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Background: Initiating newly diagnosed people living with human immunodeficiency virus (HIV) onto antiretroviral treatment (ART) and retaining patients on treatment are vital to South Africa's ART programme. In 2020, coronavirus disease 2019 (COVID-19) and its accompanying containment (lockdown) measures presented unprecedented challenges to achieving these objectives. Aim: This study describes the impact of COVID-19 and related restrictions on district-level numbers of newly diagnosed people living with HIV and defaulting ART patients. Setting: Buffalo City Metropolitan Municipality (BCMM) in the Eastern Cape of South Africa. Methods: Mixed-methods approach: Monthly aggregated electronic patient data (newly initiated and restarted on ART) from 113 public healthcare (PHC) facilities were analysed (December 2019 to November 2020) across varying levels of COVID-19 lockdown regulation periods; telephonic in-depth interviews at 10 rural BCMM PHC facilities were conducted with facility staff, community health workers (CHWs) and intervention personnel. Results: The number of newly initiated ART patients decreased dramatically compared with pre-COVID-19 levels. The overall number of restarted ART patients increased in response to fears of co-infection with COVID-19. Facility-level communications and community outreach promoting HIV testing and treatment were disrupted. Novel approaches to providing services to ART patients were developed. Conclusion: Programmes for identifying undiagnosed people living with HIV and services aimed at retaining ART patients in care were profoundly impacted by COVID-19. The value of CHWs was highlighted, as were communication innovations. Contribution: This study describes the impact of COVID-19 and related regulations on HIV testing, ART initiation and adherence to treatment in a District of the Eastern Cape of South Africa.
Subject(s)
Humans , Male , Female , Therapeutics , HIV Infections , Community Health Workers , Coinfection , COVID-19 , Delivery of Health Care , DiagnosisABSTRACT
Introduction:Immunization is one of the most cost-effective strategies forreducing child mortality. There is a vital need to assess parents’ barriers involvingchild immunization completion to improve and increase vaccination coverage and completeness. Objective:To determine the barriers of child immunization completion among parents in the Community Health Centre of Johor Bahru. Methodology:The Maternal and Child Health Clinic, Jalan Abdul Samadproviding primary immunization wasselected via non-random and convenience sampling. Children between1 month to 2 years old who were immunized were identified. Data were obtained from parents who brought intheir children for primary vaccination at the Maternaland Child Health Clinic, Jalan Abdul Samad Results:The response rate for this study was 100% (n=306). All the eligible parents who were approached by the researchers agreed to participate in this research. Out of all respondents, 3 (1.0%)completely refused the immunization of their child, 23 (7.5%) defaulted with the immunization, and 280 (91.5%) completed the immunization. In terms of perception towards immunization, 60 or 19.6% of the total respondents stated that their preference for alternative treatments is their main reason if theydecide not to have their children vaccinated.After adjusting for socio-demographic differences, the researchers discovered that parents who have significantlylower coverage for all 10 childhood vaccines themselves were less likely to agree that vaccines are necessary to protect the health of children, to believe that their child might get a disease if they aren't vaccinated, or to believe that vaccines are safe.Conclusion:This first systematic evaluation of immunization refusal in Malaysia showed that a small number of parents refused immunization
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In order to unravel the inter-relationships among the four D's viz. delay, defaulting, deformity and dehabilitation, a critical analyses was taken together on estimating conditional probabilities and their relationship to specific demographic, social and economic factors. In a descriptive, cross-sectional in-depth study design, all the qualitative and quantitative types of social science research methods have been used to collect data from a total representative random sample of 450 leprosy affected persons and their families in rural and urban areas of 2 states of Uttar Pradesh and West Bengal in India. Findings from univariate, bivariate and multivariate analysis confirm the significance of correlation among the 4 D's- delay, defaulting, deformity and de-habilitation; and also independently with all the possible influencing factors viz. type of leprosy, age, gender, religion, marital status, educational status and occupation, except for delay with religion and gender and de-habilitation with religion and type of leprosy. This study also arrives at conclusions that each of the four variables is strongly multiple correlated with the other three variables, may be explained as viz. Delay is responsible for defaulting, deformity and de-habilitation, while defaulting is responsible for deformity and de-habilitation; further Deformity is responsible for delay, defaulting and de-habilitation, subsequently. De-habilitation is the main feature that resulted by and results in delay, defaulting and deformity. Established complex association among the four variables confirms that any intervention addressing any one of the 4D's cannot produce any changes unless the intervention is intended to address all the 4D's simultaneously. The study confirms the need for a three arm social multidrug therapy similar to the medical multidrug therapy, where there would be one arm for curing the medical problems of leprosy, a second arm focusing on empowering the people, and a third arm for advocacy and peoples' full participative involvement.
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AIM: To investigate factors associated with caregiver failure to complete immunizations for their children in the parish of St Mary, Jamaica. METHODS: A case-control study was conducted with 50 cases defined as caregivers who failed to immunize their children and 179 controls defined as caregivers of children who were properly immunized. The cases were caregivers of children who were randomly selected from clinic records of children who failed to complete their immunization within the study period. Controls were caregivers of children who were identified to have completed their immunization from a similar list. Cases and controls were visited at home and interviewed using a validated questionnaire. Cases and controls were compared in terms of socio-demographic, economic and other variables. RESULTS: Participants with less than secondary school education were more likely to be non-compliant (odds ratio [OR], 2.51, 95% confidence interval [CI], 1.06 - 5.97), while participants who were aware of legislation against non-compliance with immunization (OR, 0.35; 95% CI, 0.17, 0.69) were less likely to fail to immunize their children. CONCLUSION: Policy-makers and programme managers need to use established educational and communication channels to increase awareness of childhood immunization especially among families with lower educational levels in the parish.
OBJETIVO: Investigar los factores asociados con el fracaso de los encargados del cuidado infantil en cuanto a garantizar la completa inmunización de los niños en la Parroquia de Saint Mary, Jamaica. MÉTODOS: Se llevó a cabo un estudio de caso-control con 50 casos definidos como encargados de cuidado infantil que dejaron de hacer inmunizar a sus niños y 179 controles definidos como encargados del cuidado de niños que fueron debidamente inmunizados. Los casos eran cuidadores de niños que fueron seleccionados de forma aleatoria a partir de las historias clínicas de niños que no completaron su inmunización dentro del periodo de estudio. Por el contrario, en el caso de los controles se trataba de encargados del cuidado de niños identificados por haber completado su inmunización a partir de una lista similar. Tanto los casos como los controles recibieron una visita en sus casas, y fueron entrevistados usando una encuesta validada. Ambos - casos y controles - fueron comparados en términos de sus aspectos socio-demográficos y económicos, así como otras variables. RESULTADOS: Los participantes con un nivel de escolaridad por debajo de la enseñanza secundaria presentaron una mayor probabilidad de ser incumplidores (odds ratio [OR], 2.51, 95% intervalo de confianza [IC], 1.06 - 5.97), mientras que los participantes que sabían de la legislación contra el incumplimiento de la inmunización (OR, 0.35; 95% CI, 0.17 - 0.69) presentaron una menor probabilidad de dejar de inmunizar a sus niños. CONCLUSIÓN: Los encargados de trazar políticas y los administradores de programas necesitan usar los canales de comunicación y educación - sobre todo entre las familias con nivel educacional más bajo - con el propósito de lograr una mayor concientización en torno a la necesidad de inmunizar a todos los niños de la parroquia.