Primary Care Facilities Research Articles

Organizational readiness to implement task-strengthening strategy for hypertension management among people living with HIV in Nigeria

BackgroundHypertension (HTN) is highly prevalent among people living with HIV (PLHIV), but there is limited access to standardized HTN management strategies in public primary healthcare facilities in Nigeria. The shortage of trained healthcare providers in Nigeria is an important contributor to the increased unmet need for HTN management among PLHIV. Evidence-based TAsk-Strengthening Strategies for HTN control (TASSH) have shown promise to address this gap in other resource-constrained settings. However, little is known regarding primary health care facilities’ capacity to implement this strategy. The objective of this study was to determine primary healthcare facilities’ readiness to implement TASSH among PLHIV in Nigeria.MethodsThis study was conducted with purposively selected healthcare providers at fifty-nine primary healthcare facilities in Akwa-Ibom State, Nigeria. Healthcare facility readiness data were measured using the Organizational Readiness to Change Assessment (ORCA) tool. ORCA is based on the Promoting Action on Research Implementation in Health Services (PARIHS) framework that identifies evidence, context, and facilitation as the key factors for effective knowledge translation. Quantitative data were analyzed using descriptive statistics (including mean ORCA subscales). We focused on the ORCA context domain, and responses were scored on a 5-point Likert scale, with 1 corresponding to disagree strongly.FindingsFifty-nine healthcare providers (mean age 45; standard deviation [SD]: 7.4, 88% female, 68% with technical training, 56% nurses, 56% with 1–5 years providing HIV care) participated in the study. Most healthcare providers provide care to 11–30 patients living with HIV per month in their health facility, with about 42% of providers reporting that they see between 1 and 10 patients with HTN each month. Overall, staff culture (mean 4.9 [0.4]), leadership support (mean 4.9 [0.4]), and measurement/evidence-assessment (mean 4.6 [0.5]) were the topped-scored ORCA subscales, while scores on facility resources (mean 3.6 [0.8]) were the lowest.ConclusionFindings show organizational support for innovation and the health providers at the participating health facilities. However, a concerted effort is needed to promote training capabilities and resources to deliver services within these primary healthcare facilities. These results are invaluable in developing future strategies to improve the integration, adoption, and sustainability of TASSH in primary healthcare facilities in Nigeria.Trial registrationNCT05031819.

Schistosoma haematobium urinary tract complications in African migrants attending primary care facilities in Paris, France: A retrospective cohort study (2004–2018)

ObjectivesLittle is known about the burden of urogenital schistosomiasis (UGS) outside endemic areas. This study was aimed at describing urinary complications of UGS detected among African migrants in French primary care facilities. Patients and methodsA retrospective cohort study included patients with UGS diagnosed from 2004 to 2018 in 5 primary health centers in Paris. Cases were defined by the presence of typical Schistosoma haematobium eggs at urine microscopy. Demographic, clinical, biological and imaging data were collected. Ultrasonography (U-S) findings were classified in accordance with the WHO guidelines. ResultsU-S was prescribed for all patients and performed in 100/118. Sex ratio (F/M) was 2/98, and mean age 24.4 years. Patients were from West Africa (73% from Mali) and consulted 8 months (median) after their arrival. Among the 95 patients with interpretable findings, 32 (33.7%) had abnormalities related to UGS, considered as major in 6 cases (6.3%), and mostly localized at the bladder (31/32) without detection of cancer. No sociodemographic, clinical, or biological factors were found to be associated with U-S abnormalities. All 100 patients were treated by praziquantel (PZQ). Among those with abnormalities, 20/32 received two to four doses at various time intervals. Post-cure imaging control performed in 19/32 showed persistent abnormalities in 6 patients, on average 5 months after the last PZQ uptake. ConclusionUrinary tract abnormalities associated with UGS were common and predominated at the bladder. U-S should be prescribed to any patient with positive urine microscopy. Schedules for PZQ uptake and U-S monitoring for patients with complications remain to be determined.

Feeding Problems in Young Children: A Cross-Sectional Study in Sweden.

Parents of children attending regular 10-, 18-, and 36-month visits at the child health care centers (CHCCs) in Sweden answered a questionnaire including a Swedish version of the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) as well as demographic questions. CHCCs were stratified according to a sociodemographic index. Parents of 238 girls (115) and boys (123) completed the questionnaire. Using international thresholds for FP detection, 8.4% of the children had a total frequency score (TFS) indicating FP. Based on the total problem score (TPS), the result was 9.3%. The mean score for all children was 62.7 for TFS (median 60; range 41-100), and 2.2 for TPS (median 0; range 0-22). Children aged 36 months had a significantly higher average TPS score than younger children, but TFS scores did not differ by age. There were no significant difference in gender, parents' education, or sociodemographic index. Prevalence numbers found in this study are similar to those found in studies with BPFAS in other countries. Children 36 months of age had a significantly higher prevalence of FP than children aged 10 and 18 months. Young children with FP should be referred to health care specializing in FP and PFD. Creating awareness of FP and PFD in primary care facilities and child health services may facilitate early detection and intervention for children with FP.

The State of the HIV Epidemic in the Philippines: Progress and Challenges in 2023.

In the past decade, the Philippines has gained notoriety as the country with the fastest-growing human immunodeficiency virus (HIV) epidemic in the Western Pacific region. While the overall trends of HIV incidence and acquired immunodeficiency syndrome (AIDS)-related deaths are declining globally, an increase in new cases was reported to the HIV/AIDS and ART Registry of the Philippines. From 2012 to 2023, there was a 411% increase in daily incidence. Late presentation in care remains a concern, with 29% of new confirmed HIV cases in January 2023 having clinical manifestations of advanced HIV disease at the time of diagnosis. Men having sex with men (MSM) are disproportionately affected. Various steps have been taken to address the HIV epidemic in the country. The Philippine HIV and AIDS Policy Act of 2018 (Republic Act 11166) expanded access to HIV testing and treatment. HIV testing now allows for the screening of minors 15-17 years old without parental consent. Community-based organizations have been instrumental in expanding HIV screening to include self-testing and community-based screening. The Philippines moved from centralized HIV diagnosis confirmation by Western blot to a decentralized rapid HIV diagnostic algorithm (rHIVda). Dolutegravir-based antiretroviral therapy is now the first line. Pre-exposure prophylaxis in the form of emtricitabine-tenofovir disoproxil fumarate has been rolled out. The number of treatment hubs and primary HIV care facilities continues to increase. Despite these efforts, barriers to ending the HIV epidemic remain, including continued stigma, limited harm reduction services for people who inject drugs, sociocultural factors, and political deterrents. HIV RNA quantification and drug resistance testing are not routinely performed due to associated costs. The high burden of tuberculosis and hepatitis B virus co-infection complicate HIV management. CRF_01AE is now the predominant subtype, which has been associated with poorer clinical outcomes and faster CD4 T-cell decline. The HIV epidemic in the Philippines requires a multisectoral approach and calls for sustained political commitment, community involvement, and continued collaboration among various stakeholders. In this article, we outline the current progress and challenges in curbing the HIV epidemic in the Philippines.

Sex-based differences in risk of cardiovascular disease development and cardiovascular risk factors among individuals with hypertension: A cross-sectional study from primary care facilities

BackgroundOver the last two decades, the understanding of cardiovascular disease (CVD) has expanded in Asian countries. Despite this progress, there have been limited investigations into sex-based differences in the development of CVD and cardiovascular risk factors (CVRFs). AimWe investigated whether males and females with hypertension had different risks of developing CVD and CVRFs. MethodsWe used a stratified multi-stage sampling design involving 15 primary care centers in Thailand. We recruited 1,448 individuals aged 35–74 years old. The Framingham cardiovascular risk algorithm was used to determine the risk of CVD development. ResultsFemale patients were overall more likely to have lower CVD risk scores. However, they demonstrated higher scores in the moderate-risk (p < 0.001) and high-risk (p < 0.001) groups as compared with males. One in four females was at a high risk of developing CVD. Females had higher rates of all CVRFs against males across sub-risk groups, with the highest odds ratio observed in the high-risk group, which persisted after adjusting for covariations. Overall, female patients had higher rates of diabetes, hyperlipidemia, obesity, and abdominal obesity as compared with males. Females in the overall group had a lower prevalence of uncontrolled hypertension than males, in contrast to the high-risk group. Female patients also had a lower prevalence of cigarette smoking and alcohol consumption than males. ConclusionThere is evidence of sex-based differences in the risk of CVD development in hypertensive individuals. The interaction of CVRFs with a high risk of developing CVD was noted in females.

Point-of-care test for tuberculosis: a boon in diagnosis.

Rapid diagnosis of tuberculosis (TB) is an effective measure to eradicate this infectious disease worldwide. Traditional methods for screening TB patients do not provide an immediate diagnosis and thus delay treatment. There is an urgent need for the early detection of TB through point-of-care tests (POCTs). Several POCTs are widely available at primary healthcare facilities that assist in TB screening. In addition to the currently used POCTs, advancements in technology have led to the discovery of newer methods that provide accurate and fast information independent of access to laboratory facilities. In the present article, the authors tried to include and describe the potential POCTs for screening TB in patients. Several molecular diagnostic tests, such as nucleic acid amplification tests, including GeneXpert and TB-loop-mediated isothermal amplification, are currently being used as POCTs. Besides these methods, the pathogenic component of Mycobacterium tuberculosis can also be utilized as a biomarker for screening purposes through immunological assays. Similarly, the host immune response to infection has also been utilized as a marker for the diagnosis of TB. These novel biomarkers might include Mtb85, interferon-γ inducible protein-10, volatile organic compounds, acute-phase proteins, etc. Radiological tests have also been observed as POCTs in the TB screening POCT panel. Various POCTs are performed on samples other than sputum, which further eases the screening process. These POCTs should not require large-scale manpower and infrastructure. Hence, POCT should be able to identify patients with M. tuberculosis infection at the primary healthcare level only. There are several other advanced techniques that have been proposed as future POCTs and have been discussed in the present article.

Contracting the private health sector in Thailand's Universal Health Coverage.

Private sector plays an import role in health service provision, therefore the engagement of private health facilities is important for ensuring access to health services. In Thailand, two of the three public health insurance schemes, Universal Coverage Scheme and Social Health Insurance, contract with private health facilities to fill gaps of public providers for the provision of health services under Universal Health Coverage. The National Health Security Office (NHSO) and Social Security Office (SSO), which manage the schemes respectively, have designed their own contractual agreements for private facilities. We aim to understand the current situation of contracting private health facilities within UHC of the two purchasing agencies. This qualitative descriptive case study was conducted through document review and in-depth interviews with key informants to understand how they contract private primary care facilities, service types, duration of contract, standard and quality requirement and renewal and termination of contracts. Private providers make a small contribution to the service provision in Thailand as a whole but they are important actors in Bangkok. The current approaches used by two purchasers are not adequate in engaging private sector to fill the gap of public provision in urban cities. One important reason is that large private hospitals do not find public contracts financially attractive. NHSO classifies contracts into 3 categories: main contracting units, primary care units, and referral units; while SSO only contracts main contracting units. Both allows subcontracting by the main contractors. Contractual agreements are effective in ensuring mandatory infrastructure and quality standards. Both purchasers have established technical capacities to enforce quality monitoring and financial compliance although there remains room for improvement especially on identifying fraud and taking legal actions. Contracting private healthcare facilities can fill the gap of public healthcare facilities, especially in urban settings. Purchasers need to balance the right level of incentives and accountability measures to ensure access to quality of care. In contracting private-for-profit providers, strong regulatory enforcement and auditing capacities are necessary. Further studies may explore various aspects contracting outcomes including access, equity, quality and efficiency impacts.

Exploring barriers to switching "on time" to second-line antiretroviral therapy among nurses in primary health care facilities, Ekurhuleni Health District, South Africa.

Ensuring that all HIV-infected people receive antiretroviral therapy (ART) and achieve viral suppression are key South African strategies to end the AIDS epidemic in the country. National HIV treatment guidelines recommend an immediate switch to second-line ART following virological failure with first-line ART. Nurses based in district health facilities are at the forefront of implementing this recommendation. While there are often delays in switching and in some instances no switch, the reasons for and barriers to delayed switching are not well understood at the primary care level. To explore the views of frontline nursing staff about factors contributing to delayed switching of patients who have failed first-line ART regimen in Ekurhuleni district, South Africa. A qualitative study was conducted among 21 purposively sampled nurses who provide HIV treatment and care to patients in 12 primary health care (PHC) facilities in Ekurhuleni Health District, Gauteng Province, South Africa. Individual in-depth interviews explored nurses' experiences regarding their recognition of virological failure and understanding of "on time" switching to second-line ART. Interviews probed the circumstances contributing to delays in switching. After digital audio recording and transcription, manual inductive thematic analysis was used to analyse the data. Multiple barriers were identified: 1) Healthcare provider factors included a lack of knowledge and confidence coupled with demotivation in the workplace; 2) Patient issues similarly comprised a lack of knowledge as well as resistance to being switched to another drug regimen and loss to follow up; 3) Systems factors were poor facility leadership, shortages of medication, staffing constraints, and the inability to trace laboratory results, especially for migrant patients. Reasons for delayed switching of patients to second-line ART are multifactorial and require integrated interventions at health provider, patient and health system levels.

Prevalence of probable mental, neurological and substance use conditions and case detection at primary healthcare facilities across three districts in Ghana: findings from a cross-sectional health facility survey

BackgroundFew studies have examined the prevalence of mental, neurological and substance use (MNS) conditions, case detection and treatment in primary healthcare in rural settings in Africa. We assessed prevalence and case detection at primary healthcare facilities in low-resource rural settings in Ghana.MethodsA cross-sectional survey was conducted at the health facility level in three demonstration districts situated in Bongo (Upper East Region), Asunafo North (Ahafo Region) and Anloga (Volta Region) in Ghana. The study participants were resident adult (> 17 years) out-patients seeking healthcare at primary care facilities in each of the three demonstration districts. Data were collected on five priority MNS conditions: depression, psychosis, suicidal behaviour, epilepsy and alcohol use disorders.ResultsNine hundred and nine (909) people participated in the survey. The prevalence of probable depression was 15.6% (142/909), probable psychotic symptoms was 12% (109/909), probable suicidal behaviour was 11.8% (107/909), probable epilepsy was 13.1% (119/909) and probable alcohol use disorders was 7.8% (71/909). The proportion of missed detection for cases of depression, self-reported psychotic symptoms, epilepsy and alcohol use disorders (AUD) ranged from 94.4 to 99.2%, and was similar across study districts. Depression was associated with self-reported psychotic symptoms (RR: 1.68; 95% CI: 1.12–1.54). For self-reported psychotic symptoms, a reduced risk was noted for being married (RR: 0.62; 95% CI: 0.39–0.98) and having a tertiary level education (RR: 0.12; 95% CI: 0.02–0.84). Increased risk of suicidal behaviour was observed for those attending a health facility in Asunafo (RR: 2.31; 95% CI: 1.27–4.19) and Anloga districts (RR: 3.32; 95% CI: 1.93–5.71). Age group of 35 to 44 years (RR: 0.43; 95% CI: 0.20–0.90) was associated with reduced risk of epilepsy. Being female (RR: 0.19; 95% CI: 0.12–0.31) and having a tertiary education (RR: 0.27; 95% CI: 0.08–0.92) were associated with reduced risk of AUD.ConclusionsOur study found a relatively high prevalence of probable MNS conditions, and very low detection and treatment rates in rural primary care settings in Ghana. There is a need to improve the capacity of primary care health workers to detect and manage MNS conditions.

Assessing the cost and utilization of SMS printers by primary health care facilities: lessons learned from South Africa.

Historically, paper-based laboratory reports were delivered by couriers to health facilities resulting in post-analytical delays. As a result, short message service (SMS) printers were deployed to fill this gap, with the global data service platform (GDSP) being primarily used to facilitate deployment. In addition, these printers generate binary and quantitative information that can be used to assess utilization. The objective of this study was to determine the costs and utilization of the SMS printer program in South Africa. A cost analysis for 2020 was undertaken. We determined annual equivalent costs (AEC) for staffing, printers, fixed costs related to the national coordinator, consumables, travel costs, database support/hosting/dashboard development, printer repairs, and results transmission. The main outcome of interest was the cost per SMS printer result delivered. Data were extracted to assess utilization as follows: i) months active (based on internet protocol data); ii) signal; iii) battery strength. There were 4,450,116 results delivered to printers that were situated at 2232 primary health care facilities. An AEC of $687,727 was reported, with a cost per result delivered of $0.1618. The SMS printers contributed 73.52% to the total AEC. Overall, 90% of the printers were GDSP based, of which only 69.5% were determined to be active. The majority of active printers reported a signal strength of ≥60% and a battery strength of ≥6 volts. Although the SMS printer program has the potential to reduce post-analytical delays, pathology services should migrate to an end-to-end electronic interface to improve patient care.

Association of Health Care Utilization and Access to Care With Vascular Assessment Before Major Lower Extremity Amputation Among US Veterans

Patient-level characteristics alone do not account for variation in care among US veterans with peripheral artery disease (PAD). Presently, the extent to which health care utilization and regional practice variation are associated with veterans receiving vascular assessment prior to major lower extremity amputation (LEA) is unknown. To assess whether demographics, comorbidities, distance to primary care, the number of ambulatory clinic visits (primary and medical specialty care), and geographic region are associated with receipt of vascular assessment prior to LEA. This national cohort study used US Department of Veterans Affairs' Corporate Data Warehouse data from March 1, 2010, to February 28, 2020, for veterans aged 18 or older who underwent major LEA and who received care at Veterans Affairs facilities. The number of ambulatory clinic visits (primary and medical specialty care) in the year prior to LEA, geographic region of residence, and distance to primary care. The main outcome was receipt of a vascular assessment (vascular imaging study or revascularization procedure) in the year prior to LEA. Among 19 396 veterans, the mean (SD) age was 66.78 (10.20) years and 98.5% were male. In the year prior to LEA, 8.0% had no primary care visits and 30.1% did not have a vascular assessment. Compared with veterans with 4 to 11 primary care clinic visits, those with fewer visits were less likely to receive vascular assessment in the year prior to LEA (1-3 visits: adjusted odds ratio [aOR], 0.90; 95% CI, 0.82-0.99). Compared with veterans who lived less than 13 miles from the closest primary care facility, those who lived 13 miles or more from the facility were less likely to receive vascular assessment (aOR, 0.88; 95% CI, 0.80-0.95). Veterans who resided in the Midwest were most likely to undergo vascular assessment in the year prior to LEA than were those living in other regions. In this cohort study, health care utilization, distance to primary care, and geographic region were associated with intensity of PAD treatment before LEA, suggesting that some veterans may be at greater risk of suboptimal PAD care practices. Development of clinical programs, such as remote patient monitoring and management, may represent potential opportunities to improve limb preservation rates and the overall quality of vascular care for veterans.

Dorsolateral Nigral Hyperintensity on 1.5 T Versus 3 T Susceptibility-Weighted Magnetic Resonance Imaging in Neurodegenerative Parkinsonism.

An absent dorsolateral nigral hyperintensity (DNH) is a common finding in patients with neurodegenerative parkinsonism at high or ultra-high field susceptibility-weighted magnetic resonance imaging (SWI). Despite increasing use of high field magnetic resonance imaging (MRI) in specialized centers, these scanners are still frequently unavailable in primary care or outpatient facilities and underdeveloped or emerging countries. Therefore, the aim of the present study was to evaluate the diagnostic utility of DNH assessment at 1.5 versus 3 T MRI to distinguish patients with neurodegenerative parkinsonism, including Parkinson's disease (PD), multiple system atrophy (MSA) and progressive supranuclear palsy (PSP), from healthy controls (HC). Absence of DNH was assessed on visual inspection of anonymized 1.5 T and 3.0 T SWI scans in a case-control study including 86 patients with neurodegenerative parkinsonism and 33 healthy controls (HC). All study participants were consecutively recruited to undergo 1.5 and 3 T MRI. Overall correct classification was 81.7% (95% CI, 72.6-88.4%) for 1.5 T and 95.7% (95% CI, 89.1-98.7%) for 3 T MRI in discriminating neurodegenerative parkinsonism from controls. However, while DNH was bilaterally present in all but one of the HC at 3 T MRI, it was rated as abnormal (at least unilateral absence) in 15 of 22 HC at 1.5 T MRI, resulting in a specificity of 31.8%. The results of the present study demonstrate an insufficient specificity of visual assessment of DNH at 1.5 T MRI for the diagnosis of neurodegenerative parkinsonism.

Intrinsic and extrinsic motivational factors of frontline health workers in Ghana

Background: Human resources are vital for delivering health services, and health systems cannot function effectively without enough skilled, motivated, and well-supported health workers. Even though several studies have addressed job satisfaction among healthcare professionals in different parts of the world, there is limited research examining intrinsic and extrinsic motivational factors involved in job satisfaction, particularly in low-and-middle-income countries. Methods: This was a facility-based quantitative cross-sectional study conducted in 34 primary health care facilities, across three out of the 26 districts in the Eastern Region of Ghana, between February and March 2018, analyzing job satisfaction and underlying factors. Randomly selected public health workers (n=287) from health facilities were included in the study. The two-factor theory was adopted as the measurement model for this study. Results: The odds of staff that had received management training in the past 12 months being intrinsically satisfied was 3.73 (95% CI:2.03,6.86) times higher than staff with no management training (p&lt;0.001). Compared to staff working in hospitals, Community-based Health Planning and Services (CHPS) staff showed lower levels of satisfaction on factors relating to intrinsic motivation. Technical staff had higher odds of being intrinsically and extrinsically satisfied compared to non-technical staff. Conclusions: Public healthcare workers working at primary health facilities in Ghana, at higher levels of service delivery, showed higher satisfaction compared to lower-level staff, both in terms of intrinsic and extrinsic factors underlying satisfaction. Thus, to enhance healthcare services, health facilities’ administrators should take measures to improve the working conditions of staff at all levels of service delivery, since the hierarchy of service delivery in the health system makes the contributory role of all staff critical in improving the quality of primary healthcare.

Assessment of the implementation of health education in primary health care facilities, Kavango, East Region, Namibia.

Primary Health Care (PHC) facilities are critical in preventing, detecting, and managing sickness and injury, thereby lowering morbidity and mortality. This is easily accomplished through health education, which is one of the most effective disease prevention methods. The goal of this study is to evaluate the implementation of the health education technique in PHC facilities in the Kavango East Region. A quantitative method was used in conjunction with a descriptive cross-sectional design to evaluate the implementation of health education in PHC facilities in the Kavango East Region. The outcomes show that 76% of patients who visit health facilities did not receive health education about their condition, and those who did receive health education know six times more about how to prevent the conditions they are suffering from than those who did not. The study also found that 49.14% of patients got information that was irrelevant to their conditions. These results indicate a statistically significant relationship (2.32 OR 0.93 at 95% CI) between patients who did not receive health education and frequent visits to the PHC facility with the same complaints. There is a lack of health education implementation in PHC facilities, with patients not getting or being provided with relevant health education to empower them to take care of their own health. The emphasis of PHC centers is on curative services rather than preventative and rehabilitation services. PHC facilities must improve health education as a critical approach to health promotion and disease prevention. This will allow patients to take appropriate preventive measures, resulting in fewer trips to PHC facilities.

Understanding dementia care pathways for policy development and service planning in Kenya.

In Kenya, there is lack of evidence on existing dementia care pathways, with minimal or no presentation for dementia-related symptoms in health care settings. Understanding the services available for people with dementia as well as how communities access the services could offer a practical pattern for policy makers to identify strategies that encourage early detection, care and support for people with dementia and their families. To elucidate initial responses of individuals and their families to dementia and challenges encountered in help seeking through care pathways to inform dementia care-related policies and practice. The Strengthening Responses to dementia in Developing Countries (STRiDE) Kenya team adapted case vignettes (brief hypothetical stories meant to elicit responses on how the characters would behave) developed by the entire STRiDE team. A total of 29 stakeholders were then asked to provide feedback on the completed vignettes and summarize a common pathway to dementia care in Kenya while using the proposed case vignettes. We found four initial responses to dementia suspicion in Kenya where individuals:(i) Perceive symptoms as normal part of ageing, (ii) Consult a spiritual or traditional healer, (iii) Visit a private clinic or primary health care facilities, or (iv) No action taken. These were the first points within the care pathways which determined the care trajectory the person with dementia would follow. Identification of dementia care pathways could form a basis for improving the way communities perceive dementia etiology and establish standard pathways to care whilst ensuring that some pathways do not further pose an impediment to care and treatment for dementia.

Beyond access to medication: the role of SUS and the characteristics of HIV care in Brazil.

To estimate the public-private composition of HIV care in Brazil and the organizational profile of the extensive network of public healthcare facilities. Data from the Qualiaids-BR Cohort were used, which gathers data from national systems of clinical and laboratory information on people aged 15 years or older with the first dispensation of antiretroviral therapy between 2015-2018, and information from SUS healthcare facilities for clinical-laboratory follow-up of HIV, produced by the Qualiaids survey. The follow-up system was defined by the number of viral load tests requested by any SUS healthcare facility: follow-up in the private system - no record; follow-up at SUS - two or more records; undefined follow-up - one record. SUS healthcare facilities were characterized as outpatient clinics, primary care and prison system, according to the respondents' self-classification in the Qualiaids survey (72.9%); for non-respondents (27.1%) the classification was based on the terms present in the names of the healthcare facilities. During the period, 238,599 people aged 15 years or older started antiretroviral therapy in Brazil, of which 69% were followed-up at SUS, 21.7% in the private system and 9.3% had an undefined system. Among those followed-up at SUS, 93.4% received care in outpatient clinics, 5% in primary care facilities and 1% in the prison system. In Brazil, antiretroviral treatment is provided exclusively by SUS, which is also responsible for clinical and laboratory follow-up for most people in outpatient clinics. The study was only possible because SUS maintains records and public information about HIV care. There is no data available for the private system.

Spatial Accessibility to Primary Healthcare Facilities in Iran: A GIS-Based Approach

Background: Primary healthcare facilities are essential to provide healthcare to individuals and the society closer to home. Fast, timely, and affordable access to these centers is important in each society. This is especially crucial to prevent and control the epidemics of non-communicable diseases that are highly affecting populations in urban settings. This study aimed to assess spatial accessibility to primary healthcare facilities in Yazd city (Iran), using a Geographic Information System (GIS).&#x0D; Methods: In this descriptive-analytical study, which was conducted cross-sectionally in 2022, locational information related to primary healthcare centers, population distribution, and urban zoning of Yazd city were collected and recorded in Excel format. Then, distribution maps of each of the studied uses were determined. Then, the existing indicators and standards regarding the uses were determined through documentary studies, and a geographic database was formed through the GIS software collection. Data were analyzed using indicators and models such as hot spot analysis, Thiessen's polygons algorithm, access model based on the two-step floating catchment area, and the average distance model of the nearest neighbor.&#x0D; Results: The results indicated that the comprehensive health centers in Yazd city are located next to each other with a scattered distribution pattern, and are away from each other by an average distance of 1131 meters. Also, the distance of urban health posts from each other is 1045 meters on average, and are randomly located next to each other. The main concentration of the distribution of primary health care facilities is observed in the central and traditional regions of the city, which, according to the hot spot analysis, are among the cold and low population density spots. In addition, the access score of the regions indicates that the distribution of these facilities is not according to the population density, and the highest functional pressure of comprehensive health centers as well as urban health posts is observed in the regions where there is the least access to these facilities.&#x0D; Conclusion: There is a disparity between the distribution of primary healthcare facilities and population density in Yazd city, Iran. This study provides significant evidence to local health policymakers and urban planners to design more efficient actions related to equal development of health infrastructure by using the GIS.

Assessment of Availability of Tracer Drugs and Basic Diagnostics at Public Primary Health Care Facilities in Ethiopia During COVID-19 Pandemic.

The emergence of COVID-19 pandemic has disrupted the supply chain and stock of medicines and drugs across the globe. Tracer drugs are essential medicines that address the population's priority health problems. Thus, this study aimed to assess availability of tracer drugs and basic diagnostics at public primary health care facilities in Ethiopia. Facility based cross-sectional study was employed in four regions and one city administration. The primary health care units (PHCUs) were purposively selected in consultation with respective regional health bureaus. Finally, 16 hospitals, 92 health centers and 344 health posts were included. This study adopted WHO's tool that was being used to rapidly assess the capacity of health facilities to maintain the provision of essential health services during the COVID-19. Descriptive analysis was done using frequency and percentage, and results were presented. The overall mean availability of tracer drugs in PHCUs was 77.6%. Only 2.8% of PHCUs have all tracer drugs. The mean availability of basic diagnostic at national level was 86.6% in PHUs except health posts where it was less. Health facilities with all basic diagnostic services was 53.7%. Of the total 344 health posts assessed, 71% were providing diagnostic testing for malaria using either laboratory equipment or rapid diagnostic test (RDT) while 43% provide urine test for the pregnancy. This study shows availability of all tracer drugs in PHCUs in Ethiopia was extremely low. There was regional variation in availability of tracer drugs and basic diagnostics. It is very crucial to increase availability of tracer drugs and diagnostics. Drugs and diagnostic materials should be supplied according to the capacity and location of health facilities.

Strengthening the primary health care system in the face of emerging and re-emerging epidemics; providing a native and applicable model based on best practices of countries

INTRODUCTION: Disasters affected the primary health care system in many ways. Maintaining primary health care services is a challenging issue during disasters such as epidemics. A review was conducted to study the lessons learned and successful experiences of other countries in opposing the spread of infectious diseases using the capacity of primary health care. MATERIAL AND METHODS: The present study is a comprehensive review of countries’ experiences, successful models, and structural components for development of a model for Iran. A systematic search with suitable keywords was conducted in many databases including web of science, PubMed, Scopus, Science Direct, Google Scholar, and Persian databases; Magiran, and SID. RESULTS: The results showed that generally, the successful actions of countries in case of emergency are divided into disaster cycles including preparedness, response, and recovery. PHC can help health systems to identify new epidemics through surveillance system as an early warning system. Because of the importance of continuity of care in primary health care facilities, business continuity plans are needed. CONCLUSIONS: In order to use the consequences and play an effective role in this field, Iran should use the country’s capacity and inter-sectoral cooperation to establish a comprehensive system for telemedicine programs Providing people with doctors and health professionals can strengthen the performance of the primary health care system finally can strengthen the performance of the primary health care system.

Service Availability and Readiness of Primary Care Health Facilities Offering Hypertension Diagnosis Services in Wakiso District, Uganda, 2019.

Hypertension is a growing burden in Uganda and other low- and middle-income countries. Appropriate diagnosis services are needed at primary care health facilities to identify, initiate treatment for, and manage hypertension. This study assessed service availability and readiness as well as facilitators and barriers in primary health care facilities for hypertension diagnosis services in Wakiso District, Uganda. In July and August 2019, we conducted structured interviews at 77 randomly selected primary care health facilities in Wakiso District. We used an interviewer-administered health facility checklist modified from the World Health Organization's service availability and readiness assessment tool. We also conducted 13 key informant interviews with health workers and district-level managers. Readiness was measured by availability of functional diagnostic equipment, related supplies and tools, and health provider attributes. Service availability was measured by assessing hypertension diagnosis services. Most (86%; 66 of 77) health facilities offered hypertension diagnosis services and 84% (65 of 77) had digital blood pressure measuring devices; only 69% (53 of 77) had functional blood pressure measuring devices. Lower-level facilities lacked appropriate blood pressure cuffs for use across age groups: 92% (71 of 77) lacked pediatric cuffs and 52% (40 of 77) lacked alternative adult cuffs. Facilitators for diagnosing hypertension included partners that built health facility staff capacity and funds for purchasing hypertension diagnostic supplies; common barriers were nonfunctional equipment, delays in receiving training, and inadequate staffing. The results highlight the need for an adequate supply of devices, routine replacements or repairs, and frequent refresher training for health workers.