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1.
Lancet Glob Health ; 10(3): e390-e397, 2022 03.
Article in English | MEDLINE | ID: covidwho-1747373

ABSTRACT

BACKGROUND: Universal health coverage is one of the WHO End TB Strategy priority interventions and could be achieved-particularly in low-income and middle-income countries-through the expansion of primary health care. We evaluated the effects of one of the largest primary health-care programmes in the world, the Brazilian Family Health Strategy (FHS), on tuberculosis morbidity and mortality using a nationwide cohort of 7·3 million individuals over a 10-year study period. METHODS: We analysed individuals who entered the 100 Million Brazilians Cohort during the period Jan 1, 2004, to Dec 31, 2013, and compared residents in municipalities with no FHS coverage with residents in municipalities with full FHS coverage. We used a cohort design with multivariable Poisson regressions, adjusted for all relevant demographic and socioeconomic variables and weighted with inverse probability of treatment weighting, to estimate the effect of FHS on tuberculosis incidence, mortality, cure, and case fatality. We also performed a range of stratifications and sensitivity analyses. FINDINGS: FHS exposure was associated with lower tuberculosis incidence (rate ratio [RR] 0·78, 95% CI 0·72-0·84) and mortality (0·72, 0·55-0·94), and was positively associated with tuberculosis cure rates (1·04, 1·00-1·08). FHS was also associated with a decrease in tuberculosis case-fatality rates, although this was not statistically significant (RR 0·84, 95% CI 0·55-1·30). FHS associations were stronger among the poorest individuals for all the tuberculosis indicators. INTERPRETATION: Community-based primary health care could strongly reduce tuberculosis morbidity and mortality and decrease the unequal distribution of the tuberculosis burden in the most vulnerable populations. During the current marked rise in global poverty due to the COVID-19 pandemic, investments in primary health care could help protect against the expected increases in tuberculosis incidence worldwide and contribute to the attainment of the End TB Strategy goals. FUNDING: TB Modelling and Analysis Consortium (Bill & Melinda Gates Foundation), Wellcome Trust, and Brazilian Ministry of Health. TRANSLATION: For the Portuguese translation of the abstract see Supplementary Materials section.


Subject(s)
Community Health Services/statistics & numerical data , Primary Health Care/statistics & numerical data , Tuberculosis/epidemiology , Tuberculosis/therapy , Universal Health Insurance/statistics & numerical data , Adolescent , Adult , Age Distribution , Brazil/epidemiology , Cohort Studies , Community Health Services/methods , Female , Humans , Incidence , Longitudinal Studies , Male , Poverty/statistics & numerical data , Primary Health Care/methods , Young Adult
2.
J Int Assoc Provid AIDS Care ; 20: 23259582211017742, 2021.
Article in English | MEDLINE | ID: covidwho-1724379

ABSTRACT

BACKGROUND: Maintaining essential HIV services has being a Global challenge during the COVID-19 crises. Myanmar has 54 million inhabitants. Neighbor of China, Thailand, India and Bangladesh it was impacted by COVID-19, but came up with a comprehensive and effective response, following WHO recommendations. The HIV Prevalence is 0.58% and it is concentrated among key population. A HIV Contingency Plan was developed to face this challenge. METHODOLOGY: The programme-based cross-sectional descriptive study with analysis of routinely collected data from MoHS data system, between 2019 and 2020 was conducted, comparing first six months of 2019 and 2020. RESULTS: HIV outreach activities and HIV testing were slightly affected after detection of first COVID-19 case, till mid May 2020. After that, outreach activities resumed. Introduction of HIV self-testing was initiated. 72% of more than 21,000 PWID on MMT were receiving take home dose up to 14 days and 60% of ART patients were receiving 6 months ARV dispensing. CONCLUSION: Essential HIV services were maintained.


Subject(s)
COVID-19/epidemiology , Community Health Services/methods , HIV Infections/prevention & control , HIV Infections/diagnosis , HIV Infections/drug therapy , HIV Infections/epidemiology , Health Plan Implementation , Humans , Myanmar/epidemiology , SARS-CoV-2
3.
J Med Virol ; 94(4): 1419-1427, 2022 04.
Article in English | MEDLINE | ID: covidwho-1527442

ABSTRACT

There is currently limited information on clinical severity phenotypes of symptoms and functional disability in post-coronavirus disease 2019 (COVID) Syndrome (PCS). A purposive sample of 370 PCS patients from a dedicated community COVID-19 rehabilitation service was assessed using the COVID-19 Yorkshire Rehabilitation Scale where each symptom or functional difficulty was scored on a 0-10 Likert scale and also compared with before infection. Phenotypes based on symptom severity were extracted to identify any noticeable patterns. The correlation between symptom severity, functional disability, and overall health was explored. The mean age was 47 years, with 237 (64%) females. The median duration of symptoms was 211 days (interquartile range 143-353). Symptoms and functional difficulties increased substantially when compared to before infection. Three distinct severity phenotypes of mild (n = 90), moderate (n = 186), and severe (n = 94) were identified where the severity of individual symptoms was of similar severity within each phenotype. Symptom scores were strongly positively correlated with functional difficulty scores (0.7, 0.6-0.7) and moderately negatively correlated with overall health (-0.4, -0.3, to -0.5). This is the first study reporting on severity phenotypes in a largely nonhospitalized PCS cohort. Severity phenotypes might help stratify patients for targeted interventions and planning of care pathways.


Subject(s)
COVID-19/rehabilitation , Community Health Services/organization & administration , Critical Pathways/organization & administration , SARS-CoV-2 , Adult , Aged , Community Health Services/methods , Cross-Sectional Studies , Disability Evaluation , Female , Hospitalization/statistics & numerical data , Humans , Male , Middle Aged , Phenotype , Severity of Illness Index
5.
PLoS Med ; 18(9): e1003744, 2021 09.
Article in English | MEDLINE | ID: covidwho-1440980

ABSTRACT

BACKGROUND: In South Africa, breastfeeding promotion is a national health priority. Regular perinatal home visits by community health workers (CHWs) have helped promote exclusive breastfeeding (EBF) in underresourced settings. Innovative, digital approaches including mobile video content have also shown promise, especially as access to mobile technology increases among CHWs. We measured the effects of an animated, mobile video series, the Philani MObile Video Intervention for Exclusive breastfeeding (MOVIE), delivered by a cadre of CHWs ("mentor mothers"). METHODS AND FINDINGS: We conducted a stratified, cluster-randomized controlled trial from November 2018 to March 2020 in Khayelitsha, South Africa. The trial was conducted in collaboration with the Philani Maternal Child Health and Nutrition Trust, a nongovernmental community health organization. We quantified the effect of the MOVIE intervention on EBF at 1 and 5 months (primary outcomes), and on other infant feeding practices and maternal knowledge (secondary outcomes). We randomized 1,502 pregnant women in 84 clusters 1:1 to 2 study arms. Participants' median age was 26 years, 36.9% had completed secondary school, and 18.3% were employed. Mentor mothers in the video intervention arm provided standard-of-care counseling plus the MOVIE intervention; mentor mothers in the control arm provided standard of care only. Within the causal impact evaluation, we nested a mixed-methods performance evaluation measuring mentor mothers' time use and eliciting their subjective experiences through in-depth interviews. At both points of follow-up, we observed no statistically significant differences between the video intervention and the control arm with regard to EBF rates and other infant feeding practices [EBF in the last 24 hours at 1 month: RR 0.93 (95% CI 0.86 to 1.01, P = 0.091); EBF in the last 24 hours at 5 months: RR 0.90 (95% CI 0.77 to 1.04, P = 0.152)]. We observed a small, but significant improvement in maternal knowledge at the 1-month follow-up, but not at the 5-month follow-up. The interpretation of the results from this causal impact evaluation changes when we consider the results of the nested mixed-methods performance evaluation. The mean time spent per home visit was similar across study arms, but the intervention group spent approximately 40% of their visit time viewing videos. The absence of difference in effects on primary and secondary endpoints implies that, for the same time investment, the video intervention was as effective as face-to-face counseling with a mentor mother. The videos were also highly valued by mentor mothers and participants. Study limitations include a high loss to follow-up at 5 months after premature termination of the trial due to the COVID-19 pandemic and changes in mentor mother service demarcations. CONCLUSIONS: This trial measured the effect of a video-based, mobile health (mHealth) intervention, delivered by CHWs during home visits in an underresourced setting. The videos replaced about two-fifths of CHWs' direct engagement time with participants in the intervention arm. The similar outcomes in the 2 study arms thus suggest that the videos were as effective as face-to-face counselling, when CHWs used them to replace a portion of that counselling. Where CHWs are scarce, mHealth video interventions could be a feasible and practical solution, supporting the delivery and scaling of community health promotion services. TRIAL REGISTRATION: The study and its outcomes were registered at clinicaltrials.gov (#NCT03688217) on September 27, 2018.


Subject(s)
Audiovisual Aids , Breast Feeding , Community Health Services/methods , Community Health Workers , Counseling , Health Promotion/methods , House Calls , COVID-19 , Female , Humans , Maternal-Child Health Services , Mentors , Mothers , Motion Pictures , Organizations , Pandemics , Pregnancy , South Africa , Videotape Recording
8.
J Med Internet Res ; 23(3): e21892, 2021 03 12.
Article in English | MEDLINE | ID: covidwho-1133796

ABSTRACT

BACKGROUND: Although the COVID-19 pandemic will have a negative effect on China's economy in the short term, it also represents a major opportunity for internet-based medical treatment in the medium and long term. Compared with normal times, internet-based medical platforms including the Haodf website were visited by 1.11 billion people, the number of new registered users of all platforms increased by 10, and the number of new users' daily consultations increased by 9 during the pandemic. The continuous participation of physicians is a major factor in the success of the platform, and economic return is an important reason for physicians to provide internet-based services. However, no study has provided the effectiveness of interactive tools in online health care communities to influence physicians' returns. OBJECTIVE: The effect of internet-based effort on the benefits and effectiveness of interactive effort tools in internet-based health care areas remains unclear. Thus, the goals of this study are to examine the effect of doctors' internet-based service quality on their economic returns during COVID-19 social restrictions, to examine the effect of mutual help groups on doctors' economic returns during COVID-19 social restrictions, and to explore the moderating effect of disease privacy on doctors' efforts and economic returns during COVID-19 social restrictions. METHODS: On the basis of the social exchange theory, this study establishes an internet-based effort exchange model for doctors. We used a crawler to download information automatically from Haodf website. From March 5 to 7, 2020, which occurred during the COVID-19 pandemic in China, cross-sectional information of 2530 doctors were collected. RESULTS: Hierarchical linear regression showed that disease privacy (ß=.481; P<.001), reputation (ß=.584; P<.001), and service quality (ß=.560; P<.001) had a significant positive effect on the economic returns of the physicians. The influence of mutual help groups on earnings increases with an increase in the degree of disease privacy (ß=.189; P<.001), indicating that mutual help groups have a stronger effect on earnings when patients ask questions about diseases regarding which they desire privacy. CONCLUSIONS: For platform operators, the results of this study can help the platform understand how to improve doctors' economic returns, especially regarding helping a specific doctor group improve its income to retain good doctors. For physicians on the platform, this study will help doctors spend their limited energy and time on tools that can improve internet-based consultation incomes. Patients who receive internet-based health care services extract information about a doctor based on the doctor's internet-based efforts to understand the doctor's level of professionalism and personality to choose the doctor they like the most. The data used in this study may be biased or not representative of all medical platforms, as they were collected from a single website.


Subject(s)
COVID-19/epidemiology , Community Health Services/methods , Delivery of Health Care/methods , Internet , Telemedicine , Cross-Sectional Studies , Female , Humans , Male , Models, Psychological , Pandemics , SARS-CoV-2/isolation & purification
10.
Nurs Leadersh (Tor Ont) ; 33(4): 51-61, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1094389

ABSTRACT

The initial focus of the COVID-19 pandemic was on the surge capacity of hospitals. Moving forward, however, the attention needs to shift toward keeping people healthy at home. In this paper, we discuss critical insights from the home and community care sector, which shed light on pre-pandemic fault lines that have widened. The paper, however, takes a positive look at how a better future can be built, particularly for those most vulnerable in society. We offer three key insights and analyses as well as examples of how one national homecare organization in Canada, SE Health, is facing the pandemic. We discuss the following key insights: (1) pre-pandemic systemic biases and barriers were exasperated during the pandemic, which impacted the most vulnerable; (2) nurse leaders were faced with unprecedented fear and anxiety from both patients and their staff colleagues; and (3) the pandemic provided an opportunity for significant learning, innovation and capacity development. The pandemic is far from over - we are in a marathon, not a sprint. The paper concludes with how nurse leaders can lead the way in navigating through the pandemic and build a better "new normal."


Subject(s)
Community Health Services/methods , Fear/psychology , Interprofessional Relations , Nurse Administrators/psychology , Anxiety/psychology , COVID-19 , Community Health Services/trends , Humans , Leadership
11.
Nurs Leadersh (Tor Ont) ; 33(4): 62-67, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1094388

ABSTRACT

This case study outlines the journey of a home-care organization to support practice change during the COVID-19 crisis. The leadership attributes and organizational structures and processes required for a nimble knowledge-to-action response are explored in relation to client screening, personal protective equipment and development of virtual care. A home and community practice lens was often not evident in the literature or guidance documents. This added complexity to the process of rapidly evaluating evidence and guidance across two provinces and issuing practice direction to a widely dispersed and mobile workforce. A cross-functional clinical response team has been invaluable in the organization's pandemic response.


Subject(s)
Community Health Services/trends , Delivery of Health Care/methods , Evidence-Based Practice/methods , Home Care Services/standards , COVID-19/prevention & control , COVID-19/transmission , Community Health Services/methods , Delivery of Health Care/trends , Evidence-Based Practice/trends , Home Care Services/organization & administration , Home Care Services/trends , Humans , Pandemics/prevention & control , Personal Protective Equipment/standards , Personal Protective Equipment/trends , Telemedicine/methods , Telemedicine/trends
12.
BMJ Open ; 10(12): e044197, 2020 12 29.
Article in English | MEDLINE | ID: covidwho-1083582

ABSTRACT

AIM: To explore indigenous communities' responses to the COVID-19 pandemic and its consequences for maternal and neonatal health (MNH) care in the Peruvian Amazon. METHODS: Mamás del Río is a community-based, MNH programme with comprehensive supervision covering monthly meetings with community health workers (CHW), community leaders and health facilities. With the onset of the lockdown, supervisors made telephone calls to discuss measures against COVID-19, governmental support, CHW activities in communities and provision of MNH care and COVID-19 preparedness at facilities. As part of the programme's ongoing mixed methods evaluation, we analysed written summaries of supervisor calls collected during the first 2 months of Peru's lockdown. RESULTS: Between March and May 2020, supervisors held two rounds of calls with CHWs and leaders of 68 communities and staff from 17 facilities. Most communities banned entry of foreigners, but about half tolerated residents travelling to regional towns for trade and social support. While social events were forbidden, strict home isolation was only practised in a third of communities as conflicting with daily routine. By the end of April, first clusters of suspected cases were reported in communities. COVID-19 test kits, training and medical face masks were not available in most rural facilities. Six out of seven facilities suspended routine antenatal and postnatal consultations while two-thirds of CHWs resumed home visits to pregnant women and newborns. CONCLUSIONS: Home isolation was hardly feasible in the rural Amazon context and community isolation was undermined by lack of external supplies and social support. With sustained community transmission, promotion of basic hygiene and mask use becomes essential. To avoid devastating effects on MNH, routine services at facilities need to be urgently re-established alongside COVID-19 preparedness plans. Community-based MNH programmes could offset detrimental indirect effects of the pandemic and provide an opportunity for local COVID-19 prevention and containment.


Subject(s)
COVID-19 , Communicable Disease Control , Community Health Services , Infant Health , Maternal Health , Adult , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control/organization & administration , Communicable Disease Control/standards , Community Health Services/methods , Community Health Services/organization & administration , Community Health Services/standards , Disease Transmission, Infectious/prevention & control , Female , Health Knowledge, Attitudes, Practice , Health Services Needs and Demand , Health Services, Indigenous/trends , Humans , Infant Health/statistics & numerical data , Infant Health/trends , Infant, Newborn , Male , Maternal Health/statistics & numerical data , Maternal Health/trends , Peru/epidemiology , Pregnancy , Preventive Health Services/methods , SARS-CoV-2
13.
Afr J Prim Health Care Fam Med ; 12(1): e1-e4, 2020 Nov 05.
Article in English | MEDLINE | ID: covidwho-1073603

ABSTRACT

Cape Town is currently one of the hotspots for COVID-19 on the African continent. The Metropolitan Health Services have re-organised their primary health care (PHC) services to tackle the epidemic with a community-orientated primary care perspective. Two key goals have guided the re-organisation, the need to maintain social distancing and reduce risk to people using the services and the need to prepare for an influx of people with COVID-19. Facilities were re-organised to have 'screening and streaming' at the entrance and patients were separated into hot and cold streams. Both streams had 'see and treat' stations for the rapid treatment of minor ailments. Patients in separate streams were then managed further. If patients with chronic conditions were stable, they were provided with home delivery of medication by community health workers. Community health workers also engaged in community-based screening and testing. Initial evaluation of PHC preparedness was generally good. However, a number of key issues were identified. Additional infrastructure was required in some facilities to keep the streams separate with the onset of winter. Managers had to actively address the anxiety and fears of the primary care workforce. Attention also needed to be given to the prevention and treatment of non-COVID conditions as utilisation of these services decreased. The epidemic exposed intersectoral and intrasectoral fault lines, particularly access to social services at a time when they were most needed. Community screening and testing had to be refocused due to limited laboratory capacity and a lengthening turnaround time.


Subject(s)
Community Health Services/methods , Coronavirus Infections/therapy , Delivery of Health Care/methods , Health Facilities , Health Planning , Pandemics , Pneumonia, Viral/therapy , Primary Health Care/methods , Betacoronavirus , COVID-19 , Chronic Disease , Cities , Community Health Workers , Coronavirus , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Epidemics , Health Personnel , Health Services Accessibility , Humans , Mass Screening , Organizations , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , SARS-CoV-2 , Seasons , South Africa/epidemiology , Triage
14.
J Aging Health ; 33(7-8): 458-468, 2021.
Article in English | MEDLINE | ID: covidwho-1069503

ABSTRACT

Background: Early mitigation orders for COVID-19 halted participation in community-based programs. We examined the early impact of "Stay Home, Stay Healthy" orders on functioning in older adults participating in a behavioral intervention study involving community-based exercise. Methods: A quasi-natural experiment, using mixed methods (n = 39). Participants completed interviews and questionnaires after 3-4 weeks of the Stay Home, Stay Healthy directive. PROMIS-29 outcomes were compared to pre-COVID-19 responses. Results: Participants had a mean age of 74.1 (6.5) years, 79.5% were women, and 20.5% were racial/ethnic minorities. Compared to pre-COVID-19, there was a significant increase in anxiety and decrease in fatigue and social participation. Thematic analysis revealed five main themes related to disruption of daily life, the emotional and physical impact of stay-at-home orders, unexpected positive outcomes, and perspectives on messaging surrounding the pandemic. Conclusions: Efforts to curb the spread of COVID-19 have substantially impacted the lives of older adults participating in community-based exercise.


Subject(s)
COVID-19 , Communicable Disease Control/methods , Community Health Services , Functional Status , Psychosocial Functioning , Quality of Life , Activities of Daily Living , Aged , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Community Health Services/methods , Community Health Services/organization & administration , Female , Health Behavior , Humans , Male , Quarantine , SARS-CoV-2 , Surveys and Questionnaires
15.
Mayo Clin Proc ; 96(4): 921-931, 2021 04.
Article in English | MEDLINE | ID: covidwho-1062512

ABSTRACT

OBJECTIVE: We aimed to investigate whether the stratification of outpatients with coronavirus disease 2019 (COVID-19) pneumonia by body mass index (BMI) can help predict hospitalization and other severe outcomes. PATIENTS AND METHODS: We prospectively collected consecutive cases of community-managed COVID-19 pneumonia from March 1 to April 20, 2020, in the province of Bergamo and evaluated the association of overweight (25 kg/m2 ≤ BMI <30 kg/m2) and obesity (≥30 kg/m2) with time to hospitalization (primary end point), low-flow domiciliary oxygen need, noninvasive mechanical ventilation, intubation, and death due to COVID-19 (secondary end points) in this cohort. We analyzed the primary end point using multivariable Cox models. RESULTS: Of 338 patients included, 133 (39.4%) were overweight and 77 (22.8%) were obese. Age at diagnosis was younger in obese patients compared with those overweight or with normal weight (P<.001), whereas diabetes, dyslipidemia, and heart diseases were differently distributed among BMI categories. Azithromycin, hydroxychloroquine, and prednisolone use were similar between BMI categories (P>.05). Overall, 105 (31.1%) patients were hospitalized, and time to hospitalization was significantly shorter for obese vs over- or normal-weight patients (P<.001). In the final multivariable analysis, obese patients were more likely to require hospitalization than nonobese patients (hazard ratio, 5.83; 95% CI, 3.91 to 8.71). Results were similar in multiple sensitivity analyses. Low-flow domiciliary oxygen need, hospitalization with noninvasive mechanical ventilation, intubation, and death were significantly associated with obesity (P<.001). CONCLUSION: In patients with community-managed COVID-19 pneumonia, obesity is associated with a higher hospitalization risk and overall worse outcomes than for nonobese patients.


Subject(s)
COVID-19 , Community Health Services , Obesity , Pneumonia, Viral , Age Factors , Body Mass Index , COVID-19/epidemiology , COVID-19/therapy , Community Health Services/methods , Community Health Services/statistics & numerical data , Comorbidity , Female , Hospitalization/statistics & numerical data , Humans , Italy/epidemiology , Male , Middle Aged , Obesity/diagnosis , Obesity/epidemiology , Outcome and Process Assessment, Health Care , Pneumonia, Viral/etiology , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , Proportional Hazards Models , Risk Assessment/methods , Risk Factors , SARS-CoV-2
20.
J Rehabil Med ; 52(8): jrm00089, 2020 Aug 24.
Article in English | MEDLINE | ID: covidwho-729619

ABSTRACT

OBJECTIVE: COVID-19 is a multisystem illness that has considerable long-term physical, psychological, cognitive, social and vocational sequelae in survivors. Given the scale of this burden and lockdown measures in most countries, there is a need for an integrated rehabilitation pathway using a tele-medicine approach to screen and manage these sequelae in a systematic and efficient way. METHODS: A multidisciplinary team of professionals in the UK developed a comprehensive pragmatic telephone screening tool, the COVID-19 Yorkshire Rehabilitation Screen (C19-YRS), and an integrated rehabilitation pathway, which spans the acute hospital trust, community trust and primary care service within the National Health Service (NHS) service model. RESULTS: The C19-YRS telephone screening tool, developed previously, was used to screen symptoms and grade their severity. Referral criteria thresholds were applied to the output of C19-YRS to inform the decision-making process in the rehabilitation pathway. A dedicated multidisciplinary COVID-19 rehabilitation team is the core troubleshooting forum for managing complex cases with needs spanning multiple domains of the health condition. CONCLUSION: The authors recommend that health services dealing with the COVID-19 pandemic adopt a comprehensive telephone screening system and an integrated rehabilitation pathway to manage the large number of survivors in a timely and effective manner and to enable the provision of targeted interventions.


Subject(s)
Betacoronavirus , Community Health Services/organization & administration , Coronavirus Infections/rehabilitation , Critical Pathways/organization & administration , Delivery of Health Care/organization & administration , Patient Care Team/organization & administration , Pneumonia, Viral/rehabilitation , Telemedicine/organization & administration , COVID-19 , Community Health Services/methods , Delivery of Health Care/methods , Humans , Pandemics , Referral and Consultation/organization & administration , SARS-CoV-2 , State Medicine/organization & administration , Survivors , Telemedicine/methods , United Kingdom
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