Effects of Home-based HIV Counseling and Testing on HIV/AIDS Stigma Among Individuals and Community Leaders in Western Kenya PDF Download
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Category : Electronic book
Languages : en
Pages :
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Category : Electronic book
Languages : en
Pages :
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Author: Monisha Sharma
Publisher:
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Category :
Languages : en
Pages : 208
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Knowledge of one’s HIV status is vital to accessing treatment and prevention yet only a fraction of individuals in sub-Saharan Africa are regularly tested for HIV. Community-based HIV testing and counseling (HTC), defined as HTC conducted outside of a healthcare facility, has the potential to achieve high population testing coverage and linkage to care. The studies within this dissertation describe effectiveness and efficiency (cost-effectiveness) of various modalities of community-based HTC. Aim 1 presents a systematic review of community and facility-based HTC strategies in sub-Saharan Africa. Aims 2 and 3 evaluate the cost-effectiveness of two types of community HTC interventions in western Kenya by incorporating primary cost and effectiveness data from randomized clinical trials into an HIV mathematical model. Specifically, Aim 2 assesses the health and economic impact of implementing a home-based partner education and HIV testing (HOPE) intervention for pregnant women and their male partners. Aim 3 evaluates the cost-effectiveness of scaling up provider notification services for sexual partners of recently diagnosed HIV-positive persons. In Aim 1, we found that community HTC (including home, mobile, partner notification, key populations, campaign, workplace and self-testing) successfully reached target groups (men, young adults and first-time testers) with higher coverage than facility HTC. Community HTC also identifies HIV-positive individuals at higher CD4 counts who were likely to be earlier in their disease course. Combined with the potential of community HTC with facilitated linkage to achieve high linkage to treatment with similar retention rates as facility HTC, this suggests that scaling up community interventions can reduce the morbidity, mortality and transmission associated with late or non-initiation of ART. Of all modalities examined, home HTC attained the highest population coverage (70%, 95% CI = 58–79) while mobile HTC reached the highest proportion of men (50%, 95% CI = 47–54%). Self-testing reached the highest proportion of young adults (66%, 95% CI = 65–67%). As each HTC modality reaches distinct sub-populations, a combination of modalities (differing by setting) will likely be needed to achieve high ART coverage. In Aim 2, we found that the incremental cost of adding the HOPE intervention to standard antenatal care was $31-37 USD per couple tested; task shifting intervention responsibilities to community health workers lowered the cost to $14-16 USD per couple tested. At 60% coverage of male partners, HOPE was projected to avert 6,987 HIV infections and 2,603 deaths in Nyanza province over 10 years with an incremental cost-effectiveness ratio (ICER) of $886 and $615 per DALY averted for the program and task-shifting scenario, respectively. The ICERs are below the threshold of Kenya’s per capita gross domestic product ($1,358) and are therefore considered cost-effective. We conclude that the HOPE intervention can cost-effectively decrease HIV-associated morbidity and mortality in western Kenya by linking HIV-positive male partners to care. In Aim 3, we found that implementing assisted partner services (aPS) or active tracing, exposure notification, and home HTC for sexual partners of newly diagnosed HIV-positive persons in western Kenya is projected to achieve 12% population coverage and reduce HIV infections by by 2.8% and HIV-related deaths by 1.5%. The incremental cost-effectiveness ratio (ICER) of implementing aPS is $1,703 USD (range $1,198-2,887) per disability-adjusted life year (DALY) averted. Task-shifting intervention activities from healthcare professionals to community health workers decreases the ICER to $1,302 (range $955-2,789) per DALY averted. The task-shifting scenario falls below Kenya’s per capita gross domestic product (GDP) and is therefore considered very cost-effective while the full program cost scenario is considered cost-effective under the higher threshold of 3-times Kenya’s per capita GDP. Intervention cost-effectiveness and HIV-related deaths averted among aPS partners increased with expanded ART initiation criteria. We hope that this dissertation work will be useful in forming policy deliberations regarding implementation of community HTC in countries of sub-Saharan Africa.
Author: Rosalia Rodriguez-Garcia
Publisher: World Bank Publications
ISBN: 0821397613
Category : Medical
Languages : en
Pages : 143
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Investing in Communities Achieves Results fills an important gap in the global knowledge on programs addressing HIV and AIDS, providing robust evidence that good results can be achieved by investing in communities with even limited resources.
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ISBN:
Category : AIDS (Disease)
Languages : en
Pages : 176
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Author: Ray C. Rist
Publisher: World Bank Publications
ISBN: 1464807043
Category : Social Science
Languages : en
Pages : 313
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The basic premise of this book is that the conversation on the future of development needs to shift from a focus on poverty to that of inequality. The poverty emphasis is in an intellectual and political cul de sac. It does not address the fundamental question of why people are poor nor what can be done structurally and institutionally to reduce and eliminate it. The various chapters illustrate in the context of various countries and sectors around the world, the significant contributions that evaluators can make in terms of improvement of the analytical framework, analysis of the performance and results of specific programs and projects, as well as assessing and designing better public management systems in terms of poverty and inequality reduction. Beyond the specific contributions presented, three characteristics characterize those evaluations to be relevant for poverty and inequality analysis: a global-local approach: Global to move beyond disciplinary boundaries and consider cross-cutting issues, local to account for the diversity of countries, sectors, institutions and cultures considered; a problem-solving orientation: The issue evaluated is the core focus and determines the choice of evaluation methods to analyze this issue from a variety of angles; an evolutionary approach: Chapters presented are from iconoclasts who do not have any pre-established theory or school of thought to defend. This is the result of openness of mind and ability to adapt the analytical framework, the evaluation methods, and the interpretation of results in a constant interaction with the stakeholders. Such characteristics make evaluation a domain that can help understand better complex issues like poverty, inequality, vulnerability, and their interactions as well as propose a relevant and useful theory of change for public policies and projects to improve the plight of a large part of the world population in industrialized and developing countries alike.
Author: Constance Rose Ambasa-Shisanya
Publisher: African Books Collective
ISBN: 9994455389
Category : Health & Fitness
Languages : en
Pages : 166
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This study examines the role of culture in the adoption of measures and strategies for the prevention of HIV/ AIDS among girls and women in Western Kenya. It focuses on levels of awareness of HIV/AIDS prevention measures and patterns of adoption of five the measures that are currently being promoted in Kenya: the use of condoms; screening for HIV at Voluntary Counselling and Testing (VCT) Centres; prevention of mother-to-child transmission (PMTCT); the use of post-exposure prophylaxis (PEP); and the prompt treatment of sexually transmitted infections (STIs). This research is focused on examining the cultural context of HIV/AIDS research and programmes in Western Kenya and aims to reveal how limited has been the critical analysis of culture as a determinant of adoption of these measures despite the stated prioritization of culture as a key factor to consider
Author: Becky A. Johnson
Publisher:
ISBN:
Category : AIDS (Disease)
Languages : en
Pages : 286
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From July to September, 2002 I spent ten weeks in Kenya conducting full-time research on the macroeconomic impact of HIV/AIDS and community action towards combating the epidemic in locations dominated by members of the Luo tribe in Nyanza Province, Kenya. Gathering data from both the Ministry of Health and non-governmental organizations, I sought to identify the causations and impact of the HIV/AIDS epidemic from a holistic framework. Serving as a pilot study for future research and program evaluation, my research primarily focused on four community-based organizations (CBOs) and Ministry of Health offices located in Kisumu, Nyando, Rachuonyo, and Migori Districts. My research objectives were to explore the cultural and economic variables related to the spread of the HIV/AIDS epidemic, identify which sectors of society were negatively impacted by the epidemic, record community action in response to these impacts, investigate obstacles related to implementation of such interventions, and share research and recommendations with the Ministry of Health and CBOs in Nyanza Province in a way that was meaningful and useful to them. Several qualitative and ethnographic methods were utilized. Participant observation was the principal method used and consisted of a wide range of activities. Additionally, I conducted sixteen formal semi-structured interviews, approximately thirty informal unstructured interviews, and one focus group discussion with nine youth. I found that community-based organizations and the Ministry of Health engaged in a wide variety of activities in response to the HIV/AIDS epidemic including providing Home Based Care to the sick and dying through trained community health workers; training individuals in income-generating activities to provide support for the organizations, the infected and affected, and as a means of prevention of new infections; and providing education to the communities at large. The Ministry of Health and non-governmental organizations also engaged in a significant level of collaborative work to assist each other with their programs and ensure there was no duplication of services. Despite considerable organizational efforts by both the governmental and non-profit sectors, these groups faced a number of different obstacles in their mobilization efforts including limited funding, transportation obstacles in visiting HIV/AIDS clients, and difficulties in convincing individuals to change their behaviors. Individuals interviewed cited a number of factors related to the spread of HIV/AIDS including wife inheritance, wife cleansing, poverty, commercial sex work, and distance marriages. Limited access to voluntary counseling and testing (VCT) services was also an obstacle in a number of communities. Additionally, I found a positive association between access to VCT services, perceptions of people living with HIV/AIDS, and social support for the infected. Based on my findings I concluded that individuals' behavior resulting in the transmission of HIV/AIDS is not solely related to lack of knowledge. Circumstances, especially related to poverty, lead to actions such as exchanging sex for money, distance marriages, early marriages for females, and wife inheritance. In order for HIV/AIDS prevalence to be reduced in Kenya, there must be active participation at all levels and from all sectors of society, including from community members themselves, community-based organizations, the Government of Kenya, and international governmental and non-governmental assistance organizations. Among my recommendations I propose the expansion of voluntary counseling and testing services to make it easier for individuals in rural areas to know their HIV status. I also advocate for a holistic and multisectoral response to HIV/AIDS prevention and support for the infected and affected, including through Home Based Care and social support for the infected, support for AIDS orphans, prevention of mother-to-child transmission, effective HIV/AIDS education, reducing poverty through income-generating activities, making school educations accessible for all children, and improving the overall state of health and access to health facilities for all individuals.
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Category :
Languages : en
Pages : 20
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Background: HIV-stigma is considered to be a major driver of the HIV/AIDS pandemic, yet there is a limited understanding of its epidemiology, especially at the structural/community level. Here we describe geographic patterns of two types of HIV-stigma in a population of women of child-bearing age: internalized-stigma (associated with shame) and externalized stigma (associated with blame), and explore whether individuals with similar attitudes towards people living with HIV are more likely to reside in the same geographic area. Methods: A cross-sectional sample of 405 women who gave birth within a one year period between January - December, 2010 was surveyed from the constituency of Gem, Kenya, one of three regions in the Western Kenya Health and Demographic Surveillance Area (HDSA), a 13 x 20 km region with a population of 220,000. Two forms of HIV-related stigma, self-reported HIV status, and other demographic variables were measured using a standardized, validated questionnaire. Latitude/Longitude coordinates of participants' residences were obtained with GPS devices. Residential locations of participants were compared with respect to whether or not individuals reported each form of stigma at different spatial scales using the K-function, a second order spatial data analysis used to measure spatial clustering of binary outcomes. Generalized additive models (GAMs) were used to assess whether spatial clustering of each stigma indicator occurred beyond that explained by the spatial patterns of individual-level characteristics such as age, income, education, and other socio-economic variables. Results: Among 373 women surveyed with complete GPS data, the median age was 25 years (IQR, 22-30 years), 12% self-reported positive HIV status, 45.5% reported at least one of three indicators of harboring internalized HIV-stigma (an indicator of shame) and 89.4% reported at least one of four indicators of harboring externalized stigma (an indicator of blame). There was strong evidence for a geographic trend in rates of externalized stigma among the respondents, with those who reported no form of externalized HIV-stigma being more likely to reside in the Southwestern portion of Gem compared to the Northeastern portion of the region, controlling for individual-level factors (p = 0.02). In contrast to blame, we did not observe spatial clustering for internalized stigma (shame) beyond that of complete spatial randomness (p = 0.36). Conclusions: The spatial trend observed for rates of externalized stigma compared to the random spatial distribution of internalized stigma may point to differences in the underlying social processes leading to each form of stigma. Externalized stigma may be driven more by dominant cultural beliefs disseminated within communities (i.e., churches, health facilities, or other leaders), whereas internalized stigma may be the result of individual-level characteristics outside the domain of community influence. Geographic studies of stigma can indicate higher risk areas and provide a first step in generating hypotheses as to potential community-level etiologies of stigma. Further data and hypothesis-testing is needed on community-level attributes that might promote lower rates of externalized stigma or 'high tolerance' areas. These data may inform community-level interventions to decrease HIV-related stigma.
Author:
Publisher:
ISBN:
Category : AIDS (Disease)
Languages : en
Pages : 106
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Author: Mark Anthony Damesyn
Publisher:
ISBN:
Category : AIDS (Disease)
Languages : en
Pages : 632
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