Browsing by Author "Wandera, Claude"

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    Integrating Hepatitis B Care and Treatment with Existing HIV Services is Possible: A Cost Minimization Analysis from a Low Resource Setting
    (Research Square, 2020) Ejalu, David Livingstone; Nankya Mutyoba, Joan; Wandera, Claude; Seremba, Emmanuel; Kambugu, Andrew; Easterbrook, Philippa; Amandua, Jacinto; Muganzi, Alex; Rachel, Beyagira; Mugagga, Kaggwa; Ocama, Ponsiano
    In recent years there has been growing interest in exploring methods by which the care pathways for people with comorbid physical and health problems may be integrated. The success of such an integration however would depend on several factors including feasibility, acceptability and costs involved. Therefore, this report presents estimated provider costs associated with managing an integrated HBV and HIV clinical pathway for patients on life-long treatment in low resource setting in Uganda. Methods: A cost minimisation analysis from the providers perspective was done by considering financial costs as a measure of the amount of money spent on resources used in the clinical pathways. The annual cost per patient was simulated based on total amount of resources spent for all the patient visits to the facility for HBV or HIV care per year. Results: Findings showed that drugs and laboratory tests were the main drivers of costs in the pathways. A high-volume facility (Arua regional referral hospital- ARRH) had a higher cost per patient in both clinics than did the low volume facility (Koboko District Hospital- KDH). Variations occurred due to differences in the carders of health workers, the infrastructure, the amounts of consumables used in the facilities. Cost per HBV patient was $163.59 in ARRH and $145.76 in K DH while the cost per HIV patient was $176.52 in ARRH and $173.23 in KDH. The integration resulted into total saving of $36.73 per patient per year in Arua RRH and $17.5 in Koboko DH. The cost saving accrued from savings from personnel, fixed costs, consumables and utilities incurred in running the standalone Hepatitis B clinic and the reduction in per HIV patient costs from sharing of resources in the integrated pathway. Conclusion: This analysis showed that the application of the integrated Pathway in HIV and HBV patient management could improve hospital cost efficiency compared to operating stand-alone clinics. This could further improve adherence to treatment by Hepatitis B patients and improve patient outcomes as HBV patients get access to counselling services.
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    A training for health care workers to integrate hepatitis B care and treatment into routine HIV care in a high HBV burden, poorly resourced region of Uganda: the ‘2for1’ project
    (BMC Medical Education, 2022) Nankya‑Mutyoba, Joan; Ejalu, David; Wandera, Claude; Beyagira, Rachel; Amandua, Jacinto; Seremba, Emmanuel; Mugagga, Kaggwa; Kambugu, Andrew; Muganzi, Alex; Easterbrook, Philippa; Ocama, Ponsiano
    The “2for1” project is a demonstration project to examine the feasibility and effectiveness of HBV care integrated into an HIV clinic and service. An initial phase in implementation of this project was the development of a specific training program. Our objective was to describe key features of this integrated training curriculum and evaluation of its impact in the initial cohort of health care workers (HCWs). Methods: A training curriculum was designed by experts through literature review and expert opinion. Key distinctive features of this training program (compared to standard HBV training provided in the Government program) were; (i) Comparison of commonalities between HIV and HBV (ii) Available clinic- and community-level infrastructure, and the need to strengthen HBV care through integration (iii) Planning and coordination of sustained service integration. The training was aided by a power-point guided presentation, question and answer session and discussion, facilitated by physicians and hepatologists with expertise in viral hepatitis. Assessment approach used a self-administered questionnaire among a cohort of HCWs from 2 health facilities to answer questions on demographic information, knowledge and attitudes related to HBV and its prevention, before and after the training. Knowledge scores were generated and compared using paired t- tests. Results: A training curriculum was developed and delivered to a cohort of 44 HCWs including medical and nursing staff from the two project sites. Of the 44 participants, 20 (45.5%) were male, average age (SD) was 34.3 (8.3) with an age range of 22–58 years. More than half (24, 54.5%) had been in service for fewer than 5 years. Mean correct knowledge scores increased across three knowledge domains (HBV epidemiology and transmission, natural history and treatment) post-intervention. However, knowledge related to diagnosis and prevention of HBV did not change. Conclusion: A structured HBV education intervention conducted as part of an HIV/HBV care integration training for health care workers yielded improved knowledge on HBV and identified aspects that require further training. This approach may be replicated in other settings, as a public health strategy to heighten HBV elimination efforts.