly established UNAIDS 90-90-90 targets, will require increased access to reliable and accurate POCT results. In this review, we examine various components that could improve access and uptake of quality-assured POC tests to ensure coverage and public health impact. These components include evaluation, policy, regulation, and innovative approaches to strengthen the quality of POCT. © The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail firstname.lastname@example.org.
Farber, Eugene W; Shahane, Amit A; Brown, Jennifer L; Campos, Peter E
HIV stigma remains a significant challenge for individuals living with HIV disease that can adversely affect overall well-being and patterns of HIV health service engagement. Finding ways to effectively address stigma concerns is, therefore, an important consideration in the clinical management of HIV disease. This study examined changes in perceived stigma in a sample of 48 adults living with HIV disease as an outcome of their participation in a mental health services program integrated with community-based HIV primary care. Participants completed a self-report instrument that provided a multidimensional measure of perceived HIV stigma, including distancing, blaming, and discrimination dimensions. This scale was administered at the baseline mental health service visit and then re-administered at the three-month follow-up point. Study results showed reductions in self-reported perceived HIV stigma over time for the distancing (t = 4.01, p = 0.000, d = 0.43), blaming (t = 2.79, p = 0.008, d = 0.35), and discrimination (t = 2.90, p = 0.006, d = 0.42) dimensions of stigma. These findings suggest that participation in HIV mental health services may have a favorable impact on perceived HIV stigma. Implications of these findings are discussed, including possible mechanisms that might explain the observed results as well as suggested directions for future research in this area. Randomized controlled trials would represent an important next step to investigate the extent to which HIV mental health services can reduce levels of perceived HIV stigma.
Gowling, Sarah; Persson, Jennie; Holt, Genevieve; Ashbourne, Sue; Bloomfield, James; Shortland, Hannah; Bate, Clare
IAPT (Improving Access to Psychological Therapies) is a national programme aimed at increasing availability of evidence based psychological therapies in the NHS. IAPT is primarily for people who have mild to moderate, common mental health difficulties such as depression, anxiety, phobias and post traumatic stress disorder (PTSD). The programme seeks to use the least intrusive method of care possible to treat people at the time when it will be of most help to them. Individuals are able to self...
Full Text Available The presence of rationing of financial services in the developing countries is a major obstacle to achieving sustainable growth. In recent years there have been co-ordinated efforts to increase the level of financial inclusion, i.e. to reduce the supply-side constraints restricting access to finance. This paper aims to understand household's latent behaviour decision making in accessing financial services, by analysing an entry level Mzansi account in South Africa. The willingness to access financial services is not taken as given, but it is instead defined by perceptions and attitudes. The Mzansi intervention is appealing to individuals with basic but insufficient financial education. Aspirations seem to be very influential in revealing the choice of financial services and to this end, Mzansi is perceived as a pre-entry account not meeting the aspirations of individuals aiming to climb up the financial services ladder.
Swai Andrew B
Full Text Available Abstract Background Sub-Saharan Africa has been severely affected by the HIV and AIDS pandemic. Global efforts at improving care and treatment has included scaling up use of antiretroviral therapy (ART. In Tanzania, HIV care and treatment program, including the provision of free ART started in 2004 with a pilot program at Muhimbili National Hospital in Dar es Salaam. This study describes the socio-demographic and clinical features of patients enrolled at the care and treatment clinic at MNH, Dar es Salaam, Tanzania. Methods A cross-sectional study looking at baseline characteristics of patients enrolled at the HIV clinic at MNH between June 2004 - Dec 2005 compared to those enrolled between 2006 and September 2008. Results Of all enrolled patients, 2408 (58.5% were used for analysis. More females than males were attending the clinic. Their baseline median CD4 cell count was low (136 cells/μl with 65.7% having below 200 cells/μl. Females had higher CD4 cell counts (150 cells/μl than males (109 cells/μl p Conclusion Patients enrolled to the MNH HIV clinic were predominantly females, and presented with advanced immune-deficiency. Improved access to HIV care and treatment services seems to be associated with patients' early presentation to the clinics in the course of HIV disease.
... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Part C Early Intervention Services Grant Under the Ryan White HIV/AIDS Program AGENCY: Health Resources and Services Administration (HRSA),...
Full Text Available Abstract Background The SEED integrates many publicly available genome sequences into a single resource. The database contains accurate and up-to-date annotations based on the subsystems concept that leverages clustering between genomes and other clues to accurately and efficiently annotate microbial genomes. The backend is used as the foundation for many genome annotation tools, such as the Rapid Annotation using Subsystems Technology (RAST server for whole genome annotation, the metagenomics RAST server for random community genome annotations, and the annotation clearinghouse for exchanging annotations from different resources. In addition to a web user interface, the SEED also provides Web services based API for programmatic access to the data in the SEED, allowing the development of third-party tools and mash-ups. Results The currently exposed Web services encompass over forty different methods for accessing data related to microbial genome annotations. The Web services provide comprehensive access to the database back end, allowing any programmer access to the most consistent and accurate genome annotations available. The Web services are deployed using a platform independent service-oriented approach that allows the user to choose the most suitable programming platform for their application. Example code demonstrate that Web services can be used to access the SEED using common bioinformatics programming languages such as Perl, Python, and Java. Conclusions We present a novel approach to access the SEED database. Using Web services, a robust API for access to genomics data is provided, without requiring large volume downloads all at once. The API ensures timely access to the most current datasets available, including the new genomes as soon as they come online.
McNairy, Margaret L; Bashi, Jules B; Chung, Hannah; Wemin, Louise; Lorng, Marie-Nicole Akpro; Brou, Hermann; Nioble, Cyprien; Lokossue, A; Abo, Kouame; Achi, Delphine; Ouattara, Kiyali; Sess, Daniel; Sanogo, Pongathie Adama; Ekra, Alexandre; Ettiegne-Traore, Virginie; Diabate, Conombo J; Abrams, Elaine J; El-Sadr, Wafaa M
We report the first national programme in Côte d'Ivoire to evaluate the feasibility of nurse-led HIV care as a model of task-sharing with nurses to increase coverage and decentralisation of HIV services. Twenty-six public HIV facilities implemented either a nurse-with-onsite-physician or a nurse-with-visiting-physician model of HIV task-sharing. Routinely collected patient data were reviewed to analyse patient characteristics of those enrolling in care and initiating antiretroviral therapy (ART). Retention, loss to programme and death were compared across facility-level characteristics. A total of 1224 patients enrolled in HIV care, with 666 initiating ART, from January 2012 to May 2013 (median follow-up 13 months). The majority (94%) were adults ≥15 years. Fourteen facilities provided ART initiation for the first time during the pilot period; 20 facilities were primary level. Nurse-led care with a visiting physician was provided in 14 of the primary-level facilities. Nurse-led ART care with an onsite physician was provided in all secondary-level facilities and six of the primary-level facilities. During the pilot, 567 (85%) of patients were retained, 28 (4.2%) died, 47 (7.1%) were lost to follow-up, and 24 (3.6%) transferred. Five deaths (10.9%) were recorded among children as compared to 23 deaths (3.7%) among adults (P = 0.037). There were no differences in retention by model of nurse-led ART care. Task-sharing of HIV care and ART initiation with nurses in Côte d'Ivoire is feasible. This pilot illustrates two models of nurse-led HIV care and has informed national policy on nurse-led HIV care in Côte d'Ivoire. © 2017 John Wiley & Sons Ltd.
J.F. François (Joseph); I. Wooton
textabstractWe examine interaction between trade in goods and market power in domestic trade and distribution, developing a model that highlights this interaction. Theory points to an expected linkage between service sector competition and goods trade, one supported by econometrics involving import
Baldwin, Laura-Mae; Cai, Yong; Larson, Eric H.; Dobie, Sharon A.; Wright, George E.; Goodman, David C.; Matthews, Barbara; Hart, L. Gary
Context: Cancer care requires specialty surgical and medical resources that are less likely to be found in rural areas. Purpose: To examine the travel patterns and distances of rural and urban colorectal cancer (CRC) patients to 3 types of specialty cancer care services--surgery, medical oncology consultation, and radiation oncology consultation.…
... that the number and type of providers available to plan enrollees are sufficient to meet projected... limited English proficiency or reading skills, and diverse cultural and ethnic backgrounds. (9) Ambulance... with community and social services generally available through contracting or noncontracting providers...
AJRH Managing Editor
Résumé. Les jeunes femmes et les jeunes filles en Afrique du Sud sont à risque élevé de grossesses non désirées et du VIH. ... et à d'autres services de santé sexuelle et de la reproduction (SSR) chez les ..... to adolescents and young adults.
Full Text Available Background: Documenting specific knowledge and attitudes about HIV in the culturally diverse nation of Solomon Islands is essential to inform locally targeted public health responses. As part of a large capacity-strengthening project at Atoifi Adventist Hospital in East Kwaio, Solomon Islands, researchers, using a ‘learn-by-doing’ process, worked with participants in public health research methods. Methods: Overall, 43 people attended research capacity building workshops in 2011; eight joined the HIV study group. A cross-sectional survey including semi-structured interviews on HIV was conducted by the group. In February 2014, a hospital administrator was interviewed about how the 2011 study informed local HIV responses. Results: Of the 53 survey participants, 64% self-assessed as having little or no HIV knowledge, but 90% knew HIV could be transmitted between men and women during sex. Less than 50% knew HIV could be transmitted between two men having sex, 45% thought HIV could be transmitted by mosquitoes and 55% agreed condoms help protect from HIV. Most participants reported negative attitudes towards people with HIV. Three years later the health administrator reported ad hoc responses to HIV because of low HIV prevalence, increasing noncommunicable diseases, staff turnover and resource shortages. Discussion: This HIV study was used to strengthen research skills in local health professionals and community members in Solomon Islands. It showed that community members require accurate information about HIV transmission and that entrenched stigma is an issue. Although results provided local evidence for local response, ongoing health system challenges and little local HIV transmission meant HIV services remain rudimentary.
Wyss, Susi; Ablordeppey, Joyce; Okrah, Jane; Kyei, Abigail
This paper documents the evaluation of a 20-month project to provide voluntary counselling and testing (VCT) to a mobile population of youth surrounding the Agbogbloshie market in Accra, Ghana. The specific objectives of the evaluation were to determine: 1) to what extent targets for providing VCT services to the specified population were reached; 2) how HIV prevalence among clients compared to that of the general population; 3) to what extent former clients self-reported behaviour change; and 4) whether useful lessons could be drawn regarding fees, hours, and location of services, as well as use of peer educators to increase use of VCT services among the target population. Various methodologies, including questionnaires, focus group discussions, a review of the service statistics and an exit poll of clients were used to evaluate the project. The service statistics demonstrated that the project exceeded the life-of-project target for number of clients by nearly 40%. Prevalence for the VCT client population (aged 15-25) was higher than for the general population (aged 15-24), although the gender differentials were similar. Focus group data suggested that clients may have adopted behaviour changes as a result of VCT. Finally, focus group discussions and VCT service trends showed that the high number of clients was largely influenced by three factors: services being free, location and hours of services being convenient to the target population, and use of peer educators to promote the services. In addition, the evaluation highlighted the importance of the counselling component of VCT, even as counselling can get short-changed at the expense of HIV testing when large numbers of clients are involved. The evaluation stressed the need to appropriately remunerate peer educators for their work whenever possible. Finally, VCT programmes continue to face challenges such as: HIV stigma as a barrier to people coming to be counselled and tested; insufficient availability of
Alencar Albuquerque, Grayce; de Lima Garcia, Cintia; da Silva Quirino, Glauberto; Alves, Maria Juscinaide Henrique; Belém, Jameson Moreira; dos Santos Figueiredo, Francisco Winter; da Silva Paiva, Laércio; do Nascimento, Vânia Barbosa; da Silva Maciel, Érika; Valenti, Vitor Engrácia; de Abreu, Luiz Carlos; Adami, Fernando
The relationship between users and health services is considered essential to strengthen the quality of care. However, the Lesbian, Gay, Bisexual, and Transgender population suffer from prejudice and discrimination in access and use of these services. This study aimed to identify the difficulties associated with homosexuality in access and utilization of health services. A systematic review conducted using PubMed, Cochrane, SciELO, and LILACS, considering the period from 2004 to 2014. The studies were evaluated according to predefined inclusion and exclusion criterias. Were included manuscripts written in English or Portuguese, articles examining the Lesbian, Gay, Bisexual, and Transgender population's access to health services and original articles with full text available online. The electronic databases search resulted in 667 studies, of which 14 met all inclusion criteria. Quantitative articles were predominant, showing the country of United States of America to be the largest producer of research on the topic. The studies reveal that the homosexual population have difficulties of access to health services as a result of heteronormative attitudes imposed by health professionals. The discriminatory attendance implies in human rights violations in access to health services. The non-heterosexual orientation was a determinant factor in the difficulties of accessing health care. A lot must still be achieved to ensure access to health services for sexual minorities, through the adoption of holistic and welcoming attitudes. The results of this study highlight the need for larger discussions about the theme, through new research and debates, with the aim of enhancing professionals and services for the health care of Lesbian, Gay, Bisexual, and Transgender Persons.
Erick Nelo Pedreira; Camila Lopes Cardoso; Éder do Carmo Barroso; Jorge André de Souza Santos; Felipe Paiva Fonseca; Luís Antônio de Assis Taveira
The purpose of this study was to evaluate the prevalence of oral lesions in HIV-positive patients attending the Specialized Service for Infectious-contagious Diseases and Parasitoses of the Health Secretariat of the State of Pará (URE-DIPE/SESPA), in the city of Belém, PA, Brazil. A total of 79 HIV-positive patients (53 males and 26 females) were examined. Clinical and epidemiological evaluations were done by correlating the lesions with gender, race, chronological age, risk behavior and prev...
Haddad, Lisa; Wall, Kristin M; Vwalika, Bellington; Htee Khu, Naw; Brill, Ilene; Kilembe, William; Stephenson, Rob; Chomba, Elwyn; Vwalika, Cheswa; Tichacek, Amanda; Allen, Susan
Objective To describe predictors of contraceptive method discontinuation and switching behaviors among HIV positive couples receiving couples' voluntary HIV counseling and testing services in Lusaka, Zambia. Design Couples were randomized in a factorial design to two family planning educational intervention videos, received comprehensive family planning services, and were assessed every 3-months for contraceptive initiation, discontinuation and switching. Methods We modeled factors associated with contraceptive method upgrading and downgrading via multivariate Andersen-Gill models. Results Most women continued the initial method selected after randomization. The highest rates of discontinuation/switching were observed for injectable contraceptive and intrauterine device users. Time to discontinuing the more effective contraceptive methods or downgrading to oral contraceptives or condoms was associated with the women's younger age, desire for more children within the next year, heavy menstrual bleeding, bleeding between periods, and cystitis/dysuria. Health concerns among women about contraceptive implants and male partners not wanting more children were associated with upgrading from oral contraceptives or condoms. HIV status of the woman or the couple was not predictive of switching or stopping. Conclusions We found complicated patterns of contraceptive use. The predictors of contraception switching indicate that interventions targeted to younger couples that address common contraception-related misconceptions could improve effective family planning utilization. We recommend these findings be used to increase the uptake and continuation of contraception, especially long acting reversible contraceptive (LARC) methods, and that fertility-goal based, LARC-focused family planning be offered as an integral part of HIV prevention services. PMID:24088689
Handa, Kozue; Dairoku, Hitoshi; Toriyama, Yoshiko
This study investigates the priority needs of museum service accessibility for visually impaired visitors. For this purpose, conjoint analysis was utilized. Four conjoint attributes of museum services were selected: A--facilities for wayfinding; B--exhibitions and collections including objects for touching, hearing, smelling, etc.; C--information…
Brown, K. E.; Newby, K.; Caley, M.; Danahay, A.; Kehal, I.
Sexual health service access is fundamental to good sexual health, yet interventions designed to address this have rarely been implemented or evaluated. In this article, pilot evaluation findings for a targeted public health behavior change intervention, delivered via a website and web-app, aiming to increase uptake of sexual health services among…
... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Exemption of the Immigration and....99 Exemption of the Immigration and Naturalization Service Systems-limited access. (a) The following systems of records of the Immigration and Naturalization Service are exempt from 5 U.S.C. 552a (c) (3)...
Mier, Sharon; Boone, Matthew; Shropshire, Sonya
Although the severity of psychological problems among college students and the demand for campus counseling services has increased, many students who could benefit from mental health services still do not access them. This article describes Community Consultation and Intervention, a program designed to support students who are unlikely to access…
... carrier that is not a rural telephone company under 47 U.S.C. 153(37). (5) The rate for interstate... such services by the competing ILEC or (2) The lower of: (i) The benchmark rate described in paragraph..., 2002, the benchmark rate for a CLEC's interstate switched exchange access services will be $0.025...
Wendy V. Norman
Full Text Available Background. Providing equitable access to the full range of reproductive health services over wide geographic areas presents significant challenges to any health system. We present a review of a service provision model which has provided improved access to abortion care; support for complex issues experienced by women seeking nonjudgmental family planning health services; and a mechanism to collect information on access barriers. The toll-free pregnancy options service (POS of British Columbia Women’s Hospital and Health Centre sought to improve access to services and overcome barriers experienced by women seeking abortion. Methods. We describe the development and implementation of a province-wide toll-free telephone counseling and access facilitation service, including establishment of a provincial network of local abortion service providers in the Canadian province of British Columbia from 1998 to 2010. Results. Over 2000 women annually access service via the POS line, networks of care providers are established and linked to central support, and central program planners receive timely information on new service gaps and access barriers. Conclusion. This novel service has been successful in addressing inequities and access barriers identified as priorities before service establishment. The service provided unanticipated benefits to health care planning and monitoring of provincial health care related service delivery and gaps. This model for low cost health service delivery may realize similar benefits when applied to other health care systems where access and referral barriers exist.
Full Text Available In Internet of Things, computing and processing of information is the core supporting. In this paper, we introduce “Service-Oriented Computing” to solve the computing and processing of information in IoT. However, a key challenge in service-oriented environment is the design of effective access control schemas.We put forward a model of Workflow -oriented Attributed Based Access Control (WABAC, and an access control framework based on WABAC model. WABAC model grants and adapts permissions to subjects according to subject atttribute, resource attribute, environment attribute and current task, meeting access control request of SOC. Using the approach presented can effectively enhance the access control security for SOC applications, and prevent the abuse of subject permissions.
ZHANG Yao; Ray Y. Chen; ZHANG Fu-jie; LU Lin; LI Hui-qin; LIU Wei; TANG Zhi-rong; FANG Hua; Jennifer Y. Chen; MA Ye; ZHAO Yan
Background The initiation and expansion of China's national free antiretroviral therapy program has led to significant improvement of survival among its participants. Success of further scaling up treatment coverage rests upon intensifying HIV screening and efficient linkage of care. Timely CD4 cell count testing after HIV diagnosis is necessary to determine whether a patient meets criteria for antiretroviral treatment, and represents a crucial link to engage HIV-infected patients in appropriate care, which has not been evaluated in China.Methods We evaluated all patients ≥16 years who tested HIV positive from 2005 to 2009 in Yunnan and Guangxi.Multivariate Logistic regression models were applied to identify factors associated with lack of CD4 cell count testing within 6 months after HIV diagnosis.Results A total of 83 556 patients were included. Over the study period, 30 635 (37%) of subjects received a CD4 cell count within 6 months of receiving the HIV diagnosis. The rate of CD4 cell count testing within 6 months of HIV diagnosis increased significantly from 7% in 2005 to 62% in 2009. Besides the earlier years of HIV diagnosis, negative predictors for CD4 cell count testing in multivariate analyses included older age, not married or unclear marriage status,incarceration, diagnosis at sexual transmitted disease clinics, mode of HIV transmission classified as men who have sex with men, intravenous drug users or transmission route unclear, while minority ethnicity, receipt of high school or higher education, diagnosis at voluntary counseling and testing clinics, and having HIV positive parents were protective.Conclusions Significant progress has been made in increasing CD4 testing among newly diagnosed HIV positive patients in Yunnan and Guangxi from 2005-2009. However, a sizable proportion of HIV positive patients still lack CD4testing within 6 months of diagnosis. Improving CD4 testing, particularly among patients with identified risk factors, is essential to
Kamb, L.; Weertman, B.; Trabant, C.
To meet the data management and access challenges of EarthScope, the IRIS Data Management Center is building a broad range of new and leveraged data discovery and access services. This collection of SOAP- based and REST-style web services support both the EarthScope Data Portal and IRIS DMC's operational needs. The services provide access to station metadata, waveform inventory and data, and data products from the SPADE product archive. The EarthScope Data Portal provides a single point of access to all data and products from three EarthScope component data centers: IRIS (USArray), UNAVCO (PBO), and ICDP (SAFOD). The Portal allows users to search for EarthScope stations and data matching specific search constraints. Selected data and data products can be added to a data cart for final packaging and download to the user's machine. Defining a single common service interface for all of the EarthScope components was one of the primary challenges of the Portal's development. This poster presents the design and implementation of the IRIS data access web services as it applies to the EarthScope Portal as well as a standalone service framework for the IRIS DMC.
Bennett, Cary; Donovan, Raymond
This article examines the controversy around the proposal in the late 1980s and early 1990s to mainstream HIV/AIDS treatment, services, and care in Australia. With the predicted increase in HIV infections, and with improved prophylaxis and antiretroviral therapy (such as AZT) extending the lives of people with HIV/AIDS, mainstreaming was proposed as a strategy that could meet the anticipated increased demand in HIV/AIDS services. Our analysis suggests that mainstreaming was strategically positioned as a necessary intermediary step between specialist and community control, one in which general practitioners and local health workers would serve as conduits through which specialist knowledge and information could be deployed. The strategy also reflected a general shift in thinking and acting on public health that emerged in the late 1980s, a shift that sought, inter alia, to reorientate health services towards fostering the self-managing capacities of HIV/AIDS affected communities.
Maria Vieira de Lima Saintrain
Full Text Available ABSTRACT The Brazilian National Health System guarantees universal access to health services. However, this universal access is not always achieved, making relevant studies that evaluate access to health care and the way gender influence this access. Objective: Identify the influence of gender in the access to dental services and goods such as consultation, toothbrush, toothpaste and dental prostheses use in Brazil’s Northeast region. Methods: Cross-sectional, quantitative and population coverage study, with the population of Guaiuba municipality. Data were collected by Community Health Agents from July 2007 to February 2008. We used the Community Oral Health Indicator to verify the access to oral health services, oral hygiene, dental visit, use and need of dental prosthesis. Data were analyzed using SPSS 15.0 software, using the chi-square test and significance level of 5%. Results: 2581 people participated, with a mean age of 24.42 years (SD± 19, 365, with 1628 female (63.1%. Among the interviewees, 2,341 (90.7% had access to a toothbrush, 2272 (88.0% to toothpaste, and 1175 (45.5% to a dental appointment. The need for dental prosthesis was higher in women, 581 (35.7% versus 221 (23.2% men and their access [354 (60.9%] versus [96 (43.4%] with p<0.05. Conclusion: The access to health services and dental treatment presents gender as an influence factor. Women have most of the needs and benefits. The edentulism affects mostly the population with a poor access to dental prosthesis.
McAllister, Lindy; McCormack, Jane; McLeod, Sharynne; Harrison, Linda J
Speech impairment (speech sound disorder) is a high prevalence condition that responds well to early intervention provided by speech-language pathologists (SLPs). However, not all children in Australia are able to access necessary speech-language pathology services. The aim of this research was to investigate Australian parents' experiences of accessing and engaging in speech-language pathology services for their children with speech impairment. Two studies were conducted to achieve this aim. In Study 1, questionnaires were completed by 109 parents of pre-school children who had been identified with concerns about their speech. Only a third (n = 34, 31.2%) of the parents had previously accessed speech-language pathology services for assessment of their children's speech and just 29 of these (26.6% of the entire sample) reported their children had received intervention. Two thirds (n = 68, 62.4%) of the parents had not sought speech-language pathology services and half of these (n = 35, 32.1% of the entire sample) reported that "services were not needed". There was a small number of parents (n = 7, 6.4%) who had attempted to access services but had been unsuccessful. Parents identified teachers, family, friends, and doctors as important sources of information about their children's speech. In Study 2, interviews were conducted with 13 of the parents to discuss their experiences of speech impairment and service delivery in greater depth. Parents expected that others would make them aware of their child's speech impairment and that they should be able to access speech-language pathology services when required. Consequently, there is a need to raise awareness about speech impairment and speech-language pathology services to ensure appropriate identification, referral, and service provision for children at risk.
Acesso universal? Obstáculos ao acesso, continuidade do uso e gênero em um serviço especializado em HIV/AIDS em Salvador, Bahia, Brasil Universal access? Obstacles to access, continuity of treatment, and gender issues at a specialized HIV/AIDS clinic in Salvador, Bahia State, Brazil
Isadora Borges Nolasco Oliveira
Full Text Available Desde 1996, o Brasil mantém políticas internacionalmente conhecidas como de acesso universal ao tratamento especializado em HIV/AIDS. Observa-se, que o impacto da iniciativa tem sido desigual entre diferentes populações e regiões brasileiras. Desde uma perspectiva de gênero, o estudo buscou avaliar o acesso a um serviço especializado em HIV/AIDS localizado em Salvador, Bahia, identificando fatores facilitadores e obstaculizadores ao acesso e continuidade do uso vivenciados por mulheres vivendo com HIV/AIDS. Foram realizadas observação participante e entrevistas semi e não estruturadas com 13 usuárias. Resultados indicaram que a organização das rotinas do serviço e as relações travadas entre usuários e entre eles e trabalhadores em saúde condicionavam-se por valores, concepções e práticas associados a gênero, classe e aparência. O acesso e continuidade do uso no Serviço de Atenção à AIDS de Salvador eram condicionados à disponibilidade de bens sociais e simbólicos; o serviço apresentava capacidade limitada de adequação às especificidades dos usuários. Os achados apontam para limitações da operacionalização das políticas de acesso universal; e reforçam a necessidade de estudos que considerem a noção de vulnerabilidade e regionalização da epidemia no Brasil.Since 1996, Brazil has implemented internationally acknowledged policies such as universal access to specialized treatment for HIV/AIDS. However, the initiative's impact has been unequal if one compares different population segments and regions of the country. Taking a gender perspective, the current study seeks to evaluate access to a specialized HIV/AIDS service in Salvador, Bahia, identifying facilitating factors and obstacles to access and continuity of care, as experienced by women living with HIV/AIDS. Participant observation and semi-structured and open-ended interviews with 13 women were used. The findings indicate that the organization of
Full Text Available Abstract Background Much research has shown an association between homelessness and unstable housing and HIV risk but most has relied on relatively narrow definitions of housing status that preclude a deeper understanding of this relationship. Fewer studies have examined access to housing subsidies and supportive housing programs among low-income populations with different personal characteristics. This paper explores personal characteristics associated with access to housing subsidies and supportive housing, the relationship between personal characteristics and housing status, and the relationship between housing status and sexual risk behaviors among low-income urban residents. Methods Surveys were conducted with 392 low-income residents from Hartford and East Harford, Connecticut through a targeted sampling plan. We measured personal characteristics (income, education, use of crack, heroin, or cocaine in the last 6 months, receipt of welfare benefits, mental illness diagnosis, arrest, criminal conviction, longest prison term served, and self-reported HIV diagnosis; access to housing subsidies or supportive housing programs; current housing status; and sexual risk behaviors. To answer the aims above, we performed univariate analyses using Chi-square or 2-sided ANOVA's. Those with significance levels above (0.10 were included in multivariate analyses. We performed 2 separate multiple regressions to determine the effects of personal characteristics on access to housing subsidies and access to supportive housing respectively. We used multinomial main effects logistic regression to determine the effects of housing status on sexual risk behavior. Results Being HIV positive or having a mental illness predicted access to housing subsidies and supportive housing, while having a criminal conviction was not related to access to either housing subsidies or supportive housing. Drug use was associated with poorer housing statuses such as living on the
Altunay, Mine; /Fermilab; Byrd, Gregory T.; Brown, Doug E.; Dean, Ralph A.; /North Carolina State U.
A collaboration is a collection of services that work together to achieve a common goal. Although collaborations help when tackling difficult problems, they lead to security issues. First, a collaboration is often performed by services that are drawn from different security domains. Second, a service interacts with multiple peer services during the collaboration. These interactions are not isolated from one another--e.g., data may flow through a sequence of different services. As a result, a service is exposed to multiple peer services in varying degrees, leading to different security threats. We identify the types of interactions that can be present in collaborations, and discuss the security threats due to each type. We propose a model for representing the collaboration context so that a service can be made aware of the existing interactions. We provide an access control model for a service participating in a collaboration. We couple our access control model with a policy model, so that the access requirements from collaborations can be expressed and evaluated.
Neale, Joanne; Sheard, Laura; Tompkins, Charlotte N E
International research shows that injecting drug users (IDUs) can encounter many barriers when they try to access drug treatment and other services. However, the existing literature is mostly quantitative and does not consider the kinds of factors that injectors themselves identify as enabling them to access and benefit from services. Responding to this gap in knowledge, our paper explores IDUs' own suggestions for improving service engagement and their reports of other factors enabling them to seek help. Semi-structured qualitative interviews were conducted with 75 current illicit drug injectors in three geographically diverse areas of West Yorkshire, England. Recruitment was through needle exchange programmes, with additional snowball sampling to ensure inclusivity of gender, ethnicity and primary drug injected. Transcribed data were analysed thematically using Framework. Although participants were often satisfied with current access to services, they made three broad suggestions for improving engagement. These were: providing more services (more providers and more forms of support); better operation of existing services (including better communication systems and more flexibility around individual needs); and staffing-related improvements (particularly, less judgemental and more understanding staff attitudes). Other factors identified as important enablers of help seeking were: having supporting relationships (particularly with family members); personal circumstances/life events (especially becoming a parent); and an injector's state of mind (such as feeling motivated and positive). A range of practical suggestions for improving IDUs' access to drug treatment and other services are identified.
Full Text Available Abstract Background International research shows that injecting drug users (IDUs can encounter many barriers when they try to access drug treatment and other services. However, the existing literature is mostly quantitative and does not consider the kinds of factors that injectors themselves identify as enabling them to access and benefit from services. Responding to this gap in knowledge, our paper explores IDUs' own suggestions for improving service engagement and their reports of other factors enabling them to seek help. Methods Semi-structured qualitative interviews were conducted with 75 current illicit drug injectors in three geographically diverse areas of West Yorkshire, England. Recruitment was through needle exchange programmes, with additional snowball sampling to ensure inclusivity of gender, ethnicity and primary drug injected. Transcribed data were analysed thematically using Framework. Results Although participants were often satisfied with current access to services, they made three broad suggestions for improving engagement. These were: providing more services (more providers and more forms of support; better operation of existing services (including better communication systems and more flexibility around individual needs; and staffing-related improvements (particularly, less judgemental and more understanding staff attitudes. Other factors identified as important enablers of help seeking were: having supporting relationships (particularly with family members; personal circumstances/life events (especially becoming a parent; and an injector's state of mind (such as feeling motivated and positive. Conclusion A range of practical suggestions for improving IDUs' access to drug treatment and other services are identified.
Lu, Shijun; Du, Songming; Ren, Zhoupeng; Zhao, Jing; Chambers, Christina; Wang, Jinfeng; Ma, Guansheng
This study assessed the association between accessibility of catering service venues and adolescents' alcohol use over the previous 30 days. The data were collected from cross-sectional surveys conducted in 2014, 2223 students at 27 high schools in Chaoyang and Xicheng districts, Beijing using self-administered questionnaires to collect the adolescents information on socio-demographic characteristics and recent alcohol experiences. The accessibility of, and proximity to, catering service venues were summarized by weights, which were calculated by multiplication of the type-weight and the distance-weight. All sampled schools were categorized into three subgroups (low, middle, and high geographic density) based on the tertile of nearby catering service venues, and a multi-level logistic regression analysis was performed to explore variance between the school levels. Considering the setting characteristics, the catering service venues weighted value was found to account for 8.6% of the school level variance of adolescent alcohol use. The odds ratios (OR) and 95% confidence intervals (CI) of drinking over the past 30-days among adolescents with medium and high accessibility of catering service venues were 1.17 (0.86, 1.57) and 1.47 (1.06, 2.02), respectively (p catering service venues around schools in China. Results suggest that the greater accessibility of catering service venues around schools is associated with a growing risk of recent drinking.
Full Text Available This study assessed the association between accessibility of catering service venues and adolescents’ alcohol use over the previous 30 days. The data were collected from cross-sectional surveys conducted in 2014, 2223 students at 27 high schools in Chaoyang and Xicheng districts, Beijing using self-administered questionnaires to collect the adolescents information on socio-demographic characteristics and recent alcohol experiences. The accessibility of, and proximity to, catering service venues were summarized by weights, which were calculated by multiplication of the type-weight and the distance-weight. All sampled schools were categorized into three subgroups (low, middle, and high geographic density based on the tertile of nearby catering service venues, and a multi-level logistic regression analysis was performed to explore variance between the school levels. Considering the setting characteristics, the catering service venues weighted value was found to account for 8.6% of the school level variance of adolescent alcohol use. The odds ratios (OR and 95% confidence intervals (CI of drinking over the past 30-days among adolescents with medium and high accessibility of catering service venues were 1.17 (0.86, 1.57 and 1.47 (1.06, 2.02, respectively (p < 0.001 for trend test. This study addressed a gap in the adolescent drinking influence by the catering service venues around schools in China. Results suggest that the greater accessibility of catering service venues around schools is associated with a growing risk of recent drinking.
Althoff, Keri N.; Rebeiro, Peter; Brooks, John T.; Buchacz, Kate; Gebo, Kelly; Martin, Jeffrey; Hogg, Robert; Thorne, Jennifer E.; Klein, Marina; Gill, M. John; Sterling, Timothy R.; Yehia, Baligh; Silverberg, Michael J.; Crane, Heidi; Justice, Amy C.; Gange, Stephen J.; Moore, Richard; Kitahata, Mari M.; Horberg, Michael A.; Kirk, Gregory D.; Benson, Constance A.; Bosch, Ronald J.; Collier, Ann C.; Boswell, Stephen; Grasso, Chris; Mayer, Kenneth H.; Hogg, Robert S.; Richard Harrigan, P.; Montaner, Julio SG; Cescon, Angela; Samji, Hasina; Brooks, John T.; Buchacz, Kate; Gebo, Kelly A.; Moore, Richard D.; Moore, Richard D.; Carey, John T.; Horberg, Michael A.; Silverberg, Michael J.; Thorne, Jennifer E.; Goedert, James J.; Jacobson, Lisa P.; Klein, Marina B.; Rourke, Sean B.; Burchell, Ann N.; Rachlis, Anita R.; Hunter-Mellado, Robert F.; Mayor, Angel M.; Gill, M.John; Deeks, Steven G.; Martin, Jeffrey N.; Saag, Michael S.; Mugavero, Michael J.; Willig, James; Eron, Joseph J.; Napravnik, Sonia; Kitahata, Mari M.; Crane, Heidi M.; Justice, Amy C.; Dubrow, Robert; Fiellin, David; Sterling, Timothy R.; Haas, David; Bebawy, Sally; Turner, Megan; Gange, Stephen J.; Anastos, Kathryn; Moore, Richard D.; Saag, Michael S.; Gange, Stephen J.; Kitahata, Mari M.; Althoff, Keri N.; McKaig, Rosemary G.; Justice, Amy C.; Freeman, Aimee M.; Moore, Richard D.; Freeman, Aimee M.; Lent, Carol; Kitahata, Mari M.; Van Rompaey, Stephen E.; Crane, Heidi M.; Morton, Liz; McReynolds, Justin; Lober, William B.; Gange, Stephen J.; Althoff, Keri N.; Abraham, Alison G.; Lau, Bryan; Zhang, Jinbing; Jing, Jerry; Golub, Elizabeth; Modur, Shari; Hanna, David B.; Rebeiro, Peter; Wong, Cherise; Mendes, Adell
We estimated US Department of Health and Human Services (DHHS)–approved human immunodeficiency virus (HIV) indicators. Among patients, 71% were retained in care, 82% were prescribed treatment, and 78% had HIV RNA ≤200 copies/mL; younger adults, women, blacks, and injection drug users had poorer outcomes. Interventions are needed to reduce retention- and treatment-related disparities. PMID:24463281
... Under the Ryan White HIV/AIDS Program AGENCY: Health Resources and Services Administration (HRSA), HHS. ACTION: Notice of Non-Competitive One-Time Program Expansion Supplement Award of Ryan White HIV/AIDS.../AIDS Program, Part C funds to the Tutwiler Clinic, Tutwiler, Mississippi, to support...
Full Text Available BACKGROUND: The World Health Organization is currently developing guidelines on screening for tuberculosis disease to inform national screening strategies. This process is complicated by significant gaps in knowledge regarding mass screening. This study aimed to assess feasibility, uptake, yield, treatment outcomes, and costs of adding an active tuberculosis case-finding program to an existing mobile HIV testing service. METHODS AND FINDINGS: The study was conducted at a mobile HIV testing service operating in deprived communities in Cape Town, South Africa. All HIV-negative individuals with symptoms suggestive of tuberculosis, and all HIV-positive individuals regardless of symptoms were eligible for participation and referred for sputum induction. Samples were examined by microscopy and culture. Active tuberculosis case finding was conducted on 181 days at 58 different sites. Of the 6,309 adults who accessed the mobile clinic, 1,385 were eligible and 1,130 (81.6% were enrolled. The prevalence of smear-positive tuberculosis was 2.2% (95% CI 1.1-4.0, 3.3% (95% CI 1.4-6.4, and 0.4% (95% CI 1.4 015-6.4 in HIV-negative individuals, individuals newly diagnosed with HIV, and known HIV, respectively. The corresponding prevalence of culture-positive tuberculosis was 5.3% (95% CI 3.5-7.7, 7.4% (95% CI 4.5-11.5, 4.3% (95% CI 2.3-7.4, respectively. Of the 56 new tuberculosis cases detected, 42 started tuberculosis treatment and 34 (81.0% completed treatment. The cost of the intervention was US$1,117 per tuberculosis case detected and US$2,458 per tuberculosis case cured. The generalisability of the study is limited to similar settings with comparable levels of deprivation and TB and HIV prevalence. CONCLUSIONS: Mobile active tuberculosis case finding in deprived populations with a high burden of HIV and tuberculosis is feasible, has a high uptake, yield, and treatment success. Further work is now required to examine cost-effectiveness and affordability and
Ngwenya, B. N.; Kgathi, D. L.
This case study investigates access to potable water in HIV/AIDS related home-based care households in five rural communities in Ngamiland, Botswana. Primary data collected from five villages consisted of two parts. The first survey collected household data on demographic and rural livelihood features and impacts of HIV/AIDS. A total of 129 households were selected using a two-stage stratified random sampling method. In the second survey, a total of 39 family primary and community care givers of continuously ill, bed-ridden or non-bed-ridden HIV/AIDS patients were interviewed. A detailed questionnaire, with closed and open-ended questions, was used to collect household data. In addition to using the questionnaire, data were also collected through participant observation, informal interviews and secondary sources. The study revealed that there are several sources of water for communities in Ngamiland such as off-plot, outdoor (communal) and on-plot outdoor and/or indoor (private) water connections, as well as other sources such as bowsed water, well-points, boreholes and open perennial/ephemeral water from river channels and pans. There was a serious problem of unreliable water supply caused by, among other things, the breakdown of diesel-powered water pumps, high frequency of HIV/AIDS related absenteeism, and the failure of timely delivery of diesel fuel. Some villages experienced chronic supply disruptions while others experienced seasonal or occasional water shortages. Strategies for coping with unreliability of water supply included economizing on water, reserve storage, buying water, and collection from river/dug wells or other alternative sources such as rain harvesting tanks in government institutions. The unreliability of water supply resulted in an increase in the use of water of poor quality and other practices of poor hygiene as well as a high opportunity cost of water collection. In such instances, bathing of patients was cut from twice daily to once or
McNaghten, A. D.; Mneimneh, Allison Schilsky; Farirai, Thato; Wamai, Nafuna; Ntiro, Marylad; Sabatier, Jennifer; Makhunga-Ramfolo, Nondumiso; Mwanasalli, Salli; Awor, Anna; Moore, Jan
Objective To determine which of 3 HIV testing and counseling (HTC) models in outpatient departments (OPDs) increases HIV testing and entry of newly identified HIV-infected patients into care. Design Randomized trial of HTC interventions. Methods Thirty-six OPDs in South Africa, Tanzania, and Uganda were randomly assigned to 3 different HTC models: (A) health care providers referred eligible patients (aged 18–49, not tested in the past year, not known HIV positive) to on-site voluntary counseling and testing for HTC offered and provided by voluntary counseling and testing counselors after clinical consultation; (B) health care providers offered and provided HTC to eligible patients during clinical consultation; and (C) nurse or lay counselors offered and provided HTC to eligible patients before clinical consultation. Data were collected from October 2011 to September 2012. We describe testing eligibility and acceptance, HIV prevalence, and referral and entry into care. Chi-square analyses were conducted to examine differences by model. Results Of 79,910 patients, 45% were age eligible and 16,099 (45%) age eligibles were tested. Ten percent tested HIV positive. Significant differences were found in percent tested by model. The proportion of age eligible patients tested by Project STATUS was highest for model C (54.1%, 95% confidence interval [CI]: 42.4 to 65.9), followed by model A (41.7%, 95% CI: 30.7 to 52.8), and then model B (33.9%, 95% CI: 25.7 to 42.1). Of the 1596 newly identified HIV positive patients, 94% were referred to care (96.1% in model A, 94.7% in model B, and 94.9% in model C), and 58% entered on-site care (74.4% in model A, 54.8% in model B, and 55.6% in model C) with no significant differences in referrals or care entry by model. Conclusions Model C resulted in the highest proportion of all age-eligible patients receiving a test. Although 94% of STATUS patients with a positive test result were referred to care, only 58% entered care. We found no
Sundaravel, Anu Swapna
The Space Physics Interactive Data Resource (SPIDR) is a web-based interactive tool developed by NOAA's National Geophysical Data Center to provide access to historical space physics datasets. These data sets are widely used by physicists for space weather modeling and predictions. Built on a distributed network of databases and application servers, SPIDR offers services in two ways: via a web page interface and via a web service interface. SPIDR exposes several SOAP-based web services that client applications implement to connect to a number of data sources for data download and processing. At present, the usage of the web services has been difficult, adding unnecessary complexity to client applications and inconvenience to the scientists who want to use these datasets. The purpose of this study focuses on improving SPIDR's web interface to better support data access, integration and display. This is accomplished in two ways: (1) examining the needs of scientists to better understand what web services they require to better access and process these datasets and (2) developing a client application to support SPIDR's SOAP-based services using the Kepler scientific workflow system. To this end, we identified, designed and developed several web services for filtering the existing datasets and created several Kepler workflows to automate routine tasks associated with these datasets. These workflows are a part of the custom NGDC build of the Kepler tool. Scientists are already familiar with Kepler due to its extensive use in this domain. As a result, this approach provides them with tools that are less daunting than raw web services and ultimately more useful and customizable. We evaluated our work by interviewing various scientists who make use of SPIDR and having them use the developed Kepler workflows while recording their feedback and suggestions. Our work has improved SPIDR such that new web services are now available and scientists have access to a desktop
Cruciani, Mario; Wiessing, Lucas; Serpelloni, Giovanni; Genetti, Bruno; Andreotti, Alessandra; Iulia, Carpignano; Zermiani, Monica; Suligoi, Barbara
Over the last two decades, the proportion of people who inject drugs among newly reported HIV cases in Italy has been continuously declining. This trend is reflected in the prevalence of HIV infection among problem drug users followed in drug treatment services. We report nationwide trends in the prevalence of HIV and HCV among tested clients in charge to drug addiction services from 2005 to 2011. Data on the prevalence of HIV and HCV among drug users from public drug treatment services across Italy were collected and analyzed for the period from 2005 to 2011. Prevalence of HIV and HCV were compared between clients returning to treatment and those entering treatment for the first time, and by gender. Due to the high percentage of missing data, the "inverse probability weight" method was used. Trends in testing uptake were also analysed. A significant decrease of HIV and HCV prevalence is observed among all PDUs entering treatment (from 14.7% to 11.1% and from 61.6% to 50%, respectively, in 2005-2011). By contrast, among those entering the services for the first time, after an initial decline the prevalence of HIV infection steadily increased in both sexes, from 2.2% in 2009 to 5.3% in 2011. Self-reported injecting rates in this group decreased over time, and in 2011 the proportion reporting drug injecting was lower among new clients than in people returning to services (14.5 vs. 34.4%). We also observed a progressive and significant reduction in HIV and HCV testing in drug treatment services. Changes in injection practice and type of drugs used, coupled with a concurrent reduction in HCV prevalence, do not support drug injection as the main explanation for an increased HIV transmission in people entering drug treatment services for the first time. While reductions in testing rates raise concerns over data quality, the possibility of increased sexual transmission needs to be considered.
Polo, Gina; Acosta, C Mera; Ferreira, Fernando; Dias, Ricardo Augusto
This study integrated accessibility and location-allocation models in geographic information systems as a proposed strategy to improve the spatial planning of public health services. To estimate the spatial accessibility, we modified the two-step floating catchment area (2SFCA) model with a different impedance function, a Gaussian weight for competition among service sites, a friction coefficient, distances along a street network based on the Dijkstra's algorithm and by performing a vectorial analysis. To check the accuracy of the strategy, we used the data from the public sterilization program for the dogs and cats of Bogot´a, Colombia. Since the proposed strategy is independent of the service, it could also be applied to any other public intervention when the capacity of the service is known. The results of the accessibility model were consistent with the sterilization program data, revealing that the western, central and northern zones are the most isolated areas under the sterilization program. Spatial accessibility improvement was sought by relocating the sterilization sites using the maximum coverage with finite demand and the p-median models. The relocation proposed by the maximum coverage model more effectively maximized the spatial accessibility to the sterilization service given the non-uniform distribution of the populations of dogs and cats throughout the city. The implementation of the proposed strategy would provide direct benefits by improving the effectiveness of different public health interventions and the use of financial and human resources.
White, Douglas; Solanki, Kamal; Quincey, Vicki; Minett, Andrew; Tam, Gordon; Doube, Alan; Naden, Ray
In many countries, including New Zealand, the demand for rheumatology services exceeds their supply, resulting in some patients experiencing long delays or being denied access. The principal aim of this work was to create a validated, transparent, and fair system for determining access to rheumatology services. A panel of 5 rheumatologists, 6 primary care physicians, and 4 nurse specialists ranked a series of 25 clinical scenarios in order of priority to see a rheumatologist. Important determining factors were weighted in an iterative process to generate a multidimensional additive point score to determine access to rheumatology service. The score comprises 6 domains of 2 to 4 items weighted to give a total score out of 100. The effect of the problem on the patient's life and role, the presence of an inflammatory rheumatic disease, appropriateness of current treatment, and the ability of the rheumatologist to influence the current symptoms and future prognosis were felt to be critical factors in determining access to the service. The score showed a strong correlation with the rankings agreed by the clinical panel, and the overall intraclass correlation coefficient for the rheumatologists was 0.698. Our score has face validity, is easy to perform, and has been assessed by an independent panel of rheumatologists as providing a fair system for determining access to rheumatology services. The system is acceptable to primary care physicians and has been adopted by our local primary care organizations.
Full Text Available This study integrated accessibility and location-allocation models in geographic information systems as a proposed strategy to improve the spatial planning of public health services. To estimate the spatial accessibility, we modified the two-step floating catchment area (2SFCA model with a different impedance function, a Gaussian weight for competition among service sites, a friction coefficient, distances along a street network based on the Dijkstra's algorithm and by performing a vectorial analysis. To check the accuracy of the strategy, we used the data from the public sterilization program for the dogs and cats of Bogot´a, Colombia. Since the proposed strategy is independent of the service, it could also be applied to any other public intervention when the capacity of the service is known. The results of the accessibility model were consistent with the sterilization program data, revealing that the western, central and northern zones are the most isolated areas under the sterilization program. Spatial accessibility improvement was sought by relocating the sterilization sites using the maximum coverage with finite demand and the p-median models. The relocation proposed by the maximum coverage model more effectively maximized the spatial accessibility to the sterilization service given the non-uniform distribution of the populations of dogs and cats throughout the city. The implementation of the proposed strategy would provide direct benefits by improving the effectiveness of different public health interventions and the use of financial and human resources.
This article describes urban women's role and access to sanitation and a safe water supply in Indonesia, and links potential improvements in women's health to improved access to urban infrastructure. In 1996, USAID discovered that morbidity was higher in female-headed households in urban areas. Female-headed households were only 6.5% of total households, but had 27% more illnesses than male-headed ones. USAID's study found that the health related problems of women were related to their poverty, illiteracy, lack of resources, and lack of access to the cleanest drinking water and wastewater disposal. Age was not a factor. Women had less access to clean drinking water, bathing, and toilet facilities. The USAID mission determined that its gender neutral approach to providing services was not reaching the neediest group. Women needed greater access to healthy urban environmental structures. The USAID shifted its erroneous assumption that female-headed households were headed by mostly old and widowed women and redesigned its infrastructure development to ensure that female-headed households received improved water and sanitation services. The USAID Mission also changed its practices by including women in planning and management of urban infrastructure services. The change was based on the belief that women decision-makers would improve how water, sanitation, and solid waste disposal services were provided. The Mission targeted 20% of its program funds for community participation of women. This effort will provide valuable insight into the role of women in urban service delivery.
Nancy Dancy, NLM, and Wilma Templin-Branner, ORISE
As the treatment and management of HIV/AIDS continues to evolve with new scientific breakthroughs, treatment discoveries, and management challenges, it is difficult for people living with HIV/AIDS and those who care for them to keep up with the latest information on HIV/AIDS prevention, treatment, and research. The National Library of Medicine, of the National Institutes of Health, has a wealth of health information resources freely available on the Internet to address these needs.
Colucci, Erminia; Minas, Harry; Szwarc, Josef; Guerra, Carmel; Paxton, Georgia
Refugee young people have been identified as a group with high risk for mental health problems, due to their experience of trauma, forced migration, and stressors associated with settlement. A high prevalence of mental health problems is reported in this group, however some research suggests refugee young people have low rates of mental health service access. There is little information available on barriers and facilitators to mental service delivery for this group. Using data from 15 focus groups and five key informant interviews with a total of 115 service providers from 12 agencies in Melbourne, Australia, this paper explores barriers and facilitators to engaging young people from refugee backgrounds with mental health services. Eight key themes emerged: cultural concepts of mental health, illness, and treatment; service accessibility; trust; working with interpreters; engaging family and community; the style and approach of mental health providers; advocacy; and continuity of care.
Ethelwynn L. Stellenberg
Full Text Available Background: Inequalities in healthcare between population groups of South Africa existed during the apartheid era and continue to exist both between and within many population groups. Accessibility and affordability of healthcare is a human right.Objectives: The aim of the study was to explore and describe accessibility, affordability and the use of health services by the mixed race (coloured population in the Western Cape, South Africa.Method: A cross-sectional descriptive, non-experimental study with a quantitative approach was applied. A purposive convenient sample of 353 participants (0.6% was drawn from a population of 63 004 economically-active people who lived in the residential areas as defined for the purpose of the study. All social classes were represented. The hypothesis set was that there is a positive relationship between accessibility, affordability and the use of health services. A pilot study was conducted which also supported the reliability and validity of the study. Ethics approval was obtained from the University of Stellenbosch and informed consent from respondents. A questionnaire was used to collect the data.Results: The hypothesis was accepted. The statistical association between affordability (p = < 0.01, accessibility (p = < 0.01 and the use of health services was found to be significant using the Chi-square (χ² test.Conclusion: The study has shown how affordability and accessibility may influence the use of healthcare services. Accessibility is not only the distance an individual must travel to reach the health service point but more so the utilisation of these services. Continuous Quality Management should be a priority in healthcare services, which should be user-friendly.
Full Text Available Introduction: HIV in the United States is concentrated in the South, an impoverished region with marked health disparities and high rates of incarceration, particularly among African Americans. In the Deep South state of Alabama, a policy directive to reduce prison overcrowding has diverted large numbers of convicted felons to community supervision. Probation and parole offices have yet to provide the HIV education and testing services that are offered in state prisons. This study sought to implement on-site HIV services for probationers and parolees through an intersectoral programme involving law enforcement, university and HIV agency employees. The three main objectives were to (1 involve probation/parole officers in planning, execution and assessment of the programme, (2 provide HIV education to the officers and (3 offer voluntary pretest HIV counselling and testing to probationers and parolees. Methods: The partnered programme was conducted between October and December 2015. Offenders who were recently sentenced to probation (“new offenders”, received HIV education during orientation. Offenders already under supervision prior to the programme (“current offenders” learned about the on-site services during scheduled office visits. Outcomes were measured through officer assessments, informal feedback and uptake of HIV services among offenders. Results: A total of 86 new and 249 current offenders reported during the programme (N=335. Almost one-third (31.4% of new offenders sought HIV testing, while only 3.2% of current offenders were screened for HIV. Refusals among current offenders invoked monogamy, time pressures, being tested in prison, fear of positive test results and concerns about being labelled as gay or unfaithful to women partners. Officers rated the programme as worthwhile and feasible to implement at other offices. Conclusions: The partnership approach ensured support from law enforcement and intersectoral cooperation
Weertman, B. R.; Trabant, C.; Karstens, R.; Suleiman, Y. Y.; Ahern, T. K.; Casey, R.; Benson, R. B.
The IRIS Data Management Center (DMC) has developed a suite of web services that provide access to the DMC's time series holdings, their related metadata and earthquake catalogs. In addition, services are available to perform simple, on-demand time series processing at the DMC prior to being shipped to the user. The primary goal is to provide programmatic access to data and processing services in a manner usable by and useful to the research community. The web services are relatively simple to understand and use and will form the foundation on which future DMC access tools will be built. Based on standard Web technologies they can be accessed programmatically with a wide range of programming languages (e.g. Perl, Python, Java), command line utilities such as wget and curl or with any web browser. We anticipate these services being used for everything from simple command line access, used in shell scripts and higher programming languages to being integrated within complex data processing software. In addition to improving access to our data by the seismological community the web services will also make our data more accessible to other disciplines. The web services available from the DMC include ws-bulkdataselect for the retrieval of large volumes of miniSEED data, ws-timeseries for the retrieval of individual segments of time series data in a variety of formats (miniSEED, SAC, ASCII, audio WAVE, and PNG plots) with optional signal processing, ws-station for station metadata in StationXML format, ws-resp for the retrieval of instrument response in RESP format, ws-sacpz for the retrieval of sensor response in the SAC poles and zeros convention and ws-event for the retrieval of earthquake catalogs. To make the services even easier to use, the DMC is developing a library that allows Java programmers to seamlessly retrieve and integrate DMC information into their own programs. The library will handle all aspects of dealing with the services and will parse the returned
Full Text Available Abstract Background There is a significant increase in survival for HIV-infected children who have early access to diagnosis and treatment. The goal of this multi-country review was to examine when and where HIV-exposed infants and children are being diagnosed, and whether the EID service is being maximally utilized to improve health outcomes for HIV-exposed children. Methods In four countries across Africa and Asia existing documents and data were reviewed and key informant interviews were conducted. EID testing data was gathered from the central testing laboratories and was then complemented by health facility level data extraction which took place using a standardized and validated questionnaire Results In the four countries reviewed from 2006 to 2009 EID sample volumes rose dramatically to an average of >100 samples per quarter in Cambodia and Senegal, >7,000 samples per quarter in Uganda, and >2,000 samples per quarter in Namibia. Geographic coverage of sites also rapidly expanded to 525 sites in Uganda, 205 in Namibia, 48 in Senegal, and 26 in Cambodia in 2009. However, only a small proportion of testing was done at lower-level health facilities: in Uganda Health Center IIs and IIIs comprised 47% of the EID collection sites, but only 11% of the total tests, and in Namibia 15% of EID sites collected >93% of all samples. In all countries except for Namibia, more than 50% of the EID testing was done after 2 months of age. Few sites had robust referral mechanisms between EID and ART. In a sub-sample of children, we noted significant attrition of infants along the continuum of care post testing. Only 22% (Senegal, 37% (Uganda, and 38% (Cambodia of infants testing positive by PCR were subsequently initiated onto treatment. In Namibia, which had almost universal EID coverage, more than 70% of PCR-positive infants initiated ART in 2008. Conclusions While EID testing has expanded dramatically, a large proportion of PCR- positive infants are
Rödlach, Alexander; Dlodlo, Riitta A; Hwalima, Zanele E
The objectives of the research were to explore perceptions of HIV, AIDS and tuberculosis (TB) among individuals enrolled in antiretroviral therapy (ART) at two municipal clinics in Bulawayo, Zimbabwe, and to assess the implications of these perceptions on the provision of HIV and TB care services. Data were collected using the freelist technique to elicit the elements of a cultural domain as well as open-ended interviews with ART clients, conducted during June and July 2009. Participants were recruited through non-probability convenience sampling. The freelist data were analysed using multidimensional scaling and hierarchical clustering, and the interview data were analysed using the grounded theory method. The results suggest that: 1) the participants had substantial knowledge about HIV, AIDS and TB; 2) the participants' perceptions of HIV, AIDS and TB constituted three distinct, though overlapping, cultural domains; 3) because of the availability of ART and TB treatment, a diagnosis of HIV infection or TB alone was generally perceived with hope that one would be able to live a normal life, while AIDS illness or TB/HIV coinfection were associated with notions of death and despair; and, 4) such perceptions may negatively impact the uptake of testing for HIV and TB, and thereby contribute to delayed start of the respective treatment. Health messages should build on these meanings which have the potential to either enhance or compromise available health programmes and their use by people living with HIV or TB.
Full Text Available Abstract Introduction Sustainable service delivery is a major challenge in the HIV response that is often not adequately addressed in project implementation. Sustainable strategies must be built into project design and implementation to enable HIV efforts to continue long after donor-supported projects are completed. Case description This paper presents the experiences in operational sustainability of Family Health International's Zambia Prevention, Care and Treatment Partnership in Zambia, which is supported by the US President's Emergency Plan for AIDS Relief through United States Agency for International Development (October 2004 to September 2009. The partnership worked with Zambia's Ministry of Health to scale up HIV clinical services in five of the country's nine provinces, reaching 35 districts and 219 facilities. It provided technical and financial support from within the ministry's systems and structures. By completion of the project, 10 of the 35 districts had graduated beyond receiving ongoing technical support. Discussion and evaluation By working within the ministry's policies, structures and systems, the partnership was able to increase the ministry's capacity to add a comprehensive HIV service delivery component to its health services. Ministry structures were improved through renovations of health facilities, training of healthcare workers, procurement of essential equipment, and establishment of a quality assurance plan to ensure continued quality of care. The quality assurance tools were implemented by both the ministry and project staff as the foundation for technical graduation. Facilities that met all the quality criteria for more than six months were graduated from project technical support, as were districts where most supported facilities met the criteria. The district health offices then provided ongoing supervision of services. This predetermined "graduation" exit strategy, with buy in of the provincial and district
Jaya, Ziningi; Drain, Paul K; Mashamba-Thompson, Tivani P
Rapid HIV tests have improved access to HIV diagnosis and treatment by providing quick and convenient testing in rural clinics and resource-limited settings. In this study, we evaluated the quality management system for voluntary and provider-initiated point-of-care HIV testing in primary healthcare (PHC) clinics in rural KwaZulu-Natal (KZN), South Africa. We conducted a quality assessment audit in eleven PHC clinics that offer voluntary HIV testing and counselling in rural KZN, South Africa from August 2015 to October 2016. All the participating clinics were purposively selected from the province-wide survey of diagnostic services. We completed an on-site monitoring checklist, adopted from the WHO guidelines for assuring accuracy and reliability of HIV rapid tests, to assess the quality management system for HIV rapid testing at each clinic. To determine clinic's compliance to WHO quality standards for HIV rapid testing the following quality measure was used, a 3-point scale (high, moderate and poor). A high score was defined as a percentage rating of 90 to 100%, moderate was defined as a percentage rating of 70 to 90%, and poor was defined as a percentage rating of less than 70%. Clinic audit scores were summarized and compared. We employed Pearson pair wise correlation coefficient to determine correlations between clinics audit scores and clinic and clinics characteristics. Linear regression model was computed to estimate statistical significance of the correlates. Correlations were reported as significant at p ≤0.05. Nine out of 11 audited rural PHC clinics are located outside 20Km of the nearest town and hospital. Majority (18.2%) of the audited rural PHC clinics reported that HIV rapid test was performed by HIV lay counsellors. Overall, ten clinics were rated moderate, in terms of their compliance to the stipulated WHO guidelines. Audit results showed that rural PHC clinics' average rating score for compliance to the WHO guidelines ranged between 64.4% (CI
Pang, Joseph W. M.; Tobagi, Fouad A.; Boyd, Stephen
The demand for integrated services local area networks is increasing at a rapid pace with the advent of many new and exciting applications: office and factory automation, distributed computing, and multimedia communications. To support these new applications, it is imperative to integrate traffic with diverse statistical characteristics and differing delay requirements on the same network. An attractive approach for integrating traffic has been adopted in two token passing local area network standards, the IEEE 802.4 token bus standard and FDDI. The idea is to control the transmissions of each station based on a distributed timing algorithm, so as to achieve the following goals: (1) to limit the token cycles so that time-critical traffic can be accommodated, and (2) to allocate pre-specified bandwidths to different stations when the network is overloaded. We have investigated the analysis and design of this protocol. In this paper, we generalize the transmission control algorithm used previously. The major advantages of the generalization over the original protocol are: (1) it provides a much expanded design space, (2) it guarantees convergent behavior, and (3) it gives meaningful insights into the dynamics of the basic control algorithm.
Wielding, S; Flynn, B
The sexual and reproductive health (SRH) care needs of a cohort of HIV-positive women were studied pre- and post-integration of genitourinary medicine (GUM) and SRH services. Pre-integration, 24.9% of women at risk of pregnancy were using an effective method of contraception, with a non-significant improvement post-integration to 39.3%. Pre-integration, 47.6% of pregnancies were unplanned, whilst 50% were still unplanned post-integration. Cervical cytology uptake within the previous 12 months improved significantly. It appears that the integration of services alone does not improve all aspects of the SRH of women living with HIV and additional novel strategies should be explored.
Hasty, Douglas F.
Are librarians doing all they can to ensure that customer services are delivered with the customer in mind? Librarians are great at helping, but we sometimes need help with identifying customers, defining their needs, developing services, and reviewing the processes behind the services. Fourth Generation Management provides new insight for…
Full Text Available Undocumented immigrants face significant challenges in accessing health care. Throughout the United States, these challenges may relate to the structure of the public health system in which the undocumented find themselves. In addition, local, regional, and national practices aimed at targeting immigrants for deportation or other non-health reasons may serve to punish them for seeking health services or care. Spain and the United Kingdom serve as useful case studies in comparing the ability of the undocumented to seek health services in Europe and the United States. Overall, promoting access to comprehensive health services for the undocumented should be a national priority, along with analysis of any immigration-related laws or policies for potential harmful impact on health care access.
Full Text Available AIM: Previous economic literature on the cost-effectiveness of antiretroviral treatment (ART programs has been mainly focused on the microeconomic consequences of alternative use of resources devoted to the fight against the HIV pandemic. We rather aim at forecasting the consequences of alternative scenarios for the macroeconomic performance of countries. METHODS: We used a micro-simulation model based on individuals aged 15-49 selected from nationally representative surveys (DHS for Cameroon, Tanzania and Swaziland to compare alternative scenarios : 1-freezing of ART programs to current levels of access, 2- universal access (scaling up to 100% coverage by 2015, with two variants defining ART eligibility according to previous or current WHO guidelines. We introduced an "artificial" ageing process by programming methods. Individuals could evolve through different health states: HIV negative, HIV positive (with different stages of the syndrome. Scenarios of ART procurement determine this dynamics. The macroeconomic impact is obtained using sample weights that take into account the resulting age-structure of the population in each scenario and modeling of the consequences on total growth of the economy. RESULTS: Increased levels of ART coverage result in decreasing HIV incidence and related mortality. Universal access to ART has a positive impact on workers' productivity; the evaluations performed for Swaziland and Cameroon show that universal access would imply net cost-savings at the scale of the society, when the full macroeconomic consequences are introduced in the calculations. In Tanzania, ART access programs imply a net cost for the economy, but 70% of costs are covered by GDP gains at the 2034 horizon, even in the extended coverage option promoted by WHO guidelines initiating ART at levels of 350 cc/mm(3 CD4 cell counts. CONCLUSION: Universal Access ART scaling-up strategies, which are more costly in the short term, remain the best economic
Ventelou, Bruno; Arrighi, Yves; Greener, Robert; Lamontagne, Erik; Carrieri, Patrizia; Moatti, Jean-Paul
Aim Previous economic literature on the cost-effectiveness of antiretroviral treatment (ART) programs has been mainly focused on the microeconomic consequences of alternative use of resources devoted to the fight against the HIV pandemic. We rather aim at forecasting the consequences of alternative scenarios for the macroeconomic performance of countries. Methods We used a micro-simulation model based on individuals aged 15–49 selected from nationally representative surveys (DHS for Cameroon, Tanzania and Swaziland) to compare alternative scenarios : 1-freezing of ART programs to current levels of access, 2- universal access (scaling up to 100% coverage by 2015, with two variants defining ART eligibility according to previous or current WHO guidelines). We introduced an “artificial” ageing process by programming methods. Individuals could evolve through different health states: HIV negative, HIV positive (with different stages of the syndrome). Scenarios of ART procurement determine this dynamics. The macroeconomic impact is obtained using sample weights that take into account the resulting age-structure of the population in each scenario and modeling of the consequences on total growth of the economy. Results Increased levels of ART coverage result in decreasing HIV incidence and related mortality. Universal access to ART has a positive impact on workers' productivity; the evaluations performed for Swaziland and Cameroon show that universal access would imply net cost-savings at the scale of the society, when the full macroeconomic consequences are introduced in the calculations. In Tanzania, ART access programs imply a net cost for the economy, but 70% of costs are covered by GDP gains at the 2034 horizon, even in the extended coverage option promoted by WHO guidelines initiating ART at levels of 350 cc/mm3 CD4 cell counts. Conclusion Universal Access ART scaling-up strategies, which are more costly in the short term, remain the best economic choice in the
The relationship between disability and poverty has been described in different contexts. Nevertheless, the basic characteristics of this relationship have not yet been fully established. The social exclusion and discrimination against people with disabilities increase the risk of poverty and reduce the access to basic opportunities such as health and education. This study examines the impact of a health limitation and poverty in the access to health care services in Colombia. Data from the C...
Belenko, Steven; Hiller, Matthew; Visher, Christy; Copenhaver, Michael; O'Connell, Daniel; Burdon, William; Pankow, Jennifer; Clarke, Jennifer; Oser, Carrie
HIV risk is disproportionately high among incarcerated individuals. Corrections agencies have been slow to implement evidence-based guidelines and interventions for HIV prevention, testing, and treatment. The emerging field of implementation science focuses on organizational interventions to facilitate adoption and implementation of evidence-based practices. A survey of correctional agency partners from the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) revealed that HIV policies and practices in prevention, detection, and medical care varied widely, with some corrections agencies and facilities closely matching national guidelines and/or implementing evidence-based interventions. Others, principally attributed to limited resources, had numerous gaps in delivery of best HIV service practices. A brief overview is provided of a new CJ-DATS cooperative research protocol, informed by the survey findings, to test an organization-level intervention to reduce HIV service delivery gaps in corrections.
Full Text Available Abstract Background HIV counseling and testing, HIV prevention and provision of HIV care and support are essential activities to reduce the burden of HIV among patients with TB, and should be integrated into routine TB care. Methods The development of training materials to promote HIV services for TB patients involved the definition of target health care workers (HCWs; identification of required tasks, skills and knowledge; review of international guidelines; and adaptation of existing training materials for voluntary counseling and testing, prevention of mother-to-child transmission of HIV, and management of opportunistic infections (OIs. Training effectiveness was assessed by means of questionnaires administered pre- and post-training, by correlating post-training results of HCWs with the centre's HIV testing acceptance rates, and through participatory observations at the time of on-site supervisory visits and monthly meetings. Results Pre-training assessment identified gaps in basic knowledge of HIV epidemiology, the link between TB and HIV, interpretation of CD4 counts, prevention and management of OIs, and occupational post-exposure prophylaxis (PEP. Opinions on patients' rights and confidentiality varied. Mean test results increased from 72% pre-training to 87% post-training (p Conclusion Many HCWs did not possess the knowledge or skills necessary to integrate HIV activities into routine care for patients with TB. A participatory approach resulted in training materials that fulfilled local needs.
Campbell, Tonya J; Alberga, Amanda; Rosella, Laura C
Research demonstrates that prediabetes awareness has important implications for participation in diabetes risk-reducing behaviors. We examined the impact of levels of access to health services on prediabetes awareness. In 2016, we conducted an analysis among U.S. adults with prediabetes using cross-sectional data from three cycles (2007-2008, 2009-2010, and 2011-2012) of the National Health and Nutrition Examination Survey. Participants aware and unaware of their prediabetes were classified as having full, partial, or no access to health services based on current health insurance coverage and having a routine place to go for health care. Multivariable logistic regression was used to estimate the association between access to health services and prediabetes awareness. Among a total sample of 2999U.S. adults with prediabetes, an estimated 92.0% were unaware of their prediabetes status. Participants that were unaware of their prediabetes tended to be younger, male, and were less likely to be obese or have a family history of diabetes. Having no access to health services significantly increased the odds of being prediabetes unaware (AOR: 2.65; 95% CI: 1.10-6.38). However, participants with insurance but no place of regular care had the greatest odds of being prediabetes unaware (AOR: 3.21; 95% CI: 1.21-8.55). These findings suggest that access to health services is a key factor for prediabetes awareness. Health policies and interventions should strive to ensure equitable access to health services in order to detect prediabetes, and promote awareness and engagement in risk-reducing behaviors to decrease the incidence of diabetes. Copyright © 2016. Published by Elsevier Inc.
Full Text Available Globally challenges regarding healthcare provision are sometimes related to a failure to estimate client numbers in peri-urban areas due to rapid population growth. About one-sixth of the world's population live in informal settlements which are mostly characterised by poor healthcare service provision. Poor access to primary healthcare may expose residents of informal settlement more to the human immunodeficiency virus (HIV and to acquired immunodeficiency syndrome (AIDS than their rural and urban counterparts due to a lack of access to information on prevention, early diagnosis and treatment. The objective of this study was to explore and describe the experiences of both the reproductive health services' clients and the healthcare providers with regard to the provision of reproductive health services including the prevention of HIV and AIDS in a primary healthcare setting in Tshwane. A qualitative, exploratory and contextual design using a phenomenological approach to enquire about the participants' experiences was implemented. Purposive sampling resulted in the selection of 23 clients who used the reproductive healthcare services and ten healthcare providers who were interviewed during individual and focus group interviews respectively. Tesch's method for qualitative data analysis was used. Ethical principles guided the study, and certain strategies were followed to ensure trustworthiness. The findings revealed that females who lived in informal settlements were aware of the inability of the PHC setting to provide adequate reproductive healthcare to meet their needs. The HCPs acknowledged that healthcare provision was negatively affected by policies. It was found that the community members could be taught how to coach teenagers and support each other in order to bridge staff shortages and increase health outcomes including HIV/AIDS prevention.
Miller, Paul; Kelly, Kemesha; Spawls, Nicola
This article is derived from a recently completed research study on the "Schooling Experiences of HIV+ Children in Jamaica". It is written against the background of researching children generally, and also in the context of researching vulnerable children, specifically those who are HIV+. Research carries with it various notions of power…
As HIV treatment programs in sub-Saharan Africa mature, there are rising concerns about the long-term sustainability and quality of these programs. Increasing levels of HIV drug resistance have been measured in sub-Saharan Africa, and could jeopardize long-term treatment success. This thesis present
Chapman, Jenifer L; Zechel, Annegret; Carter, Yvonne H; Abbott, Stephen
Background: In England, there are particularly pressing problems concerning access to adequate primary care services. Consequently, innovative ways of delivering primary care have been introduced to facilitate and broaden access. Aims: The aim of this study was to review the evidence of seven recent innovations in service provision to improve access or equity in access to primary care, by performing a systematic review of the literature. Design of study: Systematic review. Setting: Primary care in the United Kingdom (UK). Method: Seven electronic databases were searched and key journals were hand-searched. Unpublished and ‘grey’ literature were sought via the Internet and through professional contacts. Intervention studies addressing one of seven recent innovations and conducted in the UK during the last 20 years were included. Two researchers independently assessed the quality of papers. Results: Thirty studies (32 papers and two reports) were identified overall. Variation in study design and outcome measures made comparisons difficult. However, there was some evidence to suggest that access is improved by changing the ways in which primary care is delivered. First-wave personal medical services pilots facilitated improvements in access to primary care in previously under-served areas and/or populations. Walk-in centres and NHS Direct have provided additional access to primary care for white middle-class patients; there is some evidence suggesting that these innovations have increased access inequalities. There is some evidence that telephone consultations with GPs or nurses can safely substitute face-to-face consultations, although it is not clear that this reduces the number of face-to-face consultations over time. Nurse practitioners and community pharmacists can manage common conditions without the patient consulting a general practitioner. Conclusion: The evidence is insufficient to make clear recommendations regarding ways to improve access to primary
Fisher, Rohan; Lassa, Jonatan
Modelling travel time to services has become a common public health tool for planning service provision but the usefulness of these analyses is constrained by the availability of accurate input data and limitations inherent in the assumptions and parameterisation. This is particularly an issue in the developing world where access to basic data is limited and travel is often complex and multi-modal. Improving the accuracy and relevance in this context requires greater accessibility to, and flexibility in, travel time modelling tools to facilitate the incorporation of local knowledge and the rapid exploration of multiple travel scenarios. The aim of this work was to develop simple open source, adaptable, interactive travel time modelling tools to allow greater access to and participation in service access analysis. Described are three interconnected applications designed to reduce some of the barriers to the more wide-spread use of GIS analysis of service access and allow for complex spatial and temporal variations in service availability. These applications are an open source GIS tool-kit and two geo-simulation models. The development of these tools was guided by health service issues from a developing world context but they present a general approach to enabling greater access to and flexibility in health access modelling. The tools demonstrate a method that substantially simplifies the process for conducting travel time assessments and demonstrate a dynamic, interactive approach in an open source GIS format. In addition this paper provides examples from empirical experience where these tools have informed better policy and planning. Travel and health service access is complex and cannot be reduced to a few static modeled outputs. The approaches described in this paper use a unique set of tools to explore this complexity, promote discussion and build understanding with the goal of producing better planning outcomes. The accessible, flexible, interactive and
Full Text Available INTRODUCTION: Numerous studies report high levels of stigma and discrimination experienced by obese/overweight women within the health care system and society at large. Despite general practice being the most utilised point of access for health care services, there is very little international or national exploration of the experiences of large-bodied women (LBW accessing these services. The aim of this study was to explore LBW's experiences of accessing general practice services in New Zealand. METHODS: This is a qualitative, descriptive, feminist study. Local advertising for participants resulted in eight self-identified, large-bodied women being interviewed. A post-structural feminist lens was applied to the data during thematic analysis. FINDINGS: The women in this study provided examples of verbal insults, inappropriate humour, negative body language, unmet health care needs and breaches of dignity from health care providers in general practice. Seven themes were identified: early experiences of body perception, confronting social stereotypes, contending with feminine beauty ideals, perceptions of health, pursuing health, respecting the whole person, and feeling safe to access care. CONCLUSION: Pressure for body size vigilance has, in effect, excluded the women in this study from the very locations of health that they are 'encouraged' to attend-including socialising and exercising in public, screening opportunities that require bodily exposure, and accessing first point of care health services.
González, Lina María; Peñaloza, Rolando Enrique; Matallana, María Alexandra; Gil, Fabián; Gómez-Restrepo, Carlos; Landaeta, Angela Patricia Vega
Access to mental health services by people with mental disorders has traditionally been limited, and is associated with attitudinal, social, and structural variables. To analyse the factors that determine access to mental health services by the adult population (18-44 years old) in Colombia, from the results obtained in the 2015 National Mental Health Survey. Analysis of variables of access to attention in mental health care for adults. The reasons for not consulting were classified as barriers of behavioural supply and demand. To analyse the factors associated with access to mental health services in the Colombian adult population, the use of health services in the last 12 months for emotional, nervous or mental health problems was taken into account, as well as associated variables such as demographic characteristics, occupational activity, affiliation to social security, and health status variables. The relationships between these variables were estimated using bivariate multinomial logistic regression models. Rural residence, being married, and having a chronic disease were associated with the decision to consult or not to consult the doctor. Further studies should be conducted to evaluate the situation as regards mental health care access, as well as to determine the potential factors associated with these limitations. Copyright © 2016 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.
Oladele, Edward Adekola; Khamofu, Hadiza; Asala, Seun; Saleh, Mariya; Ralph-Opara, Uche; Nwosisi, Charles; Anyaike, Chukwuma; Gana, Catherine; Adedokun, Oluwasanmi; Dirks, Rebecca; Adebayo, Olufunsho; Oduwole, Modupe; Mandala, Justin; Torpey, Kwasi
Introduction As the world is making progress towards elimination of mother-to-child transmission of HIV, poor coverage of PMTCT services in Nigeria remains a major challenge. In order to address this, scale-up was planned with activities organized into 3 phases. This paper describes the process undertaken in eight high burden Nigerian states to rapidly close PMTCT coverage gaps at facility and population levels between February 2013 and March 2014. Methods Activities were grouped into three phases–pre-assessment phase (engagement of a wide range of stakeholders), assessment (rapid health facility assessment, a cross sectional survey using mixed methods conducted in the various states between Feb and May 2013 and impact modelling), and post-assessment (drawing up costed state operational plans to achieve eMTCT by 2015, data-driven smart scale-up). Results Over a period of 10 months starting June 2013, 2044 facilities were supported to begin provision of PMTCT services. This increased facility coverage from 8% to 50%. A 246% increase was also recorded in the number of pregnant women and their families who have access to HIV testing and counselling in the context of PMTCT. Similarly, access to antiretrovirals for PMTCT has witnessed a 152% increase in these eight states between October 2013 and October 2014. Conclusion A data-driven and participatory approach can be used to rapidly scale-up PMTCT services at community and facility levels in this region. These results present us with hope for real progress in Nigeria. We are confident that the efforts described here will contribute significantly to eliminating new pediatric HIV infection in Nigeria. PMID:28046045
Schild, A Frederick; Perez, Eduardo A; Gillaspie, Erin; Patel, Asha R; Noicely, Karlene; Baltodano, Neyton
The primary objective of this study was to establish the safety, efficacy, infection rate, and patency of the Vectra graft (polyetherurethaneurea) for dialysis access in patients diagnosed with human immunodeficiency virus (HIV) and end-stage renal disease. The Vectra graft has a unique self-sealing property; therefore we hypothesize that these patients will have fewer infections. A Vectra graft was implanted in 30 consecutive HIV-positive patients without sufficient veins for an autologous fistula. These surgeries were carried out over a 2.5-year period. Primary graft patency was 42% at 12 months and 3 (10%) of the grafts developed infection. This rate of graft infection was less (10% vs 45%) than both our prior experience and published reports using polytetrafluorothene bridge grafts. The unique self-sealing property of the Vectra graft minimizes the development of perigraft hematoma with repetitive needle cannulation and in the immunosuppressed HIV-positive patient, may account for the observed decrease in dialysis access infection.
Church, Kathryn; Warren, Charlotte E; Birdthistle, Isolde; Ploubidis, George B; Tomlin, Keith; Zhou, Weiwei; Kimani, James; Abuya, Timothy; Ndwiga, Charity; Sweeney, Sedona; Mayhew, Susannah H
The impact of integrated reproductive health and HIV services on HIV testing and counseling (HTC) uptake was assessed among 882 Kenyan family planning clients using a nonrandomized cohort design within six intervention and six "comparison" facilities. The effect of integration on HTC goals (two tests over two years) was assessed using conditional logistic regression to test four "integration" exposures: a training and reorganization intervention; receipt of reproductive health and HIV services at recruitment; a functional measure of facility integration at recruitment; and a woman's cumulative exposure to functionally integrated care across different facilities over time. While recent receipt of HTC increased rapidly at intervention facilities, achievement of HTC goals was higher at comparison facilities. Only high cumulative exposure to integrated care over two years had a significant effect on HTC goals after adjustment (aOR 2.94, 95%CI 1.73-4.98), and programs should therefore make efforts to roll out integrated services to ensure repeated contact over time. © 2017 The Population Council, Inc.
Hrasnica, Halid; Lehnert, Ralf
Recent and future communications networks have to provide QoS guarantees for a rapidly growing number of various telecommunication services, which can be ensured by application of an efficient MAC layer. Various communication technologies, such as cellular networks and PLC (PowerLine Communications) access networks, apply reservation MAC protocols, providing a good network utilization and realization of different QoS guarantees. In this investigation, we analyze possibilities for provision of QoS guarantees for various telecommunications services with a two-step reservation MAC protocol using per-packet reservation principle, which is proposed for application in broadband PLC access networks. Particularly, performance of the reservation procedure is analyzed to provide priority mechanisms which are necessary for realization of various telecommunications services ensuring the required QoS guarantees. Since the telephony, realized by the packet voice service, has the strongest QoS requirements among various telecommunications services, we analyze possibility for its realization within the two-step MAC protocol. It can be concluded that the packet voice can be efficiently implemented. However, with application of a combined reservation domains for various service classes, network performance could be further improved.
Abadía-Barrero, César Ernesto; Castro, Arachu
This study describes and conceptualizes the experiences of stigma in a group of children living with HIV in São Paulo, Brazil, and evaluates the impact of access to highly active antiretroviral therapy (HAART) over the social course of AIDS and over the children's experiences of stigma. Through ethnographic research in São Paulo from 1999 to 2001, the life trajectories of 50 children ages 1-15 living with or affected by HIV were studied. Data were collected via participant observation and semi-structured informal interviews and analyzed using social theories on illness experience and social inequality. Our results demonstrate that AIDS-related stigma occurs within complex discrimination processes that change as children reach adolescence. We found that structural violence in the forms of poverty, racism, and inequalities in social status, gender, and age fuels children's experiences of stigma. We also describe how access to HAART changes the lived experience of children, reduces stigma, and brings new challenges in AIDS care such as adolescents' sexuality and treatment adherence. Based on these results, we propose structural violence as the framework to study stigma and argue that interventions to reduce stigma that solely target the perception and attitudes toward people living with HIV are limited. In contrast universal access to HAART in Brazil is a powerful intervention that reduces stigma, in that it transforms AIDS from a debilitating and fatal disease to a chronic and manageable one, belongs to a broader mechanism to assure citizens' rights, and reduces social inequalities in access to health care.
It is essential for the strategy of open access self-archiving that scientific authors are given comprehensive information on publisher copyright policies. DINI, the German Initiative for Networked Information, has developed a German (and potentially multilingual) interface to the English SHERPA/RoMEO service to provide additional information on German publishers' open access policies. As a next step, this interface was enhanced to an integration layer combining different sources on publisher copyright policies. This integration layer can be used in many different contexts. Together with the SHERPA/RoMEO team, DINI aims to build an international support structure for open access information.
Full Text Available Abstract It is essential for the strategy of open access self-archiving that scientific authors are given comprehensive information on publisher copyright policies. DINI, the German Initiative for Networked Information, has developed a German (and potentially multilingual interface to the English SHERPA/RoMEO service to provide additional information on German publishers' open access policies. As a next step, this interface was enhanced to an integration layer combining different sources on publisher copyright policies. This integration layer can be used in many different contexts. Together with the SHERPA/RoMEO team, DINI aims to build an international support structure for open access information.
Yoon, Jong P
The advent of smartphones in recent years has changed the wireless landscape. Smartphones have become a platform for online user interface to cloud databases. Cloud databases may provide a large set of user-private and sensitive data (i.e., objects), while smartphone users (i.e., subjects) provide location-sensitive information. Secure and private services in wireless accessing to cloud databases have been discussed actively for the past recent years. However, the previous techniques are unsatisfactory for dynamism of moving subjects' wireless accesses. In this paper, we propose a novel technique to dynamically generate virtual private databases (VPD) for each access by taking subjects' location and time information into account. The contribution of this paper includes a privacy-preserving access control mechanism for dynamism of wireless access.
Hees, S. van; Cornielje, H.; Wagle, P.; Veldman, E.
Purpose: Persons with disabilities face additional barriers in accessing primary healthcare services, especially in developing countries. Consequently the prevalence of secondary health conditions is higher among this population. This study aims to explore the perceived barriers to access primary
Meskarpour-Amiri, Mohammad; Dopeykar, Nooredin; Ameryoun, Ahmad; Mehrabi Tavana, Ali
Background: Timely access to cardiovascular health services is necessary to prevent heart damages. The present study examined inequality in geographical distribution of cardiovascular health services in Iran. Methods: Present study is a cross-sectional study conducted using demographic data from all Iranian provinces (31 provinces) from 2012 census by the Statistics Center of Iran (SCI). The Gini coefficients of CCU beds and cardiologists were used to assess equality in access to cardiovascular health services in Iran. MS Excel software was used to calculate Gini coefficients. Results: The proportions of CCU bed and cardiologist per 100,000 population were 4.88 and 1.27, respectively; also the Gini coefficients were 0.129 and 0.045, respectively. Conclusion: Descriptive statistics showed a skewness in distribution of pubic cardiovascular health services in Iran, though Gini coefficient revealed no significant inequality. However, equal distribution of CCU beds and cardiovascular specialists does not mean they are sufficiently available in Iran. PMID:28210585
Davies, Mark; Nowotka, Michał; Papadatos, George; Dedman, Nathan; Gaulton, Anna; Atkinson, Francis; Bellis, Louisa; Overington, John P
ChEMBL is now a well-established resource in the fields of drug discovery and medicinal chemistry research. The ChEMBL database curates and stores standardized bioactivity, molecule, target and drug data extracted from multiple sources, including the primary medicinal chemistry literature. Programmatic access to ChEMBL data has been improved by a recent update to the ChEMBL web services (version 2.0.x, https://www.ebi.ac.uk/chembl/api/data/docs), which exposes significantly more data from the underlying database and introduces new functionality. To complement the data-focused services, a utility service (version 1.0.x, https://www.ebi.ac.uk/chembl/api/utils/docs), which provides RESTful access to commonly used cheminformatics methods, has also been concurrently developed. The ChEMBL web services can be used together or independently to build applications and data processing workflows relevant to drug discovery and chemical biology.
Pankow, Jennifer; Willett, Jennifer; Yang, Yang; Swan, Holly; Dembo, Richard; Burdon, William M; Patterson, Yvonne; Pearson, Frank S; Belenko, Steven; Frisman, Linda K
In a study aimed at improving the quality of HIV services for inmates, an organizational process improvement strategy using change teams was tested in 14 correctional facilities in 8 US states and Puerto Rico. Data to examine fidelity to the process improvement strategy consisted of quantitative ratings of the structural and process components of the strategy and qualitative notes that explicate challenges in maintaining fidelity to the strategy. Fidelity challenges included (1) lack of communication and leadership within change teams, (2) instability in team membership, and (3) issues with data utilization in decision-making to implement improvements to services delivery.
Full Text Available The intersecting HIV and Tuberculosis epidemics in countries with a high disease burden of both infections pose many challenges and opportunities. For patients infected with HIV in high TB burden countries, the diagnosis of TB, ARV drug choices in treating HIV-TB coinfected patients, when to initiate ARV treatment in relation to TB treatment, managing immune reconstitution, minimising risk of getting infected with TB and/or managing recurrent TB, minimizing airborne transmission, and infection control are key issues. In addition, given the disproportionate burden of HIV in women in these settings, sexual reproductive health issues and particular high mortality rates associated with TB during pregnancy are important. The scaleup and resource allocation to access antiretroviral treatment in these high HIV and TB settings provide a unique opportunity to strengthen both services and impact positively in meeting Millennium Development Goal 6.
Koike, Soichi; Matsumoto, Masatoshi; Ide, Hiroo; Kashima, Saori; Atarashi, Hidenao; Yasunaga, Hideo
In Japan, the number of obstetrics facilities has steadily decreased and the selection and concentration of obstetrics facilities is progressing rapidly. Obstetrics services should be concentrated in fewer hospitals to improve quality of care and reduce the workload of obstetricians. However, the impact of this intensification of services on access to obstetrics hospitals is not known. We undertook a simulation to examine how the intensification of obstetrics services would affect access to hospitals based on a variety of scenarios, and the implications for health policy. The female population aged between 15 and 49 living within a 30-min drive of an obstetrics hospital was calculated using a Geographic Information System for three possible intensification scenarios: Scenario 1 retained facilities with a higher volume of deliveries without considering the geographic boundaries of Medical Service Areas (MSAs, zones of healthcare administration and management); Scenario 2 prioritized retaining at least one hospital in each MSA and then retained higher delivery volume institutions, while Scenario 3 retained facilities to maximize population coverage using location-allocation modeling. We also assessed the impact of concentrating services in academic hospitals and specialist perinatal medical centers (PMCs) alone. In 2011, 95.0% of women aged 15-49 years lived within a 30-min drive of one of 1075 obstetrics hospitals. This would fall to 82.7% if obstetrics services were intensified into academic hospitals and general and regional PMCs. If 55.0% of institutions provided obstetrics services, the coverage would be 87.6% in Scenario 1, whereas intensification based on access would achieve over 90.5% coverage in Scenario 2 and 93.9% in Scenario 3. Intensification of obstetrics facilities impairs access, but a greater caseload and better staffing have the potential advantages of better clinical outcomes and reduced costs. It is essential to consult residents of hospital
Gallego, Gisselle; Dew, Angela; Lincoln, Michelle; Bundy, Anita; Chedid, Rebecca Jean; Bulkeley, Kim; Brentnall, Jennie; Veitch, Craig
In Australia and around the world, people with disability and their carers living in rural areas face additional challenges compared to their urban-dwelling counterparts. This cross-sectional study explored current access to therapy services for people with disability living in western New South Wales as reported by their primary carers. Data were collected using an online and paper survey distributed to carers, from December 2012 until June 2013. Information was sought about the carers, the person they care for, access to physiotherapy, speech pathology, occupational therapy and psychology services. A total of 166 carers participated. Respondents were mostly the carers of a son or daughter (83.6%) , the person they care for had an average age of 17.6 years (range 1-69 years) and more than half were males (56%). The majority of people with disability (73.5%) had received therapy services in the last 2 years. Waiting time and distance travelled to access physiotherapy, speech and occupational therapy services varied. People with disability had to wait an average of 6.6 months to receive speech pathology and had to travel an average of 2.6 hours to receive physiotherapy. The main provider of all services was the specialist disability government department, except for psychology, which is mainly provided in the private sector. From the carers' perspective, availability and accessibility to services are limited. Carers noted that availability of services was more restricted once people with disability reached adulthood. Lack of choice and frustration with the lack of availability of specialist disability services was reported frequently. Carers believed that timely allied health intervention prevented the development of more severe or complicated conditions that had a greater impact on carers, families, communities and the person with disabilities. © 2016 John Wiley & Sons Ltd.
Privacy-aware search of outsourced data ensures relevant data access in the untrusted domain of a public cloud service provider. Subscriber of a public cloud storage service can determine the presence or absence of a particular keyword by submitting search query in the form of a trapdoor. However, these trapdoor-based search queries are limited in functionality and cannot be used to identify secure outsourced data which contains semantically equivalent information. In addition, trapdoor-based...
Sundari Ravindran, T K; Fonn, Sharon
A social franchise in health is a network of for-profit private health practitioners linked through contracts to provide socially beneficial services under a common brand. The early 21st century has seen considerable donor enthusiasm for promoting social franchises for the provision of reproductive health services. Based on a compendium of descriptive information on 45 clinical social franchises, located in 27 countries of Africa, Asia and Latin America, this paper examines their contribution to universal access to comprehensive reproductive health services. It finds that these franchises have not widened the range of reproductive health services, but have mainly focused on contraceptive services, and to a lesser extent, maternal health care and abortion. In many instances, coverage had not been extended to new areas. Measures taken to ensure sustainability ran counter to the objective of access for low-income groups. In almost two-thirds of the franchises, the full cost of all services had to be paid out of pocket and was unaffordable for low-income women. While standards and protocols for quality assurance were in place in all franchises, evidence on adherence to these was limited. Informal interviews with patients indicated satisfaction with services. However, factors such as difficulties in recruiting franchisees and significant attrition, franchisees' inability to attend training programmes, use of lay health workers to deliver services without support or supervision, and logistical problems with applying quality assurance tools, all raise concerns. The contribution of social franchises to universal access to reproductive health services appears to be uncertain. Continued investment in them for the provision of reproductive health services does not appear to be justified until and unless further evidence of their value is forthcoming.
Lukenbill, W B
This study analyzes court records of a county-level obscenity trial in Austin, Texas, and the appeal of the guilty verdict beginning with a Texas appellate court up to the U.S. Supreme Court of two individuals who broadcast erotized AIDS and HIV safer sex information on a public-access cable television. The trial and appellate court decisions are reviewed in terms of argument themes, and the nature of sexual value controversy is outlined. Erotic materials often conflict with broad-based sexual and community values, and providing erotized HIV and AIDS information products can be a form of radical political action designed to force societal change. This study raises question as to how this trial and this type of informational product might affect the programs and activities of information resource centers, community-based organizations, libraries, and the overall mission of public health education.
Lopresti, Edmund F; Jinks, Andrew; Simpson, Richard C
Telerehabilitation (TR) services for assistive technology evaluation and training have the potential to reduce travel demands for consumers and assistive technology professionals while allowing evaluation in more familiar, salient environments for the consumer. Sixty-five consumers received TR services for augmentative and alternative communication or alternative computer access, and consumer satisfaction was compared with twenty-eight consumers who received exclusively in-person services. TR recipients rated their TR services at a median of 6 on a 6-point Likert scale TR satisfaction questionnaire, although individual responses did indicate room for improvement in the technology. Overall satisfaction with AT services was rated highly by both in-person (100% satisfaction) and TR (99% satisfaction) service recipients.
Siu, K.Y.; Wu, Y.; Ren, W.
The ATM Forum is currently discussing the need for a new best-effort service called UBR+, which is an enhancement to the existing UBR service, to support data traffic. The objective of the UBR+ service is to provide each user with a minimum service rate guarantee and a fair access to any excess available bandwidth. In this paper, the authors present a new efficient scheme for supporting this service. The key advantage of the scheme is that it employs only FIFO queueing (instead of per-VC queueing) and admits simple implementation in ATM switches. The ideas involve a simple scheduling mechanism that is based on per-VC queueing and incorporate the virtual queueing technique that can efficiently emulate per-VC queueing on a shared FIFO queue. Simulation results are presented to show that the schemes can deliver almost ideal performance for supporting the new service requirements of UBR+.
Full Text Available Spain has implemented several in-pharmacy HIV testing programmes performed by pharmacists as part of their everyday routine. We aim to assess the feasibility and the main outcomes of three programmes implemented in three Spanish regions with different sociological profiles and also different epidemiology for HIV.The characteristics of the 24151 people tested between 2009 and 2013 at 74 urban pharmacies are studied. We compare the main outcomes of the programmes with those of each Regional HIV Surveillance System (RHSS assessing the contribution to the total new diagnosis in each region and if priority groups are being reached.45.7% were heterosexual men (MSW, 14.4% men who have sex with men (MSM, and 27% women. The 35% were younger than 30 and 9.6% foreigners. The 52% were previously untested, and women were the most likely to be untested. The three programmes altogether diagnosed 226 people, resulting in a global prevalence of 0.9% (95%CI: 0.8-1.1; 3.4% in MSM (95%CI: 2.8-4.0. The prevalence among Spaniards was 0.8% (0.7-1.0 vs. 2.2 (1.6-2.9 among foreigners. The percentages of MSM diagnosed by all three programmes were higher than the one reported by their respective RHSS. Thirty four percent of the reactive MSM and the 71.4% of the reactive MSW did not have a previous HIV test although big testing history differences were observed across the programmes. Altogether, these services contributed with the 10.6% of all HIV diagnoses in these regions.In-pharmacy HIV testing programmes are a valuable testing option, having been able to uncover 1 out of 10 the new diagnoses reported in each region. They showed a good capacity of reaching and diagnosing previously untested populations, not only a priority population such as MSM but also heterosexual population who are more affected by delayed diagnosis. They seem to be particularly suitable for regions without large cities and specific HIV diagnostic services.
This paper outlines elements of demand for financial services among recent Latino immigrants, summarizes key factors contributing to their financial segregation, and describes products, services and administrative practices that have been used successfully by depository institutions. Throughout the research and paper particular attention has been paid to the New England region.
Meyrick, Jane; Gray, Debra; Jones, Abigail
Patient and public involvement (PPI) is a key feature of healthcare services in the UK. Sexual and reproductive health and HIV (SRHH) services face unique PPI challenges, as the anonymity and confidentiality required by service users can be a barrier to attracting patient input. PPI could improve sexual health services, through increased trust in services and the ability to tackle sexual health inequalities. However, specific practical guidance on how to address PPI in sexual health and the evidence to support it is sparse. This research aims to begin building an evidence base for PPI in sexual health services through: 1) an audit of PPI in SRHH in the Bristol region; and 2) a parallel survey of potential users of sexual health services about their experiences of PPI. For the audit, 18 SRHH organisations from all those in the region invited complete a short online survey, representing a range of different service providers. For the survey, participants, through a convenience sample via the University of the West of England and social media, were invited to complete an anonymous online survey of their experiences of PPI in SSRHs; 96 people responded. Reliance on customer satisfaction approaches and patients not being asked for feedback or what PP is for are reported. Services cite under-resourcing and a lack of time as barriers. Improving the use of patient's voice in SRHH could be supported through clarity of purpose (measured against outcomes), better communication with patients, and the need for flexible methods.
Rasch, Vibeke; Yambesi, Fortunata; Massawe, Siriel
-24 years and 25% among single women aged 25-45 years. CONCLUSION: HIV testing and condoms were accepted by most women who had an unsafe abortion. The poor reproductive health of these women could be improved by good post-abortion care that includes contraceptive counselling, VCT and condom promotion.......OBJECTIVE: To assess the acceptance and outcome of voluntary HIV counselling and testing (VCT) among women who had an unsafe abortion. METHOD: 706 women were provided with post-abortion contraceptive service and offered VCT. We collected data on socioeconomic characteristics and contraceptive use...... and marital status. RESULTS: 58% of the women who had an unsafe abortion accepted HIV testing. Women who earned an income were more likely to accept testing than housewives. Women who accepted testing were more likely to accept using a condom. The HIV prevalence rate was 19% among single women aged 20...
While previous literature has emphasized the importance of energy and public infrastructure services for economic development, questions surrounding the implications of unequal spatial distribution in access to these resources remain, particularly in the developing country context. This dissertation provides evidence on the nature, origins and implications of this distribution uniting three strands of research from the development and political economy, regional science and energy economics fields. The dissertation unites three papers on the nature of spatial inequality of access to energy and infrastructure with further implications for conflict risk , the historical institutional and biogeographical determinants of current distribution of access to energy and public infrastructure services and the response of households to fuel price changes over time. Chapter 2 uses a novel survey dataset to provide evidence for spatial clustering of public infrastructure non-functionality at schools by geopolitical zone in Nigeria with further implications for armed conflict risk in the region. Chapter 3 investigates the drivers of the results in chapter 2, exploiting variation in the spatial distribution of precolonial institutions and geography in the region, to provide evidence for the long-term impacts of these factors on current heterogeneity of access to public services. Chapter 4 addresses the policy implications of energy access, providing the first multi-year evidence on firewood demand elasticities in India, using the spatial variation in prices for estimation.
ten Hove, H.A.; Los, W.
The EU funded project BioCASE (contract nr. EVR1-CT-2001-40017) has established a web-based information service providing researchers with unified access to biological collections in Europe while leaving control of the information with the collection holders. The BioCASE project was based on the
Tolppanen, Bradley P.; Derr, Janice
The results of a recently conducted Web-based survey of Access Services department supervisors are presented in this article. The survey, which was completed by 94 respondents, identified 19 core tasks completed by student assistants and further found a high overall approval of student assistant job performance. The information generated by the…
... AGENCY Access to Confidential Business Information by Electronic Consulting Services, Inc., and Its... Protection Agency (EPA). ACTION: Notice. SUMMARY: EPA has authorized its contractor, Electronic Consulting... to a particular entity, consult the technical person listed under FOR FURTHER INFORMATION CONTACT. B...
Full Text Available Maternal mortality can be prevented if mothers had routine obstetric care and access to emergency obstetric services. However, in accessing healthcare most expecting mothers will have to struggle with distance and financial problems. The study sought to; assess the barriers that discourage women from accessing antenatal, delivery and postnatal services in the Cape coast Metropolis and give recommendations to inform policy. Questionnaire was administered to 150 pregnant women and nursing mothers with babies less than one year from ten communities in the Cape Coast Metropolis. An institutional questionnaire was administered at the University of Cape Coast Hospital which provides health care services to the communities. The study revealed that challenges such as money (16.7%, distance (15.4%, and the behaviour of health personnel (20% were the dominant barriers to accessing antenatal, delivery and post natal services in the Cape Cost Metropolis. These barriers lead to the inability of 14% of pregnant women and nursing mothers with babies less than one year to adhere to the minimum antenatal visitation number of 5 recommended by the Royal College of Obstetricians and Gynaecologists. Again 15.3% of these respondents were delivered by Traditional Birth Attendants and family members, whiles 5.8% were unable to adhere to the minimum postnatal visitation of two times. NGO’s and government organizations for women should organize training programmes aimed at improving the livelihood or employment for women in these communities.
Valencia-Garcia, Dellanira; Simoni, Jane M.; Alegria, Margarita; Takeuchi, David T.
Objective: We examined whether individual-level social capital--the intangible resources in a community available through membership in social networks or other social structures and perceived trust in the community--was associated with acculturation, depression and anxiety symptoms, and perceived access to services among women of Mexican…
Full Text Available The article discusses the possibilities and problems of development of medical tourism in the Crimea. The problems of the existing infrastructure in order to attract new tourist flow to the Crimea — people with disabilities. The measures aimed at improving the quality of services in the field of medical and accessible tourism.
Huis, Marloes; Hansen, Nina; Otten, Sabine; Lensink, Bernardus
Investing in women’s economic empowerment to increase gender equality and to reduce poverty are relevant goals of the United Nations. Herein offering access to microfinance services (i.e., micro loan, training) to women is considered an important means to strengthen women’s position. However, previo
The dynamics of our everyday life and the ubiquitous presence of information services create increasing demands for mobile access. Advanced mobile devices are now equipped with a sizeable screen, which opens the door to novel ways of interaction besides speech. This thesis investigates the advantage
Studer Ferreira, Lucio; Pichon, Dominique; Hatefi, Atoosa; Gomes, Andre; Dimitrova, Desislava; Braun, Torsten; Karagiannis, Georgios; Karimzadeh, Morteza; Branco, Monica; Correia, Luis M.
This paper addresses the novel notion of offering a radio access network as a service. Its components may be instantiated on general purpose platforms with pooled resources (both radio and hardware ones) dimensioned on-demand, elastically and following the pay-per-use principle. A novel architecture
Maryland State Dept. of Education, Baltimore. Div. of Library Development and Services.
Prepared as a part of an ongoing effort to make Maryland public libraries readily accessible to the handicapped, this directory identifies equipment, services, and facilities available to library users who are confined to wheel chairs and others who have difficulty with steps or stairs. Supplied by the administrators of Maryland's 24 public…
Huis, Marloes; Hansen, Nina; Otten, Sabine; Lensink, Bernardus
Investing in women’s economic empowerment to increase gender equality and to reduce poverty are relevant goals of the United Nations. Herein offering access to microfinance services (i.e., micro loan, training) to women is considered an important means to strengthen women’s position. However, previo
Houben, S.A.; Baken, N.; Herve, P.; Smets, R.
We examined efficiency within wireless access options for mobile devices and discovered that a classic pitfall is revisited. As with the proliferation of services in incumbents’ portfolios, leading to a number of coexisting so-called ‘stove-pipes’, we see an isomorphic phenomenon evolving in multimo
van Berchum, M.; Kraaikamp, Emilie
Data Archiving and Networked Services (DANS) promotes sustained access to digital research data. For this purpose, DANS encourages researchers to archive and reuse data in a sustained form. In the online archiving system EASY research data is stored in a permanent and sustainable manner, according t
ten Hove, H.A.; Los, W.
The EU funded project BioCASE (contract nr. EVR1-CT-2001-40017) has established a web-based information service providing researchers with unified access to biological collections in Europe while leaving control of the information with the collection holders. The BioCASE project was based on the pre
Lee, Chi Keung
The demand for pervasive access of location-related information (e.g., local traffic, restaurant locations, navigation maps, weather conditions, pollution index, etc.) fosters a tremendous application base of "Location Based Services (LBSs)". Without loss of generality, we model location-related information as "spatial objects" and the accesses…
Herkenhöner, Ralph; De Meer, Hermann; Jensen, Meiko
with trade secret protection. In this paper, we present an automated architecture to enable exercising the right of access in the domain of inter-organizational business processes based on Web Services technology. Deriving its requirements from the legal, economical, and technical obligations, we show...
Herkenhöner, Ralph; De Meer, Hermann; Jensen, Meiko;
with trade secret protection. In this paper, we present an automated architecture to enable exercising the right of access in the domain of inter-organizational business processes based on Web Services technology. Deriving its requirements from the legal, economical, and technical obligations, we show...
H.A. ten Hove; W. Los
The EU funded project BioCASE (contract nr. EVR1-CT-2001-40017) has established a web-based information service providing researchers with unified access to biological collections in Europe while leaving control of the information with the collection holders. The BioCASE project was based on the pre
Harris, Colleen S.
The former Associate Head of Access and Delivery Services of the North Carolina State University Libraries reports on successful use of matrix management techniques for the Circulation and Reserves unit of the department. Despite their having fallen out of favor in much of the management literature, matrix management principles are useful for…
Naseem, Mustafa; Shah, Altaf H; Khiyani, Muhammad Faheem; Khurshid, Zohaib; Zafar, Muhammad Sohail; Gulzar, Shabnam; AlJameel, AlBandary H.; Khalil, Hesham S.
Summary Background The prevalence of oral diseases including dental caries and periodontal conditions is remarkably higher in people with disabilities. The provision of accessible oral health services for people with learning disabilities may be challenging. Objectives The objectives of the review were to identify barriers in accessing oral health care that persists within society, enabling or disabling people with learning disabilities. Methods Using the Arksey O’Malley framework, a scoping review was conducted on PubMed/Medline, OVIDSP, and EMBASE. Studies were evaluated and short-listed based on the inclusion criteria, which consisted of: (1) study participants or population with learning disabilities, (2) aged 16 years or over, (3) reporting on access to oral health services, (4) published in the English language. Those that justified the inclusion criteria were carefully chosen after a blind peer-reviewed process when relevance and quality were debated. Results Nine studies were eventually included from searches. Tabulation of data was done under the heading of study type, outcomes, the year of publication and patient selection. The majority of studies provided a biomedical overview of access for adults with learning disabilities. Conclusions The concept of access for people with disability is still ill-defined and obscure. Access to oral health care and needs of people with learning disabilities are complex and multi-facet. PMID:28149451
Heradstveit Bård E
Full Text Available Abstract Background Intraosseous access (IO is a method for providing vascular access in out-of-hospital resuscitation of critically ill and injured patients when traditional intravenous access is difficult or impossible. Different intraosseous techniques have been used by our Helicopter Emergency Medical Services (HEMS since 2003. Few articles document IO use by HEMS physicians. The aim of this study was to evaluate the use of intraosseous access in pre-hospital emergency situations handled by our HEMS. Methods We reviewed all medical records from the period May 2003 to April 2010, and compared three different techniques: Bone Injection Gun (B.I.G® - Waismed, manual bone marrow aspiration needle (Inter V - Medical Device Technologies and EZ-IO® (Vidacare, used on both adults and paediatric patients. Results During this seven-year period, 78 insertion attempts were made on 70 patients. Overall success rates were 50% using the manual needle, 55% using the Bone Injection Gun, and 96% using the EZ-IO®. Rates of success on first attempt were significantly higher using the EZ-IO® compared to the manual needle/Bone Injection Gun (p Conclusions Newer intraosseous techniques may enable faster and more reliable vascular access, and this can lower the threshold for intraosseous access on both adult and paediatric patients in critical situations. We believe that all emergency services that handle critically ill or injured paediatric and adult patients should be familiar with intraosseous techniques.
Parker, Richard G; Perez-Brumer, Amaya; Garcia, Jonathan; Gavigan, Kelly; Ramirez, Ana; Milnor, Jack; Terto Jr, Veriano
.... Methods: Between January 2015 and October 2015, we reviewed scholarly and grey literatures to define treatment literacy and health literacy and assess the current need for literacy related to HIV prevention...
Nieves, Christina I.; Kaida, Angela; Seage, George R.; Kabakyenga, Jerome; Muyindike, Winnie; Boum, Yap; Mocello, A. Rain; Martin, Jeffrey N.; Hunt, Peter W.; Haberer, Jessica E.; Bangsberg, David R.; Matthews, Lynn T
Objective To determine individual and dyadic factors associated with effective contraceptive use among HIV-infected women accessing antiretroviral therapy (ART) in rural Uganda. Study Design HIV-infected women enrolled in the Uganda AIDS Rural Treatment Outcomes cohort completed questionnaires (detailing socio-behavioral characteristics, sexual and reproductive history, contraceptive use, fertility desires), and phlebotomy (October 2011–March 2013). We describe prevalence of effective contraceptive use (i.e., consistent condom use, and/or oral contraceptives, injectable hormonal contraception, intrauterine device, female sterilization) in the previous six months among sexually active, non-pregnant women (18–40 years). We assessed covariates of contraceptive use using multivariable logistic regression. Results 362 women (median values: age 30 years, CD4 count 397 cells/mm3, 4.0 years since ART initiation) were included. Among 284 sexually active women, 50% did not desire a(nother) child and 51% had a sero-concordant partner. 45% (n=127) reported effective contraceptive use of whom, 57% (n=72) used condoms, 42% (n=53) injectables, 12% (n=15) oral contraceptives, and 11% (n=14) other effective methods. Dual contraception was reported by 6% (n=8). Only ‘partnership fertility desire’ was independently associated with contraceptive use; women who reported neither partner desired a child had significantly increased odds of contraceptive use (aOR: 2.40, 95% CI: 1.07–5.35) compared with women in partnerships where at least one partner desired a child. Conclusions Less than half of sexually active HIV-infected women accessing ART used effective contraception, of which 44% (n=56) relied exclusively on male condoms, highlighting a continued need to expand access to a wider range of longer acting female-controlled contraceptive methods. Association with partnership fertility desire underscores the need to include men in reproductive health programming. PMID:25983013
Mesay Hailu Dangisso
Full Text Available Background: Despite the expansion of health services and community-based interventions in Ethiopia, limited evidence exists about the distribution of and access to health facilities and their relationship with the performance of tuberculosis (TB control programmes. We aim to assess the geographical distribution of and physical accessibility to TB control services and their relationship with TB case notification rates (CNRs and treatment outcome in the Sidama Zone, southern Ethiopia. Design: We carried out an ecological study to assess physical accessibility to TB control facilities and the association of physical accessibility with TB CNRs and treatment outcome. We collected smear-positive pulmonary TB (PTB cases treated during 2003–2012 from unit TB registers and TB service data such as availability of basic supplies for TB control and geographic locations of health services. We used ArcGIS 10.2 to measure the distance from each enumeration location to the nearest TB control facilities. A linear regression analysis was employed to assess factors associated with TB CNRs and treatment outcome. Results: Over a decade the health service coverage (the health facility–to-population ratio increased by 36% and the accessibility to TB control facilities also improved. Thus, the mean distance from TB control services was 7.6 km in 2003 (ranging from 1.8 to 25.5 km between kebeles (the smallest administrative units and had decreased to 3.2 km in 2012 (ranging from 1.5 to 12.4 km. In multivariate linear regression, as distance from TB diagnostic facilities (b-estimate=−0.25, p<0.001 and altitude (b-estimate=−0.31, p<0.001 increased, the CNRs of TB decreased, whereas a higher population density was associated with increased TB CNRs. Similarly, distance to TB control facilities (b-estimate=−0.27, p<0.001 and altitude (b-estimate=−0.30, p<0.001 were inversely associated with treatment success (proportion of treatment completed or cured cases
Introduction: Critical technological advances have yielded a toolkit of HIV prevention strategies. This literature review sought to provide contextual and historical reflection needed to bridge the conceptual gap between clinical efficacy and community effectiveness (i.e. knowledge and usage) of existing HIV prevention options, especially in resource-poor settings. Methods: Between January 2015 and October 2015, we reviewed scholarly and grey literatures to define treatment literacy and healt...