Primary Health Care Clinics Research Articles

Nurses’ perspectives on user-friendly self-sampling interventions for diagnosis of sexually transmitted infections among young women in eThekwini district municipality: a nominal group technique

BackgroundSyndromic management in the main non-laboratory-based management approach for sexually transmitted infections (STI) in most low- and middle-income countries (LMICs) but it has limitations. Self-sampling has been proven as a suitable alternative approach to help improve management STIs by improving access to diagnosis among vulnerable populations. We sought to determine health workers’ perspectives on user-friendly self-sampling interventions for STIs among young women in eThekwini District Municipality.MethodsHealthcare workers providing STI healthcare services in the study location participated in a nominal group technique (NGT) workshop. The NGT workshop was aimed enabling collaboration with key health providers in identifying user-friendly self-sampling interventions for diagnosis of STIs among young women. Data collection was conducted in two phases: phase 1 determined barrier that hinder young women from accessing current STI healthcare services and phase 2 focused on determining the key strategies for self-sampling interventions to diagnose STIs in young women. Thematic analysis and percentage form analysis were used to examine qualitative and quantitative data respectively.ResultsThe following barriers were identified: negligence; myths about STIs; fear of judgement; denial; operating hours; lack of knowledge of STI symptoms and safe sex practices; and stigma associated with STIs. The following strategies were suggested: hand out self-sampling kits at popular restaurants; collect self-sampling kits from security guard at primary healthcare clinics (PHCs); receive STI diagnostic results via SMS or email or the clinic for treatment; improve youth friendly services at PHCs; educate the public on proper use of the kits. Education about STIs and handing out self-sampling kits at clinics, universities, schools, pharmacies or via outreach teams were ranked high priority strategies.ConclusionsThe findings highlight the need to address stigma and fear of judgment and provide comprehensive education to improve healthcare-seeking behaviour in young women. Additionally, the study also indicates that using eHealth solutions could significantly enhance the accessibility and efficiency of STI healthcare services in LMICs.

Maternal and fetal/neonatal outcomes in pregnancy, delivery and postpartum following bariatric surgery and comparison with pregnant women with obesity: a study protocol for a prospective cohort

BackgroundBeing obese can lead to various complications during pregnancy, such as Gestational Diabetes Mellitus (GDM), pregnancy induced hypertension (PIH), Pre-Eclampsia (PE), and Large Gestational Age (LGA). Although bariatric surgery is an effective way to treat obesity, it can also result in complications and may be linked to having small for gestational age (SGA) babies. This cohort study protocol aims to compare the maternal and fetal/neonatal outcomes of two groups of Iranian pregnant women: those who have undergone bariatric surgery and those who are obese but have not had bariatric surgery.MethodsIn this study Pregnant women (< 14 weeks’ gestation) (n = 38 per group) are recruited either from one of the obesity clinic (exposure group = with a history of bariatric surgery) or primary healthcare clinics in Tehran city (comparison group = pregnant women with obesity and and no history of bariatric surgery). Dietary intake and nutrient status are assessed at < 14, 28, and 36 weeks. Maternal and fetal/neonatal outcomes are compared between the two groups, including gestational diabetes, preeclampsia, preterm labor, intrauterine growth restriction, severe nausea and vomiting, abortion, placenta previa and abruption, venous thrombosis, vaginal bleeding, cesarean delivery, meconium aspiration, and respiratory distress. Maternal serum levels of ferritin, albumin, zinc, calcium, magnesium, selenium, copper, vitamins A, B9, B12, and 25-hydroxy Vit D are checked during 24th to 28th weeks. Maternal and neonatal outcomes, including height, weight, head circumference, fetal abnormality, infection, small or large fetus, low birth weight, macrosomia, NICU admission, and total weight gain during pregnancy, are measured at birth. Maternal and offspring outcomes, including weight, height, head circumference, total weight gain during pregnancy, newborn diseases, postpartum bleeding, breastfeeding, and related problems, are assessed 6 weeks after delivery. Child's weight, height, and head circumference are followed at 2, 4, 6, 8, 10, and 12 months after birth. Maternal stress, anxiety, and depression are assessed with the DASS-21 questionnaire, and physical activity is evaluated using the PPAQ questionnaire in the first and third trimesters.DiscussionBy assessing the levels of micronutrients in the blood of pregnant women along with the evaluation of pregnancy outcomes, it is feasible to gain a more accurate understanding of how bariatric surgery affects the health and potential complications for both the mother and the fetus/newborn. This information can help specialists and patients make more informed decisions about the surgery. Additionally, by examining issues such as stress, anxiety, and depression in women undergoing surgery, this study can contribute to recognizing these problems, which can also affect pregnancy outcomes.

Assessing interventions to encourage primary care health workers to recommend influenza vaccination and the impact on vaccination uptake for persons with Non-Communicable diseases in China

BackgroundInfluenza vaccination coverage is low among persons with non-communicable diseases (NCDs) in China. Chinese health workers (HWs) do not routinely recommend influenza vaccination despite evidence that recommendations increase vaccine uptake. This study aims to assess whether interventions increased primary care HWs’ recommendation for influenza vaccination and measure their impact on influenza vaccine uptake in persons with NCDs. MethodsWe conducted a cluster randomized controlled study in public primary healthcare clinics in Hubei from November 2018 through April 2019. In the intervention clinics, primary care HWs received training on the benefits of influenza vaccination and were asked to recommend influenza vaccine in routine primary healthcare for persons with NCDs. In the control clinics, primary care HWs did not receive training and provided standard services. We conducted questionnaire surveys before and after the intervention to collect information about recommendations made and receipt of influenza vaccines. ResultsA total of 896 primary care HWs and 4552 persons with NCDs were included. After intervention, a higher percentage of HWs recommended influenza vaccines in intervention clinics compared to control clinics. Vaccinated primary care HWs were more likely to recommend vaccination. Persons with NCDs reported higher influenza vaccination coverage in intervention than control clinics, and primary care HWs’ recommendation increased vaccination uptake among persons with NCDs. ConclusionsVaccinated primary care HWs were more likely to recommend influenza vaccination than unvaccinated HWs. Promoting primary care HWs’ vaccination and encouraging them to recommend influenza vaccination during routine primary healthcare could increase influenza vaccine receipt among persons with NCDs.Registration number ChiCTR2200067140.

COVID-19 vaccination uptake and receptivity among veterans enrolled in homelessness-tailored primary health care clinics: provider trust vs. misinformation

BackgroundCompared to the general population, individuals experiencing homelessness are at greater risk of excess morbidity and mortality from COVID-19 but have been vaccinated at lower rates. The U.S. Department of Veterans Affairs (VA)’s Homeless Patient Aligned Care Team (HPACT) program integrates health care and social services for Veterans experiencing homelessness to improve access to and utilization of care.MethodsThis study explores the vaccination uptake behavior and attitudes through a qualitative comparative case study of two HPACT clinics, one in California (CA) and one in North Dakota (ND). Semi-structured telephone interviews were conducted with Veterans enrolled in the two VA HPACT clinics from August to December 2021 with 20 Veterans (10 at each clinic).ResultsFour themes emerged from the interviews: (1) Vaccination uptake and timing— While half of the Veterans interviewed were vaccinated, ND Veterans were more likely to be vaccinated and got vaccinated earlier than CA Veterans; (2) Housing— Unsheltered or precariously housed Veterans were less likely to be vaccinated; (3) Health Care— Veterans reporting positive experiences with VA health care and those who trusted health providers were more likely to vaccinate than those with negative or nuanced satisfaction with health care; (4) Refusers’ Conspiracy Theories and Objectivity Claims— Veterans refusing the vaccine frequently mentioned belief in conspiracy theories while simultaneously asserting their search for objective information from unbiased sources.ConclusionsThese findings amplify the importance of improving access to population-tailored care for individuals experiencing homelessness by reducing patient loads, expanding housing program enrollment, and increasing the provider workforce to ensure personalized care. Health care providers, and housing providers, social workers, and peers, who offer information without discrediting or criticizing Veterans’ beliefs, are also key to effectively delivering vaccine messaging to this population.

Assessing nurses’ knowledge and attitudes towards promoting female condom use in South African primary healthcare clinics

BackgroundFemale condoms protect against unplanned pregnancies and sexually transmitted infections (STIs) including HIV; however, their uptake is very low in South Africa. Nurses are frontline healthcare workers and are uniquely positioned to promote their use to their clients. This study assesses nurses’ knowledge of, attitudes to, and practices regarding the promotion of female condoms at selected primary healthcare facilities in the King Sabata Dalindyebo sub-district of the Eastern Cape, South Africa.MethodsA descriptive cross-sectional study was conducted from April to May 2021 at five community health centres in the King Sabata Dalindyebo sub-district, South Africa. A total of 139 nurses completed a self-administered questionnaire. Data were analysed using simple descriptive statistics.ResultsThe majority of the participants (82.7%) were knowledgeable about the female condom. Some participants did not have a good attitude and willingness to promote female condom use to their clients. Junior nurses (enrolled nursing assistants and newly qualified professional nurses) were less knowledgeable about the female condom than more qualified and older nurses. There was no significant association between level of knowledge and attitude or willingness to promote the use of the female condom.ConclusionThis study found good knowledge of the female condom among the nurses; however, the knowledge did not translate into a willingness to promote the device at their health facilities. Capacity building of the junior nurses will fill the knowledge gaps identified. Studies exploring the sociocultural issues around the female condom are needed in the region.

Observational study of selective screening for prediabetes and diabetes in a real-world setting: an interprofessional collaboration method between public dental services and primary health care in Sweden

Objective Describe a method in a real-world setting to identify persons with undiagnosed prediabetes and type 2 diabetes through an interprofessional collaboration between Public Dental Services and Primary Health Care in Regions Stockholm. Design A descriptive observational study. Setting The study was conducted at seven sites in the region of Stockholm, Sweden. Each collaborating site consisted of a primary health clinic and dental clinic. Subjects Study participants included adults over 18 years of age who visited the Public Dental Services and did not have a medical history of prediabetes or type 2 diabetes. Main outcome measures Selective screening is conducted in accordance with a risk assessment protocol at the Public Dental Services. In the investigated method, DentDi (Dental and Diabetes), adults diagnosed with caries and/or periodontitis over a cut-off value are referred to the Primary Health Care clinic for screening of prediabetes and type 2 diabetes. Results DentDi, introduced at seven sites, between the years 2017 and 2020, all of which continue to use the method today. A total of 863 participants from the Public Dental Services were referred to the Primary Health Care. Of those 396 accepted the invitation to undergo screening at the primary health care centre. Twenty-four individuals did not meet the inclusion criteria, resulting in a total of 372 persons being included in the study. Among the 372 participants, 27% (101) had elevated glucose levels, of which 12 were diagnosed with type 2 diabetes and 89 with prediabetes according to the study classification. Conclusions DentDi is a feasible method of interprofessional collaboration where each profession contributes with the competence included in everyday clinical practice for early identification of persons with prediabetes and type 2 diabetes with a complete chain of care. The goal is to disseminate this method throughout Stockholm County and even other regions in Sweden.

Quality of TB diagnostic services at primary healthcare clinics in eThekwini district, South Africa.

Overcoming the TB epidemic requires moving past expanding the coverage of healthcare services and looking to improve the quality of TB services. During COVID-19, the suboptimal state of TB services has further deteriorated, and little is known about how these services have fared after the pandemic. The study aims to assess the quality TB diagnostic services in primary health care (PHC) clinics in the eThekwini district, South Africa. Twenty-one clinics with the lowest and highest headcounts from each region of eThekwini were purposively selected. An audit tool adapted from the United States Agency for International Development (USAID) and the national TB guidelines was used to collect data on six different audit components. To assess quality, a 3-point scale was used where clinics could get a rating of either excellent, moderate, or poor performance. Descriptive statistics were employed to summarize and analyze clinic scores in Stata v15.1. Additionally, associations between clinic scores and clinic characteristics were investigated using Pearson's pairwise correlation coefficient and a linear regression model, where p < 0.05 was the measure of statistical significance. The audit found that the quality of diagnostic services in eThekwini was moderate. The gaps that required addressing were the lack of TB training among staff, adherence to infection prevention and control practices, and contact screening. Without feasible solutions, these will hinder current TB management strategies and slow progress toward ending the TB epidemic.

Effect of a Legal Clinic Program Within an Urban Primary Health Care Center on Social Determinants of Health: A Program Evaluation.

Individuals living in poverty often visit primary healthcare clinics for health problems stemming from unmet legal needs. We examined the impact of a medical-legal partnership on improving the social determinants of health (SDoH), health-related quality of life, and perceived health status of attendees of a Legal Clinic Program (LCP). This was a pre-post program evaluation of a weekly LCP established within an urban primary healthcare clinic to provide free legal consultation. Patients aged 18 years or older were either approached or referred to complete a screening tool to identify potential legal needs. Those identified with potential legal needs were offered an appointment with LCP lawyers who provided legal counsel, referrals, and services. For those who attended the LCP, changes in SDoH and health indicators were collected via a self-reported survey 6 months after they attended the LCP and compared to their baseline scores using paired t-tests, McNemar's test for paired proportions, and the Wilcoxon Signed Rank Test for related samples. During the 6-month evaluation period, 31 participants attended the LCP and completed both the baseline and 6-month surveys; 67.8% were female, 64.5% were white, 90.3% were not working full-time, and 61.3% had a household income of $700 to 1800 per month. At follow-up, 25.8% were receiving at least 1 new benefit and there was a statistically significant reduction in food insecurity (35.5% vs 9.7%, P < .05). Also, perceived health status using the visual analog scale (ranges from 0 to 100) significantly improved from 42.5 points (SD = 25.3) at baseline to 56.6 points (SD = 19.6) after 6 months (P < .05). The LCP has the potential to improve the health and wellbeing of patients in primary healthcare clinics by addressing unmet legal needs and SDoH.

Comparison of sinonasal symptoms in upper respiratory tract infections during the infectious diseases season of November 2023 to March 2024-a cross-sectional study.

Upper respiratory tract infections (URTIs) are among the most common reasons for patients consulting a general practitioner (GP) during the infectious diseases season, with viruses being the predominant cause. The COVID-19 pandemic has significantly impacted GPs' perception of these infections. The pandemic's progression, especially with the emergence of the Omicron variant, has complicated the diagnosis and treatment of URTIs, with evolving symptoms. The aim of this study was to assess the differences in symptoms reported by patients with various infections, such as COVID-19, influenza, common cold, and post-viral rhinosinusitis, during the infectious diseases season of November 2023 to March 2024. The study was conducted in a primary health care clinic, providing care for a population of approximately 10,000 people, among adult patients presenting with URTI symptoms during the 2023/2024 infectious diseases season. Patients qualified for the study were swabbed for SARS-CoV-2, influenza A and B and respiratory syncytial virus (RSV) antigens. Symptoms were assessed with the use of a semi-structured questionnaire. Of the 1810 patients presenting with symptoms of URTIs, 276 patients were included in the study. Among patients with COVID-19, symptoms of nasal obstruction (p = 0.005) and nasal discharge (p = 0.001) were less common than in those with influenza or common cold. However, these nasal symptoms were significantly more frequent among patients with COVID-19 who had confirmed previous immunization (COVID-19 history or vaccination) (p = 0.028). The incidence of individual sinonasal symptoms varies significantly depending on the aetiological agent of the URTI. This observation may not only help clinicians make the correct diagnosis, but also suggests an inflammatory response in the nasal mucosa and paranasal sinuses that is dependent on the aetiological agent. The study also indicates that this response is altered within the same virus species following immunization. The study's limitations include a small sample size (276 patients), focus on one season and one GP practice, and reliance on clinical signs and antigen tests. Nonetheless, the findings provide valuable insights. Further research with larger patient groups and extended follow-up periods is required to confirm these findings.

Cervical cancer screening knowledge and associated factors among Eswatini women: A cross-sectional study.

Over recent years, cervical cancer incidence and related mortality have steadily increased in Eswatini. Low cervical cancer screening uptake partly explains the situation. Cervical cancer screening-related knowledge is positively associated with screening uptake. Little is known about women's cervical cancer screening-related knowledge in Eswatini. This study aimed to assess cervical cancer screening knowledge and associated factors among Eswatini women eligible for screening. A cross-sectional study involving three hundred and seventy-seven women aged 25 to 59 selected from four primary healthcare clinics in Eswatini was conducted. A paper and pen survey assessed knowledge about cervical cancer risk factors, benefits of screening, the meaning of screening results, recommended screening intervals, and socio-demographics. Descriptive analyses were performed to assess participants' sociodemographic characteristics. Linear regression was applied to examine associations between cervical cancer screening-related knowledge and participants' sociodemographic characteristics. Two hundred and twenty-nine (61%) participants answered 80% or more knowledge questions correctly. Compared to HIV-positive participants, HIV-negative participants had 0.61 times lower cervical cancer screening knowledge scores (β = -0.39, 95% CI: -0.56, -0.19, p = 0.03). Participants who travelled more than 30 minutes to the clinic had 0.3 times lower cervical cancer screening knowledge scores (β = -0.70, 95% CI: -1.15, -0.25, p < 0.01) compared to participants who travelled less than 30 minutes to the clinic. Relatively high overall cervical cancer screening knowledge levels were observed among the study participants. Findings from the current study may inform future educational programs to create and sustain an accurate understanding of cervical cancer screening in Eswatini communities.

Prevalence of chronic kidney disease among type-2 diabetic patients in Al-Ahsa, Saudi Arabia: a cross-sectional study

Objective: This study aimed to determine the prevalence of chronic kidney disease (CKD) among type-2 diabetes mellitus (T2DM) patients in Al-Ahsa, Saudi Arabia and identify its associated risk factors. Methods: A cross-sectional study was conducted in Al-Ahsa, Saudi Arabia, from September, 2022 till June, 2023. The study population consisted of type-2 diabetic patients aged 18 to 65 years who were not previously diagnosed with CKD and who were currently receiving follow-ups at primary healthcare clinics in Al-Ahsa. Data were collected from 33,000 patient records using a randomized sampling technique, resulting in a final sample size of 190 eligible participants. The glycated hemoglobin (HBA1C) levels were used to assess the diagnoses and status of DM, and the glomerular filtration rates (GFRs), microalbuminuria, and blood urea nitrogen-to-creatinine ratios were used to diagnose CKD. Results: The study included 190 type 2 diabetic patients aged 18 to 65 years. The prevalence of CKD was 41.1%, with 33.2% patients having mild to moderately decreased GFRs. Male patients had a higher prevalence of decreased GFRs compared with females. Obesity, particularly grade II obesity, and hypertension were significantly associated with increased albuminuria. Patients receiving both oral hypoglycemic drugs and insulin had a higher prevalence of decreased GFRs compared with those on insulin alone. Conclusion: The prevalence of CKD among type 2 diabetic patients in Al-Ahsa was high, and CKD was found to be associated with several risk factors. Healthcare providers should prioritize routine CKD screenings for type 2 diabetic patients, particularly for those with additional risk factors.

Causes and clinical aspects of headaches in patients visiting the outpatient clinics in primary health care in Jeddah, Saudi Arabia

Objective: This study aimed to explore the spectrum of causes and clinical aspects of headaches in primary healthcare clinics. Methods: A cross-sectional study was conducted in the outpatient clinics of two general hospitals. The convenience sampling technique was used to conduct the study from March 2022 to December 2023. Consultants at the outpatient clinics in the two hospitals examined all subjects. Results: Out of a total of 2,501 outpatient visits, 308 (12.3%) had headaches. Headache was common among those aged 20 years or over (65%). Almost half of the headache cases (46%) were due to disorders in the cranium, face, or neck. Headaches attributed to disorder of homeostasis (12%), and headache due to infection (10%), were second in frequency. Tension-type headache (TTH) accounted for 8.1%, while migraine headache was found in 5% of the cases. Pain in the head was the most common presenting symptom (58%), followed by fever, sore throat, and cough. Headache was similar in males and females. A large proportion of patients with headaches (44%) needed investigations to conclude the diagnosis. The majority of patients with fever were prescribed antimicrobial treatment, acetaminophen, or non-steroidal anti-inflammatory drugs. Only 6.6% needed admission to the hospital for further care or referral to a higher level (1.3%). Counseling about the disease was almost neglected (0.3%). Conclusion: Headache was a common presenting symptom among outpatient visits. TTH and migraine were the most common causes of headache. Primary healthcare physicians should pay more effort to educate the people about prevention and control of headaches.

Depression and anxiety among patients attending primary Healthcare in NGHA, Riyadh

Background: Anxiety is a prevalent mental health disorder, affecting approximately 33% of the population, while depression is a leading cause of disability worldwide. This study aims to investigate the prevalence and associated factors of anxiety and depression among patients attending primary health clinics. Methods: A cohort cross-sectional study was conducted on patients at Primary Health Care and Family Medicine clinics in National Guard Health Affairs, Riyadh. The data were collected using a self-administered questionnaire. Non-probability consecutive sampling was used. Data were analyzed using Statistical Package for the Social Sciences. Results: Regarding mental health, 48.1% of patients showed no signs of depression, while the remaining 51.9% displayed varying degrees of depression. Mild depression was the most prevalent (32.4%). For anxiety, 40.7% showed signs of anxiety. Females had a higher depression rate (61.9%) compared to males (44.5%), and age played a role, with the highest depression rate observed among patients aged 21-40 years (70.9%). Marital status also influenced depression, with widowed individuals showing a 100.0% depression rate, followed by divorced (56.3%), single (73.9%), and married (39.2%) individuals. Similarly, gender significantly affected anxiety, with females (46.6%) experiencing higher rates than males (36.3%). Patients aged 21-40 years had the highest anxiety rate (56.1%). Conclusion: This study sheds light on the health factors and their impact on depression and anxiety among primary health clinic attendees. It highlights the importance of considering these factors while assessing mental health issues in a clinical setting. Further understanding of these associations can aid healthcare providers in identifying vulnerable populations and tailoring appropriate interventions to address mental health concerns effectively.

Challenges of nurse managers in creating an environment conducive to empowerment of nurses in mining primary healthcare clinics in South Africa

BackgroundNurse managers are expected to create an environment conducive to empowerment of nurses in mining primary healthcare clinics to improve patients’ outcomes. However, in a specific mining primary healthcare clinics there are seldom staff trainings and nurses has overwhelming working schedules. PurposeThe aim of the study was to explore and describe the challenges of nurse managers in creating environment conducive to empowerment of nurses in mining primary healthcare clinics in South Africa. Design and MethodsThis study was underpinned by Winkler’s theoretical framework of leadership roles to create an environment conducive to empowerment. A qualitative, exploratory, descriptive and contextual research design was used to conduct this study in specific mining primary healthcare clinics in South Africa. Individual in-depth interviews were conducted to collect data from ten nurse managers, and Giorgi’s thematic analysis method was employed to analyse data. An independent qualitative coder confirmed the study’s findings. Trustworthiness was maintained, and ethical principles were also applied throughout the study. FindingsThree themes emerged from the analysed data: (1) training budget challenges; (2) training needs in mining primary healthcare clinics; (3) Legislation, training and development. Discussion and conclusionsThere are training budget challenges in mining primary healthcare clinics but nurse managers are not hindered by these challenges in creating an environment conducive to empowerment of nurses.

Level of Satisfaction of Hypertensive Patient Receiving Health Services from Hypertension &amp; Research Centre Rangpur

Background: Hypertension (HTN) is a common disease among patients who visit primary healthcare clinics. Because uncontrolled hypertension (HTN) is linked to higher rates of morbidity and death, better control of HTN can result from understanding its risk factors and adhering to prescribed treatment. Objective: In this study, we aimed to determine the level of satisfaction of hypertensive patient receiving health Services from Hypertension &amp; Research Centre Rangpur. Methodology: A descriptive cross-sectional study was conducted to find out level of satisfaction of hypertensive patient receiving health Services from Hypertension &amp; Research Centre Rangpur. A purposive type sampling technique was used to select the participants. Results : Among 321 hypertensive patients , most were in the age group of 50-59years (26.48%), and most of them were educated up to secondary level(23.7%) .Large portion patients reported Treatment system of Hypertension &amp; Research Centre Rangpur were very good(44%), Behavior &amp; attitude of doctors were very good (47%), Communication system (44%), evaluation checkup (44%), managerial service (49%), Calendar, leaflet distribution (47%) were good and record system (46%), helpful rank (47%), Discipline system (45%) and the total environment (58%) were very good. Also, most of the patients (97.2%) were overall satisfied by background characteristics. Conclusions: A good level of satisfaction was observed among patients of HTN in Hypertension &amp; Research Centre Rangpur with respect to treatment system, behavior, communication, checkup, information, managerial service &amp; total environment, slight dissatisfaction were directed to laboratory &amp; waiting facilities, supportive attitudes. This high satisfaction level accounts for the high adherence to the treatment plan.

Knowledge and barriers to screening for colorectal cancer among individuals aged 40 years or older visiting primary healthcare clinics in Al-Khobar, Eastern Province.

Colorectal cancer (CRC) ranks third as the most common cancer in the world and the 4th most common cause of deaths from cancer. In Saudi Arabia, CRC is the most common cancer in males and the third most common in females. Early screening reduces the risk of CRC and death. However, there is a lack of awareness of CRC screening in Saudi Arabia. The objective of this study was to determine the knowledge, practices, and barriers to CRC screening using the Health Belief Model (HBM). This study enrolled Saudis aged 40 years or older visiting PHCCs in Al-Khobar. Data were collected using a self-administered questionnaire or a direct interview of the selected participants. Information sought included sociodemographics, past CRC screening, CRC knowledge, and HBM items. Data analysis was done using SPSS; the Chi-squared test and ANOVA were used to determine statistical significance. A total of 206 of the individuals approached completed the questionnaire. The average age was 51.1 years, and 51% were males. Only 10% reported that a physician had provided information on CRC prevention or discussed/recommended screening for CRC, and 10% had undergone screening for CRC. Seventy-five percent of respondents had heard of CRC, and 74% said that CRC was preventable. Regarding the HBM, no significant difference in the mean scores for perceived susceptibility, perceived severity, self-efficacy, and benefits of CRC screening was found by age groups. The mean score for perceived severity was higher for females than males. About 60% of participants were extremely likely to have a screening test for CRC done on the day if recommended by the doctor. The knowledge and awareness of CRC screening of the targeted sample is inadequate. Individuals with higher perceived susceptibility, severity of CRC, and perceived benefit of the screening tests were more willing to undergo the test. The highest perceived barrier was having no symptoms, and the lowest was "getting a stool test is too much of a hassle." These findings underline the importance of having a national screening program and campaigns to deal with the concerns of people and raise awareness of CRC.

Designing effective U = U communication strategies considering the needs of PLHIV, their partners, and healthcare worker constraints in South African clinics.

We sought to understand the Undetectable = Untransmittable (U = U) communication needs of persons living with HIV (PLHIV) and barriers to U = U communication among healthcare providers (HCPs) in South Africa. We conducted five focus group discussions (FGDs) with HCPs (N = 42) including nurses and counsellors from primary healthcare clinics (PHCs) in the Gauteng and Free State Provinces of South Africa, three FGDs (N = 27) with PLHIV recruited by snowball sampling from civil society organizations, and 27 in-depth interviews (IDIs) with recently diagnosed PLHIV in Johannesburg. IDIs and FGDs were audio recorded, transcribed, translated to English, and analysed thematically. PLHIV were largely unaware and sceptical of U = U as the message appeared to contradict the mainstream HIV prevention clinical guidance. The low viral load (VL) knowledge further reduced confidence in U = U. PLHIV need support and guidance on the best approaches for sharing U = U information and disclosing their VL status to their partners, highlighting the central role of community understanding of U = U and VL to mediate the desired stigma reduction, social acceptance and emotional benefits of U = U for PLHIV. HCPs were uneasy about sharing U = U due to concerns about risk compensation and ART non-adherence and worried about enabling any ensuing HIV transmission. HCPs also need a simple, unambiguous, and consistent narrative for U = U, integrated with other HIV prevention messages. PLHIV and HCPs alike recommended a patient-centred approach to communicating U = U, focusing primarily on attaining viral suppression and emphasizing that condomless sex is only safe during periods of ART adherence. These data highlight the need for simple U = U communication support targeting both HCP and PLHIV. Culturally appropriate communication materials, with training and ongoing mentorship of the clinic staff, are essential to improve patient-centred U = U communication in clinics.

Targeted Dementia Screening Performance, Its Barriers and Associated Factors Among Primary Care Doctors at Public Primary Healthcare Clinics in Malaysia

Introduction: Targeted dementia screening is recommended for early recognition of dementia. However, many persons with dementia were not identified and managed in timely manner. This study aimed to determine the proportion of performing targeted dementia screening, its barriers and associated factors among primary care doctors in public primary healthcare clinics. Methods: A cross sectional study was conducted at 4 public healthcare clinics, Putrajaya from December 2018 – February 2019. All primary care doctors who fulfilled the eligibility criteria were recruited. We collected data using a pre-tested self-administrated questionnaire comprised socio-demographic, medical information, healthcare experience and training, knowledge on dementia, awareness of dementia screening tool availability and barriers to dementia screening. The outcome was the performance of targeted dementia screening. Descriptive, Chi-square and independent t-test analyses were performed. Results: A total of 106 primary care doctors participated in this study. The proportion of primary care doctors who performed targeted dementia screening was 11.3%. Most participants were family medicine trainee (42.9%), with duration of service between 5 and 10 years (15.0%), had professional caring experience of dementia patients (21.4%), and had undergone dementia training (36.2%). Many of the participants perceived barriers to perform targeted dementia screening that included lack of time (72.6%) and lack of knowledge (59. 4%). Conclusion: The prevalence of performing targeted dementia screening was low with modifiable barriers. Strategies to improve the performance of targeted screening such as creating awareness among primary care doctors could be done for a start.

Who is providing HIV testing services? The profile of lay counsellors providing HIV testing services in Johannesburg, South Africa in the treat-all era

BackgroundLay counsellors are critical in sustaining access to HIV testing services (HTS) and psychosocial support for persons living with HIV (PLHIV). We aimed to describe the professional and psychosocial profiles of lay counsellors in primary healthcare (PHC) clinics in Johannesburg, South Africa under the universal-test-and-treat (UTT) policy context.MethodsWe conducted a descriptive analysis of a cross-sectional survey among adult (≥ 18 years) lay counsellors from 20 PHC facilities (2–3/ clinic) in Johannesburg, South Africa. Consenting counsellors were interviewed between June 2018 and March 2019. We report on counsellors’ demographic profiles, training, work experience, and mental and emotional well-being.ResultsOverall, 55 consenting adult (≥ 18 years) lay counsellors (92.7% female, median age 37 years, interquartile range [IQR]: 33–44, and 27.3% HIV diagnosed) were surveyed. Most (85.5%) were Department of Health lay counsellors receiving a volunteer stipend at the time. Overall, 56.4% had been working as counsellors for five years or longer. The majority (87%) had completed the National HIV Testing Services Policy Guidelines-recommended 10-day basic counselling training, but 45.2% had not completed refresher training within the guideline’s required 24 months. Reported operational barriers include lack of designated space for counselling (56.4%), inadequate professional supervision and support (40.7%) and insufficient emotional support (over 56.4%), and 60% were overwhelmed by their workload. A total of 18.2% had major depressive symptoms, and the same proportion scored low for psychological well-being. While most (87.3%) reported moderate job satisfaction, 50.9% actively sought alternative employment.ConclusionDespite lay counsellors’ significant role in delivering HIV care in South Africa, there has been minimal investment in their skills development, emotional support, and integration into the formal health workforce. Counsellors’ persisting unmet psychosocial, training, and professional needs could impact their efficacy in the UTT era.

Knowledge, attitudes and practices of oral HIV pre-exposure prophylaxis (PrEP) among healthcare workers in the Ekurhuleni District, South Africa.

Prevention of new HIV infections is crucial for controlling the HIV epidemic. Despite HIV pre-exposure prophylaxis (PrEP) being one of the highly effective approaches to preventing HIV, and being freely available through primary healthcare clinics (PHCs), the uptake of HIV PrEP in South Africa (SA) is low. To understand knowledge, attitudes and practices (KAPs) of healthcare workers responsible for generating demand for HIV PrEP services, or identifying clients eligible for HIV PrEP services in PHCs in Ekurhuleni District, South Africa. We conducted a cross-sectional interviewer-administered survey among healthcare workers from 45 randomly selected PHCs in Ekurhuleni District. We collected information on participant characteristics and their KAPs regarding HIV PrEP service delivery. KAP scores were developed using a priori cut-off points and participants were categorised into binary levels of KAPs. We performed descriptive and multivariable logistic regression analysis in line with the study objectives. We enrolled 160 study participants from 1 May to 30 June 2022. About two-thirds of the participants (64.4%) were highly knowledgeable about HIV PrEP, and 58.1% self-reported practices that were considered to be good. Notably, 73.1% of participants had negative attitudes toward HIV PrEP delivery. Participants who were aged >50 years had poor HIV PrEP knowledge (adjusted odds ratio (aOR) 0.1; 95% confidence interval (CI) 0.0 - 0.4; p=0.01) compared with participants <30 years old. Participants aged 30 - 40 years had poor HIV knowledge although their association is not statistically significant. Nurses had higher HIV PrEP knowledge (aOR 11.1; 95% CI 3.8 - 32.4, p<0.001) compared with health promoters. Both nurses (aOR=0.2, 95% CI 0.1 - 0.6; p<0.001) and HIV testing service counsellors (aOR 0.3; 95% CI 0.1 - 0.9; p=0.02) had negative attitudes toward HIV PrEP, compared with health promoters. Nurses had better practices in HIV PrEP delivery compared with health promoters (aOR 2.5; 95% CI 1.0 - 5.9; p=0.04). Among the healthcare workers tasked with generating demand and identifying clients eligible for HIV PrEP services, low knowledge of HIV PrEP and negative attitudes towards HIV PrEP may be barriers to the uptake of HIV PrEP. Training healthcare workers on HIV PrEP is recommended.