8 results on '"Arnold Mafukidze"'
Search Results
2. Implementation of the Automated Medication Dispensing System–Early Lessons From Eswatini
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Victor Williams, Samson Haumba, Fikile Ngwenya-Ngcamphalala, Arnold Mafukidze, Normusa Musarapasi, Hugben Byarugaba, Simbarashe Chiripashi, Makhosazana Dlamini, Thokozani Maseko, Nkhosikhona Advocate Dlamini, Clara Nyapokoto, Sharon Kibwana, Pido Bongomin, Sikhathele Mazibuko, Fortunate Bhembe, Sylvia Ojoo, Velephi Okello, and Deus Bazira
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COVID-19 ,automated medication dispensing system ,human immune-deficiency virus ,integrated services delivery ,client-centered care ,non-communicable diseases ,Public aspects of medicine ,RA1-1270 - Abstract
Objectives: This article describes the implementation of an automated medication dispensing system (AMDS) in Eswatini to increase medication access and presents the early lessons from this implementation.Methods: The AMDS was installed at four health facilities across two regions through collaborative stakeholder engagement. Healthcare workers were trained, and clients who met the inclusion criteria accessed their medications from the system. Each step of the implementation was documented and summarised in this article.Results: Early lessons suggest that implementation of the AMDS is acceptable and feasible to clients and healthcare workers and that phased introduction of medication classes, commencing with antiretroviral therapy (ART) and incorporating other medications in later phases is feasible. Additionally, improved client-centred messaging and communication, consistent power supply and internet network connectivity, and scheduling medication pickup with other services increase AMDS system utilisation.Conclusion: Eswatini has many clients living with HIV and non-communicable diseases (NCDs). Easy, convenient, quick, non-stigmatising and client-centred access to ART and medication for NCDs is critical in addressing retention in care and achieving optimal treatment outcomes.
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- 2023
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3. Enhanced Integration of TB Services in Reproductive Maternal Newborn and Child Health (RMNCH) Settings in Eswatini.
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Kieran Hartsough, Chloe A Teasdale, Siphesihle Shongwe, Amanda Geller, Eduarda Pimentel De Gusmao, Phumzile Dlamini, Arnold Mafukidze, Munyaradzi Pasipamire, Trong Ao, Caroline Ryan, Surbhi Modi, Elaine J Abrams, and Andrea A Howard
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Public aspects of medicine ,RA1-1270 - 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.
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- 2022
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4. Paediatric tuberculosis preventive treatment preferences among HIV-positive children, caregivers and healthcare providers in Eswatini: a discrete choice experiment
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Gavin George, Yael Hirsch-Moverman, Michael Strauss, Anthony Mutiti, Arnold Mafukidze, Siphesihle Shongwe, Gloria Sisi Dube, Wafaa M El Sadr, Joanne E Mantell, and Andrea A Howard
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Medicine - Published
- 2021
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- View/download PDF
5. Patient feedback surveys among pregnant women in Eswatini to improve antenatal care retention.
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Chloe A Teasdale, Amanda Geller, Siphesihle Shongwe, Arnold Mafukidze, Michelle Choy, Bhekinkhosi Magaula, Katharine Yuengling, Katherine King, Eduarda Pimentel De Gusmao, Caroline Ryan, Trong Ao, Tegan Callahan, Surbhi Modi, and Elaine J Abrams
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Medicine ,Science - Abstract
BackgroundUptake and retention in antenatal care (ANC) is critical for preventing adverse pregnancy outcomes for both mothers and infants.MethodsWe 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.ResultsA 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% (pConclusionThe type of rapid quality improvement intervention we implemented may be useful in improving patient-provider relationships although whether it can improve retention remains unclear.
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- 2021
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6. Birth Testing for Infant HIV Diagnosis in Eswatini: Implementation Experience and Uptake Among Women Living With HIV in Manzini Region
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Chloe A. Teasdale, Siphesihle Shongwe, Simangele Mthethwa, Hlengiwe Nhlengetfwa, Fatima Tsiouris, Arnold Mafukidze, Emilia D. Rivadeneira, Samkelisiwe Simelane, Michelle Choy, Trong Ao, Elaine J. Abrams, Caroline Ryan, and Helen Dale
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Adult ,Male ,Microbiology (medical) ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Low resource ,HIV diagnosis ,Columbia university ,Human immunodeficiency virus (HIV) ,Mothers ,HIV Infections ,Pilot Projects ,Hiv testing ,Reference laboratory ,medicine.disease_cause ,Article ,Young Adult ,03 medical and health sciences ,Neonatal Screening ,0302 clinical medicine ,Pregnancy ,030225 pediatrics ,Humans ,Medicine ,030212 general & internal medicine ,Pregnancy Complications, Infectious ,business.industry ,Health Plan Implementation ,Infant, Newborn ,Infectious Disease Transmission, Vertical ,Dried blood spot ,Infectious Diseases ,Anti-Retroviral Agents ,Pediatrics, Perinatology and Child Health ,Community health ,HIV-1 ,Female ,business ,Eswatini - Abstract
INTRODUCTION: HIV testing at birth of HIV-exposed infants (HEIs) may improve the identification of infants infected with HIV in utero and accelerate antiretroviral treatment (ART) initiation. METHODS: ICAP at Columbia University supported implementation of a national pilot of HIV testing at birth (0–7 days) in Eswatini at 2 maternity facilities. Dried blood spot (DBS) samples from neonates of women living with HIV (WLHIV) were collected and processed at the National Molecular Reference Laboratory using polymerase chain reaction (PCR). Mothers received birth test results at community health clinics. We report data on HIV birth testing uptake and outcomes for HIV-positive infants from the initial intensive phase (October 2017–March 2018) and routine support phase (April–December 2018). RESULTS: During the initial intensive pilot phase, 1669 WLHIV delivered 1697 live-born HEI at 2 health facilities and 1480 (90.3%) HEI received birth testing. During the routine support phase, 2546 WLHIV delivered and 2277 (93.5%) HEI received birth testing. Overall October 2017–December 2018, 22 (0.6%) infants of 3757 receiving birth testing had a positive PCR test, 15 (68.2%) of whom were successfully traced and linked for confirmatory testing (2 infants were reported by caregivers to have negative follow-up HIV tests). Median time from birth test to receipt of results by the caregiver was 13 days (range: 8–23). Twelve (60.0%) of 20 infants confirmed to be HIV-positive started ART at median age of 17.5 days (12–43). One mother of an HIV-positive infant who was successfully traced refused ART following linkage to care and another child died after ART initiation. Three infants (15.0%) had died by the time their mothers were reached and 4 (15.0%) infants were never located. CONCLUSION: This pilot of universal birth testing in Eswatini demonstrates the feasibility of using a standard of care approach in a low resource and high burden setting. We document high uptake of testing for newborns among HIV-positive mothers and very few infants were found to be infected through birth testing.
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- 2020
7. Patient feedback surveys among pregnant women in Eswatini to improve antenatal care retention
- Author
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Trong Ao, Amanda Geller, Bhekinkhosi Magaula, Elaine J. Abrams, Caroline Ryan, Siphesihle Shongwe, Arnold Mafukidze, Tegan Callahan, Katherine King, Eduarda Pimentel De Gusmao, Michelle Choy, Surbhi Modi, Katharine A. Yuengling, and Chloe A. Teasdale
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RNA viruses ,Maternal Health ,Health Care Providers ,Nurses ,HIV Infections ,Surveys ,Pathology and Laboratory Medicine ,Cohort Studies ,Health facility ,Immunodeficiency Viruses ,Pregnancy ,Surveys and Questionnaires ,Medicine and Health Sciences ,Retention in Care ,Medicine ,Medical Personnel ,Multidisciplinary ,Obstetrics ,Pharmaceutics ,Medical record ,Receptionists ,Obstetrics and Gynecology ,Prenatal Care ,Patient feedback ,Professions ,Research Design ,Medical Microbiology ,Patient Satisfaction ,Viral Pathogens ,Viruses ,Female ,Pathogens ,Research Article ,Adult ,medicine.medical_specialty ,Science ,Survey result ,Research and Analysis Methods ,Microbiology ,Drug Therapy ,Antenatal Care ,Retroviruses ,Humans ,Pregnancy outcomes ,Microbial Pathogens ,Survey Research ,business.industry ,Lentivirus ,Organisms ,Biology and Life Sciences ,HIV ,medicine.disease ,Health Care ,Health Care Facilities ,People and Places ,Women's Health ,Population Groupings ,Hiv status ,Pregnant Women ,business.job_title ,business ,Eswatini - 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 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.
- Published
- 2021
8. Paediatric tuberculosis preventive treatment preferences among HIV-positive children, caregivers and healthcare providers in Eswatini: a discrete choice experiment
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Anthony Mutiti, Gloria Sisi Dube, Michael Strauss, Wafaa El Sadr, Andrea A. Howard, Arnold Mafukidze, Joanne E. Mantell, Siphesihle Shongwe, Yael Hirsch-Moverman, and Gavin George
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medicine.medical_specialty ,Tuberculosis ,Service delivery framework ,Health Personnel ,HIV Infections ,Logistic regression ,Ambulatory Care Facilities ,Patient-Centred Medicine ,Health care ,Humans ,health economics ,Medicine ,Child ,Health economics ,business.industry ,Public health ,public health ,General Medicine ,medicine.disease ,Caregivers ,tuberculosis ,Pill ,Family medicine ,business ,Eswatini ,Qualitative research - Abstract
ObjectiveIsoniazid preventive therapy initiation and completion rates are suboptimal among children. Shorter tuberculosis (TB) preventive treatment (TPT) regimens have demonstrated safety and efficacy in children and may improve adherence but are not widely used in high TB burden countries. Understanding preferences regarding TPT regimens’ characteristics and service delivery models is key to designing services to improve TPT initiation and completion rates. We examined paediatric TPT preferences in Eswatini, a high TB burden country.DesignWe conducted a sequential mixed-methods study utilising qualitative methods to inform the design of a discrete choice experiment (DCE) among HIV-positive children, caregivers and healthcare providers (HCP). Drug regimen and service delivery characteristics included pill size and formulation, dosing frequency, medication taste, treatment duration and visit frequency, visit cost, clinic wait time, and clinic operating hours. An unlabelled, binary choice design was used; data were analysed using fixed and mixed effects logistic regression models, with stratified models for children, caregivers and HCP.SettingThe study was conducted in 20 healthcare facilities providing TB/HIV care in Manzini, Eswatini, from November 2018 to December 2019.ParticipantsNinety-one stakeholders completed in-depth interviews to inform the DCE design; 150 children 10–14 years, 150 caregivers and 150 HCP completed the DCE.ResultsDespite some heterogeneity, the results were fairly consistent among participants, with palatability of medications viewed as the most important TPT attribute; fewer and smaller pills were also preferred. Additionally, shorter waiting times and cost of visit were found to be significant drivers of choices.ConclusionPalatable medication, smaller/fewer pills, low visit costs and shorter clinic wait times are important factors when designing TPT services for children and should be considered as new paediatric TPT regimens in Eswatini are rolled out. More research is needed to determine the extent to which preferences drive TPT initiation, adherence and completion rates.
- Published
- 2021
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