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Article ; Online: Pharmacist-led medicines optimisation service in an inpatient mental health setting.

Hynes-Ryan, Caroline / Carolan, Aoife / Feeney, Larkin / Strawbridge, Judith / Purcell, Audrey / Gilsenan, Georgina / O'Donoghue, Darragh / Keating, Dolores

Irish journal of psychological medicine

2023 , Page(s) 1–8

Abstract: Medicines optimisation ensures that people get the best possible outcomes from their medicines. As those with severe mental illness (SMI) are frequently prescribed psychotropic medicines with potentially significant side-effects, poor adherence to ... ...

Abstract	Medicines optimisation ensures that people get the best possible outcomes from their medicines. As those with severe mental illness (SMI) are frequently prescribed psychotropic medicines with potentially significant side-effects, poor adherence to treatment and physical morbidity are common. This results in suboptimal symptom control, physical health problems and negative health outcomes. The specialist mental health pharmacist (SMHP) is best placed to provide leadership for medicines optimisation in the inpatient mental health setting. By adopting a patient-centred approach to providing information, improving adherence, screening, initiating and maintaining medicines, and supporting self-advocacy, the SMHP can ensure the patients' experience of taking medicines is optimised. As there is currently limited understanding of what a baseline clinical pharmacy service in a mental health setting looks like, we aim to outline a framework for pharmacist-led medicines optimisation for those with SMI. This framework is suitable to be scaled and adapted to other settings.
Language	English
Publishing date	2023-11-30
Publishing country	England
Document type	Journal Article
ZDB-ID	227751-7
ISSN	2051-6967 ; 0790-9667
ISSN (online)	2051-6967
ISSN	0790-9667
DOI	10.1017/ipm.2023.46
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Article ; Online: Evaluation of the Ebola Virus Disease (EVD) preparedness and readiness program in Uganda: 2018 to 2019.

Nsubuga, Peter / Masiira, Ben / Kihembo, Christine / Byakika-Tusiime, Jayne / Ryan, Caroline / Nanyunja, Miriam / Kamadjeu, Raoul / Talisuna, Ambrose

The Pan African medical journal

2021 Volume 38, Page(s) 130

Abstract: Introduction: the Democratic Republic of Congo (DRC) declared its 10: Methods: during the EVD preparedness phase, Uganda's government conducted a risk assessment and divided the districts into three categories, based on the potential risk of EVD. ... ...

Abstract	Introduction: the Democratic Republic of Congo (DRC) declared its 10 Methods: during the EVD preparedness phase, Uganda's government conducted a risk assessment and divided the districts into three categories, based on the potential risk of EVD. Category I included districts that shared a border with the DRC provinces where EVD was ongoing or any other district with a direct transport route to the DRC. Category II were districts that shared a border with the DRC but not bordering the DRC provinces affected by the EVD outbreak. Category III was the remaining districts in Uganda. EVD-PR was implemented at the national level and in 22 category I districts. We interviewed key informants involved in program design, planning and implementation or monitoring at the national level and in five purposively selected category I districts. Results: Ebola virus disease preparedness and readiness was a success and this was attributed mainly to donor support, the ministry of health's technical capacity, good coordination, government support and community involvement. The resources invested in EVD-PR represented good value for the funds and the activities were well aligned to the public health priorities for Uganda. Conclusion: Ebola virus disease preparedness and readiness program in Uganda developed capacities that played an essential role in preventing cross border spread of EVD from the affected provinces in the DRC and enabled rapid containment of the two importation events. These capacities are now being used to detect and respond to the COVID-19 pandemic.
MeSH term(s)	COVID-19/epidemiology ; COVID-19/prevention & control ; Civil Defense/organization & administration ; Disease Outbreaks/prevention & control ; Hemorrhagic Fever, Ebola/epidemiology ; Hemorrhagic Fever, Ebola/prevention & control ; Humans ; Public Health ; Uganda/epidemiology
Language	English
Publishing date	2021-02-04
Publishing country	Uganda
Document type	Journal Article
ZDB-ID	2514347-5
ISSN	1937-8688 ; 1937-8688
ISSN (online)	1937-8688
ISSN	1937-8688
DOI	10.11604/pamj.2021.38.130.27391
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Article ; Online: Analysis of the 2017-2018 Rift valley fever outbreak in Yirol East County, South Sudan: a one health perspective.

Ramadan, Otim Patrick Cossy / Berta, Kibebu Kinfu / Wamala, Joseph Francis / Maleghemi, Sylvester / Rumunu, John / Ryan, Caroline / Ladu, Alice Igale / Joseph, Julu Louis Kenyi / Abenego, Abraham Aduet / Ndenzako, Fabian / Olu, Olushayo Oluseun

The Pan African medical journal

2022 Volume 42, Issue Suppl 1, Page(s) 5

Abstract: Introduction: the emergence and re-emergence of zoonotic diseases have threatened both human and animal health globally since their identification in the 20th century. Rift Valley fever (RVF) virus is a recurrent zoonotic disease in South Sudan, with ... ...

Abstract	Introduction: the emergence and re-emergence of zoonotic diseases have threatened both human and animal health globally since their identification in the 20th century. Rift Valley fever (RVF) virus is a recurrent zoonotic disease in South Sudan, with the earliest RVF cases confirmed in 2007 in Kapoeta North County, Eastern Equatoria state. Methods: we analyzed national RVF outbreak data to describe the epidemiological pattern of the RVF outbreak in Yirol East county in Lakes State. The line list of cases (confirmed, probable, suspected, and non-cases) was used to describe the pattern and risk factors associated with the outbreak. The animal and human blood samples were tested using Enzyme-Linked Immunosorbent Assay (ELISA) (Immunoglobulin IgG and IgM) and Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR). Qualitative data were collected from weekly RVF situation reports, and national guidelines and policies. Results: between December 2017 and December 2018, 58 suspected human RVF cases were reported. The cases were reclassified based on laboratory and investigations results, such that as of 16th December 2018, there were a total of six (10.3%) laboratory-confirmed, three (5.2%) probable, one (1.7%) suspected, and 48 (82.8%) non-cases were reported. A total of four deaths were reported during the outbreak (case fatality rate (CFR) 6.8% (4/58). A total of 28 samples were collected from animals; of these, six tested positives for RVF (positivity rate of 32.1% (9/28). The outbreak was announced in March 2018, after four months of the first reported suspected RVF case. Several factors were attributed to the delayed notification and outbreak announcement such as lack of multi-sectorial coordination at the state and county level, multi-sectoral coordination at national level mostly attended by public health experts from human health, inadequate animal health surveillance, poor coordination between livestock disease surveillance and public health surveillance, limited in-country laboratory diagnostic capacity, the laboratory results for the animal health took longer than expected, and lack of a national One Health approach strategy. Conclusion: the outbreak demonstrated gaps to investigate and respond to zoonotic disease outbreaks in South Sudan.
MeSH term(s)	Animals ; Disease Outbreaks ; Humans ; Immunoglobulin G ; Immunoglobulin M ; One Health ; RNA-Directed DNA Polymerase ; Rift Valley Fever/epidemiology ; Rift Valley fever virus ; South Sudan/epidemiology ; Zoonoses/epidemiology
Chemical Substances	Immunoglobulin G ; Immunoglobulin M ; RNA-Directed DNA Polymerase (EC 2.7.7.49)
Language	English
Publishing date	2022-06-09
Publishing country	Uganda
Document type	Journal Article
ZDB-ID	2514347-5
ISSN	1937-8688 ; 1937-8688
ISSN (online)	1937-8688
ISSN	1937-8688
DOI	10.11604/pamj.supp.2022.42.1.33769
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Article ; Online: Enhanced Integration of TB Services in Reproductive Maternal Newborn and Child Health (RMNCH) Settings in Eswatini.

Hartsough, Kieran / Teasdale, Chloe A / Shongwe, Siphesihle / Geller, Amanda / Pimentel De Gusmao, Eduarda / Dlamini, Phumzile / Mafukidze, Arnold / Pasipamire, Munyaradzi / Ao, Trong / Ryan, Caroline / Modi, Surbhi / Abrams, Elaine J / Howard, Andrea A

PLOS global public health

2022 Volume 2, Issue 4, Page(s) e0000217

Abstract: Tuberculosis (TB) primarily affects women during their reproductive years and contributes to maternal mortality and poor pregnancy outcomes. For pregnant women living with HIV (WLHIV), TB is the leading cause of non-obstetric maternal mortality, and ... ...

Abstract	Tuberculosis (TB) primarily affects women during their reproductive years and contributes to maternal mortality and poor pregnancy outcomes. For pregnant women living with HIV (WLHIV), TB is the leading cause of non-obstetric maternal mortality, and pregnant WLHIV with TB are at increased risk of transmitting both TB and HIV to their infants. TB diagnosis among pregnant women, particularly WLHIV, remains challenging, and TB preventive treatment (TPT) coverage among pregnant WLHIV is limited. This project aimed to strengthen integrated TB and reproductive, maternal, neonatal and child health (RMNCH) services in Eswatini to improve screening and treatment for TB disease, TPT uptake and completion among women receiving RMNCH services. The project was conducted from April-December 2017 at four health facilities in Eswatini and introduced enhanced monitoring tools and on-site technical support in RMNCH services. We present data on TB case finding among women, and TPT coverage and completion among eligible WLHIV. A questionnaire (S1 Appendix) measured healthcare provider perspectives on the project after three months of project implementation, including feasibility of scaling-up integrated TB and RMNCH services. A total of 5,724 women (HIV-negative or WLHIV) were screened for active TB disease while attending RMNCH services; 53 (0.9%) were identified with presumptive TB, of whom 37 (70%) were evaluated for TB disease and 6 (0.1% of those screened) were diagnosed with TB. Among 1,950 WLHIV who screened negative for TB, 848 (43%) initiated TPT and 462 (54%) completed. Forty-three healthcare providers completed the questionnaire, and overall were highly supportive of integrated TB and RMNCH services. Integration of TB/HIV services in RMNCH settings was feasible and ensured high TB screening coverage among women of reproductive age, however, symptom screening identified few TB cases, and further studies should explore various screening algorithms and diagnostics that optimize case finding in this population. Interventions should focus on working with healthcare providers and patients to improve TPT initiation and completion rates.
Language	English
Publishing date	2022-04-20
Publishing country	United States
Document type	Journal Article
ISSN	2767-3375
ISSN (online)	2767-3375
DOI	10.1371/journal.pgph.0000217
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Article ; Online: Evaluation of Community-Based, Mobile HIV-Care, Peer-Delivered Linkage Case Management in Manzini Region, Eswatini.

Suraratdecha, Chutima / MacKellar, Duncan / Hlophe, Thabo / Dlamini, Makhosazana / Ujamaa, Dawud / Pals, Sherri / Dube, Lenhle / Williams, Daniel / Byrd, Johnita / Mndzebele, Phumzile / Behel, Stephanie / Pathmanathan, Ishani / Mazibuko, Sikhathele / Tilahun, Endale / Ryan, Caroline

International journal of environmental research and public health

2022 Volume 20, Issue 1

Abstract: The success of antiretroviral therapy (ART) requires continuous engagement in care and optimal levels of adherence to achieve sustained HIV viral suppression. We evaluated HIV-care cascade costs and outcomes of a community-based, mobile HIV-care, peer- ... ...

Abstract	The success of antiretroviral therapy (ART) requires continuous engagement in care and optimal levels of adherence to achieve sustained HIV viral suppression. We evaluated HIV-care cascade costs and outcomes of a community-based, mobile HIV-care, peer-delivered linkage case-management program (CommLink) implemented in Manzini region, Eswatini. Abstraction teams visited referral facilities during July 2019-April 2020 to locate, match, and abstract the clinical data of CommLink clients diagnosed between March 2016 and March 2018. An ingredients-based costing approach was used to assess economic costs associated with CommLink. The estimated total CommLink costs were $2 million. Personnel costs were the dominant component, followed by travel, commodities and supplies, and training. Costs per client tested positive were $499. Costs per client initiated on ART within 7, 30, and 90 days of diagnosis were $2114, $1634, and $1480, respectively. Costs per client initiated and retained on ART 6, 12, and 18 months after diagnosis were $2343, $2378, and $2462, respectively. CommLink outcomes and costs can help inform community-based HIV testing, linkage, and retention programs in other settings to strengthen effectiveness and improve efficiency.
MeSH term(s)	Humans ; Case Management ; Eswatini ; HIV Infections/drug therapy ; HIV Infections/diagnosis ; CD4 Lymphocyte Count ; Mass Screening ; Anti-HIV Agents/therapeutic use
Chemical Substances	Anti-HIV Agents
Language	English
Publishing date	2022-12-20
Publishing country	Switzerland
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S. ; Research Support, Non-U.S. Gov't
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph20010038
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Article ; Online: Management of patients treated with pertuzumab in the Australian clinical practice setting.

Woodward, Natasha / White, Michelle / Pugliano, Lina / Tsoi, Daphne / Ryan, Caroline

Asia-Pacific journal of clinical oncology

2016 Volume 12 Suppl 2, Page(s) 5–15

Abstract: Aim: Treatment with pertuzumab-trastuzumab-taxane combinations has become the international standard of care for patients with HER2-positive metastatic breast cancer. In this paper we discuss the practicalities of treating patients with this combination ...

Abstract	Aim: Treatment with pertuzumab-trastuzumab-taxane combinations has become the international standard of care for patients with HER2-positive metastatic breast cancer. In this paper we discuss the practicalities of treating patients with this combination with a particular focus on treatment in the Australian setting. Method: An expert panel was convened to discuss practical aspects for use of pertuzumab in the Australian clinical setting. The findings of this panel are reported in this article. Results: The combination of pertuzumab-trastuzumab-docetaxel has established efficacy in patients with HER2-positive metastatic breast cancer, prolonging progression-free and overall survival compared to trastuzumab-taxane combinations. In Australia, combinations of pertuzumab and trastuzumab with docetaxel or paclitaxel are reimbursed. Management of treatment related side-effects such as diarrhea, febrile neutropenia and neuropathy typically include dose reduction or switching taxane. Specific patients with poorer tolerance of chemotherapy such as the elderly or those from Asian backgrounds may require particular management strategies. Conclusions: The advent of targeted therapies for women with metastatic HER2-positive breast cancer has markedly improved survival. Combinations of pertuzumab-trastuzumab and a taxane are the standard of care in patients with good performance status. Given prolongation of survival and the importance of quality of life endpoints, the treatment paradigm for patients with metastatic HER2-positive breast cancer is changing rapidly. Careful management of toxicities is required, and dose reduction or switching taxane may be necessary. Further research is required on the efficacy of pertuzumab combinations in patients with brain metastases, and on those who relapse quickly following adjuvant therapy.
MeSH term(s)	Antibodies, Monoclonal, Humanized/administration & dosage ; Antibodies, Monoclonal, Humanized/chemistry ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Australia ; Breast Neoplasms/drug therapy ; Breast Neoplasms/enzymology ; Breast Neoplasms/pathology ; Bridged-Ring Compounds/administration & dosage ; Disease Management ; Disease Progression ; Female ; Humans ; Neoplasm Recurrence, Local/drug therapy ; Neoplasm Recurrence, Local/enzymology ; Neoplasm Recurrence, Local/pathology ; Paclitaxel/administration & dosage ; Receptor, ErbB-2/biosynthesis ; Taxoids/administration & dosage ; Trastuzumab/administration & dosage
Chemical Substances	Antibodies, Monoclonal, Humanized ; Bridged-Ring Compounds ; Taxoids ; docetaxel (15H5577CQD) ; taxane (1605-68-1) ; ERBB2 protein, human (EC 2.7.10.1) ; Receptor, ErbB-2 (EC 2.7.10.1) ; pertuzumab (K16AIQ8CTM) ; Trastuzumab (P188ANX8CK) ; Paclitaxel (P88XT4IS4D)
Language	English
Publishing date	2016-06
Publishing country	Australia
Document type	Journal Article ; Review
ZDB-ID	2187409-8
ISSN	1743-7563 ; 1743-7555
ISSN (online)	1743-7563
ISSN	1743-7555
DOI	10.1111/ajco.12500
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Article ; Online: Cranberry extract attenuates hepatic inflammation in high-fat-fed obese mice.

Glisan, Shannon L / Ryan, Caroline / Neilson, Andrew P / Lambert, Joshua D

The Journal of nutritional biochemistry

2016 Volume 37, Page(s) 60–66

Abstract: Cranberry (Vaccinium macrocarpon) consumption has been associated with health beneficial effects. Nonalcoholic fatty liver disease (NAFLD) is a comorbidity of obesity. In the present study, we investigated the effect of a polyphenol-rich cranberry ... ...

Abstract	Cranberry (Vaccinium macrocarpon) consumption has been associated with health beneficial effects. Nonalcoholic fatty liver disease (NAFLD) is a comorbidity of obesity. In the present study, we investigated the effect of a polyphenol-rich cranberry extract (CBE) on hepatic inflammation in high fat (HF)-fed obese C57BL/6J mice. Following dietary treatment with 0.8% CBE for 10 weeks, we observed no change in body weight or visceral fat mass in CBE-supplemented mice compared to HF-fed control mice. We did observe a significant decrease in plasma alanine aminotransferase (31%) and histological severity of NAFLD (33% decrease in area of involvement, 29% decrease in lipid droplet size) compared to HF-fed controls. Hepatic protein levels of tumor necrosis factor α and C-C chemokine ligand 2 were reduced by 28% and 19%, respectively, following CBE supplementation. CBE significantly decreased hepatic mRNA levels of toll-like receptor 4 (TLR4, 63%) and nuclear factor κB (NFκB, 24%), as well as a number of genes related to the nucleotide-binding domain, leucine-rich-containing family, pyrin domain-containing 3 inflammasome. In conclusion, CBE reduced NAFLD and hepatic inflammation in HF-fed obese C57BL/6J mice. These effects appear to be related to mitigation of TLR4-NFκB related signaling; however, further studies into the underlying mechanisms of these hepatoprotective effects are needed.
MeSH term(s)	Animals ; Anthocyanins/analysis ; Anthocyanins/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/analysis ; Anti-Inflammatory Agents, Non-Steroidal/chemistry ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Biomarkers/blood ; Biomarkers/metabolism ; Diet, High-Fat/adverse effects ; Dietary Supplements/analysis ; Dyslipidemias/blood ; Dyslipidemias/etiology ; Dyslipidemias/metabolism ; Dyslipidemias/prevention & control ; Fruit/chemistry ; Gene Expression Regulation ; Inflammasomes/immunology ; Inflammasomes/metabolism ; Insulin Resistance ; Lipid Droplets/immunology ; Lipid Droplets/metabolism ; Lipid Droplets/pathology ; Liver/immunology ; Liver/metabolism ; Liver/pathology ; Male ; Mice, Inbred C57BL ; Non-alcoholic Fatty Liver Disease/etiology ; Non-alcoholic Fatty Liver Disease/metabolism ; Non-alcoholic Fatty Liver Disease/pathology ; Non-alcoholic Fatty Liver Disease/prevention & control ; Obesity/diet therapy ; Obesity/etiology ; Obesity/immunology ; Obesity/physiopathology ; Plant Extracts/chemistry ; Plant Extracts/therapeutic use ; Polyphenols/analysis ; Polyphenols/therapeutic use ; Random Allocation ; Tannins/analysis ; Tannins/therapeutic use ; Vaccinium macrocarpon/chemistry
Chemical Substances	Anthocyanins ; Anti-Inflammatory Agents, Non-Steroidal ; Biomarkers ; Inflammasomes ; Plant Extracts ; Polyphenols ; Tannins
Language	English
Publishing date	2016
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	1014929-6
ISSN	1873-4847 ; 0955-2863
ISSN (online)	1873-4847
ISSN	0955-2863
DOI	10.1016/j.jnutbio.2016.07.009
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Article ; Online: Characteristics of human adipose derived stem cells in scleroderma in comparison to sex and age matched normal controls: implications for regenerative medicine.

Griffin, Michelle / Ryan, Caroline M / Pathan, Omar / Abraham, David / Denton, Christopher P / Butler, Peter E M

Stem cell research & therapy

2017 Volume 8, Issue 1, Page(s) 23

Abstract: Background: Adipose-derived stem cells (ADSCs) are emerging as an alternative stem cell source for cell-based therapies. Recent data suggest that autologous ADSC-enriched micrografting improves the effects of facial involvement in systemic sclerosis ( ... ...

Abstract	Background: Adipose-derived stem cells (ADSCs) are emerging as an alternative stem cell source for cell-based therapies. Recent data suggest that autologous ADSC-enriched micrografting improves the effects of facial involvement in systemic sclerosis (SSc). We have extensively characterised ADSCs from SSc patients and compared their phenotype and function to healthy age- and sex-matched control ADSCs. Methods: ADSCs were isolated and characterised from a cohort of six SSc patients (ADSC-SSc) and were compared to six healthy age- and sex-matched controls (ADSC-N). Cell surface phenotype lineage commitment was explored by flow cytometric analysis of mesenchymal and hematopoietic markers and by the capacity to differentiate to chondrogenic, osteogenic, and adipogenic lineages. Functional activities of ADSCs were assessed by biochemical and cellular assays for proliferation, metabolism, adhesion, morphology, migration, and invasion. Results: Upon characterization of ADSC-SSc, we found that there was no alteration in the phenotype or surface antigen expression compared to healthy matched control ADSCs. We found that the differentiation capacity of ADSC-SSc was equivalent to that of ADSC-N, and that ADSC-SSc did not display any morphological or adhesive abnormalities. We found that the proliferation rate and metabolic activity of ADSC-SSc was reduced (p < 0.01). We found that the migration and invasion capacity of ADSC-SSc was reduced (p < 0.01) compared to healthy matched control ADSCs. Conclusions: This study provides important findings that can differentially characterise ADSCs from SSc patients. Results indicate that the surface phenotype and differentiation capacity of ADSCs from SSc patients are identical to healthy matched ADSCs. While the findings indicate that the proliferation and migration capacity of ADSC-SSc is reduced, ADSC-SSc are capable of ex-vivo culture and expansion. These findings encourage further investigation into the understanding by which ADSCs can impact upon tissue fibrosis.
MeSH term(s)	Adipocytes/metabolism ; Adipocytes/pathology ; Adipose Tissue/metabolism ; Adipose Tissue/pathology ; Adult ; Age Factors ; Antigens, CD/genetics ; Antigens, CD/metabolism ; Biomarkers/metabolism ; Case-Control Studies ; Cell Adhesion ; Cell Differentiation ; Cell Movement ; Cell Proliferation ; Chondrocytes/cytology ; Chondrocytes/metabolism ; Female ; Gene Expression ; Humans ; Immunophenotyping ; Osteoblasts/cytology ; Osteoblasts/metabolism ; Phenotype ; Primary Cell Culture ; Regenerative Medicine/methods ; Scleroderma, Systemic/genetics ; Scleroderma, Systemic/metabolism ; Scleroderma, Systemic/pathology ; Sex Factors ; Stem Cells/metabolism ; Stem Cells/pathology
Chemical Substances	Antigens, CD ; Biomarkers
Language	English
Publishing date	2017-02-07
Publishing country	England
Document type	Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2548671-8
ISSN	1757-6512 ; 1757-6512
ISSN (online)	1757-6512
ISSN	1757-6512
DOI	10.1186/s13287-016-0444-7
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Article ; Online: Patient feedback surveys among pregnant women in Eswatini to improve antenatal care retention.

Teasdale, Chloe A / Geller, Amanda / Shongwe, Siphesihle / Mafukidze, Arnold / Choy, Michelle / Magaula, Bhekinkhosi / Yuengling, Katharine / King, Katherine / De Gusmao, Eduarda Pimentel / Ryan, Caroline / Ao, Trong / Callahan, Tegan / Modi, Surbhi / Abrams, Elaine J

PloS one

2021 Volume 16, Issue 3, Page(s) e0248685

Abstract: Background: Uptake and retention in antenatal care (ANC) is critical for preventing adverse pregnancy outcomes for both mothers and infants.: Methods: We implemented a rapid quality improvement project to improve ANC retention at seven health ... ...

Abstract	Background: Uptake and retention in antenatal care (ANC) is critical for preventing adverse pregnancy outcomes for both mothers and infants. Methods: We implemented a rapid quality improvement project to improve ANC retention at seven health facilities in Eswatini (October-December 2017). All pregnant women attending ANC visits were eligible to participate in anonymous tablet-based audio assisted computer self-interview (ACASI) surveys. The 24-question survey asked about women's interactions with health facility staff (HFS) (nurses, mentor mothers, receptionists and lab workers) with a three-level symbolic response options (agree/happy, neutral, disagree/sad). Women were asked to self-report HIV status. Survey results were shared with HFS at monthly quality improvement sessions. Chi-square tests were used to assess differences in responses between months one and three, and between HIV-positive and negative women. Routine medical record data were used to compare retention among pregnant women newly enrolled in ANC two periods, January-February 2017 ('pre-period') and January-February 2018 ('post-period') at two of the participating health facilities. Proportions of women retained at 3 and 6 months were compared using Cochran-Mantel-Haenszel and Wilcoxon tests. Results: A total of 1,483 surveys were completed by pregnant women attending ANC, of whom 508 (34.3%) self-reported to be HIV-positive. The only significant change in responses from month one to three was whether nurses listened with agreement increasing from 88.3% to 94.8% (p<0.01). Overall, WLHIV had significantly higher proportions of reported satisfaction with HFS interactions compared to HIV-negative women. A total of 680 pregnant women were included in the retention analysis; 454 (66.8%) HIV-negative and 226 (33.2%) WLHIV. In the pre- and post-periods, 59.4% and 64.6%, respectively, attended at least four ANC visits (p = 0.16). The proportion of women retained at six months increased from 60.9% in the pre-period to 72.7% in the post-period (p = 0.03). For HIV-negative women, pre- and post-period six-month retention significantly increased from 56.6% to 71.6% (p = 0.02); however, the increase in WLHIV retained at six months from 70.7% (pre-period) to 75.0% (post-period) was not statistically significant (p = 0.64). Conclusion: The type of rapid quality improvement intervention we implemented may be useful in improving patient-provider relationships although whether it can improve retention remains unclear.
MeSH term(s)	Adult ; Cohort Studies ; Eswatini ; Female ; HIV Infections/epidemiology ; Humans ; Patient Satisfaction/statistics & numerical data ; Pregnancy ; Pregnant Women/psychology ; Prenatal Care/statistics & numerical data ; Retention in Care/statistics & numerical data ; Surveys and Questionnaires
Language	English
Publishing date	2021-03-24
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0248685
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Article ; Online: HIV testing and ART initiation among partners, family members, and high-risk associates of index clients participating in the CommLink linkage case management program, Eswatini, 2016-2018.

Williams, Daniel / MacKellar, Duncan / Dlamini, Makhosazana / Byrd, Johnita / Dube, Lenhle / Mndzebele, Phumzile / Mazibuko, Sikhathele / Ao, Trong / Pathmanathan, Ishani / Beyer, Alysha / Ryan, Caroline

PloS one

2021 Volume 16, Issue 12, Page(s) e0261605

Abstract: To help diagnose and initiate antiretroviral therapy (ART) for ≥95% of all persons living with HIV (PLHIV), the World Health Organization (WHO) recommends offering HIV testing to biological children, and sexual and needle-sharing partners of all PLHIV ( ... ...

Abstract	To help diagnose and initiate antiretroviral therapy (ART) for ≥95% of all persons living with HIV (PLHIV), the World Health Organization (WHO) recommends offering HIV testing to biological children, and sexual and needle-sharing partners of all PLHIV (index-client testing, ICT). Many index clients, however, do not identify or have contactable partners, and often substantially fewer than 95% of HIV-positive partners initiate ART soon after index testing. To help improve early HIV diagnosis and ART initiation in Eswatini (formerly Swaziland), we implemented a community-based HIV testing and peer-delivered, linkage case management program (CommLink) that provided ICT as part of a comprehensive package of WHO recommended linkage services. CommLink was implemented June 2015 -March 2017 (Phase I), and April 2017 -September 2018 (Phase II). In addition to biological children and partners, HIV testing was offered to adult family members (Phases I and II) and high-risk associates including friends and acquaintances (Phase II) of CommLink index clients. Compared with Phase I, in Phase II proportionally more CommLink clients disclosed their HIV-infection status to a partner or family member [94% (562/598) vs. 75% (486/652)], and had ≥1 partners, family members, or high-risk associates (contacts) tested through CommLink [41% (245/598) vs. 18% (117/652)]. Of 537 contacts tested, 253 (47%) were HIV-positive and not currently in HIV care, including 17% (17/100) of family members aged <15 years, 42% (78/187) of non-partner family members aged ≥15 years, 60% (73/121) of sexual partners, and 66% (85/129) of high-risk associates. Among 210 HIV-positive contacts aged ≥15 years who participated in CommLink, nearly all received recommended linkage services including treatment navigation (95%), weekly telephone follow-up (93%), and ≥3 counseling sessions (94%); peer counselors resolved 76% (306/404) of identified barriers to care (e.g., perceived wellness); and 200 (95%) initiated ART at a healthcare facility, of whom 196 (98%) received at least one antiretroviral refill before case-management services ended. To help countries achieve ≥90% ART coverage among all PLHIV, expanding ICT for adult family members and high-risk associates of index clients, and providing peer-delivered linkage case management for all identified PLHIV, should be considered.
MeSH term(s)	AIDS Serodiagnosis/statistics & numerical data ; Adolescent ; Adult ; Anti-HIV Agents/therapeutic use ; Continuity of Patient Care ; Eswatini/epidemiology ; Family ; Female ; HIV Infections/diagnosis ; HIV Infections/drug therapy ; Health Services Accessibility ; Humans ; Information Storage and Retrieval ; Male ; Spouses/statistics & numerical data ; Young Adult
Chemical Substances	Anti-HIV Agents
Language	English
Publishing date	2021-12-20
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0261605
Database	MEDical Literature Analysis and Retrieval System OnLINE

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