A qualitative assessment of disease surveillance activities in a resource-limited environment: Perceptions and opinions of volunteer staff working in Northern Uganda.

Annually, groups of health professionals from high-income countries are drawn to work in low- and middle-income countries (LMICs) through timed engagements intended to improve the well-being of people in most disadvantaged communities. The existing evidence on understanding volunteer experience in LMICs often focuses on activities within the medical discipline; whereas little research has been conducted on the experiences of volunteers in other disciplines. This paper focuses on understanding veterinary and public health professional's experiences conducting disease surveillance work in Northern Uganda. Forty US-based health care professionals were recruited to complete multiple-choice and open-ended questions to understand prior and current experiences working in resource-limited settings. Responses were coded using NVivo 10®, qualitative analysis package. Of the 44 volunteers, 50% completed the questionnaire. Responses were largely positive towards surveillance activities; they reported personal and professional gains, new cultural experiences and mutual learning environment with local colleagues. Nevertheless, respondents highlighted challenges during various stages of program implementation-some difficulty with program logistics, inadequacy of preparation materials, in addition to concerns inherent to working in a resource-limited environment. This assessment suggests that international volunteer work could positively influence programmatic outcomes, personal experiences, furthering health organizational goals, often achieved in a limited time-frame. To maximize volunteer impact, these assessments are critical and suggest that volunteer and institutional capacities should be seriously considered when planning placement as it can influence programmatic decision-making, gauge training needs and volunteer readiness.

Interventions to Improve Linkage to HIV Care in the Era of "Treat All" in Sub-Saharan Africa: a Systematic Review.

PURPOSE OF THE REVIEW: In 2015, antiretroviral therapy (ART) was recommended for all people living with HIV (PLHIV) regardless of CD4 count ("Treat All"). To better understand how to improve linkage to care under these new guidelines, we conducted a systematic review of studies evaluating linkage interventions in Sub-Saharan Africa under Treat All. RECENT FINDINGS: We identified 14 eligible articles and qualitatively analyzed the effectiveness of the interventions. Increases in linkage were reported by supply-side and counseling interventions. Mobile testing and economic incentives did not increase linkage. Given the lag time between adoption and implementation, only two of the studies were conducted in a Treat All setting. None of the interventions specifically focused on re-linking PLHIV who had disengaged from care. Future studies must design interventions that target not only newly diagnosed or treatment naïve PLHIV, but should explicitly focus on PLHIV who have disengaged from care.

Evaluating Barriers and Opportunities in Delivering High-Quality Oncology Care in a Resource-Limited Setting Using a Comprehensive Needs Assessment Tool.

PURPOSE: Despite recognition of both the growing cancer burden in low- and middle-income countries and the disproportionately high mortality rates in these settings, delivery of high-quality cancer care remains a challenge. The disparities in cancer care outcomes for many geographic regions result from barriers that are likely complex and understudied. This study describes the development and use of a streamlined needs assessment questionnaire (NAQ) to understand the barriers to providing quality cancer care, identifies areas for improvement, and formulates recommendations for implementation. METHODS: Using a comprehensive NAQ, in-depth interviews were conducted with 17 hospital staff involved in cancer care at two teaching hospitals in Nigeria. Data were analyzed using content analysis and organized into a framework with preset codes and emergent codes, where applicable. RESULTS: Data from the interviews were organized into six broad themes: staff, stuff, system, space, lack of palliative care, and provider bias, with key barriers within themes including: financial, infrastructural, lack of awareness, limited human capacity resources, lack of palliative care, and provider perspective on patient-related barriers to cancer care. Specific solutions based on ability to reasonably implement were subcategorized into short-, medium-, and long-term goals. CONCLUSION: This study provides a framework for a streamlined initial needs assessment and a unique discussion on the barriers to high-quality oncology care that are prevalent in resource-constrained settings. We report the feasibility of collecting and organizing data using a streamlined NAQ and provide a thorough and in-depth understanding of the challenges in this setting. Knowledge gained from the assessments will inform steps to improve oncology cancer in these settings.