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Background: HIV is a condition that requires lifelong treatment. Treatment options currently consist of oral antiretroviral therapies (ART) taken once or twice daily. Long-acting injectable HIV treatments are currently in development to be administered monthly or every other month. Preferences for route of administration could influence treatment adherence, which could affect treatment outcomes. The purpose of this study was to examine patient perceptions of oral and injectable routes of administration for ART. Methods: Qualitative thematic analysis was conducted to examine 5122 online discussion threads by people living with HIV (PLHIV) in the POZ Community Forums from January 2013 to June 2018. Analysis focused on identifying perceptions of oral or injectable routes of administration for ART. Relevant threads were extracted and imported into the qualitative data analysis software package ATLAS.ti.8 so that text could be reviewed and coded. Results: Analyses identified 684 relevant discussion threads including 2626 coded quotations from online posts by 568 PLHIV. The oral route of administration was discussed more frequently than injectable (2516 quotations for oral; 110 injectable). Positive statements on the oral route of administration commonly mentioned the small number of pills (276 quotations), dose frequency (245), ease of scheduling (153), and ease of use (146). PLHIV also noted disadvantages of the oral route of administration including negative emotional impact (166), difficulty with medication access (106), scheduling (131), and treatment adherence (121). Among the smaller number of PLHIV discussing injectable ART, common positive comments focused on dose frequency (34), emotional benefits of not taking a daily pill (7), potential benefits for adherence (6), overall convenience (6), and benefits for traveling (6). Some comments from PLHIV perceived the frequency of injections negatively (10), and others had negative perceptions of needles (8) or appointments required to receive injections (7). Conclusions: Qualitative analysis revealed that route of administration was frequently discussed among PLHIV on this online forum. While many expressed positive views about their daily oral medication regimen, others perceived inconveniences and challenges. Among PLHIV who were aware of a possible monthly injectable treatment, many viewed this new route of administration as a convenient alternative with potential to improve adherence.

Background: Person-centred, re-engineered primary health care (PHC) is a national and global priority. Faith-based health care is a significant provider of PHC in Sub- Saharan Africa but there is very limited published data on the reasons for patient choice of faith-based health care, particularly in South Africa. Aim: The objective of this study was to determine and explore the reasons for patients' choice of a faith-based primary care clinic over their local public sector primary care clinic. The secondary objective was to determine to what extent demography influences reasons for patient choice. Setting: The study was conducted at Jubilee Health Centre (JHC) a faith-based primary care clinic attached to Jubilee Community Church in Observatory, Cape Town, South Africa.

Excerpt: Reid Blackwelder, M.D., knows medical education. For more than 25 years, the former AAFP president has been training family physicians through his work in one role or another, from professor to residency program director to his current position as chair of the Department of Family Medicine at Quillen College of Medicine at East Tennessee State University.

Background: Women are at high risk of HIV and sexually transmitted infections (STIs) prior to and during pregnancy. There is limited research on the link between quality of sexual relationships, intimate partner violence (IPV) and STIs in pregnancy. This study aims to evaluate the association between relationship type and quality, IPV, and STI diagnosis in pregnant women. Methods We conducted a cohort study of 242 pregnant women ≥18 years attending their first antenatal care visit in Cape Town, South Africa between February 2017 and February 2019. We conducted interviews and tested pregnant women for three different STIs: Chlamydia trachomatis (CT), Neisseria gonorrhoea (NG) and Trichomonas vaginalis (TV) using point-of-care PCR testing (GeneXpert, Cepheid, USA). We used multivariable logistic regression to evaluate the association between relationship quality, STI, and IPV during pregnancy, adjusting for maternal age, gestational age and relationship status. Results In 242 pregnant women (median age 29 years [IQR = 24–34], and median gestational age 19 weeks [IQR= 14-24]), 78 (32%) were diagnosed with CT, NT, and/or TV at baseline. Unmarried, non-cohabiting women had almost 2-times the odds of having an STI during pregnancy (aOR=1.92, 95% CI=1.06-3.48); women living with HIV had increased odds of having an STI (aOR=1.97, 95% CI=1.07-3.62) adjusting for covariates. Overall, 5% of women who had an STI reported experiencing IPV during the past year (n=4) and 2% of the women who tested STI-negative (n=4). Women who reported having high relationship quality in their primary relationship had decreased odds of experiencing IPV (aOR=0.11, 95% CI=0.017-0.073) compared to those who reported low relationship quality, adjusting for covariates, but this was not associated with STI diagnosis. Reporting recent IPV was not associated with STI acquisition (aOR=2.41, 95% CI=0.55-10.45). Conclusion: We found a high prevalence of STIs among pregnant women. Women who were unmarried or noncohabiting with the father of the baby or were living with HIV had increased odds of having a STI during pregnancy. Women who reported better relationship quality were associated with decreased odds of experiencing IPV. Experiencing IPV was not associated with STI acquisition.

Background: Tuberculosis (TB) remains a major contributor to morbidity and mortality in people living with HIV (PLHIV). The use of Isoniazid preventative therapy (IPT) has been proven to be effective and safe to reduce this burden. Despite overwhelming evidence, uptake op IPT is poor. This study evaluated an urban population of PLHIV and described associations with the delivery of IPT. Methods: A retrospective folder review. Results: A total of 198 folders were reviewed of which 31 had been/currently were on IPT. In the no-IPT group the fast majority, 86%, of the patients were eligible (according to current national HIV guidelines) for IPT. Only 4% had true contraindications. Factors favouring the delivery of IPT was the duration on ART (p=0.0038) and being part of the ART adherence club(AC) system (<0.0001). Conclusion: The vast majority of patients are screened but do not receive TPT. The duration of ART increased the likelihood of a patient to receive IPT. However, patients recently started on ART are at higher risk of TB disease and will benefit greatly from IPT. Patients who were enrolled in the AC system had a higher IPT penetrance. Quality improvement cycles should be implemented to address the situation. Increasing the role that adherence clubs play may be an option for future interventions.

Faith-based mental health provision as a model of mental health service delivery is not widely acknowledged or researched, despite being highly utilised, especially in the African context. There is currently limited empirical research or review work on the various types of faith-based health providers which contribute mental health services, the magnitude of these services, or their quality. This mixed-methods systematic review study looked at these aspects of faith-based mental health provision in the African context. In the first phase of this study, we conducted a scoping review with a wider, which resulted in a typology of models of faith-based mental health provision The typology included five different types of faith-based health individual and organisational providers (herbalists, traditional and faith healers, Christian and Muslim clergy, faith-based organisations, and chaplains). In the second phase of the study, we conducted a systematic review based on the typology in which we assessed these models of FBHP against service type and level (facility or community, individual or organisational providers); medical provision type (biomedical or alternative). There were 53 studies included in this systematic review and the findings suggest that there is a wide array of types of faith-based providers providing a variety of mental health services across Africa. The research question formulated for the purposes of the systematic review aim to address the types, magnitude and quality of faith-based mental health services in Africa. For the purposes of this review, magnitude was categorised as including frequency of utilisation and availability of faith-based mental health services, but the information was limited. In addition, there are red flags regarding the quality of these mental health services which include human rights abuses that were discussed in this review. This exploratory review demonstrates some of the challenges in dealing with the complex variety of 'religious entities' in Africa. To some degree, developing conclusions that are applicable to all faith-based mental health providing entities is counterproductive - and instead a main conclusion is that future research and engagement needs to take this variety into account. There are a few common trends - for example challenges facing most faith-based providers in relation to faith-based provision of mental health services is financial support for mental health services. Regarding both traditional/alternative and biomedical mental health services, it has been noted that, there is a need to consider cost to the patient (e.g., reduce out of pocket payments). In addition, the literature suggests that better training for some types of faith-based health providers is urgently needed, especially those working close to community. Community mental health education interventions could strengthen faith-based provision of mental healthcare, and prevent some human rights abuses (religious perils), and improve the quality of faith-based mental health service provision. Better referral systems and improved communication between faith-based health providers and biomedical practitioners is required. In addition, varied types of faith-based health providers need to be included in mental health policy development and implementation. Finally, the most comprehensive conclusion of this exploratory review, is that further research is needed on specific types of faith-based providers engaged in mental health service provision, and further research is needed on the integration of mental health services in African health systems.

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