ABSTRACT
Background: Integrated care is increasingly used to manage chronic conditions. In Uganda, the integration of HIV, diabetes and hypertension care has been piloted leveraging the well facilitated and established HIV health care provision structures. This qualitative study aimed to investigate the perceptions and experiences of patients, health care providers, clinical researchers, representatives from international NGOs, community members/leaders and policy makers on integrated management of HIV, diabetes and hypertension at selected government clinics in Central Uganda. Methods: : We adopted a qualitative-observational design and participants were purposively selected. In-depth interviews were conducted with patients and with health care providers, clinical researchers, policy makers, and representatives from international NGOs. Focus group discussions were conducted with community members and leaders. Clinical procedures in the integrated care clinic were also observed. Data were managed using Nvivo 12 and analyzed thematically. Results: : Triangulated findings revealed perceptions of integration reducing the frequency with which patients with comorbidities (HIV, diabetes, hypertension) visited health facilities, reduced the associated treatment costs, increased interpersonal relationships among patients and healthcare providers, and promoted capacity of health care providers to manage multiple chronic conditions. Integration also reduced stigma mainly through creating opportunities for health education, which allayed patient fears and increased their resolve to enroll for and adhere to treatment. Patients also had an opportunity to offer and receive psycho-social support and coupled with the support they received from healthcare workers, this strengthened the patient-patient relationship and provider-patient relationship, one of the building blocks of integration. Although, the integrated model significantly reduced stigma in general, it did not eradicate service level challenges and societal discrimination among HIV patients. Conclusion: The study narratives reveal that, in low resource settings like Uganda, integration of HIV, diabetes and hypertension care has potential to support patient experiences of co-morbid care. Integrated clinics may function as a central stigma mitigation strategy, operating independently of existing clinics and treating a range of conditions including HIV and other STIs.
Subject(s)
HIV Infections , HypertensionABSTRACT
Background: Past infection with COVID-19 or vaccination against SARS-CoV-2 may induce immune responses that prevent infection (sterilising immunity), reduce disease severity and infectivity after being reinfected. Methods: We developed a deterministic, discrete-time population dynamic model to assess impacts of vaccination programmes on future dynamics of SARS-CoV-2 transmission in England. The model explicitly considered durability and different types of naturally acquired and vaccine-induced immunity against SARS-CoV-2 and their impacts on COVID-19 transmission dynamics from 2020 to 2029 in England. We explored a large number of projection scenarios. Findings: If vaccine efficacy is ≥70%, the vaccine-induced sterilising immunity lasts ≥182 days on average, and the reinfectivity is greatly reduced (by ≥40%), annual mass vaccination programmes can prevent further COVID-19 outbreaks in England. Under such optimistic scenarios, the cumulative number of COVID-19 deaths is estimated to be from 113,000 to 115,000 by the end of 2029 in England. However, under plausible scenarios with lower vaccine efficacy, shorter durability of immunity, and smaller reduction in reinfectivity, repeated vaccination programmes could not prevent further COVID-19 outbreaks. Interpretations: Because of great uncertainty in the impacts of mass vaccination on COVID-19 pandemics, it is crucial to monitor vaccination effects in the real world, and to better understand characteristics of naturally acquired and vaccine induced immunity against SARS-CoV-2. Funding: No specific funding received for this study.Declaration of Interests: No competing interests declared.
Subject(s)
COVID-19ABSTRACT
Background: After the outbreak of Coronavirus disease in 2019 (COVID-19), stringent lockdown measures were imposed in Wuhan between January 23, 2020 and April 8, 2020. To provide evidence on the post-lockdown risk of COVID-19 epidemic in Wuhan, the city government conducted a citywide nucleic acid screening of SARS-CoV-2 infection between May 14 and June 1, 2020. Methods: All city residents aged [≥]6 years were potentially eligible to participate the screening programme. The rate of detection of asymptomatic infected cases was calculated, and their demographic and geographic distributions were investigated. ArcGIS 10.0 was used to draw a geographic distribution of asymptomatic infected persons. Results: The screening programme recruited a total of 9,899,828 persons (response rate, 92.9%). The screening found no newly confirmed patients with COVID-19, and identified 300 asymptomatic infected cases (detection rate 0.303/10,000). In addition, 107 of 34,424 previously recovered patients with a history of COVID-19 diagnosis were tested positive (relapse rate, 0.31%). Virus culture of SARS-CoV-2 was negative for all 300 asymptomatic cases and all 107 recovered COVID-19 patients. A total of 1,174 close contacts of asymptomatic cases were traced and all of them had a negative nucleic acid testing result. Conclusions: Prevalence of COVID-19 nucleic acid test positivity was very low in the Wuhan general population, in recovered cases and in contacts of asymptomatic cases, five to eight weeks after the end of lockdown. These findings help resolve concerns about the post-lockdown risk of COVID-19 epidemic, and promote the recovery of economy and normal social life in Wuhan.