Utilization Of Treatment Services Research Articles

Assessing the Impact of the COVID-19 Pandemic on Maternal and Child Health Services: A Comprehensive Analysis of Government Initiatives in Northern India.

The coronavirus disease (COVID-19) pandemic has significantly impacted healthcare services globally, with particular challenges observed in maternal and child health (MCH) care. This study aimed to assess the impact of the pandemic on MCH services in northern India, focusing on key government programs. Data were collected from four major MCH programs in India: Janani Suraksha Yojana (JSY), Janani Shishu Suraksha Karyakram (JSSK), Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), and the Universal Immunization Program (UIP). The study compared MCH service utilization and outcomes during the pandemic period (March-September 2020) with the same period in 2019. Preliminary findings indicated a significant reduction in the utilization of MCH services during the pandemic, with a decrease observed in institutional deliveries, antenatal care visits, and immunization coverage. For instance, institutional deliveries declined by 30% compared with the previous year, with a similar decrease observed in antenatal care visits. Immunization coverage also decreased by approximately 25%, indicating a substantial decline in preventive care services. Challenges in accessing essential treatments for sick infants have also been reported, with a 40% decrease in the utilization of free treatment services under the JSSK program. The COVID-19 pandemic has substantially impacted MCH services in northern India, highlighting the vulnerability of these essential health programs during public health emergencies. Addressing the challenges identified in this study is crucial to ensuring the continuity and resilience of MCH services in similar settings.

Impact of social determinants of health and individual characteristics on substance use disorder treatment utilization among emerging adults aged 18-25

Background Emerging adulthood (typically ages 18–25) is a developmental period associated with increased likelihood of developing substance use disorders (SUDs) resulting in life-altering negative consequences. While SUD treatment can be effective and diminish substance-related consequences, very few emerging adults with SUDs actually receive treatment and research is needed to identify potential determinants of receiving care. We examined associations between individual factors and social determinants of health (SDOH) with SUD treatment service utilization to inform treatment engagement strategies for emerging adults. Methods Using pooled cross-sectional data from the 2015–2019 years of the National Survey on Drug Use and Health, we evaluated past-year treatment utilization among emerging adults (i.e. respondents aged 18–25 years-old) with a past-year SUD (N = 12,594). Logistic regression analyses evaluated sex, race, education level, lifetime arrest history and age of alcohol initiation in addition to mental illness, employment, food stamp utilization, poverty status, and frequency of housing relocation. Results Past-year mental illness, Non-Hispanic White identity, not having a college degree, lifetime arrest history, part-time employment or unemployment, and relocating for housing more than 2 times in the past year were significantly associated with greater likelihood of treatment utilization in adjusted analyses. Conclusions Findings from this nationally representative survey of emerging adults highlight the possible contribution of some SDOH associated with social disadvantage and/or criminal justice involvement on SUD treatment utilization. These results may guide providers in tailoring service delivery mode, community organizations to target populations, and implementation strategies that are effective in reducing SUD treatment service utilization inequity.

Vaccination and its impact on healthcare utilization in two groups of vaccinated and unvaccinated patients with COVID-19: A cross-sectional study in Iran between 2021 and 2022.

One of the main responsibilities of health systems impacted by the global Coronavirus disease 2019(COVID-19) pandemic, where the first case was discovered in Wuhan, China, in December 2019, is the provision of medical services. The current study looked into the impact of vaccination on the utilization of services provided to COVID-19 patients. This study was conducted in Iran between 2021 and 2022, utilizing a cross-sectional research design. The research team collected data on the utilization of provided services and the number of COVID-19 vaccines administered to 1000 patients in Iran through a random sampling approach. The data wereanalyzed with statistical methods, including the mean difference test, and multiple linear regression. Regression estimates show that after controlling for confounding variables like age, type of admission, and comorbidities, vaccination reduces the utilization of healthcare services in the general majority of services. The study's results reveal a fall in COVID-19 patients' utilization of services, specifically in patients administered two or three doses of the vaccine. However, the reduction is not statistically significant. Regression models are in contrast to univariate analysis findings that vaccination increases the mean utilization of healthcare services for COVID-19 patients in general. Comorbidities are a crucial factor in determining the utilization of diagnostic and treatment services for COVID-19 patients. Full COVID-19 vaccination and other implementations, including investing in public health, cooperating globally, and vaccinating high-risk groups for future pandemics, are essential as a critical response to this pandemic as they reduce healthcare service utilization to alleviate the burden on healthcare systems and allocate resources more efficiently.

Mobile resonance frequency breathing smartphone application to support recovery among people with opioid use disorder: Study protocol for feasibility study.

Experiencing drug cravings is an aspect of substance use disorders that frequently compromises the recovery efforts of people who use drugs. Most treatment approaches that address drug cravings either involve cognitive strategies or medication. Few interventions directly address the physiological aspects of craving, such as increased heart rate. Previous research has demonstrated that slow-paced breathing may be effective in managing drug cravings by manipulating an individual's heart rate. The purpose of this paper is to describe a study protocol for an intervention that offers resonance frequency breathing training for managing cravings via a smartphone application (app). This trial is registered in ClinicalTrials.gov (Identifier: NCT05830773). The intervention focuses on persons in recovery from opioid use disorder who receive services from the Texas Health and Human Service Commission Recovery Support Services division. Participants will be trained to use Camera Heart Rate Variability (CHRV), a resonance frequency breathing app. The CHRV app measures heart rate and the volumetric variations of blood circulation. When experiencing stress, anxiety, or cravings, participants will use the app to practice breathing exercises. Participants (N = 60) will also complete surveys at baseline, 4 weeks, and 8 weeks; the survey questions, covers demographic characteristics, personal trauma history, substance use experience, and utilization of substance use treatment services. The surveys will also include psychosocial measures of craving, stress, and anxiety to allow the study team to assess changes between baseline and study completion. Participants who complete the full 8-week intervention will be invited to participate in a 30-minute interview about their experience with the app. Interviews will provide details on implementation outcomes, including acceptability, appropriateness, and feasibility. Many evidence-based interventions for opioid use require interpersonal communication with individuals in one's recovery network. However, individuals may be unable to engage others in their recovery network in the moments when they are experiencing cravings or stress- and anxiety-related triggers. Therefore, recovery support interventions that emphasize individual self-management of cravings, stress, and anxiety when they occur can empower individuals in recovery and enhance existing interventions.

Integrating the HBM and the PEN-3 model to explain the health behavior of persons with DLD

Background: Investigating factors that dictate the health-seeking process in persons with developmental language disorders (DLDs) is critical for enhancing early intervention and effective utilization of treatment services among persons with DLDs. This study sought to understand factors that determine health seeking in persons with DLDs using the Health Belief Model (HBM) and the PEN-3 model. Methods: A qualitative study of 36 semi-structured interviews explored health-seeking behavior among stakeholders involved in the management of children with DLDs. Interviews were conducted with parents, teachers, and speech-language therapists on health behaviors and factors that dictate health behavior during intervention seeking. Data coding was done inductively, and analysis was carried out using qualitative content analysis. Results: Findings revealed that both the HBM and the PEN-3 model were well represented in the dataset, and that integration of both models contributes to a systematic understanding of health behavior in persons with DLDs. Conclusion: The study details how demographic, psychological, and sociocultural variables interact to shape the health-seeking process among persons with DLDs and the resulting impact of these interactions on the effective management of DLDs.

Extended cost-effectiveness analysis of interventions to improve uptake of diabetes services in South Africa.

The rising prevalence of diabetes in South Africa (SA), coupled with significant levels of unmet need for diagnosis and treatment, results in high rates of diabetes-associated complications. Income status is a determinant of utilization of diagnosis and treatment services, with transport costs and loss of wages being key barriers to care. A conditional cash transfer (CCT) programme, targeted to compensate for such costs, may improve service utilization. We applied extended cost-effectiveness analysis (ECEA) methods and used a Markov model to compare the costs, health benefits and financial risk protection (FRP) attributes of a CCT programme. A population was simulated, drawing from SA-specific data, which transitioned yearly through various health states, based on specific probabilities obtained from local data, over a 45-year time horizon. Costs and disability-adjusted life years (DALYs) were applied to each health state. Three CCT programme strategies were simulated and compared to a 'no programme' scenario: (1) covering diagnosis services only; (2) covering treatment services only; (3) covering both diagnosis and treatment services. Cost-effectiveness was reported as incremental net monetary benefit (INMB) using a cost-effectiveness threshold of USD3015 per DALY for SA, while FRP outcomes were reported as catastrophic health expenditure (CHE) cases averted. Distributions of the outcomes were reported by income quintile and sex. Covering both diagnosis and treatment services for the bottom two quintiles resulted in the greatest INMB (USD22 per person) and the greatest CHE cases averted. There were greater FRP benefits for women compared to men. A CCT programme covering diabetes diagnosis and treatment services was found to be cost-effective, when provided to the poorest 40% of the SA population. ECEA provides a useful platform for including equity considerations to inform priority setting and implementation policies in SA.

Spatial and Environmental Correlates of Prevalence of Treatment for Substance Use Disorders, Retention, and SUD Services Utilization in South Sardinia.

This study explored the economic, social, and spatial correlates of treatment prevalence, retention, and service utilization for substance use disorder (SUD) in South Sardinia. Data from 1,667 patients with an ICD-10 diagnosis of SUD were extracted from the medical records of individuals assisted by three public addiction services in 2019. We used a spatial autoregressive model, a parametric proportional hazard model, and Poisson regression to examine the associations of spatial factors and residents' socioeconomic status with the prevalence of treatment at the census block level, treatment retention, and SUD service utilization at the individual level. The prevalence was higher among residents of areas closer to competent treatment centers, with the worst building conservation status, a lower percentage of high school and university graduates, and a higher percentage of unemployed, divorced, separated, or widowed residents. Men who were older at the time of their first treatment access; primary users of cocaine, cannabis, and alcohol; had higher education level; and who lived far from competent treatment centers and closer to drug trafficking centers interrupted their treatment earlier. Primary heroin users experienced more SUD treatment encounters. Living in economically and socially disadvantaged areas and near treatment facilities was associated with a higher prevalence, whereas living near drug-dealing centers and far from competent treatment centers was associated with a decrease in treatment retention.

Intersecting Epidemics: The Predictors of Continued Utilization of HIV Care and Treatment Services During the COVID-19 Outbreak Among People Living with HIV in ZIMBABWE.

Globally, there have been considerable achievements towards HIV care and treatment. AIDS-related deaths have been reduced by 60% since the peak in 2004. Potentially, the fight against the HIV epidemic was made more difficult with the outbreak of COVID-19. Thus, this study examined the implications of COVID-19 in the utilization of HIV care and treatment services among people living with HIV on antiretroviral therapy (ART) in Zimbabwe. The study aimed to identify the critical factors defining the utilization of HIV services at the advent of COVID-19 using the fifth revision of the Anderson Behavioral Model of Healthcare Utilization. The study utilized a concurrent triangulation design of which only one data collection phase was used. The quantitative data was collected from 2,157 people living with HIV on antiretroviral viral therapy through a structured interviewer-administered questionnaire. On the other hand, qualitative data was collected through in-depth interviews. Regarding accessing ART refills, the study findings revealed that adolescents aged 15-19 (aOR = 2.16; 95% CI: 1.18-3.96) had higher odds of utilizing ART refills compared to their counterparts who were aged 20-24. Living in arural area was associated with higher odds of utilizing the ART refill service (aOR = 2.20; 95% CI: 1.49-3.24). Regarding accessing viral load monitoring adults aged 25-39 (aOR = 0.41; 95% CI: 0.26-0.66) were less likely to utilize viral load monitoring compared to young people aged 20-24. Being vaccinated for COVID-19 was significantly associated with higher odds of utilizing the viral load monitoring service (aOR = 1.97; 95% CI: 1.36-2.87) than those not yet vaccinated. Living ina rural area was associated with higher odds of utilizing viral load monitoring (aOR = 1.50; 95% CI: 1.09-2.08). Regarding tuberculosis preventative therapy, adults aged 25-39 (aOR = 0.30; 95% CI: 0.20-0.47) were less likely to utilize tuberculosis preventative therapy compared to young people aged 20-24. Being vaccinated for COVID-19 was significantly associated with higher odds of utilizing tuberculosis preventative therapy (aOR = 1.59; 95% CI: 1.12-2.25) than those not yet vaccinated. Living ina rural area was associated with higher odds of utilizing tuberculosis preventive therapy (aOR = 1.58; 95% CI: 1.19-2.08). Regarding tuberculosis screening being vaccinated for COVID-19 was significantly associated with higher odds of utilizing tuberculosis screening services (aOR = 1.89; 95% CI: 1.41-2.54) than those not yet vaccinated. Although the severity of the COVID-19 pandemic has dwindled, COVID-19 appears to come and go in waves, and a few countries are still recording relatively high cases. It is therefore likely that the factors associated with utilization of HIV services identified by the study such as age, residence, type of health facility, vaccination of COVID-19 and fear of contracting COVID-19, among others, need to be included when planning to improve access to health utilization.

Noncommunicable Disease Service Utilization from the Upgraded Primary Care Centers: A Cross-Sectional Study from Kerala, India

ABSTRACT Introduction: World Health Organization recommends the integrated management of noncommunicable diseases (NCDs) in primary care. Hence, this study aimed to determine the NCD service utilization from an upgraded primary care center and to find the reasons for nonutilization. Materials and Methods: This community-based cross-sectional analytical study was conducted among 387 individuals aged 30 years and above in a selected upgraded primary care center. A validated semistructured questionnaire was used. A log-binomial regression was done, and adjusted prevalence ratios (aPR) were calculated. Results: The prevalence of utilization of NCD services from upgraded primary care center was 55.3% (95% confidence interval [CI] 50.2–60.3). The screening or treatment service utilization for hypertension, diabetes, and cardiovascular diseases was reported to be 54% (95% CI 48.9–59.1), 37.5% (95% CI 32.6–42.5), and 7.2% (95% CI 4.9–1.3), respectively. The reasons for the nonutilization of services were preference for the private sector (35.3%), distance to the facility (27.2%), and lack of awareness regarding the amenities at family health centers (11.3%). The younger age (aPR = 1.70, 95% CI 1.29–2.23, P = 0.033), unemployment (aPR = 1.46, 95% CI 1.01–2.10, P = 0.043), and social class (aPR = 1.62, 95% CI 1.16–2.26, P = 0.004) were significantly associated with NCD service nonutilization. The willingness to avail of NCD services among nonutilizers was 46.8% and salaried individuals had a high chance of unwillingness (aPR = 5.01, 95% CI 1.69–14.78, P = 0.003) compared to daily waged workers. Conclusion: Nearly half of the participants were not utilized upgraded primary care centers for NCD care. Strengthening outreach services and improving awareness among beneficiaries may improve the utilization in the community.

The impact of war on HIV/AIDS service provision: In rural health facilities of Tigray, northern Ethiopia, a cross-sectional study.

HIV/AIDS remained among the common public health problems in developing country. Despite the extensive delivery of ART and improved coverage of the service access, still, man-made problems like war have negatively influenced the utilization of antiretroviral treatment services. The war in Tigray Region in the northern Ethiopia broke out in November 2020 and thereby has brought about an extreme damage on most of the infrastructure in Tigray, including the health institutions. The purpose of this study is, therefore, to assess and report the trend of HIV service provision across the war affected rural health facilities in Tigray. The study was conducted in 33 rural health facilities during the active war in Tigray. A facility based retrospective cross-sectional study design was conducted among health facilities from July 03 to August 05, 2021. A total of 33 health facilities from 25 rural districts were included in the HIV service delivery assessment. A total of 3274 and 3298 HIV patients were seen during pre-war period in September and October 2020, respectively. The number of follow-up patients during the war period in January remained to be only 847(25%) which is significantly reduced with a P value<0.001. A similar trend was observed during the subsequent months until May. The trend of follow-up patients on ART significantly declined from 1940 in September (pre-war) to 331(16.6%) in May (during the war). This study also revealed a 95.5% reduction of laboratory service provision to HIV/AIDS patients during the war in January and with similar trends thereafter (P<0.001). The war has led to a significant decline of HIV service provision in the rural health facilities and most part of the region during the first eight months of active war in Tigray.

Analysis Factors Affecting the Utilization of Antiretroviral Treatment Services in HIV Patients in Ambon City Puskesmas

Analysis Factors Affecting the Utilization of Antiretroviral Treatment Services in HIV Patients in Ambon City Puskesmas

Six-Year Follow-up of People Who Use Methamphetamine in Iran: A Case Series Study

Background: Despite the increased use of methamphetamine, little is known about its adverse effects in developing countries. Objectives: This study aimed to investigate the adverse events of methamphetamine use in Iran. Materials and Methods: A total of 29 subjects who were recruited in the Iranian Mental Health Survey (IranMHS, a 2011 national household survey) and used methamphetamine more than five times in the past year enrolled in this case series study. Six years after the index interview, eligible participants were contacted to assess their frequency of methamphetamine use in the past year, the incidence of adverse events, and utilization of substance use treatment services. Results: One death was recorded among 29 eligible cases. Of the 13 completed interviews (all male), the majority (n = 10) reported abstinence, and 2 reduced their methamphetamine use in the past year. More than two-thirds (n = 9) of participants experienced at least 1 adverse event. Incarceration and violent behavior were the most common adverse events. Of the 10 individuals with methamphetamine use disorder, none received specific health care treatment. Conclusions: The study participants experienced a high rate of adverse events, and none of those with methamphetamine use disorder received specific treatment. Further prospective studies are needed to investigate the causal relationship between methamphetamine use and adverse events.

Predictors of Under-Five Caregivers' Utilization of Co-Packaged Zinc and Oral Rehydration Salts for Childhood Diarrhea in East Wollega Zone, Western Ethiopia.

Diarrhea morbidity and mortality remain child health and economic burdens in low resource settings. In Ethiopia, diarrheal disease treatment service utilization remains very low. However, evidence on the level of utilization of zinc bundled with ORS among under-five caregivers' was not addressed. The study aimed to identify predictors of under-five caregivers' utilization of co-packaged zinc and oral rehydration salts for childhood diarrhea in East Wollega Zone, Western Ethiopia, in 2022. The study design used was a community-based cross-sectional study that was conducted among 540 randomly selected participants from April 1 to 30, 2022. Data were collected using interviewer-administered semi-structured questionnaires. It was entered into Epi-data version 3.1 and analyzed using SPSS version 26. An adjusted odds ratio along with a 95% confidence level was estimated, and a P value <0.05 was considered to declare the statistical significance in the multivariable analysis. About 39.6% of under-five caregivers' had utilized co-packaged zinc and oral rehydration salts for their childhood diarrhea at least once in the last 12 months. Having family size less than 5 [AOR and 95% CI = 5.72 (2.93,11.15)]; heard about the co-pack [AOR and 95% CI = 9.52 (4.95,23.68)]; perceived health status for the recent episode as poor [AOR and 95% CI = 5.90 (2.58, 15.96)] and medium [AOR and 95% CI = 2.20 (1.02, 4.83)]; perceived severity for recent episodes [AOR and 95% CI = 4.48 (1.36, 14.76)] and being community-based health insurance non-member [AOR and 95% CI = 2.28 (1.34, 6.90)] were statistically associated with co-packaged zinc and ORS utilization. The study found that co-packaged zinc and oral rehydration salt utilization was low. Family size, heard about the co-pack, perceived health status, perceived severity, and CBHI membership were predictors of co-packaged utilization of zinc and ORS. Hence, concerned bodies in the health system should have devoted to maximize its uptake.

Accessing Behavioral Health Services and the Justice-Involved: The Significance of Ecological Considerations

Knowledge and understanding of reentry challenges, reentry programming, and reentry evaluations is primarily limited to formerly incarcerated persons (FIPs) who return to urban areas despite the structural and contextual differences between urban and non-urban locales. These differences may be especially salient when it comes to access to services for behavioral health needs that, if left untreated, increase the likelihood of recidivism. Reentry planning prior to release has been found to be beneficial, as well as providing direct linkages to services post-release. However, barriers or competing priorities may keep FIPs from accessing needed behavioral health services after release. To increase the probability for more successful post-release transitions, studies need to determine and understand soon-to-be-released inmates’ likelihood of utilizing these services. Thus, the purpose of this research was to examine the importance of demographic characteristics, ecological factors, and utilization of treatment services for drugs, alcohol, mental health, and anger management prior to release to FIPs’ intent to receive these services after their release. Data was collected from 173 individuals incarcerated in either a prison or a community-based correctional facility (CBCF) and analyzed via logistic regressions. Results suggest that being female and utilization of services while incarcerated predicted intent to use drug and mental health services after release; not surprisingly, crime type and type of facility was predictive of intent to utilize anger management services post release; type of facility, and interaction of housing and concentrated disadvantage was predictive of intent to take advantage of alcohol treatment services. These findings have micro, mezzo, and macro implications and are especially relevant given the limitations of resource availability and accessibility in urban and non-urban areas. Streamlining these services to FIPs’ needs and building community capacity to meet specific needs identified by FIPs is more likely to engage them and increase their likelihood to improve reentry outcomes.

Utilization of HIV Prevention, Care, and Treatment Services Among Young Men Who Have Sex With Men and Transgender Persons of Color in the U.S. South: A Qualitative Analysis.

To better understand utilization of HIV prevention, care, and treatment services by young men who have sex with men (YMSM) and young transgender persons (YTG), of Black race or Hispanic/Latino/Latina ethnicity in the U.S. South, we conducted semi-structured interviews with 127 clients at one of four community based organizations (CBOs) in Miami, Atlanta, New Orleans/Baton Rouge, or Columbia, South Carolina. Across sites, the service that most commonly drew respondents into the CBO was HIV and STD testing. Other services commonly used included HIV/STI treatment, counseling services/support groups, and PrEP services. Social/organizational/structural facilitators of service utilization include the welcoming climate/culture of the CBOs, ease of access to the services, and transportation services to reach the CBOs. Suggested service enhancements include broader range of comprehensive, navigational-type services beyond HIV testing and service co-location. Research on how to reduce stigma in the surrounding communities may help reduce health disparities experienced by these populations.

Socioeconomic inequality in rehabilitation service utilization for schizophrenia in China: Findings from a 7-year nationwide longitudinal study.

AimsFew studies have focused on the utilization of rehabilitation services among people with schizophrenia. In this study, we aimed to examine the trend of pharmacological and psychotherapy service utilization among adults with schizophrenia and to identify the associated socioeconomic factors.MethodsData were obtained from the Second National Sample Survey on Disability in 2006 and from the follow-up investigation in 2007–2013. Individuals with schizophrenia were ascertained by the combination of self-reports and on-site diagnosis by psychiatrists. Random effect logistic regression models were applied to examine the socioeconomic disparity in service utilization and the time trend in the association.ResultsOverall, the percentage of individuals using pharmacological treatment services increased from 23.7 in 2007 to 55.0% in 2013, and the percentage of individuals using psychotherapy services increased from 11.4 to 39.4%. Living in rural areas, being illiterate, living in families with lower income and being uninsured were less likely to receive pharmacological treatment and psychotherapy. The pace of growth in service utilization was higher among individuals with rural residence, illiteracy or low-income status than among their counterparts with advantaged backgrounds.ConclusionsThis study demonstrated an upward trend in pharmacological treatment and psychotherapy service utilization and a downward trend in socioeconomic disparity among Chinese adults with schizophrenia. Future studies to explore the reasons for the observed changes and to identify policies for improving the health service access of this vulnerable group are warranted.

The impact of COVID-19 pandemic on mental health in gay, bisexual, and other men who have sex with men in China: Difference by HIV status

Population-based measures and public health response to stem the spread of the coronavirus may have caused unintended isolation and increased the risk of psychiatric illnesses. The objective of this study is to assess psychological distress among gay, bisexual, and other men who have sex with men (MSM) in China during the COVID-19 pandemic and examine whether these mental health outcomes differ by HIV status. Data were derived from a cross-sectional survey on the impact of COVID-19 on users of Blued, the largest gay social networking app in July 2020. All active users on Blued were invited to complete a survey regarding sexual behaviors, HIV prevention and treatment service utilization, and various health and mental health outcomes. Among all participants (n = 1205), over half (53.2%) of the participants screened mild to severe psychological distress: 34.9% screened mild, 11.6% screened moderate, and 6.6% screened severe psychological distress. Of all participants, 20.9% met the criteria for anxiety and 19.6% for depression. Psychological distress was associated with younger age having a degree below college, being unemployed, and having lower income. MSM with HIV were more likely to report depression or anxiety compared to HIV negative/unknown status MSM after adjusting for study covariates (AOR = 1.80, 95%CI 1.01–3.26; AOR = 2.04, 95%CI 1.11–3.67, respectively). MSM in China experience a high burden of psychological distress during the COVID-19 pandemic. Integrated HIV treatment and mental health services are needed to provide adequate and timely mental health support to MSM living with HIV.

Burden of Cancer and Utilization of Local Surgical Treatment Services in Rural Hospitals of Ethiopia: A Retrospective Assessment from 2014 to 2019.

Global cancer estimations for Ethiopia announced 77 352 new cases in 2020 based on the only population-based registry in Addis Ababa. This study characterizes cancer patients in rural Ethiopia at 8 primary and secondary hospitals between 2014 and 2019. All clinically or pathologically confirmed cancer cases that were diagnosed between 1 May 2014 and 29 April 2019 were included. A structured data extraction tool was used to retrospectively review patients' charts and descriptive analysis was done. A total of 1298 cancer cases were identified, of which three-fourths were females with a median age of 42 years. Breast (38%) and cervical (29%) cancers were the most common among females, while prostate (19%) and oesophageal cancers (16%) were the most common among males. Only 39% of tumors were pathologically confirmed. Nearly two-thirds of the cases were diagnosed at an advanced stage. Surgery was the only accessible treatment option for more than half of the cancer patients, and systemic treatment (except endocrine) was rarely available. One in 5 patients did not receive the recommended surgical procedure, half due to patient refusal or lack of the patient returning to the hospital. The pattern of cancer diagnoses in rural hospitals shows an exceptionally high burden in women in their middle-ages due to breast and cervical cancers. Advanced stage presentation, lack of pathology services, and unavailability of most systemic treatment options were common. The surgery was offered to nearly 60% of the patients, showing the significant efforts of health workers to reduce sufferings.

How to be self-reliant in the context of stigma? The dilemma of people who inject drugs in Vietnam

Integration of substance use disorder (SUD) treatment and HIV care can increase antiretroviral therapy coverage among people with opioid use disorder (OUD). However, implementation of integrated treatment models remains limited. Stigma towards people with OUD poses a barrier to initiation of, and adherence to, HIV treatment. We sought to understand the extent of stigma towards SUD and HIV among people with OUD in Vietnam, and the effect of stigma on integrated OUD and HIV treatment services utilization. Between 2013 and 2015, we conducted in-depth interviews with 43 patients and 43 providers at 7 methadone clinics and 8 HIV clinics across 4 provinces in Vietnam. We used thematic analysis with a mixed deductive and inductive approach at the semantic level to analyze key topics. Two main themes were identified: (1) Confidentiality concerns about HIV status make patients reluctant to receive integrated care at HIV clinics, given the requirements for daily buprenorphine dosing at HIV clinics. (2) Provider stigma existed mostly toward people with OUD and seemed to center on the belief that substance use causes a deterioration in one’s morals, and was most frequently manifested in the form of providers’ apprehensive approach towards patients. Concerns regarding stigmatization may cause patients to feel reluctant to receive treatment for both OUD and HIV at a single integrated clinic. Interventions to reduce stigma at the clinic and policy levels may thus serve to improve initiation of and adherence to integrated care.

Mental health status and factors related on mental health status of the older adults living alone

Purpose This study aims to describe the mental health status and factors related to the mental health status of older adults living alone. Design/methodology/approach This is a descriptive correlational study. Older adults living alone from the urban area of the Northeast of Thailand were recruited randomly from within a stratified sampling frame and received a questionnaire. Data were collected using a demographic form, way of coping, social support, family relationship, and Thai Mental Health Indicator-15 (TMHI-15). Data were analysed using descriptive statistics, Spearman's rank correlation coefficient, and Chi-square test. Findings The mental health status related to personal factors at p &lt; 0.05 including gender, education level, income, health status, coping strategies, social support and family relationship are related to mental health status. Research limitations/implications This study provides further empirical support for older adults who are living alone, especially females who have low income and have a disease. Consequently, policy on social support in older adults should be directed to developing a range of divergent intervention strategies. Practical implications This study requires some form of long-term care as well as utilization of treatment and support services, enhanced quality of life for older adults living alone. Social implications This study requires some form of long-term care as well as utilization of treatment and support services, enhanced quality of life for older adults living alone. Originality/value This study provides further empirical support for older adults who are living alone.