ART access-related barriers faced by HIV-positive persons linked to care in southern Ghana: a mixed method study.

BACKGROUND: Timely and enduring access to antiretroviral therapy (ART) by HIV-infected individuals has been shown to substantially reduce HIV transmission risk, HIV-related morbidity and mortality. However, there is evidence that in addition to limited supply of antiretrovirals (ARVs) and linkage to ART in many low-income countries, HIV+ persons often encounter barriers in accessing ART-related services even in contexts where these services are freely available. In Ghana, limited research evidence exists regarding the barriers HIV+ persons already linked to ART face. This paper explores ART access-related barriers that HIV+ persons linked to care in southern Ghana face. METHODS: A mixed method study design, involving a cross-sectional survey and qualitative in-depth interviews, was conducted to collect data from four healthcare providers and a total of 540 adult HIV+ persons receiving ART at four treatment centres in Ghana. We used univariate analysis to generate descriptive tabulations for key variables from the survey. Data from qualitative in-depth interviews were thematically analysed. Results from the survey and in-depth interviews were brought together to illuminate the challenges of the HIV+ persons. RESULTS: All (100%) the HIV+ persons interviewed were ARV-exposed and linked to ART. Reasons for taking ARVs ranged from beliefs that they will suppress the HIV virus, desire to maintain good health and prolong life, and desire to prevent infection in unborn children, desire both to avoid death and to become good therapeutic citizens (abide by doctors' advice). Despite this, more than half of the study participants (63.3%) reported seven major factors as barriers hindering access to ART. These were high financial costs associated with accessing and receiving ART (26%), delays associated with receiving care from treatment centres (24%), shortage of drugs and other commodities (23%), stigma (8.8%), fear of side effects of taking ARVs (7.9%), job insecurity arising from regular leave of absence to receive ART (5.3%), and long distance to treatment centres (4.9%). CONCLUSIONS: The results in this study suggest that efforts to provide and scale-up ART to all HIV+ persons must be accompanied by interventions that address structural and individual level access barriers.

Prevention-of-Mother-To-Child-Transmission of HIV Services in Sub-Saharan Africa: A Qualitative Analysis of Healthcare Providers and Clients Challenges in Ghana.

BACKGROUND: Developed by the World Health Organization (WHO) and partners, the correct adaptation and implementation of the global guidelines on prevention of mother-to-child transmission (PMTCT) of HIV is critical. This study explored the challenges that health workers face implementing WHO's PMTCT guidelines, and the experiences of HIV-positive clients receiving these services. METHODS: We interacted with 14 health professionals, and 16 PMTCT clients through in-depth interviews. Four of seven PMTCT sites within the Accra Metropolis were purposively included. Interviews were tape-recorded, transcribed, analyzed, and then sorted into themes. RESULTS: Health workers had challenges translating PMTCT guidelines into useful messages for their clients. Their counselling was often prescriptive. Counselors identified inadequate in-service training as a key reason for their out-dated and inconsistent messages. HIV-positive clients exhibited general knowledge about the importance of doing exclusive breast-feeding for the first six months of life. Clients had confidence in antiretroviral for PMTCT. However, deeply rooted socio-cultural practices and the attitudes of counselors remain challenges to clients. CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS: Counselors require refresher training which addresses, among other things, long-held socio-cultural practices. Publicizing these challenges will prod policy makers and program implementers to develop strategies that address the challenges both locally and globally.

Reproductive rights and options available to women infected with HIV in Ghana: perspectives of service providers from three Ghanaian health facilities.

BACKGROUND: Owing to improved management of HIV and its associated opportunistic infections, many HIV-positive persons of reproductive age are choosing to exercise their right of parenthood. This study explored the knowledge of health workers from two Ghanaian districts on the reproductive rights and options available to HIV-positive women who wish to conceive. METHODS: Facility-based cross-sectional in design, the study involved the entire population of nurse counselors (32) and medical officers (3) who provide counseling and testing services to clients infected with HIV. Both structured and in-depth interviews were conducted after informed consent. RESULTS: Two main perspectives were revealed. There was an overwhelmingly high level of approbation by the providers on HIV-positive women's right to reproduction (94.3%). At the same time, the providers demonstrated a lack of knowledge regarding the various reproductive options available to women infected with HIV. Site of facility, and being younger were associated with practices that violated client's right to contraceptive counseling (p < 0.05) in each case. Some of the providers openly expressed their inability to give qualified guidance to HIV-positive women on the various reproductive options. CONCLUSIONS: Taken together, these findings suggest that many HIV-positive clients do not receive comprehensive information about their reproductive options. These findings highlight some of the problems that service providers face as HIV counselors. Both service providers and policy makers need to recognize these realities and incorporate reproductive health issues of HIV-persons into the existing guidelines.

Community perception of malaria and its influence on health-seeking behaviour in rural Ghana: a descriptive study.

Background: Approximately 300 million clinical episodes of malaria occur globally, out of which an estimated 1 million persons die every year. Ninety per cent of these malaria deaths occur in tropical Africa. Despite decades of great effort to control malaria in Ghana, it still remains a serious public health problem affecting all ages. Materials and Methods: A descriptive cross-sectional study was conducted to assess local perceptions on malaria and health seeking behaviour among inhabitants in the Kassena-Nankana district in the Upper East Region of Ghana. A total of 120 respondents were included in the study through a systematic random sampling procedure of households. The head of a household or his/her partner was interviewed using a structured questionnaire. Results: The majority (65%) of respondents had awareness about malaria and linked it to mosquito bites. They had knowledge about malaria through health workers including health professionals from the Navrongo Health Research Centre (NHRC) (83.3%), radio (7.3%), television (5.8%), friends (1.7%) or newspapers (0.8%). The results also showed that people incorporated traditional and modern elements into their concept of the disease and treatment strategies. Conclusions: Perceptions and health-seeking behaviour are critical to the success and sustainability of malaria management and control. Understanding local concepts of illness and their influence on health care-seeking behaviour can complement existing knowledge to help develop more effective malaria control interventions in these communities.