The sub-Saharan region of Africa is the most severely affected HIV/AIDS region in the world. The population of this region accounts for 67% of all people living with HIV/AIDS and 72% of all AIDS-related deaths. As international collaboration makes access to HIV treatment more widely available in this region the need to increase the population's awareness of its serostatus becomes greater. The incorporation of provider-initiated HIV testing and counseling (routine HIV testing model) as part of a routine medical care would not only increase the population's serostatus awareness but also lead to a better understanding of HIV prevention and treatment and ultimately, increased utilization of available HIV/AIDS prevention programs on a much larger scale. This mini-review summarizes some important regional, sociocultural, economic, legal, and ethical issues that may be deterrent factors to maximal implementation and integration of provider initiated HIV testing and counseling as part of routine medical care in the sub-Saharan African region.
"On the one hand, many of the barriers to HIV prevention that were identified for the target populations in Bondo and Rarieda (e.g., stigma and fear of learning one’s HIV status) are widespread in sub-Saharan Africa and elsewhere. Many of the barriers also support others’ findings regarding likely challenges to PrEP implementation, particularly stigma and lack of trained staff [39,40]. "
[Show abstract][Hide abstract] ABSTRACT: Background
As pre-exposure prophylaxis (PrEP) moves closer to availability in developing countries, practical considerations for implementation become important. We conducted a consultation with district-level community stakeholders experienced in HIV-prevention interventions with at-risk populations in Bondo and Rarieda, Kenya to generate locally grounded approaches to the future rollout of oral PrEP to four populations: fishermen, widows, female sex workers, and serodiscordant couples.
The 20 consultation participants represented the Ministry of Health, faith- and community-based organizations, health facilities, community groups, and nongovernmental organizations. Participants divided into breakout groups and followed a structured discussion guide asking them to identify barriers to implementing HIV-prevention interventions (including PrEP) with each population. Questions also solicited solutions for addressing these barriers, as well as other facilitators for PrEP implementation. In particular, questions focused on how to encourage people to screen for PrEP eligibility by having HIV and other blood tests and how to encourage compliance with ongoing HIV testing.
The barriers and facilitators/solutions discussants provided were frequently population-specific, but there were also broad-level similarities across populations. Service delivery barriers to HIV-prevention interventions concerned the need for staff trained to address the needs of particular populations. Service delivery facilitators to provision of ongoing HIV testing consisted of offering testing options besides facility-based testing. Stigma was the main community-level barrier for all groups, whereas barriers at the level of target populations included mobility; lifestyle and life circumstances, especially cultural norms among fishermen and widows; and fears, lack of awareness, and misinformation. Proposed facilitators and strategies for addressing community- and population-level barriers included topic-specific education within the populations and community, involvement of partners and family members, mass HIV testing, and peer educators. Barriers to PrEP uptake included non-adherence to pill taking and missing clinic visits. For drug adherence, facilitators were counselling and involving family members. Discussants suggested that client reminders, e.g., home visits, were needed to encourage clients to keep their clinic appointments.
Strategies for encouraging eligibility screening and ongoing HIV testing will have local and population-specific aspects. Our results nonetheless apply to similar populations throughout sub-Saharan Africa and reach beyond oral PrEP to other ARV-based PrEP formulations.
BMC Health Services Research 05/2014; 14(1):231. DOI:10.1186/1472-6963-14-231 · 1.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This paper proposes a digital hysteresis-modulation technique based on switching-time prediction. Sampling controlled variables several times within a switching period, it ensures a dynamic performance comparable to that obtainable with analog hysteresis modulation. Compared to conventional digital hysteresis modulation, it avoids frequency jitter since it predicts switching transitions. Compared to hysteresis modulation based on the detection of the zero crossing of current errors, it avoids external analog circuits. Compared to pulsewidth-modulation (PWM) techniques, it ensures faster dynamic response. These advantages are obtained at the expense of increased signal-processing requirements and of control complexity. Switching-frequency stabilization and synchronization with an external clock can be obtained extending the techniques proposed for analog hysteresis modulations. The proposed predictive algorithm does not require knowledge of load parameters and only a rough estimation of the inductor value, which can be easily self-adjusted. The proposed solution is suited for high-performance current (or sliding-mode) control where the digital hardware has enough computational power to allow multiple samples within a switching period. The proposed modulation technique has been applied to a sliding-mode control of a single-phase uninterruptible power supply (UPS). Experimental results confirm the effectiveness of the proposed approach.
IEEE Transactions on Industry Applications 06/2006; 42(3-42):763 - 769. DOI:10.1109/TIA.2006.873665 · 1.76 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: As efficacy trials of antiretroviral pre-exposure prophylaxis (PrEP) continue, a growing literature has begun anticipating the potential challenges of implementing PrEP for HIV prevention. These efforts coincide with a shift toward combination interventions for preventing HIV, which integrate biomedical, behavioral, and structural components. The optimal implementation of PrEP would exemplify this combination model, incorporating not only PrEP drugs, but also HIV testing, safety screening, behavioral interventions addressing adherence and risk behavior, and long-term monitoring. Efforts to plan for PrEP implementation therefore present an opportunity to advance the science of implementation and delivery in HIV prevention, in order to better address the challenges of scaling up combination approaches. We review the published and unpublished literature on PrEP implementation, organizing themes into five categories: scientific groundwork, regulatory and policy groundwork, stakeholder and infrastructure groundwork, delivery, and long-term monitoring. The lessons from PrEP planning can benefit the scale-up of future combination interventions.
Current HIV/AIDS Reports 11/2010; 7(4):210-9. DOI:10.1007/s11904-010-0062-4 · 3.80 Impact Factor
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