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  • 1.
    Njozing, Barnabas N
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Bridging the Gap: implementing tuberculosis and HIV/AIDS collaborative activities in the Northwest Region of Cameroon2011Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction

    The human immunodeficiency virus (HIV) epidemic has led to the upsurge of tuberculosis (TB) infection globally, but most especially in areas with high HIV prevalence. In the past, there was lack of a coordinated global and national response between TB and HIV programmes to curb the devastating impacts of both infections. However, the ProTEST Initiative piloted in sub-Saharan Africa in 1997 demonstrated that TB and HIV programmes could collaborate successfully in delivering joint services. This prompted the development of the WHO interim policy on collaborative TB/HIV activities in 2004, aimed at reducing the burden of TB and HIV in populations affected by both infections. This thesis explores how collaborative activities between TB and HIV programmes have been established in Cameroon and implemented in the Northwest Region. It also highlights the achievements and constraints in delivering joint services to TB patients co-infected with HIV.

    Methods

    The study was conducted in the Northwest Region, one of the 10 regions of Cameroon with the highest HIV prevalence. The study uses health system research combining qualitative and quantitative methods to explore the research objectives. Qualitative methods were used to capture the perspectives of: i) the service providers; key informants from the central, regional and district levels concerned with the collaboration process and in delivering HIV services to TB patients, and ii) TB patients regarding HIV testing as an entry point to HIV services. Quantitative methods were used to ascertain TB patients’ access to HIV services provided for by the collaboration.

    Results

    The study demonstrated that although there were varying levels of collaboration between TB and HIV programmes from the central to operational level in the health system, delivering joint services was feasible. Furthermore, despite the challenges TB patients faced in testing for HIV, overall implementing TB/HIV collaborative activities increased TB patients’ acceptability and accessibility to HIV services. These were facilitated by the improved collaboration at the operational level, and enhanced service provider-patient alliance which was instrumental in building patients’ trust in the health system. Collaboration also led to cross-training and teamwork between staffs from both programmes, and improved networking between service providers and other actors involved in TB and HIV care. Nevertheless, there were health system constraints including inadequate leadership and management, shortage of human and infrastructural resources, frequent interruptions in the supply of essential drugs and laboratory materials

    Conclusion

    TB/HIV collaborative activities have improved service delivery and TB patients’ access to HIV services. Nonetheless, appropriate stewardship which guarantees joint planning, monitoring and evaluation of essential activities, and accountability at all levels in the health system is invaluable. Besides, the identified health system constraints which could adversely influence effective joint service delivery and a sustainable collaboration deserve due appraisal.

     

     

  • 2.
    Njozing, Barnabas N
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Edin, Kerstin E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    San Sebastián, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Voices from the frontline: counsellors’ perspectives on TB/HIV collaborative activities in the Northwest Region, Cameroon2011In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 11, p. 328-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The overlapping epidemiology of tuberculosis (TB) and human immunodeficiency virus (HIV) infections prompted the World Health Organisation in 2004 to recommend collaboration between national TB and HIV programmes. The goal of this collaboration is to decrease the burden of both infections in the population. This policy was subsequently adopted by the national TB and HIV programmes in Cameroon with TB and HIV nurses/counsellors acting as frontline implementers of the collaborative activities in the 10 regions of the country.

    METHODS: Qualitative research interviews were conducted with 30 nurses/counsellors in four approved treatment centres providing comprehensive TB and HIV/AIDS services in the Northwest region of Cameroon. The aim was to explore their experiences in counselling, in delivering joint TB and HIV services, and the constraints to effective collaboration between TB and HIV services. To complement the findings from the counsellors' interviews, as part of an emergent design, further interviews with 2 traditional healers and non-participant observations in two HIV support group meetings were conducted.

    RESULTS: According to the respondents, counselling was regarded as a call to serve humanity irrespective of the reasons for choosing the profession. In addition, the counselling training and supervision received, and the skills acquired, have altogether contributed to build patients' trust in the healthcare system. Teamwork among healthcare workers and other key stakeholders in the community involved in TB/HIV prevention and control was used as a strategy to improve joint service delivery and patients' uptake of services. Several constraints to effective collaboration between TB and HIV services were identified, including shortage of human resources, infrastructure and drug supplies, poor patients' adherence to treatment and the influence of traditional healers who relentlessly dissuade patients from seeking mainstream medical care.

    CONCLUSIONS: In order to achieve a sustainable collaboration between TB and HIV services, adequate planning, investment and strengthening of the health system including human resources, infrastructure and ensuring uninterrupted supplies of medicines are essential. A multidisciplinary approach to service delivery particularly focusing on harnessing the enormous potentials of traditional healers in TB/HIV prevention and control would also be indispensible.

  • 3.
    Njozing, Barnabas N
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. St. Mary Soledad Catholic Hospital, Mankon, Bamenda, P.O.Box 157, Cameroon.
    Edin, Kerstin E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    San Sebástian, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    “If the patients decide not to tell what can we do?”: TB/HIV counsellors’ dilemma on partner notification for HIV2011In: BMC International Health and Human Rights, ISSN 1472-698X, E-ISSN 1472-698X, Vol. 11, article id 6Article in journal (Refereed)
    Abstract [en]

    Background: There is a global consensus towards universal access to human immunodeficiency virus (HIV) services consequent to the increasing availability of antiretroviral therapy. However, to benefit from these services, knowledge of one's HIV status is critical. Partner notification for HIV is an important component of HIV counselling because it is an effective strategy to prevent secondary transmission, and promote early diagnosis and prompt treatment of HIV patients' sexual partners. However, counsellors are often frustrated by the reluctance of HIV-positive patients to voluntarily notify their sexual partners. This study aimed to explore tuberculosis (TB)/HIV counsellors' perspectives regarding confidentiality and partner notification. Methods: Qualitative research interviews were conducted in the Northwest Region of Cameroon with 30 TB/HIV counsellors in 4 treatment centres, and 2 legal professionals between September and December 2009. Situational Analysis (positional map) was used for data analysis. Results: Confidentiality issues were perceived to be handled properly despite concerns about patients' reluctance to report cases of violation due to apprehension of reprisals from health care staffs. All the respondents encouraged voluntary partner notification, and held four varying positions when confronted with patients who refused to voluntarily notify their partners. Position one focused on absolute respect of patients' autonomy; position two balanced between the respect of patients' autonomy and their partners' safety; position three wished for protection of sexual partners at risk of HIV infection and legal protection for counsellors; and position four requested making HIV testing and partner notification routine processes. Conclusion: Counsellors regularly encounter ethical, legal and moral dilemmas between respecting patients' confidentiality and autonomy, and protecting patients' sexual partners at risk of HIV infection. This reflects the complexity of partner notification and demonstrates that no single approach is optimal, but instead certain contextual factors and a combination of different approaches should be considered. Meanwhile, adopting a human rights perspective in HIV programmes will balance the interests of both patients and their partners, and ultimately enhance universal access to HIV services.

  • 4.
    Njozing, Nwarbébé Barnabas
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Edin, Kerstin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    "When I get better I will do the test": facilitators and barriers to HIV testing in Northwest region of Cameroon with implications for TB and HIV/AIDS control programmes2010In: SAHARA-J: Journal of Social Aspects of HIV/AIDS, ISSN 1729-0376, E-ISSN 1813-4424, Vol. 7, no 4, p. 24-32Article in journal (Refereed)
    Abstract [en]

    The World Health Organization has recommended collaborative activities between TB and HIV programmes with routine counselling and testing for HIV among TB patients in order to improve the uptake of HIV services. We carried out qualitative research interviews with 21 TB patients in four selected TB and HIV/AIDS treatment centres in the Northwest Region of Cameroon to explore the facilitators and barriers to HIV testing. The desire to be healthy and live longer from knowing one’s status inspired by the anticipated support from loved ones, faith in a supreme being, influence and trust in the medical authority, encouraged HIV testing. Men also demonstrated their masculinity by testing, thus portraying themselves as positive role models for other men. Meanwhile, the overwhelming burden of facing both TB and HIV simultaneously, influenced by the fear of disclosure of results, harmful gender norms and practices, fear of stigma and discrimination, and misconceptions surrounding HIV/AIDS deterred HIV testing. However, as a result of conflicting emotional experiences regarding to test or not to test, the decision-making process was not straightforward and this complex process needs to be acknowledged by health care providers when advocating for routine HIV testing among TB patients.

  • 5.
    Njozing, Nwarbébé Barnabas
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. St Mary Soledad Catholic Hospital, Mankon, Bamenda, Cameroon .
    Miguel, San Sebastian
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Tih, Pius Muffih
    Cameroon Baptist Convention Health Board, Nkwen, Bamenda, Cameroon.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Assessing the accessibility of HIV care packages among tuberculosis patients in the Northwest Region, Cameroon2010In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 10, p. Article nr 129-Article in journal (Refereed)
    Abstract [en]

    Background: Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection is a major source of morbidity and mortality globally. The World Health Organization (WHO) has recommended that HIV counselling and testing be offered routinely to TB patients in order to increase access to HIV care packages. We assessed the uptake of provider-initiated testing and counselling (PITC), antiretroviral (ART) and co-trimoxazole preventive therapies (CPT) among TB patients in the Northwest Region, Cameroon.

    Methods: A retrospective cohort study using TB registers in 4 TB/HIV treatment centres (1 public and 3 faith-based) for patients diagnosed with TB between January 2006 and December 2007 to identify predictors of the outcomes; HIV testing/serostatus, ART and CPT enrolment and factors that influenced their enrolment between public and faith-based hospitals.

    Results: A total of 2270 TB patients were registered and offered pre-HIV test counselling; 2150 (94.7%) accepted the offer of a test. The rate of acceptance was significantly higher among patients in the public hospital compared to those in the faith-based hospitals (crude OR 1.97; 95% CI 1.33 - 2.92) and (adjusted OR 1.92; 95% CI 1.24 - 2.97). HIV prevalence was 68.5% (1473/2150). Independent predictors of HIV-seropositivity emerged as: females, age groups 15-29, 30-44 and 45-59 years, rural residence, previously treated TB and smear-negative pulmonary TB. ART uptake was 50.3% (614/1220) with 17.2% (253/1473) of missing records. Independent predictors of ART uptake were: previously treated TB and extra pulmonary TB. Finally, CPT uptake was 47.0% (524/1114) with 24% (590/1114) of missing records. Independent predictors of CPT uptake were: faith-based hospitals and female sex.

    Conclusion: PITC services are apparently well integrated into the TB programme as demonstrated by the high testing rate. The main challenges include improving access to ART and CPT among TB patients and proper reporting and monitoring of programme activities.

1 - 5 of 5
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