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Public Health Action ; 13(Suppl 1): 1-5, 2023 Mar 21.
Article in English | MEDLINE | ID: covidwho-2265305


SETTING: In alignment with the UN Sustainable Development Goals (SDGs), Kerala State in India aims to end the HIV/AIDS epidemic, using its strong background in local governance to implement the National AIDS Control Programme (NACP). OBJECTIVE: To examine the role of local governments in the implementation of NACP in tune with SDGs. DESIGN: We conducted a state-wide exploratory study using document reviews, key informant and in-depth interviews, which were analysed thematically. RESULTS: Four overarching themes that emerged were 1) preparation for programme implementation, 2) positive impact of local government involvement, 3) convergence with other organisations, and 4) barriers to implementation. Local government commitment to implementing the programme was evidenced by their adoption of the HIV/AIDS policy, facilitative interdepartmental coordination and local innovations. Interventions focused on improving awareness about the disease and treatment, and social, financial and rehabilitative support, which were extended even during the COVID-19 pandemic. Fund shortages and poor visibility of the beneficiaries due to preference for anonymity were challenges to achieving the expected outcomes. CONCLUSION: The NACP is ably supported by local governments in its designated domains of interventions, prevention, treatment, and care and support. The programme can achieve its target to end the AIDS epidemic by overcoming the stigma factor, which still prevents potential beneficiaries from accessing care.

CONTEXTE: En accord avec les Objectifs de développement durable (SDG) des Nations unies, l'État du Kérala en Inde a pour objectif de mettre fin à l'épidémie de VIH/SIDA en s'appuyant sur sa forte expérience de gouvernance locale en matière de mise en œuvre du Programme national de lutte contre le SIDA (NACP). OBJECTIF: Examiner le rôle des gouvernements locaux dans la mise en œuvre du NACP, en accord avec les SDG. MÉTHODES: Nous avons réalisé une étude exploratoire à l'échelle de l'État, par le biais d'analyses documentaires, d'entretiens avec des informateurs clés et d'entretiens approfondis, qui ont ensuite été analysés de manière thématique. RÉSULTATS: Quatre thèmes centraux ont été identifiés : 1) préparation de la mise en place du programme, 2) impact positif de l'implication des gouvernements locaux, 3) convergence avec d'autres organisations, et 4) obstacles à la mise en œuvre. L'engagement des gouvernements locaux à mettre en œuvre le programme se manifestait par l'adoption de la politique de lutte contre le VIH/SIDA, par une coordination interdépartementale facilitée et par des innovations locales. Les interventions portaient sur l'amélioration de la sensibilisation au VIH/SIDA et à son traitement, ainsi qu'aux systèmes de soutien social, financier et de réadaptation disponibles ; ces interventions ont même été maintenues pendant la pandémie de COVID-19. Le manque de financements et la mauvaise visibilité des bénéficiaires en raison d'une volonté d'anonymat représentaient autant d'obstacles empêchant d'atteindre les résultats escomptés. CONCLUSION: Les gouvernements locaux apportent leur soutien efficace au NACP dans les domaines d'intervention qui lui ont été assignés (prévention, traitement, soins et soutien). Le programme peut atteindre son objectif d'éradication de l'épidémie de SIDA s'il parvient à lutter contre la stigmatisation associée à la maladie, qui empêche encore d'éventuels bénéficiaires d'accéder aux soins.

International Journal of Stroke ; 17(3 Supplement):168, 2022.
Article in English | EMBASE | ID: covidwho-2139011


Background and Aims: The case fatality rate of acute spontaneous intracerebral hemorrhage (ICH) is high 54% at 1 year, and only 12% to 39% of survivors achieve long term functional independence. The INTEnsive care bundle with blood pressure Reduction in Acute Cerebral haemorrhage Trial (INTERACT3) was an international, multicentre, cluster-randomized clinical trial to assess a multifaceted goal-directed care bundle of physiological management in patients with acute ICH. We aimed to study the challenges encountered in recruitment during the pandemics in India. Method(s): Between August 2020 and October 2022, all adult patients presenting with spontaneous ICH within 6 hours from symptom onset were enrolled under the standard of usual care management until they are informed of crossing over to intervention and to be contacted at 6 months follow-up. Result(s): Six out of ten screened centres participated. The pandemic posed many challenges to the recruitment of patients in the trial: The ethics committee meetings were interrupted, preventing us enrolling more sites. Fewer patients presented to hospital due to fear of covid, economic crisis, transportation barriers, delayed presentation beyond 6 hours due to poor triaging, delay in RTPCR testing, slow referrals, unwillingness to followup in outpatient clinic. Solutions: frequent virtual meetings with ethics committees were held by site PIs, RTPCR switched to rapid testing, ER physicians trained to rapidly identify ICH cases and trial strategy was modified at each centre to boost recruitment. Conclusion(s): Alternative approaches for rapid triaging and modified strategies to recruitment are needed to overcome challenges of implementing a stroke trial during a pandemic.

Cerebrovascular Diseases ; 50(SUPPL 1):1, 2021.
Article in English | Web of Science | ID: covidwho-1576568