Learners’ perspectives on training for HIV management in sub-Saharan Africa: Insights from the AFREhealth HIV project

Framing the Future: Exploring Inter-Professional Education and Practice in an Undergraduate Course

Kidney disease is increasingly being recognized as a public health problem, not only because large numbers of patients are affected, but also because of the diagnostic and therapeutic challenges associated with its management, especially in low resource settings, where conflicts between financing, equity and social values frequently arise. When kidneys fail, either acutely or chronically, dialysis represents an immediate life-saving therapy. Dialysis is technically available in most countries, but is time, labor and resource intensive, which limits access largely to those who can afford to pay when not covered through universal health coverage or health insurance. Access to dialysis is therefore highly inequitable across country income groups globally and within countries. Dialysis poses ethical challenges at many levels in low-resource settings. Policy makers must consider whether to provide dialysis at all or leave it to market forces. If dialysis is to be provided, who, where and how to dialyze safely and equitably are necessary questions to consider. When these questions are not addressed transparently at a policy level, clinicians and families must face complex decisions about whether to start dialysis or not at the bedside. Policy-making requires evidence. Based on broad inequities in access to dialysis and the potential consequences for individuals and families, health care workers, the health system and society, this PhD begins with an epidemiologic description of outcomes in patients requiring dialysis in sub-Saharan Africa and consequent moral distress experienced by nephrologists at the bedside, investigates overarching strategies to reduce the global burden of kidney disease, and focuses on the ethical implications of priority setting and policy making regarding provision of dialysis in sub-Saharan Africa.

ObjectiveTo assess the impact of an interprofessional case-based training programme to enhance clinical knowledge and confidence among clinicians working in high HIV-burden settings in sub-Saharan Africa (SSA).SettingHealth professions training institutions...

There is little HIV counselling that directly meets the needs of men in Eastern and Southern Africa, limiting men's knowledge about the benefits of HIV treatment and how to overcome barriers to engagement, contributing to poorer HIV-related outcomes than women. Male-specific approaches are needed to improve men's outcomes but may be difficult for healthcare workers (HCWs) to implement with fidelity and quality in low-resource settings. We developed a male-specific counselling curriculum which was implemented by male HCWs and then conducted a mixed-methods quality assessment. We audio-recorded counselling sessions to assess the quality of implementation (n = 50) by male HCWs from two cadres (nurse, n = 10 and lay cadre, n = 10) and conducted focus group discussions (FGDs) with HCWs at 6 and 9 months after rollout to understand barriers and facilitators to implementation. Counselling sessions and FGDs were translated, transcribed and analysed using thematic analysis adapted from WHO Quality Counselling Guidelines. We assessed if sessions were respectful, informative, interactive, motivating and included tailored action plans for overcoming barriers to care. All data were collected September 2021-June 2022. All sessions used respectful, non-judgemental language. Sessions were highly interactive with most HCWs frequently asking open-ended questions (n = 46, 92%) and often incorporating motivational explanations of how antiretroviral therapy contributes to life goals (n = 42, 84%). Few sessions included individually tailored action plans for clients to overcome barriers to care (n = 9, 18%). New counselling themes were well covered; however, occasionally themes of self-compassion and safe sex were not covered during sessions (n = 16 and n = 11). HCWs believed that having male HCWs conduct counselling, ongoing professional development and keeping detailed counselling notes facilitated quality implementation. Perceived barriers included curriculum length and client hesitancy to participate in action plan development. Findings were similar across cadres. Implementing high-quality male-specific counselling using male nurses and/or lay cadre is feasible. Efforts to utilize lay cadres should be prioritized, particularly in low-resource settings. Programmes should provide comprehensive job aids to support HCWs. Ongoing training and professional development are needed to (1) improve HCWs' skills in tailored action plans, and (2) sensitize HCWs to the need for self-compassion within male clients to promote holistic sexual health.

A key limiting factor in the scale up and sustainability of HIV care and treatment programmes is the global shortage of trained health care workers. This paper discusses why it is important to move beyond conceptualising health care workers simply as 'inputs' in the delivery of HIV treatment and care, and to also consider their roles as partners and agents in the process of health care. It suggests a framework for thinking about their roles and responses in HIV care, considers the current evidence base, and concludes by identifying key areas for future research on health care workers' responses in HIV treatment and care in low and middle income settings.

Understanding Sickle Cell Disease Pain: Perception from Patients, Parents and Healthcare Providers in Northwestern Tanzania

AIDS in Africa

Women Deliver post–2015

Cancer and COVID-19 vaccines: a complex global picture.

Maternal fetal and infant mortality and morbidity are among the most significant public health problems in developing and resource-poor nations. In most developing countries important contributing factors to perinatal and maternal mortality are the lack of adequate diagnostic and pathology facilities inadequate or absent postmortem examination poor diagnostic pathology and microbiology capabilities and deficiency in surveillance systems statistical reporting and diagnostic accuracy of adverse maternal and perinatal health events. Most resource-poor nations have no pathologist trained in perinatal pathology who is available to address the clinical diagnostic public health and research aspects of these mortality and morbidity issues which are so prevalent in the developing world. The following article highlights some of the most important global perinatal health problems - including malaria low birth weight HIV/AIDS maternal malnutrition maternal death unsafe abortion and political turmoil - which would benefit by increased contributions from collaborations with physicians trained in perinatal pathology.

Cotrimoxazole prophylaxis for African HIV-infected children: no more delays, no more misinterpretations!

Clinical microbiology laboratories in low-resource settings, it is not only about equipment and reagents, but also good governance for sustainability

It may be assumed that supportive supervision effectively builds capacity, improves the quality of care provided by frontline health workers, and positively impacts clinical outcomes. Evidence on the role of supervision in Sub-Saharan Africa has been inconclusive, despite the critical need to maximize the workforce in low-resource settings. To review the published literature from Sub-Saharan Africa on the effects of supportive supervision on quality of care, and health worker motivation and performance. A systematic review of seven databases of both qualitative and quantitative studies published in peer-reviewed journals. Selected studies were based in primary healthcare settings in Sub-Saharan Africa and present primary data concerning supportive supervision. Thematic synthesis where data from the identified studies were grouped and interpreted according to prominent themes. Supportive supervision can increase job satisfaction and health worker motivation. Evidence is mixed on whether this translates to increased clinical competence and there is little evidence of the effect on clinical outcomes. Results highlight the lack of sound evidence on the effects of supportive supervision owing to limitations in research design and the complexity of evaluating such interventions. The approaches required a high level of external inputs, which challenge the sustainability of such models.

Healthcare-associated infections in sub-Saharan Africa

The rising burden of non-communicable diseases in sub-Saharan Africa