- ItemOpen AccessAssessing effectiveness of teen clubs in improving ART outcomes among HIV infected adolescents: A case of Zingwangwa Health Centre(2022-03-01) Chilimba, FrancisAdolescents 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
- ItemOpen AccessA comparative analysis of primary antiretroviral therapy outcomes by service provider type in Blantyre District, Malawi(2022-03-01) Chuka, Stuart, RodneyThe 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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- ItemOpen AccessFactors that are related to adherence and care seeking for hypertension treatments in individuals on antiretroviral therapy in central Malawi(2020-03-01) Phiri, KhumboHypertension 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.
- ItemOpen AccessApplying 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 NyamboseCervical 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