Browsing by Author "Hardon, Anita"

Now showing 1 - 7 of 7
  • Thumbnail Image
    Item
    Client-provider interactions in provider-initiated and voluntary HIV counseling and testing services in Uganda
    (BMC Health Services Research, 2013) Wanyenze, Rhoda K.; Kyaddondo, David; Kinsman, John; Makumbi, Fredrick; Colebunders, Robert; Hardon, Anita
    Provider-initiated HIV testing and counselling (PITC) is based on information-giving while voluntary counselling and testing (VCT) includes individualised client-centered counseling. It is not known if the providerclient experiences, perceptions and client satisfaction with the information provided differs in the two approaches. Methods: In 2008, we conducted structured interviews with 627 individuals in Uganda; 301 tested through PITC and 326 through voluntary counselling and testing (VCT). We compared client experiences and perceptions based on the essential elements of consent, confidentiality, counseling, and referral for follow-up care. We conducted multivariate analysis for predictors of reporting information or counselling as sufficient. Results: In VCT, 96.6% (282) said they were asked for consent compared to 91.3% (198) in PITC (P = 0.01). About the information provided, 92.0% (286) in VCT found it sufficient compared to 78.7% (221) in PITC (P = <0.01). In VCT 79.9% (246) thought their results were kept confidential compared to 71.7% (200) in PITC (P = 0.02). Eighty percent (64) of HIV infected VCT clients said they were referred for follow-up care versus 87.3% (48) in PITC (p = 0.2). Predictors of perceived adequacy of information in PITC included an opportunity to ask questions (adj.RR 1.76, CI 1.41, 2.18) and expecting the test results received (adj.RR 1.18, CI 1.06, 1.33). For VCT significant factors included being given an opportunity to ask questions (adj.RR 1.62, CI 1.00, 2.60) and 3+ prior times tested, (adj.RR 1.05, CI 1.00, 1.09).
  • Thumbnail Image
    Item
    Disclosure of HIV status between parents and children in Uganda in the context of greater access to treatment
    (Journal of Social Aspects of HIV/AIDS, 2013) Kyaddondo, David; Wanyenze, Rhoda K.; Kinsman, John; Hardon, Anita
    While disclosure of HIV sero-status is encouraged in the management of the HIV and AIDS epidemic, it remains a challenge, especially among family members. This article examines the moral dilemmas and pragmatic incentives surrounding disclosure of HIV status in contemporary Uganda. Our findings are based on 12 in-depth interviews, 2 focus-group discussions, 6 key informant interviews with AIDS activists, and open-ended responses derived from 148 HIV-positive persons in a quantitative survey. The study was conducted in 2008–2009 in Kampala, Mpigi, and Soroti districts in Uganda. We found both parents and adult children facing dilemmas in disclosure, whether it was parents revealing their own HIV status to their children or the status of their perinatally infected children, or young people infected through sexual intercourse telling their parents. For both groups, there is fear of blame, stigma, discrimination, and shame and guilt related to unsafe sex, while young people also fear loss of privileges. On the other hand, there are practical imperatives for disclosure in terms of gaining access to care, treatment, and material resources. Faced with these dilemmas, HIV-positive people and their families require professional counselling to help them work through the emotional challenges encountered and identify mechanisms of support and coping.
  • Thumbnail Image
    Item
    Do support groups members disclose less to their partners? The dynamics of HIV disclosure in four African countries
    (BMC Public Health, 2013) Hardon, Anita; Gomez, Gabriela B.; Vernooij, Eva; Desclaux, Alice; Wanyenze, Rhoda K.; Ky-Zerbo, Odette; Kageha, Emmy; Namakhoma, Ireen; Kinsman, John; Spronk, Clare; Meij, Edgar; Neuman, Melissa; Makhlouf Obermeyer, Carla
    Background: Recent efforts to curtail the HIV epidemic in Africa have emphasised preventing sexual transmission to partners through antiretroviral therapy. A component of current strategies is disclosure to partners, thus understanding its motivations will help maximise results. This study examines the rates, dynamics and consequences of partner disclosure in Burkina Faso, Kenya, Malawi and Uganda, with special attention to the role of support groups and stigma in disclosure. Methods: The study employs mixed methods, including a cross-sectional client survey of counselling and testing services, focus groups, and in-depth interviews with HIV-positive individuals in stable partnerships in Burkina Faso, Kenya, Malawi and Uganda, recruited at healthcare facilities offering HIV testing. Results: Rates of disclosure to partners varied between countries (32.7% – 92.7%). The lowest rate was reported in Malawi. Reasons for disclosure included preventing the transmission of HIV, the need for care, and upholding the integrity of the relationship. Fear of stigma was an important reason for non-disclosure. Women reported experiencing more negative reactions when disclosing to partners. Disclosure was positively associated with living in urban areas, higher education levels, and being male, while being negatively associated with membership to support groups. Conclusions: Understanding of reasons for disclosure and recognition of the role of support groups in the process can help improve current prevention efforts, that increasingly focus on treatment as prevention as a way to halt new infections. Support groups can help spread secondary prevention messages, by explaining to their members that antiretroviral treatment has benefits for HIV positive individuals and their partners. Home-based testing can further facilitate partner disclosure, as couples can test together and be counselled jointly.
  • Thumbnail Image
    Item
    From access to adherence: the challenges of antiretroviral treatment
    (World Health Organization, 2006) Hardon, Anita; Davey, Sheila; Gerrits, Trudie; Hodgkin, Catherine; Irunde, Henry; Kgatlwane, Joyce; Kinsman, John; Nakiyemba, Alice; Laing, Richard
    Since the launch of WHO’s ʹ3 by 5ʹ initiative in 2003, many countries in sub‐Saharan Africa have established national antiretroviral treatment (ART) programmes. Although the WHO target of providing access to ART for 3 million people by 2005 was not achieved, by end‐2005 an estimated 1.3 million people in low‐ and middle‐income countries had access to treatment (about 20% of those estimated to be in need) (WHO and UNAIDS, 2006). By mid‐2005, the WHO target had already been overtaken by an even more ambitious aim. In July 2005, the G8 group of industrialized countries committed to the goal of achieving ʹas close as possible to universal access to treatment for all those who need it by 2010.ʹ (UNAIDS, 2006, G8 Gleneagles Summit, 2005). Nonetheless, the challenges in the region remain great. Health systems are weak, and the target orientation of ART programmes risks an emphasis on initiating people on ART at the expense of ensuring effective use of medicines. As discussed in Chapter 2, extremely high levels of adherence (at least 95%) are needed to ensure positive treatment outcomes and prevent the development of drug‐resistance (Paterson et al., 2000). Up till now, only limited operational research has been carried out to identify adherence problems in resource‐poor settings and to strengthen adherence support (Jaffar et al., 2005; Bennet, Boerma and Brugha, 2006; Kent et al., 2003; Akileswaran et al., 2005; Farmer et al., 2001). Previous studies on adherence to ART in Africa have provided quantitative estimates of adherence and data on clinical outcomes, mainly from experimental settings (Ivers, Kendrick and Doucette, 2005; Coetzee et al., 2004; Orrell et al., 2003; Koenig, Léandre and Farmer, 2004; Gill et al., 2005). A recent review of six of these studies reported that 68%‐99% of patients took at least 95% of their medicines. The authors, Ivers et al., conclude that adherence levels in Africa are high, i.e. comparable to those in industrialized settings. However, Gill and colleagues (2005) and Laurent et al., 2002) stress that there is no room for complacency, noting that adherence rates tend to deteriorate over time.
  • Thumbnail Image
    Item
    Home-based HIV counseling and testing: Client experiences and perceptions in Eastern Uganda
    (BMC Public Health, 2012) Kyaddondo, David; Wanyenze, Rhoda K; Kinsman, John; Hardon, Anita
    Though prevention and treatment depend on individuals knowing their HIV status, the uptake of testing remains low in Sub-Saharan Africa. One initiative to encourage HIV testing involves delivering services at home. However, doubts have been cast about the ability of Home-Based HIV Counseling and Testing (HBHCT) to adhere to ethical practices including consent, confidentiality, and access to HIV care post-test. This study explored client experiences in relation these ethical issues. Methods: We conducted 395 individual interviews in Kumi district, Uganda, where teams providing HBHCT had visited 6–12 months prior to the interviews. Semi-structured questionnaires elicited information on clients’ experiences, from initial community mobilization up to receipt of results and access to HIV services post-test. Results: We found that 95% of our respondents had ever tested (average for Uganda was 38%). Among those who were approached by HBHCT providers, 98% were informed of their right to decline HIV testing. Most respondents were counseled individually, but 69% of the married/cohabiting were counseled as couples. The majority of respondents (94%) were satisfied with the information given to them and the interaction with the HBHCT providers. Most respondents considered their own homes as more private than health facilities. Twelve respondents reported that they tested positive, 11 were referred for follow-up care, seven actually went for care, and only 5 knew their CD4 counts. All HIV infected individuals who were married or cohabiting had disclosed their status to their partners. Conclusion: These findings show a very high uptake of HIV testing and satisfaction with HBHCT, a large proportion of married respondents tested as couples, and high disclosure rates. HBHCT can play a major role in expanding access to testing and overcoming disclosure challenges. However, access to HIV services post-test may require attention.
  • Thumbnail Image
    Item
    Socio-economic determinants of HIV testing and counselling: a comparative study in four African countries
    (Tropical Medicine and International Health, 2013) Obermeyer, Carla M.; Neuman, Melissa; Hardon, Anita; Desclaux, Alice; Wanyenze, Rhoda; Ky-Zerbo, Odette; Namakhoma, Ireen; Cherutich, Peter
    Research indicates that individuals tested for HIV have higher socio-economic status than those not tested, but less is known about how socio-economic status is associated with modes of testing. We compared individuals tested through provider-initiated testing and counselling (PITC), those tested through voluntary counselling and testing (VCT) and those never tested. methods Cross-sectional surveys were conducted at health facilities in Burkina Faso, Kenya, Malawi and Uganda, as part of the Multi-country African Testing and Counselling for HIV (MATCH) study. A total of 3659 clients were asked about testing status, type of facility of most recent test and socio-economic status. Two outcome measures were analysed: ever tested for HIV and mode of testing. We compared VCT at stand-alone facilities and PITC, which includes integrated facilities where testing is provided with medical care, and prevention of mother-to-child transmission (PMTCT) facilities. The determinants of ever testing and of using a particular mode of testing were analysed using modified Poisson regression and multinomial logistic analyses. results Higher socio-economic status was associated with the likelihood of testing at VCT rather than other facilities or not testing. There were no significant differences in socio-economic characteristics between those tested through PITC (integrated and PMTCT facilities) and those not tested. conclusions Provider-initiated modes of testing make testing accessible to individuals from lower socio-economic groups to a greater extent than traditional VCT. Expanding testing through PMTCT reduces socio-economic obstacles, especially for women. Continued efforts are needed to encourage testing and counselling among men and the less affluent.
  • Thumbnail Image
    Item
    Women’s views on consent, counseling and confidentiality in PMTCT: a mixed-methods study in four African countries
    (BMC Public Health, 2012) Hardon, Anita; Vernooij, Eva; Bongololo-Mbera, Grace; Cherutich, Peter; Desclaux, Alice; Kyaddondo, David; Ky-Zerbo, Odette; Neuman, Melissa; Wanyenze, Rhoda; Obermeyer, Carla
    Ambitious UN goals to reduce the mother-to-child transmission of HIV have not been met in much of Sub-Saharan Africa. This paper focuses on the quality of information provision and counseling and disclosure patterns in Burkina Faso, Kenya, Malawi and Uganda to identify how services can be improved to enable better PMTCT outcomes. Methods: Our mixed-methods study draws on data obtained through: (1) the MATCH (Multi-country African Testing and Counseling for HIV) study’s main survey, conducted in 2008-09 among clients (N = 408) and providers at health facilities offering HIV Testing and Counseling (HTC) services; 2) semi-structured interviews with a sub-set of 63 HIV-positive women on their experiences of stigma, disclosure, post-test counseling and access to follow-up psycho-social support; (3) in-depth interviews with key informants and PMTCT healthcare workers; and (4) document study of national PMTCT policies and guidelines. We quantitatively examined differences in the quality of counseling by country and by HIV status using Fisher’s exact tests. Results: The majority of pregnant women attending antenatal care (80-90%) report that they were explained the meaning of the tests, explained how HIV can be transmitted, given advice on prevention, encouraged to refer their partners for testing, and given time to ask questions. Our qualitative findings reveal that some women found testing regimes to be coercive, while disclosure remains highly problematic. 79% of HIV-positive pregnant women reported that they generally keep their status secret; only 37% had disclosed to their husband. Conclusion: To achieve better PMTCT outcomes, the strategy of testing women in antenatal care (perceived as an exclusively female domain) when they are already pregnant needs to be rethought. When scaling up HIV testing programs, it is particularly important that issues of partner disclosure are taken seriously.