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1.
J Acquir Immune Defic Syndr ; 93(4): 305-312, 2023 08 01.
Article in English | MEDLINE | ID: mdl-37040123

ABSTRACT

BACKGROUND: The World Health Organization recommends that persons diagnosed with HIV be offered assisted partner notification services (APS). There are limited data on the safety of APS as implemented in public health programs. SETTING: Three public health centers in Maputo, Mozambique, 2016-2019. METHODS: Counselors offered APS to persons with newly diagnosed HIV and, as part of a program evaluation, prospectively assessed the occurrence of adverse events (AEs), including (1) pushing, abandonment, or yelling; (2) being hit; and (3) loss of financial support or being expelled from the house. RESULTS: Eighteen thousand nine hundred sixty-five persons tested HIV-positive in the 3 clinics, 13,475 (71%) were evaluated for APS eligibility, 9314 were eligible and offered APS, and 9219 received APS. Index cases (ICs) named 8933 partners without a previous HIV diagnosis, of whom 6137 tested and 3367 (55%) were diagnosed with HIV (case-finding index = 0.36). APS counselors collected follow-up data from 6680 (95%) of 7034 index cases who had untested partners who were subsequently notified; 78 (1.2%) experienced an AE. Among 270 ICs who reported a fear of AEs at their initial APS interview, 211 (78%) notified ≥1 sex partner, of whom 5 (2.4%) experienced an AE. Experiencing an AE was associated with fear of loss of support (odds ratio [OR] 4.28; 95% confidence interval [CI]: 1.50 to 12.19) and having a partner who was notified, but not tested (OR 3.47; 95% CI: 1.93 to 6.26). CONCLUSION: Case-finding through APS in Mozambique is high and AEs after APS are uncommon. Most ICs with a fear of AEs still elect to notify partners with few experiencing AEs.


Subject(s)
HIV Infections , Humans , HIV Infections/diagnosis , HIV Infections/prevention & control , HIV Infections/epidemiology , Contact Tracing , Mozambique , Sexual Partners , Eligibility Determination
2.
BMC Health Serv Res ; 19(1): 855, 2019 Nov 21.
Article in English | MEDLINE | ID: mdl-31752838

ABSTRACT

BACKGROUND: Adverse events (AE) resulting from voluntary medical male circumcision (VMMC) are commonly used to measure program quality. Mozambique's VMMC program data reports a combined moderate and severe AE rate of 0.2% through passive surveillance. With active surveillance, similar programs report AE rates ranging from 1.0 to 17.0%. The objective of this activity was to assess potential underreporting of AEs via the passive surveillance system in Mozambique. METHODS: This mixed-methods assessment randomly selected one third (16) of all 46 VMMC clinics through stratified sampling, based on volume. A retrospective record review was conducted including patient clinical files, stock records of Amoxicillin/Clavulanic Acid (the choice antibiotic for VMMC-related infections), and clinic-level AE rates from the national database. Records from the month of April 21 to May 20, 2017 were analyzed to identify both reported and potentially unreported AEs. In addition, external, expert clinicians observed post-operative visits (n = 167). Descriptive statistics were calculated, including difference between reported and identified AEs, an adjusted retrospective AE rate, and an observed prospective AE rate in each clinic. RESULTS: A total of 5352 circumcisions were performed in the 16 clinics: 8 (0.15%) AEs were reported. Retrospective clinical record reviews identified 36 AEs (0.67%); AE severity or type was unknown. Using Amoxicillin/Clavulanic Acid dispensation as a proxy for VMMC-related infections, 39 additional AEs infections were identified, resulting in an adjusted AE rate of 1.4%, an 8.3 fold increase from the reported AE rate. Prospective, post-operative visit observations of 167 clients found 10 AEs (5.9%); infection was common and boys 10-14 years old represented 80% of AE clients. CONCLUSIONS: Evidence suggests underreporting of AEs in the Mozambican VMMC program. Quality improvement efforts should be implemented in all VMMC sites to improve AE identification, documentation and prevention efforts.


Subject(s)
Circumcision, Male/adverse effects , Data Accuracy , Voluntary Programs , Adolescent , Adult , Child , Humans , Male , Middle Aged , Mozambique , Program Evaluation , Prospective Studies , Retrospective Studies , Young Adult
3.
Rev. moçamb. ciênc. saúde ; 2: [44-52], 2015. ill, tab
Article in Portuguese | AIM (Africa), RSDM | ID: biblio-1517399

ABSTRACT

Introdução: Moçambique enfrenta escassez de recursos humanos de saúde para prestar cuidados à população. Este cenário é agravado pelo alastramento do HIV e SIDA que aumenta a demanda pelos serviços de saúde, e pelas possíveis perdas de recém-graduados no momento da colocação no Serviço Nacional de Saúde após a formação, embora não haja dados fiáveis que quantifiquem estas perdas em Moçambique. Métodos: Foi realizado um estudo transversal que envolveu os 2.246 recém-graduados dos anos 2007 e 2008 de 12 Instituições de Formação em Saúde do país, com o propósito de determinar as taxas de perdas de recém-graduados na colocação e identificar razões associadas a essas perdas. Os dados foram obtidos dos livros de registos das Instituições de Formação em Saúde, Departamento dos Recursos Humanos do Ministério da Saúde, Direcções Provinciais de Saúde, listas de pagamento de subsídios de almoço e através de chamadas telefónicas aos recém-graduados considerados como perdidos no Serviço Nacional de Saúde. Os dados foram introduzidos no software ACESS e analisados no SPSS, onde foi feita a análise estatística descritiva e aplicado o teste Qui-Quadrado com o nível de significância de =5%. Resultados: Os registos das Direcções Provinciais de Saúde mostraram uma perda de 688 (30,6%) recém graduados. Ao se consultar as listas de pagamento de subsídio de almoço, estas perdas ficaram reduzidas a 241 (10,7%), ou seja, recuperaram-se 447 recém-graduados dos considerados como perdidos pelos registos das Direcções Provinciais de Saúde. Ainda, recuperaram-se mais 150 recém-graduados através de chamadas telefónicas aos considerados como perdidos pelas listas de pagamento de subsídio de almoço, perfazendo uma perda final de 91 (4,05%) recém-graduados. Estes últimos foram considerados realmente perdidos no Serviço Nacional de Saúde. Destes, 16 % (91) consentiram em ser inquiridos sobre as razões que estive ram na origem das perdas, tendo referido a necessidade de continuação dos estudos (38%), baixos salários (31%) e local de colocação distante do da família (31%). Conclusão: Os resultados revelam a existência de falhas no sistema de registo e seguimento dos recém graduados desde o nível central, provincial, distrital até à unidade sanitária.


Introduction: Mozambique lacks human resources to provide health care services to population. This scenario is exacerbated by the spread of HIV and AIDS which increases the demand for health services as well as by the possible loss of recent graduates at the time of placement in the National Health Service. However, there are no reliable data quantifying these losses in Mozambique. Methods: A cross-sectional study was conducted. This study included all 2.246 recent graduates of 2007 and 2008 of 12 health training institutions. The aim of the study was to determine the rates of loss of recent graduates at the time of placement and to identify reasons for these losses. Data were obtained from record books from health training institutions, the Department of Human Resources of the Ministry of Health, Provincial Health Directorates, lists of lunch subsidy payment and also through telephone calls to recent graduates who were considered lost in the National Health Service. Data were introduced in the ACESS software and were analyzed through SPSS. Descriptive statistical analysis was performed and a chi-square test was used. The level of statistical significance was = 5%. Results: The record books from Provincial Health Directorates revealed that 688 (30%) recent-graduates were lost. However, when the lists of lunch subsidy payments were examined, the number of losses de creased to 241 (10,7%), it means that, 447 recent graduates who had been considered lost were regained. Moreover, more than 150 recent graduated who had been considered lost in the lunch subsidylists, were regained through telephone calls. Thus, the final list of lost graduates totalizes 91 (4,05%) cases. These 91 were really considered lost in the National Health Service. About 16% of these 91 graduated gave us permission to interrogate them about the reasons associated to their loss. They presented the following reasons: need to proceed with their studies (38%), low wages (31%), and placement distant from their families (31%) Conclusion: The results of this study indicate failures in the system of record and monitoring of recent graduates at all levels: central, provincial, district and health center unit.


Subject(s)
Humans , Male , Female , Adult , Health Human Resource Training , Schools , Educational Measurement , Mozambique
4.
Maputo; s.n; Set. 2013. 103 p. fig., mapas, ilus, tab..
Thesis in Portuguese | RSDM | ID: biblio-1343804

ABSTRACT

Ao longo de algumas décadas, a epidemia do HIV e SIDA tornou-se num ícone de grandes questões que afligem o mundo devido a sua dinâmica que configura suas manifestações de acordo com as características culturais e sócio demográficas em diferentes populações. O HIV e SIDA constitui um dos grandes problemas de saúde pública no plano mundial, ameaça a vida de milhões de pessoas e desafia a formulação de políticas de saúde, educação e desenvolvimento...


Over a few decades, the HIV and AIDS epidemic has become an icon of major issues that afflict the world due to their dynamics that configure their manifestations according to the cultural and socio-demographic characteristics in different populations. HIV and AIDS is one of the major public health problems worldwide, it threatens life millions of people and challenges the formulation of health, education and development policies...


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Adaptation, Psychological , HIV/immunology , Anti-Retroviral Agents/supply & distribution , Demography/statistics & numerical data , Acquired Immunodeficiency Syndrome , HIV , HIV/drug effects , HIV Seropositivity/epidemiology , Anti-HIV Agents/supply & distribution , Mozambique
5.
Maputo; s.n; 2013. 103 p. Graf, Map, Il..
Thesis in Portuguese | RSDM | ID: biblio-1283470

ABSTRACT

Ao longo de algumas décadas, a epidemia do HIV e SIDA tornou-se num ícone de grandes questões que afligem o mundo devido a sua dinâmica que configura suas manifestações de acordo com as características culturais e sócio demográficas em diferentes populações. O HIV e SIDA constitui um dos grandes problemas de saúde pública no plano mundial, ameaça a vida de milhões de pessoas e desafia a formulação de políticas de saúde, educação e desenvolvimento. Acredita-se que ao conhecer como as pessoas enfrentam o HIV e SIDA possa orientar os profissionais em estratégias de intervenção psicológica e programas de prevenção e promoção de saúde, de modo a controlar a proliferação do HIV. OBJECTIVO: A pesquisa pretendeu identificar as estratégias de coping utilizadas pelas PVHS em TARV de acordo com as suas condições sócio demográficas (sexo, idade, nível de escolaridade, ocupação, estado civil, zona de residência e condição socioeconómica). MÉTODOS: Para a concretização do objectivo proposto foi imprescindível a realização de uma pesquisa mista com duas partes (quantitativa e qualitativa), sendo, observacional transversal analítica e qualitativa com enfoque fenomenológico usando o referencial teórico de Merleau-Ponty, no período de Abril à Setembro de 2012 à uma amostra selecionada sistematicamente. A recolha de dados quantitativos foi feita com recurso ao questionário sócio demográfico e à Escala Modos de Enfrentar Problemas-EMEP (dados resultaram das respostas dos participantes na escala Likert da EMEP). Os dados qualitativos foram recolhidos usando os mesmos questionários, o sócio demográfico e a Escala Modos de Enfrentar Problemas (dados obtidos através dos relatos verbais dos participantes ao responderem as questões da EMEP e obtidos também através da pergunta aberta patente na EMEP). Os dados recolhidos através da EMEP (em escala de Likert) foram analisados quantitativamente, e os obtidos através dos relatos verbais dos participantes e da pergunta aberta da EMEP foram analisados qualitativamente. RESULTADOS: Foi estudado um total de 393 PVHS em TARV, sendo, 121 homens e 272 mulheres com idades compreendidas entre 22 à 73 anos (Média=37,2 e Desvio Padrão=9,6). Os resultados obtidos através da abordagem quantitativa indicaram maior utilização das estratégias de coping focalizado no problema e focalizado na busca de práticas religiosas e menor utilização das estratégias de coping focalizado na emoção e de busca de suporte social. Em pessoas casadas ou que 12 viviam em união de factos, pessoas sem nenhum nível instrução ou com nível primário de educação, pessoas que viviam na zona suburbana da cidade de Maputo e pessoas que pertenciam ao nível de riqueza baixo verificou-se maior predominância das estratégias de coping focalizado no problema e focalizado na busca de práticas religiosas se comparadas com as pessoas com nível secundário ou superior, pessoas que viviam na zona urbana da cidade de Maputo e em pessoas com nível de riqueza mais elevado. Os resultados obtidos por meio da abordagem qualitativa evidenciaram as razões para a maior utilização das estratégias de coping focalizado no problema e focalizado na busca de práticas religiosas pelas PVHS em TARV e trouxeram também novas estratégias de coping como o conformismo, entendido como a aceitação do seroestado embora as adversidades da doença por vezes não o permitissem, a estratégia de coping focalizado na fuga/esquiva do estigma e discriminação perpetrados pela sociedade contra as PVHS, e a estratégia de coping focalizado na busca do suporte familiar, que veio suportar os achados da infrequente utilização da estratégia de coping focalizado na busca de suporte social medidos através da abordagem quantitativa. CONCLUSÃO: Desta pesquisa pode-se concluir que a maior parte das PVHS em TARV elaboravam estratégias de coping que visavam superar ou aliviar as tensões originadas pela seropositividade (coping focalizado no problema e coping focalizado na busca de práticas religiosas). A utilização simultânea dessas duas estratégias de coping se confluiu para a apropriação de mecanismos para a apresentação de uma melhor vivência com a seropositividade. Um pouco mais da metade de PVHS em TARV recorria a estratégia de coping focalizado na fuga ou esquiva do estigma e discriminação como solução para enfrentar o stressor, através da busca de cuidados de HIV e SIDA existentes nas Unidades Sanitárias próximas das suas residências em locais distantes, esta estratégia baseava-se no intuito de se protegerem do preconceito gerado pelo meio social a que pertenciam. A pesquisa mostra também que o medo pelo estigma e discriminação condicionou com que uma grande maioria de PVHS em TARV buscassem unicamente pelo suporte familiar como estratégia para contar com apoio de outrem para ajudar a enfrentar as adversidades relacionadas com a seropositividade em detrimento da utilização da estratégia de coping focalizada no apoio que a sociedade pudesse oferecer. RECOMENDAÇÕES: Apesar da utilização do coping focalizado na emoção ter sido reportada em menor frequência, a pesquisa fornece subsídios para intervenção psicológica tratando-se de pessoas seropositivas. Outrossim, são avançadas algumas recomendações que ajudariam a minimizar o medo pelo preconceito social que emperra a busca pelo apoio em redes de relações sociais e a busca de cuidados de HIV e SIDA de forma condigna isenta de estigma e discriminação social.


Over a few decades, the HIV/AIDS epidemic has become an icon of major issues facing the world due to its dynamics manifested according to cultural and socio-demographic characteristics in different populations. The HIV and AIDS epidemic is one of major public health problem on a global scale, threatening the lives of millions of people and challenging health, education and development policy making. It is believed that knowing how people face HIV and AIDS can guide practitioners in designing psychological intervention strategies and programs for health prevention and promotion, in order to control the spread of HIV. OBJECTIVE: The research sought to identify the coping strategies used by PLWHA on ART according to their socio demographic conditions (gender, age, education level, occupation, marital status, area of residence and socioeconomic status). METHODS: To achieve the proposed objective it was essential to carry out a two component (quantitative and qualitative) study. An analytic observational cross-sectional study and a qualitative study using a phenomenological approach drawing on the theoretical framework of Merleau-Ponty, in the period of April to September 2012 with a systematically selected sample. Quantitative data collection was made using the demographic questionnaire and the Ways of Coping Questionnaire (data derived from WCQ responses using the Likert Scale). Qualitative data were collected using the same questionnaires, i.e., the sociodemographic questionnaire and Ways of Coping Questionnaire (data obtained from participant verbal responses to WCQ questions, as well as data obtained through WCQ open-ended question). WCQ Data (Likert scale) were analyzed quantitatively, whereas data obtained from participants verbal responses to the WCQ open-ended question were analyzed qualitatively. RESULTS: The research covered a total of 393 PLWHA on ART, including 121 men and 272 women aged 22 to 73 years (Mean = 37.2 and standard deviation = 9.6). The results obtained through the quantitative approach indicated greater use of problem-focused coping and religious coping strategies and less use of emotion-focused coping and seeking social support. 14 Married and common-law married people, people without any education level or with primary education level, people living in the suburban area of Maputo city and people with a low level of wealth showed a higher prevalence of problem-focused coping and religious coping compared with those with secondary or higher level, people living in the urban area of Maputo and in people with higher levels of wealth. The results obtained through the qualitative approach revealed the reasons for the increased use of problem-focused coping strategies and religious coping by PLWHA on ART, as well as new coping strategies such as conformism, understood as the acceptance of HIV status although the adversity of illness has often not allowed such attitude, the coping strategy focused on escape/avoidance of stigma and discrimination perpetrated by society against PLWHA, and the family support strategy, which support the research's findings on the infrequent use the coping strategy focused on social support measured through a quantitative approach. CONCLUSION: The research allows to conclude that most of PLWHA on ART have adopted coping strategies aimed at overcoming or alleviating the tensions caused by HIV status (problem-focused coping and religious coping). The simultaneous use of these two coping strategies dictates the need to establish mechanisms for providing better living with HIV status. A little more than half of PLWHA on ART resorted to the coping strategy focused on escape or avoidance of stigma and discrimination as a solution to cope with the stressor, by seeking care for HIV and AIDS in existing health facilities near their homes in distant locations. This strategy was based on the PLWHA's logic to protect themselves against the social prejudice generated by the social environment to which they belonged. The research also shows that the fear of social prejudice is the root cause of a large majority of PLWHA on ART having to solely seek family support as a strategy to obtain support to help cope with HIV related adversities, rather than relying on the support society could offer. RECOMMENDATIONS: Based on the fact that the emotion-focused coping strategy has been reported less frequently, the research provides inputs for psychological intervention in the case of HIV-positive people. Further, the research provides some recommendations that may help minimize the fear of social prejudice hampering the search for support through social networks and seeking HIV/AIDS care in dignity free from stigma and social discrimination.


Subject(s)
Communicable Diseases , Acquired Immunodeficiency Syndrome , HIV , Therapeutics , Adaptation, Psychological , Health , Public Health , Disease , Epidemics , Medicine , Mozambique
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