ABSTRACT
BACKGROUND: Coronavirus disease-2019 (COVID-1) 9 pandemic is spreading like a wildfire across the globe. For its containment, measures such as isolation and quarantine are followed. The patients tested positive for COVID-19 disease are kept in isolation with no interaction with the family members leading to negative mental health consequences. To address this, Parul Sevashram Hospital adapted to a more holistic approach to treatment. METHODOLOGY: A process documentation of the best practices was undertaken. Key Informant Interviews (KIIs) were used to gather responses of the project implementers (n = 2), physiotherapists (n = 2), dietician (n = 1), Ayurveda practitioners (n = 2), and staff nurses (n = 2) who were mainly involved in tailoring the package of services to be offered as well as their implementation. In addition, KIIs were also conducted with the patients (n = 10) their views on the additional package of services offered to them and the overall level of satisfaction with the care. FINDINGS: The holistic care services involved diet therapy, physiotherapy and yoga, AYUSH medicines for boosting immunity, music therapy and books and indoor games. Few implementation challenges include convincing healthcare workers for providing care to COVID patients, availing raw materials for preparing AYUSH medicines during lockdown. Trainings were also provided to HCW on infection control practices, provided monetary incentive and mobilised the existing resources for addressing the challenges. CONCLUSION: The holistic care has potential influence on patient's mental health, recovery rate, and satisfaction of COVID-19 patients. These approaches can be up-scaled with a minimum investment and has a potential to benefit patients both in public and private hospitals.
ABSTRACT
OBJECTIVES: To know the perceptions regarding barriers and facilitators to cART adherence among people living with HIV/AIDS MATERIALS AND METHODS: To adapt U.S. based SAFETALK "prevention with positives" intervention to be culturally relevant in Gujarat, India in assisting PLWHA, a formative study was conducted. We conducted 30 in-depth interviews with PLWHA in the local language, assessing the experiences, perceived barriers, and facilitators to combination antiretroviral therapy (cART) among PLWHA in Gujarat. PLWHA were selected from the Voluntary Counseling and Testing Centre (VCTC) in Gujarat. To triangulate interview findings, we conducted two focus group discussions (FGDs) with medical and non-medical providers, respectively. RESULTS: Travel and commuting to clinic, fear of possible physical reactions, high cost of ART from private practitioners, CD4 count being in normal limits and resistance to medication acted as barriers to cART adherence. Initiation of cART was facilitated by family members' suggestion, advice of treating doctors and counselors, appropriate counseling before starting cART, belief that cART would aid in living a better and longer life and due to lowering of the CD4 count. INTERPRETATION AND CONCLUSIONS: Our study suggests that several issues need to be considered when providing cART. Further research is needed to study interactions between patients and their health care providers.
ABSTRACT
BACKGROUND: Human immunodeficiency virus (HIV) disclosure offers important benefits to people living with HIV/AIDS. However, fear of discrimination, blame, and disruption of family relationships can make disclosure a difficult decision. Barriers to HIV disclosure are influenced by the particular culture within which the individuals live. Although many studies have assessed such barriers in the U.S., very few studies have explored the factors that facilitate or prevent HIV disclosure in India. Understanding these factors is critical to the refinement, development, and implementation of a counseling intervention to facilitate disclosure. MATERIALS AND METHODS: To explore these factors, we conducted 30 in-depth interviews in the local language with HIV- positive individuals from the Integrated Counselling and Testing Centre in Gujarat, India, assessing the experiences, perceived barriers, and facilitators to disclosure. To triangulate the findings, we conducted two focus group discussions with HIV medical and non-medical service providers, respectively. RESULTS: Perceived HIV-associated stigma, fear of discrimination, and fear of family breakdown acted as barriers to HIV disclosure. Most people living with HIV/AIDS came to know of their HIV status due to poor physical health, spousal HIV-positive status, or a positive HIV test during pregnancy. Some wives only learned of their husbands' HIV positive status after their husbands died. The focus group participants confirmed similar findings. Disclosure had serious implications for individuals living with HIV, such as divorce, maltreatment, ostracism, and decisions regarding child bearing. INTERPRETATION AND CONCLUSION: The identified barriers and facilitators in the present study can be used to augment training of HIV service providers working in voluntary counseling and testing centers in India.
ABSTRACT
AIMS: To identify the reproductive health issues associated with adolescence and the readiness to avail services like Adolescent Friendly Clinic (AFC) among urban school going children. MATERIALS AND METHODS: A quantitative survey was carried out using a self-administered structured questionnaire among 1440 (748 girls and 692 boys) students from classes 6 -12 in 7 English medium and 23 Gujarati medium schools. Focus group discussions, 5 each with adolescent boys and girls and teachers were held from Gujarati and English medium schools. RESULTS: A higher proportion of boys and girls could identify visible external changes in the opposite sex as compared to the changes not seen outwardly. The sources of information on human reproduction for most of the boys and girls were schoolbooks, television, teachers, friends and parents in the same order. Over two-thirds of the boys and girls expressed a need for more information on reproduction. Teachers also perceived that adolescents, though curious, lacked opportunities for open discussions to answer their queries related to reproductive health. One-third of the boys and one-fourth of the girls had heard about contraception. Two-thirds of boys and girls had heard of HIV/AIDS, and about half of them correctly knew various modes of transmission of HIV. Majority of the adolescents expressed their readiness to use the services of Adolescent Friendly Centre. CONCLUSIONS AND RECOMMENDATIONS: Information on the human reproductive system and related issues on reproductive health need special attention. Teachers' sensitization to adolescent health care is required.
ABSTRACT
OBJECTIVES: To identify the reproductive health issues associated with adolescence and their readiness to avail services like Adolescent Friendly Clinic (AFC) among rural school going children. MATERIALS AND METHODS: A quantitative survey was carried out using a self-administered structured questionnaire among 768 (428 boys and 340 girls) students from 15 schools by systematic random sampling from schools (3 schools from 5 talukas). Focus group discussions, 5 each with adolescent boys and girls and teachers were held. RESULTS AND DISCUSSION: Only 31% of the boys and 33% of the girls mentioned that they had heard about contraception. More than half of the adolescent boys and girls knew correctly about various modes of transmission of HIV/AIDS. A large proportion of boys and girls have mentioned changes in the opposite sex such as increase in height, change in voice, breast development, and growth of facial hair, growth of hair in private parts, onset of menstruation in girls, etc. Nearly 70% of adolescents were ready to use AFC. Teachers perceived that adolescents become curious about the changes taking place in them, but they lack information and opportunities for open-discussions to get answers to their queries related to reproductive health. They are willing to take help from teachers but teachers are not equipped with knowledge nor are they comfortable discussing these issues with their students. RECOMMENDATIONS: Information on the human reproductive system and related issues on reproductive health need special attention. Teachers' sensitization to "adolescent health care" is required.
