Mediating antiretroviral treatment for HIV during COVID-19: lessons from implementation in Gomba District, Uganda

Initial and subsequent waves of COVID-19 in Uganda disrupted the delivery of HIV care. In rural areas, village health teams and organisations on the ground had to develop strategies to ensure that people living with HIV could continue their treatment. It was necessary to take evolving circumstances into account, including dealing with movement restrictions, constrained access to food and stigma due to anonymity being lost as a result of a shift from health facility-based services to community-level support. Uganda has a long history of community-driven response to HIV, although health systems and response programming have become more centralised through government and donors to address political commitments to HIV treatment and other targets. The delivery system for antiretroviral therapy was vulnerable to the impacts of COVID-19 restrictions and related circumstances. To understand the continuum of challenges, and to inform ongoing and future support of treatment for people living with HIV, interviews were conducted with HIV organisation implementers, health workers, village health team members and people living with HIV. It was found that stigma was a central challenge, which led to nuanced adaptations for delivering antiretroviral treatment. There is a need to strengthen support to households of people living with HIV through improving community capacity to manage crises through improving household food gardens and savings, as well as capacity to organise and interact with support systems such as the village health teams. In communities, there is a need to evoke dialogue on stigma and to support community leadership on pressing issues that affect communities as a whole and their vulnerable groups. There are opportunities to reawaken the grassroots civic response systems that were evident in Uganda's early response to HIV yet were lacking in the COVID-19 context.

Application of Interprofessional Education Model to University Pre-Licensure Health Students in the Management of Chronic Care Conditions in Zambia

Background:Thereisevidencethatmultidisciplinary healthcare teams can provide better quality of care and treatment outcomes compared to that delivered by individuals from a single health discipline. The project on which this article isbased applied the interprofessional education model to university pre-licensure health students in the management of chronic care conditions in Zambia. Methods:Four distinct but interrelated approaches, name ly desk review; module development workshops; review and validation of modules by experts; piloting and review of the training modules were employed. Results: Severalmodelsofinterprofessionaleducationcurrentlyinexistenceandusedsuccessfully by higher education institutions in other settings were identified. While several models of Interprofessional Education were identified, our project adapted the "didactic program, community-based experience, and interprofessional-simulation experience" models. To apply the models, modules of seven chronic care conditions were developed and piloted. The extent to which the module activities promoted interprofessional education were rated between 74 - 87% (agree or strongly agree) by the students. Conclusion: Three models of Interprofessional Education were identified and adapted in the project and seven modules were developed and administered to the students. The process was effective for putting forth an interprofessional training program at the undergraduate level, with the potential to improve quality of care for patients.

Preconception care and sickle cell anemia in pregnancy

Background: Pregnancy in women with sickle cell anemia is associated with adverse outcome for mother and child; but with improvements in medical care; the outcome has greatly improved in developed countries. Despite being the most prevalent genetic disease in Africa; sickle-cell disease; along with its serious health problems in pregnancy; is largely neglected. Objective: To determine the effects of preconceptual care on pregnancy outcome among booked patients with homozygous sickle cell disease at Aminu Kano Teaching Hospital; Kano; Nigeria. Materials and Methods: A cohort study of the pregnancy outcome; among booked 39 pregnant women with homozygous sickle cell disease (Hbss); who had preconception care; and an equal number of booked pregnant women with homozygous sickle cell disease (Hbss); who did not have preconception care (controls); at Aminu Kano Teaching Hospital; between January 2000 and December 2006. Results: There was no statistically significant difference in the occurrence of complications between the two groups; but complications occurred with less frequency among the cases compared to the controls. Conclusion: This study suggest that preconception care and effective prenatal care by a multidisciplinary team; and delivery in a hospital which is accustomed to management of sickle cell disease and its complications; is associated with good pregnancy outcome in women with sickle cell anemia in pregnancy