Bioethics, Behavioral & Health Social Sciences

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    Open Access
    Barriers and facilitators to the uptake of HIV testing services among adolescents and young adults in Machinga district, Malawi
    (2020-03-01) Sakala, Joseph Jasper
    While studies generally indicate a low uptake of HIV testing Services (HTS) among young people, other reports also indicate a worrying HIV burden among the same group. For example, the United Nations Children’s Fund (UNICEF) recently reported that globally, new infections have been dropping in all demographic groups except amongst young people where they have largely remained constant. The low HTS uptake among young people, therefore, mean that many of these infections remain undiagnosed, limiting the ability to control transmission.The study’s objective was to explore the factors that motivate, as well as factors that hinder, the uptake of HIV Testing Services among adolescents and young adults in Machinga District of Malawi at the individual, interpersonal, community and health service system levels. 24 In-depth interviews and 4 key-informant interviews were used to collect data, and purposive sampling was used to identify respondents. Respondents were adolescents and young adults aged 15-24 years, as well as HTS and youth-friendly health service (YFHS) providers. Data from audio recordings were transcribed in Microsoft Word and analyzed for content to generate themes. Data coding and analysis was done using Atlas 7. The study found that perceived risk of infection, perceived benefits of knowing one’s status for couples, availability of community-level youth clubs and other interaction fora, and the provision of HTS through outreach clinics were key facilitators for HIV testing. The findings also established that fear of a positive result, poor communication in relationships and families, cultural norms as well as lack of youth-friendly HIV testing services were key barriers to HIV testing. The study establishes the critical role of mobile HIV testing through outreach clinics and other community-based avenues in encouraging access to HTS by young people. The findings also suggest that stigma and misconceptions associated with HIV/AIDS are still issues in Malawi as evidenced by the fear of a positive result also emerging as a critical barrier to HTS
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    Factors that are related to adherence and care seeking for hypertension treatments in individuals on antiretroviral therapy in central Malawi
    (2020-03-01) Phiri, Khumbo
    Hypertension which occurs in 1 out of 3 adults is the most common non communicable disease (NCD) in Malawi. Despite its high prevalence, treatment coverage for hypertension is low. Low rates of health seeking behavior, unhealthy lifestyles and poor access to health care remain key challenges to the prevention, control and management of hypertension. The objective of the study is to identify the factors related to care seeking for hypertension among adults on antiretroviral therapy (ART). We conducted in-depth interviews with 30 individuals who are 18 years or older, on ART who also have hypertension. Interview questions focused on challenges and enablers to care seeking for hypertension and patients’ perceived risks and benefits to health care utilization for hypertension. Andersen’s behavior model for health services utilization (BMHU) was used as an organizing framework. Data were analyzed through constant comparison methods using Atlas.ti 8, applying both deductive and inductive techniques using a modified grounded theory approach. The results are presented based on common themes within the BMHU framework. The most common barriers for care seeking, adherence to medication and general management of hypertension included financial challenges due to poor health and weakened physical ability and medication side effects. At the health system level, lack of integrated care, lack of available hypertension medications, long wait times, and poor quality of care were the major challenges to care seeking. Respondents perceived risks of hypertension influenced their decision to start or stay on hypertension treatment. Knowledge about the benefits of treating hypertension encouraged individuals to properly manage their hypertension, despite barriers to care.Among our participants on ART with hypertension there was a high level of knowledge about the risks of hypertension and high motivation for treatment, but individuals faced significant challenges to care seeking. Patient barriers could be reduced through integration of hypertension treatment within ART clinics, free or low cost access to antihypertensives, improvements in the supply chain for hypertension medication, and support services (counseling or other) for patients with multi-morbidity.
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    Antiretroviral therapy adherence and the youth: An assessment of teen clubs’ implementation fidelity in southern Malawi
    (2020-03-01) Kunje, Gertrude Magomero
    Globallythereare2.1millionadolescentslivingwithHIV.1.7millionarein subSaharanAfrica.MalawihasoneofthehighestHIV/AIDSprevalenceratesinthe worldwith12.0%ofthoseaged15-49yearsinfected.AdherencetoARThasprovedto bedifficultforpeoplelivingwithHIVandoftenfallsbelowtherequiredlevelsandthus, youthslivingwithHIVareamongthepopulationgroupswithpoorerARTadherence rates.Fidelityisdefinedasadherence,integrityandqualityofimplementationofan intervention.HoweverhighlevelsofadherencearecrucialtothesuccessofHIV therapiesinordertosustainviralsuppression. Objective:ToassessthefidelityofimplementingteenclubsdesignedtoenhanceART adherenceinBlantyreDistrict WeconductedaFormativeEvaluationQualitativeResearchthatwasguided byaConsolidated FrameworkforImplementationResearchusing KeyInformant Interviewstoestablishifteenclubinterventionisimplementedwithfidelity.Thestudy wasconductedinfiveBlantyreHealthCentreTeenClubsnamely:Chilomoni,Chileka, SouthLunzu,Mpemba,NdirandeandLightHouseClinicatQueenElizabethCentral Hospital. Weusedacasestudymethodandpurposivesampling.Eligiblestudy participantswereteenclubfacilitatorswhohavefacilitatedteenclubsforatleasta year.IndepthInterviewswereaudiorecordedandthentranscribedverbatim.Thematic contentanalysiswasusedtoanalyzethedatamanually. HalfofthesampledteenclubshadguidelinesforconductingTeenClub Activities.TheexistedguidelinescompliedwiththeBaylorInternationalPediatricsAIDS Initiative.However,someelementswerenotfollowed.Trainingoftheteenclub vi facilitatorswasoneofthefactorsthatinfluencedcompliancewiththeguidelines. From theresults,theassessmenthasgeneratedinformationonattributes thatleadtocomplianceandnoncomplianceofHIVteenclubguidelinesinrelationto implementationfidelityoftheteenclubintervention.Ateenclubcannotbeoperated withoutthedesignatedguidelinesthatareestablishedtobefollowedassuchthey shouldbecompliedwith.
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    Applying a gender lens in cervical cancer programming: the assessment of sexually active young men involvement in cervical cancer preventive efforts
    (2020-03-01) Nkosi, Chimwemwe Nyambose
    Cervical cancer remains a public health concern across the world especially in developing countries including Malawi. Much as country’s policies calls for male involvement in sexual reproductive health, their involvement in cervical cancer prevention is still not clear. Sexually active young men are usually left behind despite their important role in its prevention.The study’s main objective was to assess the involvement of sexually active young men in cervical cancer preventive efforts in Lilongwe Urban. This was mixed methods study. A sample of 196 randomly selected study participants and 10 key informants were interviewed. Inclusion criteria were sexually active young men aged 15 to 24 patronising Bwaila and Kawale health centres. Thematic analysis was used for qualitative data and analysed using NVivo 7.4 software. Quantitative data was analysed using STATA version 14 statistical program. The study findings suggest knowledge of causes of cervical cancer, partner’s risks and whether one is circumcised or not as having a significant impact on young men involvement in cervical cancer preventive efforts. Their non-involvement is attributed to a number of factors which includes structural barriers in terms of access to cervical cancer information and services, lack of a standalone policy, lack of access points of the services such as youth-friendly health corners. Culturally, the misconception that cervical cancer is a feminine disease and men as sole decision makers also deters them from assessing the services.The study findings suggest low involvement of sexually active young men in cervical cancer prevention despite their willingness and their important role in the disease prevention. Deliberate efforts therefore have to be put in place to involve them if the disease is to be contained. The study suggests their involvement in policy and programme formulation as well as implementation and integration of cervical cancer in youth friendly health services as some of the strategies that could be employed to increase their involvement
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    Effectiveness of HIV status disclosure to sex partners in promotion of safer sex practice among youth living with HIV in Machinga district, Malawi.
    (2020-03-01) Kamwela, Catherine
    Disclosing HIV test results to one's sexual partner allows the couple to make informed decision regarding preventive behaviours as well as engaging the partner to the access of necessary support for coping with serostatus and illness. It may encourage partners to seek testing or change behaviour, and eventually decrease the transmission of HIV. The present study was done to determine the rate, outcomes such as condom use and factors associated with HIV positive status disclosure in Machinga District. The aim of this study was to assess the effectiveness of HIV status disclosure to sex partners in promotion of condom use as a safer sex method among young people living with HIV.The study used mixed methods; descriptive cross-sectional and qualitative approaches. Self-administered questionnaires were completed by 238 enrolled participants while 21 participants were involved in an in-depth interview. Simple random sampling and purposeful sampling were used to recruit the study participants in both cross-sectional and qualitative studies respectively. SPSS, Stata version 14, thematic analysis and NVivo 10 were used in data analysis.Of 238 enrolled participants, 121(50.84%) were able to disclose their status to their sexual partners. Bivariate analysis showed that several factors which include; condom use, gender, education were significantly associated with HIV disclosure. Among those who did not disclose, majority stated their reason as fear of negative reaction from their partner and discrimination from the community. Similarly, the seriousness of relationship also mattered to the study participants when it came to disclosure of status. Low disclosure rate by the study participants may result into inadequate ability to engage in preventive behaviours and to access support. It may also lead to further transmission of HIV as the partner may have other sexual partners. Programmatic and counselling efforts should focus on significance of disclosure of status to sexual partners.
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    Reduced bone mineral density among people living with HIV and receiving anti-retroviral therapy in Blantyre, Malawi: Pharmacological challenges, prevalence and the role of exercise
    (2021-01-01) Chisati, Enock Madalitso
    Reduced bone mineral density (BMD) is common among people living with HIV (PLWHIV) following the use of tenofovir (TDF) based antiretroviral therapy (ART) drugs. Although pharmacological therapies used to manage reduced BMD are associated with adverse effects, non-pharmacological strategies to manage reduced BMD resulting from ART drugs in PLWHIV have not been investigated. Despite evidence that exercise is effective in increasing BMD, there has been minimum effort to investigate effects of exercise on low BMD resulting from ART drugs in PLWHIV. The purpose of the research project was to investigate the prevalence of reduced BMD with its associated factors and the role of exercise in increasing bone mineral density among people living with HIV and receiving antiretroviral therapy in Blantyre, Malawi. This was a cross sectional and randomised controlled study involving HIV-positive adults receiving TDF based ART recruited from Blantyre, Malawi. Data on prevalence of BMD and physical activity (PA) was collected using the Dual Energy X-ray Absorptiometry (DEXA) and a global PA questionnaire. Eligible and willing participants with reduced BMD were then randomised into either maximal strength training group (TG) or control group (CG). Variables of BMD, Peak Oxygen Uptake (VO2max), Peak Heartrate (HRpeak) and One repetition maximum (1 RM) were obtained and analysed at base line and after the exercise intervention in both the TG and CG. Data were analysed using IBM Statistical Package for the Social Sciences (SPSS) version 21. Descriptive statistics using mean and standard deviation (SD) were used to characterize demographic variables. Student T – tests were used to analyse the differences between TG and CG. Out of 282 participants, 55 (20%) had low BMD while 227 (80%) had their BMD within the expected ranges for age. Most participants (40%) had low PA levels, followed by those who were moderately physically active (36%) while a smaller number of participants (24%) had high PA levels. Participants with low PA level (OR 1.23, p = 0.6) were more likely to have reduced BMD than those with high PA level. Data of 24 participants with reduced BMD randomised into TG (14) and CG (10) were analysed. After the intervention, there were significant improvements in lumbar BMD (p <0.001) and resting heart rate (p = 0.03) in the TG compared to the CG. There were significant improvements in 1 RM in both the TG (p <0.001) and the CG (p = 0.01). Prevalence of reduced BMD is high among PLWHIV in Malawi especially male Malawian adults. Most PLWHIV and receiving ART in the sample had low PA levels. The occurrence of reduced BMD was more likely among participants with low PA level. Maximal strength training improves lumbar BMD, resting herat rate and strength in PLWHIV receiving ART in Blantyre, Malawi
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    Assessing effectiveness of teen clubs in improving ART outcomes among HIV infected adolescents: A case of Zingwangwa Health Centre
    (2022-03-01) Chilimba, Francis
    Adolescents and young adults present a growing share of people getting newly infected or living with HIV. Globally, 40% of all new infections occur in adolescents (10-19 years) and young adults (20-24 years). Compared to their adult counterparts, about half of HIV infected adolescents who are on ART are reported to be non-adherent to ART. Further evidence available also suggests that there is little specialized care for adolescents living with HIV as opposed to their adult counterparts. Other studies conducted to measure ART outcomes among adolescents in urban clinics in Zimbabwe showed that adolescents and young adults had high loss to follow up, unlike adults in the same set up HIV positive adolescents on ART have usually lower viral suppression rates when compared to adults and children, meaning their viral load remains relatively high even though they are on ART. According to spectrum data for 2018, viral load suppression in all ART clients in Malawi was at 89%. A further analysis also indicated that the viral load suppression was different across different age and sex groups. Where as in adults the suppression rates were at above 82%, viral load suppression in children 0 -14 years was at 58%. Additionally, a 2019 study by Umar et al in selected six districts of the southern region of Malawi showed that viral load suppression among adolescents aged 13 – 24 was at 61% Interventions aimed at improving optimal ART uptake among adolescents would therefore go a long way in improving ART outcomes among the adolescents, and one such intervention is teen clubs, implemented in selected health facilities in the country. The main objective of the study is to assess whether teen clubs as a model of care for HIV and AIDS can improve ART outcomes among infected adolescents. Using a retrospective analytical cross sectional design, the study assessed ART outcomes among adolescents aged 10 – 24 years attending teen club and those not enrolled in any teen club program, but were enrolled in ART program at Zingwangwa Health Centre. The study employed quantitative data collection and analysis methods. Sample size for study participants was 225 and it was nearly evenly matched for cases (113) and controls (112). This number represented all adolescents aged 10-24 years and on ART at the facility. Patient level data was collected from all the 113 adolescents belonging to the teen club, as well as the 112 adolescents not enrolled in any teen club program but on ART at the health facility. The data was abstracted from patient records such as attendance registers, ART, Defaulter, Viral Load and High Viral Load registers. In addition to the facility registers, viral load results were accessed from Lab Management Information System (LIMS) database for all the adolescents registered at the health center. Out of the total 225 adolescents enrolled in the study, results showed that 79 adolescents had high viral load (HVL), representing 35% of total adolescents while 146 had low detectable levels (LDL) of viral load (<1000 copies). For the 112 adolescents not enrolled in any teen club program, 44 had high viral load levels (>1000 copies), thus representing about 39% of the total non-teen club adolescents, while 68 had low detectable levels for viral load, which is about 61% of adolescents on ART but not in any teen club program. On the other hand, out of the 113 adolescents enrolled in teen club program at the health center, 35 adolescents had high viral load level, representing about 31% of total adolescents in the program, while a total of 78 adolescent teen club members, representing about 69% had a low detectable viral load level. Despite results of the study showing that more adolescents enrolled in the teen club reporting to have low viral load levels than their counterparts, calculated p-value of 0.192 and Pearson Chi2 value of 1.7058 suggest there is no strong statistical evidence to suggest an association between viral load level and belonging to a teen club program or not. In terms of adherence to ART, results show that there was no statistical significant difference in adherence between youths in teen clubs and those not in teen clubs evidenced by p-value being greater than 0.05. (p-value = 0.0814). However, adherence level for youth in the teen club was higher (89.7%) when to compared to that of the youth not belonging to teen club (86.7%) Results of the study show teen club program is effective in ART care of HIV infected adolescents, demonstrated by better ART outcomes among adolescents that are exposed to teen club program when compared with adolescents not enrolled in teen club program
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    A comparative analysis of primary antiretroviral therapy outcomes by service provider type in Blantyre District, Malawi
    (2022-03-01) Chuka, Stuart, Rodney
    The Antiretroviral Therapy (ART) Program for Malawi started in 2004 and the key providers in provision of ART services in Malawi include; the public sector, the private sector for-profit and non-profit and Christian Health Association of Malawi (CHAM). Since then, no known studies have been conducted to compare primary ART treatment outcomes by service provider type thus public, private and CHAM. In addition, information on variation of primary ART treatment outcomes by service provider type is not known and probably has not been published The Objective was to examine primary Antiretroviral Therapy outcomes in Blantyre District using ART data from 1st January 2017 to 31st December, 2018 in public, private and Christian Health Association of Malawi ART clinics This was a cross-sectional study and utilized both quantitative and qualitative methods. The quantitative method used facility level secondary data from the Malawi National ART Program in the Ministry of Health HIV AIDS Department. The qualitative method used in-depth interviews using an interview guide to key informants. Data was analysed using STATA statistical software package version 15.Analysis of Variance (ANOVA) was used to compare the variations of primary ART outcomes among in public, private and CHAM ART sites. To compare proportions, the researcher used Scheffe's-Test. The qualitative data was analyzed using thematic analysis to explain the relationship between the variables. Overall the findings indicate that Primary Antiretroviral Therapy Outcomes in Public, Private and CHAM ART Clinics are different. According to the results, there are more defaulters in the public ART clinics followed by private and lowest in the CHAM ART sites. This may be attributed lack of privacy and confidentiality, stigma and discrimination iv and long distance to the health facility which result in high cost expenses.Overall died on ART outcome is higher in private ART clinics compared to public and CHAM ART clinics and no significant differences between public and private ART clinics. The study has also clearly demonstrated that the private ART clinics have more transfer outs than public and CHAM due to change of location for work related issues of the clients. Retention in care (Alive on ART) is high in CHAM ART Clinics followed by public then lastly private. Generally, stop on ART is not a common outcome in all service provider types. Overall the findings indicate that Primary Antiretroviral Therapy Outcomes in Public, Private and CHAM ART Clinics are different. Some of the factors contributing to the primary Art outcomes include; lack of privacy and confidentiality, stigma and discrimination and long distance to the health facility which result in high cost expenses and change of location for work related issues of the clients. Generally, stop on ART is not a common outcome in all service provider types.
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