Nurses' experiences of self-management support for adults with tuberculosis and human immunodeficiency virus coinfection.

Background: Professional nurses provide self-management support to adults (18 years and older) living with tuberculosis (TB) and human immunodeficiency virus (HIV) coinfection to enable them to mitigate its impact on their lives. However, the experiences of professional nurses providing self-management support to adults with TB-HIV coinfection remain unclear. Aim: This study explored and described the experiences of professional nurses on the provision of self-management support to adults living with TB-HIV coinfection in Greater Accra, Ghana. Setting: Three public primary health facilities in Greater Accra, Ghana. Methods: An exploratory, descriptive qualitative design was used. Twenty-two purposively sampled professional nurses were interviewed face-to-face individually using an interview guide. Interviews were recorded with participants' permission, transcribed and analysed thematically using MAXQDA software. Results: The three themes generated revealed that the: (1) self-management problems of adults living with TB-HIV coinfection included their recurring physical, mental and social problems, (2) the support provided to adults with TB-HIV coinfection included symptom, nutritional, medication and psychosocial self-management support, (3) the factors related to providing self-management support showed that self-management support was influenced by patient, nurse and health facility-related factors but was feasible, equitable and acceptable to patients and stakeholders. Conclusion: Professional nurses' self-management support practice entailed improvising limited resources to address the recurring problems of adults living with TB-HIV coinfection. Nurses require adequate resources to provide comprehensive self-management support. Contribution: The contextual evidence provides insight into the self-management problems of adults with TB-HIV coinfection and the factors influencing professional nurses' self-management support.

Best practice guidelines for professional nurses to provide self-management support to adults with tuberculosis-human immunodeficiency virus coinfection: A scoping review.

BACKGROUND: Adults with tuberculosis-human immunodeficiency virus coinfection require professional nurses' support to manage their illness, treatment and its effect on their daily lives. This scoping review maps recommendations in clinical or best practice guidelines that guide professional nurses to provide self-management support to adults with tuberculosis-human immunodeficiency virus coinfection in primary healthcare settings. METHODS: We conducted a scoping review by searching for guidelines in six online databases, guideline clearing houses and search engines from 16th April 2022 to 25th May 2022. The title, abstract and full-text screening of guidelines were conducted independently and in duplicate by two reviewers based on predetermined eligibility criteria. The guidelines were critically appraised with the Appraisal of Guidelines Research and Evaluation (AGREE) II instrument. Relevant data regarding the characteristics of the guideline, recommendations and underlying evidence were extracted, analysed and reported. RESULTS: The six guidelines on self-management support found were developed in four high-income countries. Five of the guidelines recorded <60% across all six domains of the AGREE II instrument. One high-quality guideline scored >60% in all AGREE II domains but was informed by outdated evidence produced between 1977 to 2010. Twenty-five practice, education and organisational/policy recommendations were extracted from the high-quality guideline. The guidelines did not report evidence-to-decision frameworks and the strength of the recommendations. The guidelines also lacked direct underlying evidence on the effectiveness and cost of self-management support. Lastly, the review found a paucity of contextual (equity, acceptability and feasibility) evidence on self-management support among adults with tuberculosis-human immunodeficiency virus in the guidelines. CONCLUSION: There is a dearth of updated and relevant high-quality guidelines that guide healthcare professionals to provide self-management support to adults with tuberculosis-human immunodeficiency virus coinfection in primary healthcare settings. Systematic reviews of effectiveness, economic and contextual evidence related to self-management support interventions are required for guideline production.

Mothers' perspectives of physical and psychological issues associated with caring for Ghanaian children living with tuberculosis: A qualitative study.

AIM: The aim of the study was to explore and describe the mothers' perspectives on issues associated with caring for Ghanaian children aged 0-14 years living with tuberculosis. DESIGN: Exploratory descriptive qualitative design. METHODS: Semi-structured individual interviews were conducted face to face with 15 purposively sampled mothers from two health facilities in the Greater Accra area. Transcribed data were analysed using computer-enhanced thematic analysis. RESULTS: Findings were grouped into (1) physical burden on the mothers and (2) psychological burden on mothers. The eight subthemes indicate that mothers of children living with tuberculosis experienced tiredness, sleeplessness, body pains, weight loss and sicknesses as they cared for their children. In addition to worrying, mothers experienced stigma and negative emotions such as sadness, guilt, fear and loneliness. CONCLUSION: Mothers of children diagnosed with tuberculosis in Ghana experience physical and psychological health problems related to their caregiving roles. Nurses and other healthcare providers should identify specific problems and offer broad-based emotional and other support for these women.

Correlates of quality of life among persons living with tuberculosis: A cross-sectional study.

INTRODUCTION: The correlates of quality of life originating from the demographic characteristics, comorbidities and sources of social support among persons living with tuberculosis remain underreported. The aim of this study was to examine the correlates of quality of life among persons living with tuberculosis within Greater Accra, Ghana. METHODS: A cross-sectional survey design was used to assess the correlates of quality of life among 250 randomly sampled persons living with tuberculosis. Quality of life was assessed with the Quality of Life Brief Version (WHOQOL-BREF) questionnaire and correlates were derived using Spearman rho correlations. Chi-square analyses assessed associations among respondent characteristics. RESULTS: All four quality of life domains (physical, psychological, social relationship and environmental) of persons living with tuberculosis were positively correlated. Furthermore, receiving social support from family or friends correlated positively with respondents' quality of life. Human Immunodeficiency Virus (HIV) infection and receiving social support mainly from work colleagues or religious institutions correlated negatively with respondents' quality of life domains. Other correlates of quality of life included age, pleuritis with pleural effusion, number of dependants and distance to tuberculosis treatment centres. Social support from family and friends corresponded with better quality of life among persons living with tuberculosis. CONCLUSION: The quality of life domains of persons living with tuberculosis are interrelated and can be enhanced by social support. Healthcare providers should involve the significant others of persons living with tuberculosis, human immunodeficiency virus and pleuritis with pleural effusion in their care to promote patients' quality of life.

Health-related quality of life of persons living with tuberculosis: A cross-sectional study.

Background: Tuberculosis is a chronic infectious disease that can affect the quality of life of persons living with tuberculosis in resource-limited settings. There is a dearth of research on the quality of life of persons living with tuberculosis within Greater Accra, Ghana. Purpose: This study investigated the quality of life and its related factors among persons living with tuberculosis in the Greater Accra region of Ghana. Methods: This descriptive cross-sectional survey assessed the physical, psychological, social relationship and environmental quality of life of 250 persons living with tuberculosis in four public health facilities using the World Health Organization's Quality of Life Brief Questionnaire instrument. Results: Respondents' mean (standard deviation) physical, psychological, social relationship and environmental health-related quality of life domain scores were 46.19 (21.27), 50.67 (23.95), 40.9 (21.74) and 51.91 (20.13) respectively out of 100. Sociodemographic factors which influenced all four quality of life domains were their marital and employment statuses. Respondents' site of TB infection (pulmonary or extrapulmonary) and phase of treatment influenced their physical, psychological and social domains. Other determinants of the quality of life were their sex, highest level of education and average monthly income. Conclusions: The quality of life of persons living with tuberculosis was found to be poor and influenced by the patients' socioeconomic status. Strategies that identify and address any deterioration in the quality of life of persons living with TB are required throughout their management.

Promoters and inhibitors of treatment adherence among HIV/AIDS patients receiving antiretroviral therapy in Ghana: Narratives from an underserved population.

Adherence to antiretroviral therapy (ART) is essential to achieving an improved cluster of differentiation-4 (CD4) count, viral load, and quality of life while preventing drug resistance. Medication adherence among people living with Human Immunodeficiency Virus (HIV) is influenced by different factors. Several studies have identified adherence promoters and inhibitors that emanate from the internal and external environment. We conducted six (6) individual in-depth interviews and three (3) focus group discussions to explore adherence behaviour among patients diagnosed with HIV in a teaching hospital in Accra, Ghana. Participants were drawn from the intervention arm of a mobile phone adherence intervention program. They had been enrolled in the study for at least six (6) months before the interviews are conducted. Results revealed that participants adhered to treatment irrespective of prompts from significant others. Adherence promoters included perception of ART as part of daily routines, benefits of the ART, awareness of regimen, access to food, and transparency. Adherence inhibitors were forgetfulness, secrecy, waiting time, religious beliefs, and sleep. People living with HIV (PLWHIV) have the personal motivation to take medication; however, negative perceptions about HIV must be addressed to ensure optimum adherence behaviour.