Factors Underlying Taking a Child to HIV Care: Implications for Reducing Loss to Follow-up among HIV-Infected and Exposed Children

Objective: With the aim of reducing pediatric loss to follow-up (LTFU) from HIV clinical care programs in sub-Saharan Africa; we sought to understand the personal and socio-cultural factors associated with the behavior of caregivers taking HIV-infected and -exposed children for care in western Kenya.Methods: Between Mayand August; 2010; in-depth interviews were conducted with 26 purposively sampled caregivers caring for HIVinfected(7); HIV-exposed (17) and HIV-unknown status (2) children; documented as LTFU from an urban and rural HIV care clinic. All were women with a majority (77) being biological parents. Interviews were audio-recorded; transcribed and content analyzed.Results: Thematic content analysis of the women's perceptions revealed that their decision about routinely taking their children to HIV care involved multiple levels of factors including: (1) intrapersonal: transport costs; food availability; time constraints due to work commitment; disclosure of HIV status for both mother and child; perception that child is healthy and religious beliefs; (2) interpersonal: unsupportive male partner; stigma by the family and family conflicts; (3) community: cultural norms; changing community dynamics and perceived stigma; (4) health care system: clinic location; lack of patient-centered care; delays at the clinic and different appointment schedules (mother and child). Furthermore; the factors across these different levels interacted with each other in a complex way; illustrating the challenges women face in taking their children to HIV care.Conclusion: The complexity and interconnectedness of the factors underlying retention of children in HIV care perceived by these women caregivers suggests that interventions to reduce pediatric LTFU need to be holistic and address multiple socio-ecological levels. Patient-centered care that integrates a family-centered approach to HIV pediatric care is recommended

Psychosocial factors underlying the mother's decision to continue exclusive breastfeeding for 6 months: an elicitation study.

BACKGROUND: Despite numerous benefits of exclusive breastfeeding (EBF) for infants and mothers, a significant decrease in the EBF rate in the USA at six months compared to the rate at birth suggests that reasons for initiation and continuation of EBF may differ. The purpose of this qualitative study was to explore psychosocial factors underlying the continued EBF behaviour for six months, in order to identify salient belief structures according to the theory of planned behaviour. METHODS: Participants were recruited from central Indiana in the USA. They were asked to respond to an open-ended questionnaire designed to elicit positive/negative consequences, approving/disapproving social referents, and easy/difficult circumstances in continuing EBF for six months. Responses were translated into behavioural, normative, and control beliefs of the theory. RESULTS: Findings suggest that respondents (1) value emotional and health benefits of continued EBF for six months; (2) feel the approval from family and friends but disapproval from the society; (3) view health professional's position as positive and negative. CONCLUSIONS: Breastfeeding educators can more likely improve the EBF duration by addressing these salient beliefs. Identified beliefs provide a basis for the development of a quantitative instrument to further study the EBF behaviour.

Strategies to maximize retention of a sample of young adolescents in a longitudinal evaluation of Healthy & Alive!

The authors implemented strategies to maximize cohort retention to avert loss of statistical power and minimize bias in a longitudinal evaluation of a middle school HIV/STD prevention intervention. A retention rate of 80% of the baseline sample (n = 2,975) at six months and 73% at 18 months was achieved despite high reported rates of student mobility and a major system reorganization in one urban district. The strategies increased retention but did not eliminate differences in demographic characteristics and behaviors between the groups of retained and lost students. Results confirm the need to implement retention strategies early and to maintain them throughout data collection. Information from a tracking data base can be used to prioritize students for follow-up to reduce bias from sample loss.

Practice patterns for the elicitation of sexual history, education, and counseling among providers of STD services: results from the gonorrhea community action project (GCAP).

BACKGROUND: The frequently asymptomatic nature and high incidence of severe complications of sexually transmitted diseases (STD) calls for targeted efforts to identify those at greatest risk. Earlier studies have shown inconsistencies regarding STD evaluation by primary care clinicians and physicians. However, the literature regarding the consistency of practice patterns regarding elicitation of sexual history is limited. We examined practice patterns for the elicitation of sexual history among providers across seven sites nationwide. METHODS: As part of a multisite study to encourage health seeking for populations specifically at risk for gonorrhea (GC) and other STDs, semistructured interviews that included questions regarding sexual history elicitation were conducted with 208 service providers in a total of 121 publicly and privately funded clinics, managed care organizations (MCOs), hospital clinics, community- and school-based clinics in Denver, New York, Los Angeles, Birmingham, St. Louis, Indianapolis, and Prince Georges County, MD. RESULTS: Among the providers interviewed, practice patterns for the elicitation of sexual history were inconsistent. Sexual histories were described as routine (i.e., solicited from every client regardless of reason for visit) in 57% of sites. Providers most frequently asked clients their number of sex partners (57%), their contraceptive history (55%), and STD history (34%). Client discomfort among 46% and provider discomfort among 13% was cited as barriers to the elicitation of sexual history. A quarter (26%) of providers agreed that the elicitation of sexual history can be fostered by improved provider communication skills and 16% agreed increasing training and experience for providers is needed. CONCLUSIONS: These findings suggest that interventions with providers to standardize sexual history elicitation can help to reduce barriers to prevention, diagnosis, and treatment of STD.

The use of theory based semistructured elicitation questionnaires: formative research for CDC's Prevention Marketing Initiative.

Through one of its many HIV prevention programs, the Prevention Marketing Initiative, the Centers for Disease Control and Prevention promotes a multifaceted strategy for preventing the sexual transmission of HIV/AIDS among people less than 25 years of age. The Prevention Marketing Initiative is an application of marketing and consumer-oriented technologies that rely heavily on behavioral research and behavior change theories to bring the behavioral and social sciences to bear on practical program planning decisions. One objective of the Prevention Marketing Initiative is to encourage consistent and correct condom use among sexually active young adults. Qualitative formative research is being conducted in several segments of the population of heterosexually active, unmarried young adults between 18 and 25 using a semistructured elicitation procedure to identify and understand underlying behavioral determinants of consistent condom use. The purpose of this paper is to illustrate the use of this type of qualitative research methodology in designing effective theory-based behavior change interventions. Issues of research design and data collection and analysis are discussed. To illustrate the methodology, results of content analyses of selected responses to open-ended questions on consistent condom use are presented by gender (male, female), ethnic group (white, African American), and consistency of condom use (always, sometimes). This type of formative research can be applied immediately to designing programs and is invaluable for valid and relevant larger-scale quantitative research.

Social norms for condom use: implications for HIV prevention interventions of a KABP survey with heterosexuals in the Eastern Caribbean.

PIP: A knowledge, attitude, belief, and practices survey was given to a sample of 591 residents of St. Lucia in the fall of 1990. The survey posed a host of questions relating to whether respondents were inclined to use condoms when having sex. Respondents were sexually experienced, aged 15-60 years, and interviewed in their homes. Questions were posed and viewed as possible indicators of AIDS knowledge, cues to action, perceived susceptibility, perceived severity, perceived locus of control, normative pressure, and condom use outcome expectancies. Statistical analysis suggests that each variable is related to condom use. Analysis also indicates that perceived normative pressure to use condoms was by far the single most important determinant of condom use among the sample. The author closes by discussing the implications of these findings for designing mass media campaigns to increase condom use and strongly recommends a normative campaign.^ieng

Encouraging discussion with partners and building negotiation skills: HIV prevention strategies for women in relationships in Brazil, Tanzania and Indonesia.

PIP: Results from an ongoing 4-phase research and intervention project on women in relationships in Brazil, Tanzania, and Indonesia are discussed. The project is being conducted with the goal of increasing the levels of discussion with women's partners about sex, health, and ways to protect themselves from AIDS. Like men, women are at risk of contracting HIV from both their own behavior and that of their partners. Regarding condom use, however, women are at a particular disadvantage in that they must ask for and subsequently receive the consent of male partners before condoms will be used. Talking, discussing, and negotiating are therefore important processes to understand and employ when helping women to reduce their exposure to HIV. Preliminary results suggest that many women recognize the benefits of communicating in protecting themselves against AIDS, in bringing them closer to their partners, and in helping men change their behavior. Participants also recognize the potential of communication and negotiation in making male partners angry and suspicious, ultimately driving them away. Women who talked with their partners differed significantly from those who did not in their perceptions of what significant others, such as closest friends, doctors, church members, thought they should do. Strategies are discussed for increasing dialogue, with special attention given to the challenges of applying consumer research tools in developing countries.^ieng

Health and occupational correlates of perceived occupational stress in symphony orchestra musicians.

The authors examined the relationship between perceived occupational stress and the prevalence of a number of psychologic and physical ailments in a sample of professional symphony orchestra musicians and related musicians' self-reports of stress to demographic and occupational characteristics. Results of a survey of 2,212 musicians from 47 symphony orchestras revealed a significant relationship between perceived occupational stress and prevalence of a number of psychologic as well as physical medical problems. Age and occupational factors, such as the orchestra in which the musician plays, the instrument played, and status as a soloist, were also found to be significant correlates of perceived stress.