Suchergebnisse

OBJECTIVES: A study designed to assess the public perception of the response of government and its institutions to the COVID-19 pandemic in Nigeria. SETTING: Self-selecting participants throughout Nigeria completed a self-administered questionnaire through an online cross-sectional survey. PARTICIPANTS: 495. RESULTS: The majority of respondents were married (76.6%), were males (61.8%), had tertiary level education (91.0%), were public servants (36.8%), Christians (82.6%), and resident either in the Federal Capital Territory (Abuja) (49.1%) or in the South-East Region of Nigeria (36.6%). Over 95% of the respondents had heard of COVID-19 (98.8%) and knew it is a viral disease (95.4%). The government and its institutions response to the pandemic were rated as poor, with the largest rating as poor for Federal President's Office (57.5%). Communication (50.0%) and prevention messages (43.7%) received the highest perception good rating. Female respondents and those less than 40 years generally rated the governmental responses as poor. CONCLUSIONS/RECOMMENDATIONS: It is recommended that as a public–private partnership approached was efficiently used to more effectively disseminate public health communication and prevention messages, the Nigerian Government should expand this collaboration to improve the quality of services provided in other areas of COVID-19 outbreak management.

OBJECTIVES: A study designed to assess the public perception of the response of government and its institutions to the COVID-19 pandemic in Nigeria. SETTING: Self-selecting participants throughout Nigeria completed a self-administered questionnaire through an online cross-sectional survey.495. RESULTS: The majority of respondents were married (76.6%), were males (61.8%), had tertiary level education (91.0%), were public servants (36.8%), Christians (82.6%), and resident either in the Federal Capital Territory (Abuja) (49.1%) or in the South-East Region of Nigeria (36.6%). Over 95% of the respondents had heard of COVID-19 (98.8%) and knew it is a viral disease (95.4%). The government and its institutions response to the pandemic were rated as poor, with the largest rating as poor for Federal President's Office (57.5%). Communication (50.0%) and prevention messages (43.7%) received the highest perception good rating. Female respondents and those less than 40 years generally rated the governmental responses as poor. CONCLUSIONS/RECOMMENDATIONS: It is recommended that as a public-private partnership approached was efficiently used to more effectively disseminate public health communication and prevention messages, the Nigerian Government should expand this collaboration to improve the quality of services provided in other areas of COVID-19 outbreak management. ; https://doi.org/10.1136/bmjopen-2020-041936

AbstractObjectiveThe aim was to assess the reported family relationships during the COVID‐19 pandemic and the association between these relationships and individual, interpersonal, and country‐level income in eight Middle East and North Africa (MENA) countries.BackgroundCOVID‐19 causes fear of infection, loss of loved ones, and economic problems that may affect family relationships.MethodsData were collected from eight MENA countries using an online survey (July–August 2020). The dependent variable was change in family relationship during COVID‐19, and the independent variables were individual, interpersonal, and country‐level factors represented by sociodemographic factors, COVID‐19 status, financial impact (whether participants lost or had reduced wages) and country income. Multilevel logistic regression analysis was conducted.ResultsThere were 1854 responses, mean (SD) age of 30.6 (9.9) years, 65.8% were female, 3.4% tested COVID‐19 positive, and 20.8% reported lost/reduced wages. Family relationships were more likely to improve or remain unchanged (84.3%) for participants who had a history of COVID‐19 (adjusted odds ratio [AOR] = 3.54, 95% confidence interval [CI]: [1.25, 10.01]). However, family relationships were more likely to not improve for those who knew someone who died of COVID‐19 (AOR = 0.76, 95% CI [0.58, 0.99]) and those with lost/reduced wages (AOR = 0.69, 95% CI [0.52, 0.94]).ConclusionFamily relationship improved or remained unchanged for those who tested positive for COVID‐19 and did not improve for those who lost wages or lost someone due to COVID‐19.ImplicationsPolicy makers should develop strategies to provide social and financial support to employees to reduce the losses and adverse social impact caused by the pandemic.

AbstractINTRODUCTIONTo eliminate cervical cancer (CC), access to and quality of prevention and care services must be monitored, particularly for women living with HIV (WLHIV). We assessed implementation practices in HIV clinics across sub‐Saharan Africa (SSA) to identify gaps in the care cascade and used aggregated patient data to populate cascades for WLHIV attending HIV clinics.METHODSOur facility‐based survey was administered between November 2020 and July 2021 in 30 HIV clinics across SSA that participate in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. We performed a qualitative site‐level assessment of CC prevention and care services and analysed data from routine care of WLHIV in SSA.RESULTSHuman papillomavirus (HPV) vaccination was offered in 33% of sites. Referral for CC diagnosis (42%) and treatment (70%) was common, but not free at about 50% of sites. Most sites had electronic health information systems (90%), but data to inform indicators to monitor global targets for CC elimination in WLHIV were not routinely collected in these sites. Data were collected routinely in only 36% of sites that offered HPV vaccination, 33% of sites that offered cervical screening and 20% of sites that offered pre‐cancer and CC treatment.CONCLUSIONSThough CC prevention and care services have long been available in some HIV clinics across SSA, patient and programme monitoring need to be improved. Countries should consider leveraging their existing health information systems and use monitoring tools provided by the World Health Organization to improve CC prevention programmes and access, and to track their progress towards the goal of eliminating CC.

AbstractIntroductionYouth engagement in HIV research is generally recognized as essential, but often neglected or minimally implemented in practice. Engagement is a process of working collaboratively with diverse groups of people to address common issues. We conducted a scoping review of youth HIV prevention interventions in sub‐Saharan Africa to identify and categorize forms and levels of youth engagement across the lifespan of intervention research.MethodsWe followed Arksey and O'Malley's framework for organizing a scoping review. We searched seven databases for related articles on identified intervention studies through May 28th 2020. Included studies focused on youth (10 to 24 years old) HIV prevention interventions in sub‐Saharan Africa. Two reviewers independently examined citations and full manuscripts for inclusion. Data were extracted on study characteristics, location, description of youth engagement and extent of engagement. Youth engagement approaches were categorized based on Hart's ladder as substantial engagement (strong youth decision‐making power), moderate engagement (shared decision making with adults), minimal engagement (no youth decision‐making power) or no engagement.ResultsWe identified 3149 citations and included 112 studies reporting on 74 unique HIV interventions. Twenty‐two interventions were in low‐income countries, 49 in middle‐income countries, and three were in both. Overall, only nine interventions (12%) had substantial or moderate youth engagement, two‐thirds (48, 65%) had minimal youth engagement and 17 interventions (23%) had no youth engagement. We also identified specific engagement strategies (e.g. youth‐led research, crowdsourcing) that were feasible in multiple settings and resulted in substantial engagement.ConclusionsWe found limited youth engagement in youth HIV prevention intervention studies in sub‐Saharan Africa. However, several activities resulted in substantial youth engagement and could be relevant in many low‐and‐middle‐income‐country (LMIC) settings.

AbstractIntroductionDolutegravir is being scaled up globally as part of antiretroviral therapy (ART), but for people with HIV and tuberculosis co‐infection, its use is complicated by a drug–drug interaction with rifampicin requiring an additional daily dose of dolutegravir. This represents a disadvantage over efavirenz, which does not have a major drug–drug interaction with rifampicin. We sought to describe HIV clinic practices for prescribing concomitant dolutegravir and rifampicin, and characterize virologic outcomes among patients with tuberculosis co‐infection receiving dolutegravir or efavirenz.MethodsWithin the four sub‐Saharan Africa regions of the International epidemiology Databases to Evaluate AIDS consortium, we conducted a site survey (2021) and a cohort study (2015–2021). The cohort study used routine clinical data and included patients newly initiating or already receiving dolutegravir or efavirenz at the time of tuberculosis diagnosis. Patients were followed from tuberculosis diagnosis until viral suppression (<1000 copies/ml), a competing event (switching ART regimen; loss to program/death) or administrative censoring at 12 months.ResultsIn the survey, 86 of 90 (96%) HIV clinics in 18 countries reported prescribing dolutegravir to patients who were receiving rifampicin as part of tuberculosis treatment, with 77 (90%) reporting that they use twice‐daily dosing of dolutegravir, of which 74 (96%) reported having 50 mg tablets available to accommodate twice‐daily dosing. The cohort study included 3563 patients in 11 countries, with 67% newly or recently initiating ART. Among patients receiving dolutegravir (n = 465), the cumulative incidence of viral suppression was 58.9% (95% confidence interval [CI]: 54.3–63.3%), switching ART regimen was 4.1% (95% CI: 2.6–6.2%) and loss to program/death was 23.4% (95% CI: 19.7–27.4%). Patients receiving dolutegravir had improved viral suppression compared with patients receiving efavirenz who had a tuberculosis diagnosis before site dolutegravir availability (adjusted subdistribution hazard ratio [aSHR]: 1.47, 95% CI: 1.28–1.68) and after site dolutegravir availability (aSHR 1.28, 95% CI: 1.08–1.51).ConclusionsAt a programmatic level, dolutegravir was being widely prescribed in sub‐Saharan Africa for people with HIV and tuberculosis co‐infection with a dose adjustment for the drug–drug interaction with rifampicin. Despite this more complex regimen, our cohort study revealed that dolutegravir did not negatively impact viral suppression.

To investigate factors associated with healthcare utilization by adults in the Kingdom of Saudi Arabia (KSA) during the COVID-19 pandemic. Based on Andersen's Behavioral Model of Health Services utilization, we conducted logistic regressions to determine the relationship between predisposing factors (age, gender, education, employment status), need factors (critical medical needs), and enabling factors (insurance coverage, financial loss) on healthcare utilization (challenges accessing medical health care needs, resorting to alternative care, unable to attend medical appointments) as the main outcome. Data of 958 adults residing in KSA were extracted. Financial loss increased the odds of challenges in accessing healthcare (OR: 1.73) and lowered the odds of resorting to alternative medical care (OR: 0.63) and inability to attend healthcare appointments (OR: 0.55). Public insurance increased the odds of skipping healthcare appointments (OR: 1.62). Need factors were associated with lower odds of facing challenges accessing healthcare (OR: 0.37), higher odds of resorting to alternative medical care (OR: 5.65), and failure to attend healthcare appointments (OR: 1.92) respectively. Factors known to enable healthcare utilization should be continuously evaluated during emergency situations. Alternative routes of health provision, along with proper health education, should be accessible to all socioeconomic groups.