Breast cancer screening pathways in Ghana: applying an exploratory single case study methodology with cross-case analysis.

Background: Breast cancer is steadily increasing in Ghana, with the majority of Ghanaians only seeking care in the advanced stage of the disease. Furthermore, structured breast cancer control strategies are mostly non-existent. This study aimed to examine breast cancer and breast screening pathways in a tertiary healthcare facility within the Kumasi metropolis. Method: We used a single exploratory case-study design to purposefully select one healthcare facility as a case with embedded sub-units of analysis (patients, first-degree relatives of patients, and clinicians) to address the study's aim. In-depth interview was used to generate evidence from 35 participants. Applying Miles and Huberman's thematic strategy, a cross-case analysis was conducted using Morse's analytical framework. Results: Five (5) main themes emerged from the data: description of breast cancer, breast health education in Ghana, breast screening practices among women, the state of breast screening and barriers to breast screening uptake and lastly, the way forward. Malignancy of the breast was described as common, especially among young women who commonly present with advanced disease with poor prognostic outcomes. There were reports of limited breast cancer awareness and knowledge among women. Comparatively, urban educated women were noted to be relatively knowledgeable and more proactive about breast cancer than the less-privileged women in rural communities. Self and clinical-breast examination practices were reported as unusual habits for Ghanaian women. Several provider-related factors, lack of screening facilities, and attitude of women were highlighted as barriers to breast screening practices. Education among health professionals and interventions to promote opportunistic and organized breast screening were cited as the way forward for breast cancer control and early detection in Ghana. Conclusion: This is a confirmatory result of a stark burden of breast cancer in Ghana, inferring a need to address the deficiencies around breast cancer and early detection practices.

Men's experience of perpetrating intimate partner violence following disclosure of HIV status by their seropositive female intimate partners: a qualitative study.

BACKGROUND: Gender-Based (GB) intimate partner violence is a social and public health issue globally. Several risks of violence related to male sexual partners' perpetration of intimate partner violence (IPV) following the disclosure of their female intimate partners' HIV + status have been reported. No research has been conducted on male sexual partner's perspectives of perpetrating IPV following their female intimate partners' disclosure of human immunodeficiency virus (HIV) seropositive status as a risk factor for the perpetration of IPV in Ghana. OBJECTIVE: The objective of this study is to explore and describe male sexual partners' views or perspectives of perpetrating IPV following their female intimate partners' disclosure of being HIV positive in Ghana. METHODS: Interpretive phenomenological approach was used to collect and analyse data from a purposive sample of 18 Male participants whose female intimate relations informed them of being HIV + in Ghana. The sample population was taken from Ghana because such research has been reported elsewhere but none has been done in Ghana. A semi-structured interview guide was used to collect the data. The interview guide covered topics such as background information, participants' reaction to HIV positive disclosure, lived experiences of participants, and Participants' understanding of different forms of IPV. RESULTS: The findings of this study reveal five main themes that emerged from the interviews which include views on the perpetration of emotional, psychological, and verbal abuse; views on the perpetration of sexual deprivation; views on the perpetration of social isolation; views on the perpetration of financial abuse and views on escalated perpetration of physical abuse. CONCLUSION: From the data, HIV positive status disclosure served as a risk factor for different forms of GB IPV against HIV positive women in Ghana, thus making this group more vulnerable and exposed to more GB IPV. Strategies to prevent the perpetration of IPV against women newly diagnosed as HIV positive are needed. We recommend screening all newly diagnosed HIV-positive women for abuse as an additional prevention strategy for IPV associated with disclosure of positive HIV status. KEY MESSAGESHIV positive status disclosure serves as a risk for the perpetration of IPV.Men are predisposed to violence upon hearing that their female heterosexual intimate partners are HIV positive.HIV infection information is distressful to receive from an intimate partner.

Scoping review of food safety at transport stations in Africa.

OBJECTIVE: The WHO has declared food safety as a public health concern. Transport hubs such as taxi ranks, bus stations and other transport exchange sites are major food trading/purchasing sites, particularly in Africa. Research evidence is needed to improve food safety policies and ensure consumption of safe food, owing to the increasing burden of foodborne diseases, particularly in the WHO Africa Region. We systematically mapped and described research evidence on food safety at transport stations in Africa. DESIGN: A scoping review guided by the Arksey and O'Malley framework. DATA SOURCES: We searched for original research articles in PubMed, Web of Science, and EBSCOhost (Academic search complete, CINAHL with Full-text and Health Source), SCOPUS, and Google Scholar from their inception to 25 October 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included studies that focused on food safety, involved transport stations, involved African countries and were published in English. DATA EXTRACTION AND SYNTHESIS: Data extraction was performed by two reviewers using a piloted-tested form. Thematic analysis was used to organise the data into themes and subthemes, and a narrative summary of the findings is presented. RESULTS: Of the total 23 852 articles obtained from the database searches, 16 studies published in 6 countries met the inclusion criteria. These 16 studies were published between 1997 and 2019, with the most (5) in 2014. Of the 16 studies, 43.8% (7) were conducted in South Africa, 3 studies in Ghana, 2 in Ethiopia and 1 study each in Nigeria, Kenya, Lesotho and Zambia. Most (44.4%) of the included studies focused on microbial safety of food; few studies (22.2%) focused on hygienic practices, and one study investigated the perspective of consumers or buyers. Microbes detected in the foods samples were Salmonella spp, Escherichia coli, Shigella spp, Bacillus sp, Staphylococcus aureus, which resulted mainly from poor hygiene practices. CONCLUSIONS: There is limited research that focused on food safety at transport stations in Africa, especially on aspects such as hygiene practices, food storage and occupational health and food safety. Therefore, we recommend more research in these areas, using various primary study designs, to inform and improve food safety policies and practices for transport stations in African countries alongside improving access to clean water/handwashing facilities, and undertaking structural changes to facilitate behaviours and monitoring for unintended consequences such as livelihoods of vulnerable populations.

Mapping Evidence of Neonatal Resuscitation Training on the Practices of Unskilled Birth Attendants in Low-Resource Countries: Protocol for a Scoping Review.

BACKGROUND: Competence in neonatal resuscitation of the newborn is very critical to ensure the safety and well-being of newborn infants. The acquisition of neonatal resuscitation skills by birth attendants improves self-efficacy, thereby reducing neonatal mortality as a result of asphyxia. Approximately one-quarter of all neonatal deaths globally are caused by birth asphyxia. The need for neonatal resuscitation is most imperative in resource-constrained settings, where access to intrapartum obstetric care is inadequate. OBJECTIVE: This protocol describes the methodology of a scoping review on evidence of training in neonatal resuscitation and its association with practice in low-resource countries. The aim of the review is to map the available evidence of neonatal resuscitation training on the practices of unskilled birth attendants. METHODS: The scoping review will use the Population, Concept, and Context (PCC) framework proposed by Arksey and O'Malley, refined by Levac et al, and published by Joanna Briggs Institute, while following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The search strategy was developed with the assistance of the college librarian. A number of databases of peer-reviewed research (PsycINFO and Wiley Online Library [via EBSCOhost], PubMed, MEDLINE with full text, Google Scholar [via ScienceDirect], and CINAHL Plus with full text [via EBSCOhost]) and databases committed to grey literature sources will be searched, and reference extraction will be performed. Two independent reviewers will screen and extract data, and discrepancies will be resolved by a third reviewer. The extracted data will undergo a descriptive analysis of contextual data and a quantitative analysis using appropriate statistical methods. RESULTS: Data relating to neonatal resuscitation training and practices in low-resource settings will be extracted and included for analysis. We expect that the review will be completed 12 months from the publication of this protocol. CONCLUSIONS: This scoping review will focus on the review of evidence and provide an insight into the existing literature to guide further research and identify implementation strategies to improve the practices of unskilled birth attendants through the acquisition of skills and self-efficacy in neonatal resuscitation. The results of this review will be presented at relevant conferences related to newborn and child health and neonatal nursing studies and published in a peer-reviewed journal. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/18935.

Mapping evidence of food safety at transport stations in Africa: a scoping review protocol.

INTRODUCTION: In Africa, travels, urbanisation and changing consumer habits are increasing the number of people buying and eating food prepared/sold at public spaces including transport stations, particularly in the urban and periurban areas. Although food trading in such public spaces serves as a source of livelihood for many people, unsafe food can have a negative impact on health. We, therefore, aim to systematically explore and examine the literature, and describe the evidence on food safety (food handling, storage, preparation and sale, packaging of food when sold, hygiene of sale venue and quality (nutrition) of food sold/purchased/eaten) at transport stations to inform policy, as well as identify research gaps for future studies in Africa. METHODS AND ANALYSIS: We will employ the Arksey & O'Malley framework, Levac et al recommendations and the Joanna Briggs Institute guidelines to guide this study. We will conduct a comprehensive search in PubMed, SCOPUS, Web of Science, Google Scholar and EBSCOhost (Academic search complete, CINAHL with Full-text and Health Source) from inception to December 2019 for relevant peer-review articles using a combination of keywords/search terms with no limitations. We will also search for relevant literature from the reference list of all included articles. Two investigators will independently screen the articles in parallel at the abstract and full-text phases using the eligibility criteria as a guide. Data extraction will be done using a piloted data extraction form designed in a Microsoft Word tabular format. Afterward, the extracted data will be collated into themes and subthemes, summarised, and the results reported using a narrative approach. We will the Preferred Reporting Items for Systematic Reviews and Meta-analyses: Extension for scoping reviews checklist to report this study results. ETHICS AND DISSEMINATION: Ethics approval is not required. All sources of data will be adequately cited and added to the reference list. We will present the final scoping review results at the appropriate workshops, meetings, conferences, as well as submit for peer-review and publication in a scientific journal.

Perceived needs of patients and family caregivers regarding home-based enteral nutritional therapy in South Africa: A qualitative study.

INTRODUCTION: The need for specialized care, particularly enteral nutritional therapy in community settings is now increasing with implications for both patients and primary care providers. More research is needed to identify the needs of patients and primary caregivers. The study aimed to explore the perceived support needs regarding the provision of home-based enteral nutritional therapy among critically ill adult patients and family caregivers in the KwaZulu-Natal Province of South Africa. METHODS: A qualitative study of purposely selected adult patients on homebased enteral nutritional therapy and family caregivers was conducted in a district hospital, a community health centre, two primary health care clinics and selected households in the KwaZulu-Natal Province, South Africa. Semi-structured individual interviews were conducted between June and September 2018 and the content analysis approach was used to analyse data. RESULTS: Two major themes and five subthemes emerged from the results of the interviews. The major themes concerned socioeconomic and psychosocial support needs related to the provision of home-based enteral nutritional therapy. Subthemes included the need for financial assistance, need for enteral nutrition products and supplementary supplies, need for infrastructure for continuity of care, and psychological support needs. CONCLUSION: Results of this study confirm the need for developing strategies adapted to a South African context and yonder to meet patients' and family caregivers' needs with regard to nutritional services. More research on the identification of needs through monitoring and evaluation of the implementation of nutritional guidelines is needed, particularly in the district hospital and primary health care (PHC) setting.

The use of information and communication technologies to promote healthy lifestyle behaviour: a systematic scoping review.

INTRODUCTION: Health-promoting lifestyle behaviours are part of the activities of daily living that influence individual happiness, values and well-being. They play a crucial role in prevention and control of non-communicable diseases (NCDs) among all age groups. Current statistics on mortality, disability and morbidity associated with NCDs are alarming globally. The use of information and communication technology (ICT) for a health-promoting lifestyle behaviour programme enhances health behaviours that are important in the prevention and control of both communicable and non-communicable diseases. Our study aimed to map evidence on the use of ICT in comprehensive health-promoting lifestyle behaviour among healthy adults. METHODS: Eleven electronic databases were searched for the study. We included studies published in English between January 2007 and December 2018 reporting on healthy adults, ICT and any subscales of the health-promoting lifestyle profile (HPLP). Studies focusing on diseases or disease management and studies that combine monitoring tools in the form of hardware (accelerometer or pedometer) with ICT or computer games were excluded. Data were summarised numerically and thematically. RESULTS: All the studies reviewed were conducted in developed countries. Most of the studies reported on physical activity, and findings of one study covered all the subscales of HPLP. The use of ICT for health-promoting lifestyle behaviours was reported to be effective in ensuring health behaviours that can improve physical and mental health. CONCLUSION: Our findings showed that there is a dearth of knowledge on comprehensive health-promoting lifestyle behaviour that can be beneficial for the control and prevention of NCDs. There is a need to carry out primary studies on the use of ICT and comprehensive health-promoting lifestyle, especially among adults in low-income and middle-income countries where there are alarming statistics for mortality and disability associated with NCDs. PROSPERO REGISTRATION NUMBER: CRD42016042568.

Evidence of perpetration of intimate partner violence among HIV-positive couples: a systematic scoping review protocol.

BACKGROUND: Human immunodeficiency virus (HIV) infection and intimate partner violence (IPV) remain highly sensitive areas that have issues to do with stigmatization in many African countries. Despite the fact that there are several studies on the prevention of HIV, the prevalence of HIV in many African countries is still high. Literature shows that prevention of intimate partner violence is key in the spread of HIV infection. This study will focus on evidence of experiences of HIV positive couples with intimate partner violence and the types of violence experienced. This scoping review will map information about intimate partner violence in low- and middle-income countries as well as other countries with intimate partner violence. There is the need to review these studies on HIV positive couples with intimate partner violence to establish gaps and identify where primary research is necessary. The purpose of this study will be to explore evidence of experiences of HIV-positive couples with IPV and the types of violence experiences by HIV-positive couples. METHODS: This scoping review will involve electronic databases, which will include academic search premier, CINAHL, PsycARTICLES (EBSCO), PsycINFO (EBSCO), ScienceDirect, PubMed, MEDLINE (EBSCO) and Google Scholar. The study will be conducted in two stages: the first stage will map out the studies descriptively while the second stage will map the additional inclusion criteria of quality assessment. Two independent reviewers will undertake the data extraction. Relevant outcomes of the studies will be analyzed thematically using NVivo computer software. RESULTS: Results on the evidence of the experiences of HIV-positive couples with partner violence will be coded independently by the authors. Thereafter, the authors will critically cross-examine the relationship of the research questions to the emerging themes from the selected articles. CONCLUSION: The authors hope to find studies on intimate partner violence among HIV-positive couples to establish gaps where primary research will be necessary. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017062190.

Integration of breast cancer prevention and early detection into cancer palliative care model.

BACKGROUND: Breast cancer is common among Ghanaian women. Late stage presentation has been credited to knowledge deficit and lack of breast cancer prevention and early detection services for women. OBJECTIVE: This study aimed to develop a model to facilitate the integration of breast cancer prevention and early detection into cancer palliative care. METHOD: This study used synthesized concepts emerging from a single case study research. The case was a tertiary health care facility, embedded with sub-units of analysis. Mixed-method approach was used to collect data from 102 participants. The study examined the experiences and views of the participants on breast cancer and screening pathways in Ghana. Thematic analysis and descriptive statistics ware used to analyze the qualitative and quantitative data respectively. This was followed with a cross-case analysis across the sub-units of analysis. A theory development approach was further used towards the development of a model, following three steps: concept analysis, statement synthesis and theory synthesis. RESULTS: Six key concepts synthesized from the data were used to develop the model: initiate and sustain breast cancer prevention and early detection program, collaboration of health professionals, patients, families and micro-communities, conducive environment of the health care facility and needed resources, actions, services, and lastly diffusing innovation into the community through agents. CONCLUSION: A model has been developed based on the experiences shared by women diagnosed with advanced breast cancer, their first degree relatives, micro-communities as well as clinicians working in a palliative care setting. This model will aid clinicians to provide breast cancer education, teach breast self-examination and offer clinical breast examination to families and micro-communities of advanced breast cancer patients receiving supportive care in a resource-limited setting.

Recognizing and appraising symptoms of breast cancer as a reason for delayed presentation in Ghanaian women: A qualitative study.

BACKGROUND: The burden of late presentation is well established in women presenting with advanced breast cancer in Africa. This paper aims to explore the reasons for delayed presentation in Ghanaian women with breast cancer. METHOD: Eleven (11) women diagnosed with advanced breast cancer were purposively sampled within three years of diagnosis at the palliative care clinic of the Komfo Anokye Teaching Hospital, Ghana. Participation was voluntary. Data was collected through in-depth interviews using a self-devised semi-structured interview guide. The interviews were conducted in "Twi" (local language), audio-tape recorded and covered the women's journey from symptom discovery to their intention to seek help. All audio-taped interviews were transcribed based on the meaning of the respondents' comments. The data was managed using Nvivo version 11 qualitative software. Data was analyzed concurrently with data collection applying the principles of thematic analysis. KEY FINDINGS: All the women delayed presentation due to overlapping reasons. Symptom appraisal among the women occurred in two main stages: individual understanding of breast symptom and interactive understanding of the breast symptom. These stages were based on cognitive, psycho-cultural and social factors. The five main themes generated from the data were: symptom experience, knowledge of breast cancer, role of social life and network, coping with a breast symptom and lastly intent to seeking health care. A conceptual model was developed to illustrate the relationships among the key factors and concepts emanated from this study. CONCLUSION: Recognition and appraisal of breast cancer symptom in the eleven (11) Ghanaian women interviewed in this study was poor. For instance, a painless breast lump was considered not serious until a sensory symptom appears. This led women to experience appraisal and time point intervals. To minimize the incidence of late presentation of breast cancer cases in Ghana, adequate educational intervention should be provided for Ghanaian women and their social network, and other stakeholders.

Evidence of promoting prevention and the early detection of breast cancer among women, a hospital-based education and screening interventions in low- and middle-income countries: a systematic review protocol.

BACKGROUND: Given the increasing burden of breast cancer in the low- and middle-income countries, cost-effective approaches are needed to improve the early detection of breast cancer in these continents. Global policies and guidelines are now placing much emphasis on promoting early detection of breast cancer through integrated education and screening interventions. The proposed systematic review aims to map evidence on hospital-based breast cancer education, breast self-examination, and clinical breast examination services for women in low- and middle-income countries. METHODS/DESIGN: We will conduct a systematic review of peer-reviewed studies on hospital-based breast cancer prevention intervention (breast cancer education, breast self-examination, and clinical breast examination) for women in low- and middle-income countries. An electronic search will be conducted in the following electronic databases CINAHL Plus with full text (EBSCOhost), MEDLINE with full-text (EBSCOhost) PsychINFO (EBSCOhost), and PubMed. Articles will also be searched through the "Cited by" search and citations included in the reference list of included articles. A two-stage mapping approach will be conducted. The first stage will involve screening studies through assessing their titles. Also, we will screen abstracts of identified studies descriptively and by focus and methods as dictated by the inclusion and exclusion criteria. The second stage will include extraction of data from eligible studies. A parallel screening and data extraction will be conducted by two reviewers. The quality of included studies will be assessed using the mixed methods appraisal tool (MMAT). A narrative account of the data extracted from the included studies will be analyzed using the thematic analysis. DISCUSSION: We hope to find relevant studies reporting evidence on promoting prevention and the early detection of breast cancer among women in a hospital-based education and screening interventions in low- and middle-income countries. The evidence obtained from the included studies when summarized will help guide future research. The study results will be disseminated electronically and in print. Also, it will be presented at conferences related to breast cancer. SYSTEMATIC REVIEW REGISTRATION: The protocol has been registered with PROSPERO, with registration number CRD42017077818.

Measuring health system responsiveness at facility level in Ethiopia: performance, correlates and implications.

BACKGROUND: Health system responsiveness measures (HSR) the non-health aspect of care relating to the environment and the way healthcare is provided to clients. The study measured the HSR performance and correlates of HIV/AIDS treatment and care services in the Wolaita Zone of Ethiopia. METHODS: A cross-sectional survey across seven responsiveness domains (attention, autonomy, amenities of care, choice, communication, confidentiality and respect) was conducted on 492 people using pre-ART and ART care. The Likert scale categories were allocated percentages for analysis, being classified as unacceptable (Fail) and acceptable (Good and Very Good) performance. RESULTS: Of the 452 (91.9%) participants, 205 (45.4%) and 247 (54.6%) were from health centers and a hospital respectively. 375 (83.0%) and 77 (17.0%) were on ART and pre-ART care respectively. A range of response classifications was reported for each domain, with Fail performance being higher for choice (48.4%), attention (45.5%) and autonomy (22.7%) domains. Communication (64.2%), amenities (61.4%), attention (51.4%) and confidentiality (50.1%) domains had higher scores in the 'Good' performance category. On the other hand, 'only respect (54.0%) domain had higher score in the 'Very Good' performance category while attention (3.1%), amenities (4.7%) and choice (12.4%) domains had very low scores. Respect (5.1%), confidentiality (7.6%) and communication (14.7%) showed low proportion in the Fail performance. 10.4 and 6.9% of the responsiveness percent score (RPS) were in 'Fail' and Very Good categories respectively while the rest (82.7%) were in Good performance category. In the multivariate analysis, a unit increase in the perceived quality of care, satisfaction with the services and financial fairness scores respectively resulted in 0.27% (p < 0.001), 0.48% (p < 0.001) and 0.48% (p < 0.001) increase in the RPS. On the contrary, visiting traditional medicine practitioner before formal HIV care was associated with 2.1% decrease in the RPS. CONCLUSION: The health facilities performed low on the autonomy, choice, attention and amenities domains while the overall RPS masked the weaknesses and strengths and showed an overall good performance. The domain specific responsiveness scores are better ways of measuring responsiveness. Improving quality of care, client satisfaction and financial fairness will be important interventions to improve responsiveness performance.

Analysis of experiences with exclusive breastfeeding among HIV-positive mothers in Lusaka, Zambia.

BACKGROUND: Exclusive breastfeeding in the first 6 months offers protection from postnatal HIV infection but remains low in resource-poor settings. Documentation of experiences with exclusive breastfeeding is needed to strengthen infant feeding counselling by health care workers. OBJECTIVE: To explore HIV-positive mothers' experiences with exclusive breastfeeding during the first 6 months of the infant's life. DESIGN: A health facility- and community-based exploratory qualitative study was conducted among 30 HIV-positive mothers practising exclusive breastfeeding and meeting the selection criteria. In-depth interviews were conducted four times with the same participants at 6 days, 6 weeks, 12 weeks and 18 weeks after giving birth. Interviews were transcribed verbatim and files were imported into QRS NVivo Version 10 for coding, and data were analysed using the framework analysis. RESULTS: We found that mothers were aware of the risks of mother-to-child transmission of HIV through breastmilk and recognised the benefits of exclusive breastfeeding to their exposed babies. However, they were particularly concerned about achieving HIV-free survival for their exposed infants because of problems faced during the first 6 months of infant feeding. Although they reported being supported by their families and/or friends, their poor health and nutrition impacted how well they cared for their infants' well-being. CONCLUSIONS: We conclude that exclusive breastfeeding was difficult to achieve because of individual circumstances. Therefore, prevention of mother-to-child transmission interventions that adopt a once-off infant feeding counselling do not achieve adequate preparation on the part of mothers to practice exclusive breastfeeding. There is a need to provide frontline health care workers with steps for consideration during infant feeding counselling.

Correlates of Strengthening Lessons from HIV/AIDS Treatment and Care Services in Ethiopia Perceived Access and Implications for Health System.

BACKGROUND: Access to healthcare is an important public health concept and has been traditionally measured by using population level parameters, such as availability, distribution and proximity of the health facilities in relation to the population. However, client based factors such as their expectations, experiences and perceptions which impact their evaluations of health care access were not well studied and integrated into health policy frameworks and implementation programs. OBJECTIVE: This study aimed to investigate factors associated with perceived access to HIV/AIDS Treatment and care services in Wolaita Zone, Ethiopia. METHODS: A cross-sectional survey was conducted on 492 people living with HIV, with 411 using ART and 81 using pre-ART services accessed at six public sector health facilities from November 2014 to March 2015. Data were analyzed using the ologit function of STATA. The variables explored consisted of socio-demographic and health characteristics, type of health facility, type of care, distance, waiting time, healthcare responsiveness, transportation convenience, satisfaction with service, quality of care, financial fairness, out of pocket expenses and HIV disclosure. RESULTS: Of the 492 participants, 294 (59.8%) were females and 198 (40.2%) were males, with a mean age of 38.8 years. 23.0% and 12.2% believed they had 'good' or 'very good' access respectively, and 64.8% indicated lower ratings. In the multivariate analysis, distance from the health facility, type of care, HIV clinical stage, out of pocket expenses, employment status, type of care, HIV disclosure and perceived transportation score were not associated with the perceived access (PA). With a unit increment in satisfaction, perceived quality of care, health system responsiveness, transportation convenience and perceived financial fairness scores, the odds of providing higher rating of PA increased by 29.0% (p<0.001), 6.0%(p<0.01), 100.0% (p<0.001), 9.0% (p<0.05) and 6.0% (p<0.05) respectively. CONCLUSION: Perceived quality of care, health system responsiveness, perceived financial fairness, transportation convenience and satisfaction with services were correlates of perceived access and affected healthcare performance. Interventions targeted at improving access to HIV/AIDS treatment and care services should address these factors. Further studies may be needed to confirm the findings.

A socio-ecological perspective of access to and acceptability of HIV/AIDS treatment and care services: a qualitative case study research.

BACKGROUND: Access to healthcare is an essential element of health development and a fundamental human right. While access to and acceptability of healthcare are complex concepts that interact with different socio-ecological factors (individual, community, institutional and policy), it is not known how these factors affect HIV care. This study investigated the impact of socio-ecological factors on access to and acceptability of HIV/AIDS treatment and care services (HATCS) in Wolaita Zone of Ethiopia. METHOD: Qualitative case study research was conducted in six woredas (districts). Focus group discussions (FGDs) were conducted with 68 participants in 11 groups (six with people using antiretroviral therapy (ART) and five with general community members). Key informant interviews (KIIs) were conducted with 28 people involved in HIV care, support services and health administration at different levels. Individual in-depth interviews (IDIs) were conducted with eight traditional healers and seven defaulters from (ART). NVIVO 10 was used to assist qualitative content data analysis. RESULTS: A total of 111 people participated in the study, of which 51 (45.9%) were male and 60 (54.1%) were female, while 58 (53.3%) and 53 (47.7%) were urban and rural residents, respectively. The factors that affect access to and acceptability of HATCS were categorized in four socio-ecological units of analysis: client-based factors (awareness, experiences, expectations, income, employment, family, HIV disclosure and food availability); community-based factors (care and support, stigma and discrimination and traditional healing); health facility-based factors (interactions with care providers, availability of care, quality of care, distance, affordability, logistics availability, follow up and service administration); and policy and standards (healthcare financing, service standards, implementation manuals and policy documents). CONCLUSIONS: A socio-ecological perspective provides a useful framework to investigate the interplay among multilevel and interactive factors that impact on access to and acceptability of HATCS such as clients, community, institution and policy. Planners, resource allocators and implementers could consider these factors during planning, implementation and evaluation of HATCS. Further study is required to confirm the findings.

Perceived quality of HIV treatment and care services in Wolaita Zone of southern Ethiopia: a cross-sectional study.

OBJECTIVE: To investigate the levels and factors affecting the perceived quality of HIV/AIDS treatment and care services. DESIGN: A cross-sectional study. SETTING: The study was conducted in Wolaita Zone of southern Ethiopia in one hospital and five health centres providing antiretroviral therapy (ART) and pre-ART. PARTICIPANTS: 481 persons infected with HIV on outpatient care, 408 (83.8%) on ART and 73 (16.2%) on pre-ART care. RESULTS: 324 (71.4%) of the participants perceived the quality of HIV care as 'good', while 130 (28.6%) stated that it was 'not good'; 219 (46.2%) and 255 (53.8%) were satisfied and not satisfied with the services, respectively. In the multivariate analysis, a unit increase in the doctors subscale of multidimensional health locus of control-form c score resulted in a 1.27 (1.04 to 1.55) increase in the odds of perceived good quality of care (p<0.05). Similarly, a unit increase in the responsiveness, perceived financial fairness, and perceived transportation convenience scores was associated with a 1.03 (1.01 to 1.05) (p<0.05), 1.08 (1.05 to 1.15) (p<0.01), and 1.07 (1.05 to 1.18) (p<0.05) increase in the odds of perceived good quality of HIV care, respectively. In terms of client satisfaction with services, a 1 km increase in the distance from health facilities, and unemployment were associated with a 4.64 (2.61 to 8.25) (p<0.001), 1.02 (1.01 to 1.04) (p<0.05) and 2.23 (1.30 to 4.54) (p<0.01) times, respectively, increase in the perceived quality of HIV treatment and care services. CONCLUSIONS: The majority of the participants reported perceptions of good quality HIV care and satisfaction with the services. Satisfaction with services; responsiveness; health locus of control; perceived financial fairness; perceived transportation convenience; employment status; and distance from the health facility were predictors of the perceived quality of HIV care. Thus, improving quality of HIV treatment services may require addressing the above factors.