This document summarizes issues related to pediatric adherence for HIV treatment in children and adolescents. It provides data on pediatric enrollment and adherence from ICAP programs in multiple countries. Key challenges to pediatric adherence are forgetting doses, staying away from home, and sleeping through doses. Developmental factors like age and disclosure status can also impact adherence. The document discusses strategies to support pediatric adherence, including education, reminders, involvement of caregivers, clinics that are child-friendly, and multidisciplinary teams. Country examples from South Africa, Kenya, and Ethiopia demonstrate approaches like appointment diaries, integration of services, and collaboration between medical and psychosocial teams to address children's developmental needs.
Key Findings and Programmatic Implications: OVC Program Evaluations in Kenya ...MEASURE Evaluation
Program exposure and coverage of key interventions was lower than expected based on registry data. Services targeting one domain, such as children's psychosocial well-being, had unintended effects on other domains. Exposure to multiple interventions showed additive benefits. While some programs improved children's outcomes, guardian outcomes were less consistently affected. Comprehensive HIV education, stigma reduction, and addressing guardians' psychological health and children's legal protection require more focus. Regular monitoring of coverage and participation is needed to improve program implementation and outcomes.
A presentation given by Gabrielle Murphy at The Journey, CHA Conference 2012, in the 'Innovations in Mental Health Care for Children and Young People' stream.
SBHC Innovations: The Intersection of Public Health and EducationCHC Connecticut
This document summarizes a webinar discussing considerations for reopening school-based health centers during the COVID-19 pandemic. Experts discussed various reopening models including in-person, hybrid, and distance learning and the mental health impacts on students. They also addressed health, educational, and operational concerns and the role school-based health centers can play in supporting students, staff, and collaborating with schools. This includes providing medical services, COVID-19 testing and education, mental health support, and helping establish safety protocols and track cases. Advocacy efforts to support these programs were also discussed.
This presentation summarizes research on the determinants of access to quality health care for children in Georgia. The study used a merged dataset containing information on over 1,300 Georgia children ages 4-17. Access was defined based on utilization of preventive care and quality of received care. Results from descriptive analyses and multivariable logistic regressions found that over 30% of children had access to higher quality care. Factors like having insurance, higher income levels, and being in better health were associated with higher odds of access, while being a racial/ethnic minority was associated with lower odds. The findings can help inform efforts to improve insurance coverage and reduce disparities in access to quality care for children in Georgia.
This presentation to the Australian Disease Management Association looks at integrated whole-person chronic care with a focus on the Canadian system.
Using information from BHI’s report Healthcare in Focus 2014: How does NSW compare? and the Commonwealth Fund International Health Policy survey of older adults, the presentation covers healthcare delivery, patients and providers perspectives on chronic disease care in Australia, Canada and 10 other countries, with insights from one province, Ontario, on Canadian primary healthcare reforms.
Commonwealth Fund data for 2013 and 2014 is available on the Bureau of Health Information’s interactive portal, Healthcare Observer, at bhi.nsw.gov.au
This document provides an overview of the P20 Telehealth Research Lab and its goals of improving access to specialized psychosocial services for children and families in rural Kentucky using telehealth technologies. It discusses the need for increased services due to high rates of mental health issues and lack of treatment. The lab uses telehealth to reduce geographic barriers and is currently conducting a project using telebehavioral family intervention for ADHD. It is looking for further funding and partnerships to expand its services to other areas and conditions.
Exposure to Medicaid in early childhood was found to decrease the prevalence of adult chronic conditions but did not improve economic status. The study used a difference-in-differences approach comparing individuals exposed to Medicaid in early childhood to those with no exposure, finding a 0.4 reduction in the probability of chronic conditions for the low-income group targeted by Medicaid. However, no significant effects were found for economic outcomes like education, income, and wealth. The results suggest early childhood Medicaid coverage provides long-term health benefits but the mechanisms and potential effects on economics require more research.
Telemedicine has grown significantly in India over the past two decades. The COVID-19 pandemic accelerated this growth as telemedicine allowed for continued access to healthcare while reducing exposure. National telemedicine guidelines released in 2020 facilitated widespread telemedicine use. Telemedicine was used in both public and private sectors in urban, rural, and remote areas for non-COVID and COVID care, including triaging, home monitoring, and continuing medical education. While unable to replace in-person care, most patients expressed satisfaction with telehealth services. Telemedicine is likely to remain an integral part of India's healthcare system post-pandemic.
Key Findings and Programmatic Implications: OVC Program Evaluations in Kenya ...MEASURE Evaluation
Program exposure and coverage of key interventions was lower than expected based on registry data. Services targeting one domain, such as children's psychosocial well-being, had unintended effects on other domains. Exposure to multiple interventions showed additive benefits. While some programs improved children's outcomes, guardian outcomes were less consistently affected. Comprehensive HIV education, stigma reduction, and addressing guardians' psychological health and children's legal protection require more focus. Regular monitoring of coverage and participation is needed to improve program implementation and outcomes.
A presentation given by Gabrielle Murphy at The Journey, CHA Conference 2012, in the 'Innovations in Mental Health Care for Children and Young People' stream.
SBHC Innovations: The Intersection of Public Health and EducationCHC Connecticut
This document summarizes a webinar discussing considerations for reopening school-based health centers during the COVID-19 pandemic. Experts discussed various reopening models including in-person, hybrid, and distance learning and the mental health impacts on students. They also addressed health, educational, and operational concerns and the role school-based health centers can play in supporting students, staff, and collaborating with schools. This includes providing medical services, COVID-19 testing and education, mental health support, and helping establish safety protocols and track cases. Advocacy efforts to support these programs were also discussed.
This presentation summarizes research on the determinants of access to quality health care for children in Georgia. The study used a merged dataset containing information on over 1,300 Georgia children ages 4-17. Access was defined based on utilization of preventive care and quality of received care. Results from descriptive analyses and multivariable logistic regressions found that over 30% of children had access to higher quality care. Factors like having insurance, higher income levels, and being in better health were associated with higher odds of access, while being a racial/ethnic minority was associated with lower odds. The findings can help inform efforts to improve insurance coverage and reduce disparities in access to quality care for children in Georgia.
This presentation to the Australian Disease Management Association looks at integrated whole-person chronic care with a focus on the Canadian system.
Using information from BHI’s report Healthcare in Focus 2014: How does NSW compare? and the Commonwealth Fund International Health Policy survey of older adults, the presentation covers healthcare delivery, patients and providers perspectives on chronic disease care in Australia, Canada and 10 other countries, with insights from one province, Ontario, on Canadian primary healthcare reforms.
Commonwealth Fund data for 2013 and 2014 is available on the Bureau of Health Information’s interactive portal, Healthcare Observer, at bhi.nsw.gov.au
This document provides an overview of the P20 Telehealth Research Lab and its goals of improving access to specialized psychosocial services for children and families in rural Kentucky using telehealth technologies. It discusses the need for increased services due to high rates of mental health issues and lack of treatment. The lab uses telehealth to reduce geographic barriers and is currently conducting a project using telebehavioral family intervention for ADHD. It is looking for further funding and partnerships to expand its services to other areas and conditions.
Exposure to Medicaid in early childhood was found to decrease the prevalence of adult chronic conditions but did not improve economic status. The study used a difference-in-differences approach comparing individuals exposed to Medicaid in early childhood to those with no exposure, finding a 0.4 reduction in the probability of chronic conditions for the low-income group targeted by Medicaid. However, no significant effects were found for economic outcomes like education, income, and wealth. The results suggest early childhood Medicaid coverage provides long-term health benefits but the mechanisms and potential effects on economics require more research.
Telemedicine has grown significantly in India over the past two decades. The COVID-19 pandemic accelerated this growth as telemedicine allowed for continued access to healthcare while reducing exposure. National telemedicine guidelines released in 2020 facilitated widespread telemedicine use. Telemedicine was used in both public and private sectors in urban, rural, and remote areas for non-COVID and COVID care, including triaging, home monitoring, and continuing medical education. While unable to replace in-person care, most patients expressed satisfaction with telehealth services. Telemedicine is likely to remain an integral part of India's healthcare system post-pandemic.
Tele-resuscitation and tele-consultation can improve neonatal care in rural hospitals. Tele-resuscitation supports pediatricians during complex resuscitations, improves quality of care, and reduces transfers. Neonatologists use tele-consultation to positively influence management decisions. Virtual rounding allows neonatologists to provide care to preterm infants in rural hospitals, reducing their hospital stay and need for support. Telehealth expands access to specialty neonatal care for rural communities.
This study examined factors that predict healthcare utilization among Medicaid-eligible infants in Philadelphia. The researchers analyzed data from 579 infants followed for 2 years from birth, including healthcare visits, maternal characteristics, and social support. They found that having a chronic disease diagnosis was the strongest predictor of increased healthcare use. Maternal education level, prenatal care adherence, and employment status also impacted the likelihood of well-child visits and emergency department use. The researchers recommend postpartum education for mothers on the importance of well-child visits, especially for those with low prenatal care adherence or full-time employment.
This document summarizes a research project on child protection conducted at Birmingham Children's Hospital. It involved a literature review on child protection guidelines, interviews with clinical staff, and a survey distributed to hospital staff. The survey presented a hypothetical child abuse case study and assessed staff understanding of clinical guidelines. The majority (96.4%) of hospital staff demonstrated a clear understanding of guidelines for identifying potential child abuse cases. While adherence to clinical documents was encouraging, the research concluded more should be done to prevent abuse through longer-term measures rather than just identifying evidence of abuse. Overall, the research found hospital staff generally understood how to appropriately handle potential child abuse cases according to clinical guidelines.
This study examined the association between systems of care and activity limitations in children with special health care needs using a national health survey dataset. The study found that children who met criteria for access to family-centered care, comprehensive and coordinated care, and overall quality systems of care were less likely to experience moderate or severe activity limitations compared to children who did not meet these criteria, after controlling for covariates. Key factors associated with fewer activity limitations included meeting criteria for family-centered care, comprehensive and coordinated care, and quality systems of care. The study supports that improved access to supportive, collaborative, and coordinated care can help reduce activity limitations for children with special health care needs.
This document discusses neonatal abstinence syndrome (NAS) and universal maternal drug testing. It provides background information on NAS including trends showing large increases in incidence and costs associated with NAS. It outlines objectives related to describing NAS trends, identifying legislative activities impacting NAS, describing family planning for women in substance abuse treatment, and explaining a hospital program using universal drug testing. The document then covers topics including NAS symptoms, incidence and geographic trends, costs of NAS, opioid use in women of childbearing age, unintended pregnancy rates, contraceptive use among opioid users, and maternal drug exposure sources.
This presentation by Cathy Schoen, Senior Vice President of the Commonwealth Fund, uses results from the Fund’s annual International Health Policy surveys plus US examples to illustrate the potential to re-design health care in the 21st century with a focus on primary care linked to a continuum of care.
Cathy shares insights gleaned from the Commonwealth Fund’s three most recent international surveys—general population (2013), primary care doctors (2012), and adults with complex medical conditions (2011)—that compare Australia with 10 other countries.
Cathy also highlights examples of care system innovation and improvement.
The Role Of Telehealth In Emerging Models Of CareYasnof
Between 2006 and 2036 the proportion of New Zealand’s population aged 65 or over as a proportion of the working-age population is expected to rise from 18 to 40%,” The number of people over Chronic conditions are estimated to account for 70 percent of health funding and 80 percent of all deaths in New Zealand and health workforce numbers per person are expected to decrease over next 20 years. This presentation explores the potential of Telehealth to address these challenges
This document provides an overview of issues facing children with special health care needs (CSHCN) in California. It discusses key focus areas like care coordination and family engagement. It notes that California ranks poorly nationally in areas like preventative care, care coordination, and family-centered care for CSHCN. The document also discusses the medical and social complexity of CSHCN, the importance of care coordination systems, and the need to better support families providing care.
This document summarizes Israel Nieves-Rivera's presentation on San Francisco's approach to HIV prevention and care. It discusses:
1) San Francisco's comprehensive continuum of HIV prevention, care, and treatment services.
2) Key data on the HIV epidemiology in San Francisco, including populations most at risk and underlying risk factors.
3) San Francisco's efforts to optimize various aspects of the HIV care continuum, including testing rates, linkage to care, viral suppression, and expanding access to antiretroviral treatment.
1) Philadelphia's infant mortality rate is higher than the national average, which may be due to high rates of preterm births and low birthweight. The closure of 13 obstetrics units has increased demand on the remaining 6 units.
2) The study assessed prenatal care capacity in Philadelphia by surveying providers on appointment availability, wait times, and other access factors. On average, newly pregnant women waited over 10 days for an initial appointment.
3) Recommendations include expanding prenatal care hours, increasing the provider workforce, standardizing scheduling policies, and addressing socioeconomic barriers through partnerships between medical centers and public health.
This webinar discusses childhood trauma related to COVID-19 and beyond. It notes that over 100,000 US children have lost caregivers to COVID, disproportionately affecting Black and Latinx children. The pandemic has also led to decreased well visits and increased neglect and abuse reports. Moving forward, the webinar emphasizes the importance of discussing potentially traumatic events with families, providing psychoeducation, and implementing self-care strategies to address the fatigue caused by the ongoing impacts of the pandemic.
Dan witters wellbeing of american caregivers (6 24-13)bsinatro
This document summarizes research on the well-being of American caregivers. It finds that employed caregivers are less well-rested than non-caregivers, having 7 fewer productive days per year. Caregivers also have slightly lower job satisfaction, higher rates of high blood pressure, and more physical pain. Caregiving costs the US economy $25.2 billion per year in lost productivity due to missed work.
Beyond survival: Improving long-term outcomes for survivors of serious newborn illness in Asia and the Pacific
Dr Kate Milner
Centre for International Child Health, Department of Paediatrics
University of Melbourne
The document discusses strategies for engaging communities in COVID-19 vaccination efforts. It provides data on current US COVID cases and deaths. It also summarizes two new oral antiviral treatments: Paxlovid, which reduces risk of hospitalization by 89% if taken within 3 days of symptoms, and Molnupiravir, which is about 50% effective within 5 days. The document then outlines best practices for conducting community outreach, including assessing needs, partnering with local organizations, addressing misinformation, and creating convenient vaccination opportunities through schools and businesses.
This document discusses several studies that evaluated the impact of community support programs on HIV treatment outcomes. It found that community-based ART, community support initiatives, community health workers, and peer treatment supporters can help improve retention in care, adherence, viral suppression, quality of life, and other outcomes. Specific interventions like daily home visits, directly observed therapy, treatment education, counseling, and accompaniment to clinics were found to increase retention and suppress viral loads.
The document summarizes an assessment of Adolescent Girls Power Groups (AGPGs) created by the ENRICH program in Bangladesh to empower adolescent girls and address gender inequalities. It finds that AGPGs have contributed significantly to improving girls' confidence, decision-making, and health knowledge. However, COVID-19 has negatively impacted the girls' mental health, safety, education, and access to healthcare. The AGPGs have still provided social support and COVID information to the girls during the pandemic. The assessment recommends expanding the AGPG model, formally linking them to local government, and engaging boys to further support girls' empowerment.
Telehealth and Patient Engagement Strategies: The Operation Team Perspective CHC Connecticut
This document provides information about telehealth and patient engagement strategies from an operations team perspective during the COVID-19 pandemic. It discusses how a community health center implemented a telehealth program, including establishing teams to support telehealth providers, patients, and COVID-19 testing. The document outlines workflows for telehealth visits, including deciding between phone or video visits and scheduling in-person visits when needed. It also provides data on the increase in telehealth calls and examples of telehealth outreach projects to keep patient visits and schedules full during the pandemic.
Web only rx16 treat-wed_1115_1_hudson_2badaOPUNITE
The document discusses treatment and outcomes of neonatal abstinence syndrome (NAS). It summarizes a presentation by two doctors on NAS treatment. It then describes a study examining outcomes of a palliative early treatment model for NAS at Greenville Memorial Hospital. The model involved early low-dose methadone treatment for opioid exposed newborns in a low-acuity nursery setting. Results showed lower length of stay, less weight loss and medical complications compared to national averages, with total hospital costs averaging $5,909 per case.
Kristen santiago –attitude & usage trends among african american and hispanic...bsinatro
This document summarizes findings from a survey of African American and Hispanic populations on their awareness, knowledge and attitudes regarding palliative care and hospice care. Some key findings include:
- Awareness and knowledge of palliative care was lower among African Americans compared to Hispanics, though both groups expressed a desire to learn more.
- Discussions around hospice care tended to happen late in the illness process. There was also some misconception that it decreases length of life.
- Doctors and other healthcare providers were seen as the most trusted sources of information about end-of-life care options.
- Quality of life factors like time with family and minimizing pain were higher priorities than prolonging
Family-based programmes for preventing smoking by children and adolescents: W...Health Evidence™
Health Evidence hosted a 60 minute webinar examining whether family interventions can influence children and adolescents not to smoke. Roger Thomas, Professor, Faculty of Medicine, University of Calgary, led the session, and presented findings from his latest Cochrane review:
Thomas, R.E., Baker, P.R.A., Thomas, B.C., & Lorenzetti, D. (2015). Family-based programmes for preventing smoking by children and adolescents. Cochrane Database of Systematic Reviews, 2015(2), Art. No. CD004493.
Preventing children from starting to smoke is important to avoid a lifetime of addiction, poor health, and social and economic consequences. Family members influence whether children and adolescents smoke. This review includes 27 trials (23 in US, one each in Australia, India, the Netherlands, and Norway). There is moderate quality evidence that family-based interventions can prevent children and adolescents from starting to smoke. Intensive programs may be more likely to be successful than those of lower intensity. There is also evidence to suggest that adding a family-based component to a school intervention may be effective.
Rosemary Frasso's presentation from the
Penn Urban Doctoral Symposium
May 13, 2011
Co-sponsored with Penn’s Urban Studies program, this symposium celebrates the work of graduating urban-focused doctoral candidates. Graduates present and discuss their dissertation findings. Luncheon attended by the students, their families and their committees follows.
Ijsrp p8825 Caregiver factors influencing seeking of Early Infant Diagnosis (...Elizabeth kiilu
Caregiver factors influencing seeking of Early Infant Diagnosis (EID) of HIV services in selected hospitals in Nairobi County, Kenya:A qualitative Study
Tele-resuscitation and tele-consultation can improve neonatal care in rural hospitals. Tele-resuscitation supports pediatricians during complex resuscitations, improves quality of care, and reduces transfers. Neonatologists use tele-consultation to positively influence management decisions. Virtual rounding allows neonatologists to provide care to preterm infants in rural hospitals, reducing their hospital stay and need for support. Telehealth expands access to specialty neonatal care for rural communities.
This study examined factors that predict healthcare utilization among Medicaid-eligible infants in Philadelphia. The researchers analyzed data from 579 infants followed for 2 years from birth, including healthcare visits, maternal characteristics, and social support. They found that having a chronic disease diagnosis was the strongest predictor of increased healthcare use. Maternal education level, prenatal care adherence, and employment status also impacted the likelihood of well-child visits and emergency department use. The researchers recommend postpartum education for mothers on the importance of well-child visits, especially for those with low prenatal care adherence or full-time employment.
This document summarizes a research project on child protection conducted at Birmingham Children's Hospital. It involved a literature review on child protection guidelines, interviews with clinical staff, and a survey distributed to hospital staff. The survey presented a hypothetical child abuse case study and assessed staff understanding of clinical guidelines. The majority (96.4%) of hospital staff demonstrated a clear understanding of guidelines for identifying potential child abuse cases. While adherence to clinical documents was encouraging, the research concluded more should be done to prevent abuse through longer-term measures rather than just identifying evidence of abuse. Overall, the research found hospital staff generally understood how to appropriately handle potential child abuse cases according to clinical guidelines.
This study examined the association between systems of care and activity limitations in children with special health care needs using a national health survey dataset. The study found that children who met criteria for access to family-centered care, comprehensive and coordinated care, and overall quality systems of care were less likely to experience moderate or severe activity limitations compared to children who did not meet these criteria, after controlling for covariates. Key factors associated with fewer activity limitations included meeting criteria for family-centered care, comprehensive and coordinated care, and quality systems of care. The study supports that improved access to supportive, collaborative, and coordinated care can help reduce activity limitations for children with special health care needs.
This document discusses neonatal abstinence syndrome (NAS) and universal maternal drug testing. It provides background information on NAS including trends showing large increases in incidence and costs associated with NAS. It outlines objectives related to describing NAS trends, identifying legislative activities impacting NAS, describing family planning for women in substance abuse treatment, and explaining a hospital program using universal drug testing. The document then covers topics including NAS symptoms, incidence and geographic trends, costs of NAS, opioid use in women of childbearing age, unintended pregnancy rates, contraceptive use among opioid users, and maternal drug exposure sources.
This presentation by Cathy Schoen, Senior Vice President of the Commonwealth Fund, uses results from the Fund’s annual International Health Policy surveys plus US examples to illustrate the potential to re-design health care in the 21st century with a focus on primary care linked to a continuum of care.
Cathy shares insights gleaned from the Commonwealth Fund’s three most recent international surveys—general population (2013), primary care doctors (2012), and adults with complex medical conditions (2011)—that compare Australia with 10 other countries.
Cathy also highlights examples of care system innovation and improvement.
The Role Of Telehealth In Emerging Models Of CareYasnof
Between 2006 and 2036 the proportion of New Zealand’s population aged 65 or over as a proportion of the working-age population is expected to rise from 18 to 40%,” The number of people over Chronic conditions are estimated to account for 70 percent of health funding and 80 percent of all deaths in New Zealand and health workforce numbers per person are expected to decrease over next 20 years. This presentation explores the potential of Telehealth to address these challenges
This document provides an overview of issues facing children with special health care needs (CSHCN) in California. It discusses key focus areas like care coordination and family engagement. It notes that California ranks poorly nationally in areas like preventative care, care coordination, and family-centered care for CSHCN. The document also discusses the medical and social complexity of CSHCN, the importance of care coordination systems, and the need to better support families providing care.
This document summarizes Israel Nieves-Rivera's presentation on San Francisco's approach to HIV prevention and care. It discusses:
1) San Francisco's comprehensive continuum of HIV prevention, care, and treatment services.
2) Key data on the HIV epidemiology in San Francisco, including populations most at risk and underlying risk factors.
3) San Francisco's efforts to optimize various aspects of the HIV care continuum, including testing rates, linkage to care, viral suppression, and expanding access to antiretroviral treatment.
1) Philadelphia's infant mortality rate is higher than the national average, which may be due to high rates of preterm births and low birthweight. The closure of 13 obstetrics units has increased demand on the remaining 6 units.
2) The study assessed prenatal care capacity in Philadelphia by surveying providers on appointment availability, wait times, and other access factors. On average, newly pregnant women waited over 10 days for an initial appointment.
3) Recommendations include expanding prenatal care hours, increasing the provider workforce, standardizing scheduling policies, and addressing socioeconomic barriers through partnerships between medical centers and public health.
This webinar discusses childhood trauma related to COVID-19 and beyond. It notes that over 100,000 US children have lost caregivers to COVID, disproportionately affecting Black and Latinx children. The pandemic has also led to decreased well visits and increased neglect and abuse reports. Moving forward, the webinar emphasizes the importance of discussing potentially traumatic events with families, providing psychoeducation, and implementing self-care strategies to address the fatigue caused by the ongoing impacts of the pandemic.
Dan witters wellbeing of american caregivers (6 24-13)bsinatro
This document summarizes research on the well-being of American caregivers. It finds that employed caregivers are less well-rested than non-caregivers, having 7 fewer productive days per year. Caregivers also have slightly lower job satisfaction, higher rates of high blood pressure, and more physical pain. Caregiving costs the US economy $25.2 billion per year in lost productivity due to missed work.
Beyond survival: Improving long-term outcomes for survivors of serious newborn illness in Asia and the Pacific
Dr Kate Milner
Centre for International Child Health, Department of Paediatrics
University of Melbourne
The document discusses strategies for engaging communities in COVID-19 vaccination efforts. It provides data on current US COVID cases and deaths. It also summarizes two new oral antiviral treatments: Paxlovid, which reduces risk of hospitalization by 89% if taken within 3 days of symptoms, and Molnupiravir, which is about 50% effective within 5 days. The document then outlines best practices for conducting community outreach, including assessing needs, partnering with local organizations, addressing misinformation, and creating convenient vaccination opportunities through schools and businesses.
This document discusses several studies that evaluated the impact of community support programs on HIV treatment outcomes. It found that community-based ART, community support initiatives, community health workers, and peer treatment supporters can help improve retention in care, adherence, viral suppression, quality of life, and other outcomes. Specific interventions like daily home visits, directly observed therapy, treatment education, counseling, and accompaniment to clinics were found to increase retention and suppress viral loads.
The document summarizes an assessment of Adolescent Girls Power Groups (AGPGs) created by the ENRICH program in Bangladesh to empower adolescent girls and address gender inequalities. It finds that AGPGs have contributed significantly to improving girls' confidence, decision-making, and health knowledge. However, COVID-19 has negatively impacted the girls' mental health, safety, education, and access to healthcare. The AGPGs have still provided social support and COVID information to the girls during the pandemic. The assessment recommends expanding the AGPG model, formally linking them to local government, and engaging boys to further support girls' empowerment.
Telehealth and Patient Engagement Strategies: The Operation Team Perspective CHC Connecticut
This document provides information about telehealth and patient engagement strategies from an operations team perspective during the COVID-19 pandemic. It discusses how a community health center implemented a telehealth program, including establishing teams to support telehealth providers, patients, and COVID-19 testing. The document outlines workflows for telehealth visits, including deciding between phone or video visits and scheduling in-person visits when needed. It also provides data on the increase in telehealth calls and examples of telehealth outreach projects to keep patient visits and schedules full during the pandemic.
Web only rx16 treat-wed_1115_1_hudson_2badaOPUNITE
The document discusses treatment and outcomes of neonatal abstinence syndrome (NAS). It summarizes a presentation by two doctors on NAS treatment. It then describes a study examining outcomes of a palliative early treatment model for NAS at Greenville Memorial Hospital. The model involved early low-dose methadone treatment for opioid exposed newborns in a low-acuity nursery setting. Results showed lower length of stay, less weight loss and medical complications compared to national averages, with total hospital costs averaging $5,909 per case.
Kristen santiago –attitude & usage trends among african american and hispanic...bsinatro
This document summarizes findings from a survey of African American and Hispanic populations on their awareness, knowledge and attitudes regarding palliative care and hospice care. Some key findings include:
- Awareness and knowledge of palliative care was lower among African Americans compared to Hispanics, though both groups expressed a desire to learn more.
- Discussions around hospice care tended to happen late in the illness process. There was also some misconception that it decreases length of life.
- Doctors and other healthcare providers were seen as the most trusted sources of information about end-of-life care options.
- Quality of life factors like time with family and minimizing pain were higher priorities than prolonging
Family-based programmes for preventing smoking by children and adolescents: W...Health Evidence™
Health Evidence hosted a 60 minute webinar examining whether family interventions can influence children and adolescents not to smoke. Roger Thomas, Professor, Faculty of Medicine, University of Calgary, led the session, and presented findings from his latest Cochrane review:
Thomas, R.E., Baker, P.R.A., Thomas, B.C., & Lorenzetti, D. (2015). Family-based programmes for preventing smoking by children and adolescents. Cochrane Database of Systematic Reviews, 2015(2), Art. No. CD004493.
Preventing children from starting to smoke is important to avoid a lifetime of addiction, poor health, and social and economic consequences. Family members influence whether children and adolescents smoke. This review includes 27 trials (23 in US, one each in Australia, India, the Netherlands, and Norway). There is moderate quality evidence that family-based interventions can prevent children and adolescents from starting to smoke. Intensive programs may be more likely to be successful than those of lower intensity. There is also evidence to suggest that adding a family-based component to a school intervention may be effective.
Rosemary Frasso's presentation from the
Penn Urban Doctoral Symposium
May 13, 2011
Co-sponsored with Penn’s Urban Studies program, this symposium celebrates the work of graduating urban-focused doctoral candidates. Graduates present and discuss their dissertation findings. Luncheon attended by the students, their families and their committees follows.
Ijsrp p8825 Caregiver factors influencing seeking of Early Infant Diagnosis (...Elizabeth kiilu
Caregiver factors influencing seeking of Early Infant Diagnosis (EID) of HIV services in selected hospitals in Nairobi County, Kenya:A qualitative Study
This document discusses using telemedicine in schools for children with developmental disabilities. It describes how telemedicine can be used for psychotherapy, assessments, training teachers, and more. While telemedicine improves access to care and support, there are also challenges like difficulty establishing rapport and scheduling emergencies remotely. The Marcus Autism Center has collaborated with other organizations to provide telemedicine services for 1,459 patient appointments across 34 sites in Georgia.
This document discusses a study on supporting children's adherence to anti-retroviral (ART) therapy in Malawi. The study followed 47 HIV-positive children on ART over 6 months to a year. 72% of children never missed a dose according to caregiver reports. Clinic attendance was also good, with over 80% of visits either on time or within a week of the scheduled date. Focus groups and interviews with caregivers provided insights into challenges of supporting children's adherence, such as costs of medication and transport as well as caregiver responsibilities, but also motivations like seeing children's health improve. The findings highlight the need for more affordable and less complex ART regimes as well as tools to help caregivers support children's adherence
Tracking HIV Positive Children in India Through Family Case ManagementMatt Avery
1) The Balasahyoga project in India used a Family Case Management approach to minimize loss to follow up of children and adults infected with HIV across the HIV testing and treatment cascade.
2) Key aspects of the approach included family counseling, home visits, referrals to treatment facilities, tracking individuals across services, and data sharing between community and health facilities.
3) The approach significantly increased the number of children and adults registered for HIV testing and treatment, tested, initiated on antiretroviral therapy, and retained in care, demonstrating its effectiveness in improving access and continuity of HIV services.
Impact of palliative care education on nurses' knowledge, attitude and exper...Alexander Decker
1) The study evaluated the impact of palliative care education on nurses' knowledge, attitude, and experience in caring for chronically ill children.
2) A questionnaire was used to assess nurses' knowledge, attitude, and experience before and after receiving education based on guidelines developed by the researchers.
3) The results showed that the majority of nurses had a bachelor's degree but none had cared for dying children in the past year. There were also significant improvements in nurses' knowledge, attitude, and experience regarding palliative care after receiving the educational intervention.
Epidemiological aspects of maternal and child healthnew 3Sinmayee Kumari
"maternal and child health refers to the promotive, preventive, curative and rehabilitative health care for mothers and children"
this topic is very essential for all the health care personnel
The IMPACT model implemented by World Education/Bantwana Initiative Zimbabwe identifies HIV+ children through community volunteers and links them to health facilities for care and treatment. From 2010 to 2013, the program identified 1,974 HIV+ children, with 1,369 initiated on antiretroviral therapy (ART). The expanded IMPACT model will reach an additional 17 districts and target 23,000 HIV+ children with the goal of national scale-up in partnership with the Ministry of Health and Child Care.
Child-health practitioners in Iowa must find better ways to address family, neighborhood and economic factors that shape children' health and well being, according to CFPC executive director Charles Bruner and Debra Waldron, director and chief medical officer of the Child Health Specialty Clinics at the University of Iowa. They presented at the Iowa Governor's Conference on Public Health in Ames on April 5.
This document outlines the objectives, principles, and benefits of an advanced nursing course on management of common acute pediatric health problems. The course aims to develop students' skills in pediatric health assessment and management of urgent/emergent issues in hospital settings. It covers topics like the role of advanced pediatric nurses, principles of patient- and family-centered care, benefits of this approach for patients, families, and healthcare providers, and conclusions about incorporating these concepts into practice.
Targeted Evaluation of Five Programs Supporting Orphans and Vulnerable Childr...MEASURE Evaluation
This document summarizes the background, methods, and goals of targeted evaluations of five programs supporting orphans and vulnerable children (OVC) in Kenya and Tanzania. The evaluations aimed to determine what intervention models and components are most effective and cost-effective in improving outcomes for OVC and their caregivers. The evaluations used case studies, surveys of children and caregivers, and analyses of program expenditures. Key outcomes examined included psychosocial well-being, education, health, HIV prevention, and legal protection. The findings provide evidence to guide decisions around scaling and improving OVC programs.
This document discusses the benefits of childhood intervention services for children with autism spectrum disorder (ASD). It argues that early intervention and school-age intervention can help children with ASD develop social and behavioral skills that allow them to transition successfully into adulthood. Research shows that childhood interventions like applied behavior analysis therapy and video modeling can significantly improve outcomes for children with ASD in areas like language, cognitive development, and adaptive behaviors. However, many children do not receive these beneficial services due to lack of insurance coverage and high costs. The document concludes that public health policies are needed to ensure children with ASD have access to evidence-based interventions throughout childhood.
Realizing Pediactric Adherence in TBM and HIV Home Treatment: 2013 Internship...Kate Okrasinski
The document summarizes research on understanding how treatment programs are structured to support pediatric adherence for tuberculosis (TB) meningitis (TBM) and HIV/AIDS. It identifies key actors and networks involved in treatment programs at two facilities in South Africa. Interviews revealed that a calendar adherence tool was useful for strengthening communication between healthcare workers and caregivers, engaging and educating children, and identifying domestic situations that impacted adherence. However, the HIV program could better incorporate social assessments and support systems to improve pediatric adherence. Overall, the tool shows promise for enhancing adherence when incorporated into program configurations, but may be limited by disease factors, healthcare systems, and patient volumes.
Caregivers' knowledge, attitudes, and practices influence clinical outcomes for disabled children under five. The study assessed 200 caregivers in Bawku, Ghana. It found that while caregivers were aware their children were sick, many did not view the illness as severe and delayed seeking treatment. Economic and socio-cultural factors like cost of care, education levels, and cultural beliefs influenced treatment-seeking. The study recommends improving healthcare access to ensure prompt treatment of childhood illnesses.
This study assessed the disclosure status and associated factors among caregivers of children on antiretroviral therapy in Addis Ababa, Ethiopia. The disclosure status was found to be high, with 53.9% of children knowing their positive HIV status. Factors that increased the likelihood of disclosure included children aged 10-15 years, being on ART for 6-13 years, good treatment adherence, and receiving adequate advice from healthcare providers. While disclosure prevalence was higher than previous studies, more work is needed as many children still did not know their status, primarily due to young age and fear of discrimination. The study recommends improved counseling for caregivers on age-appropriate disclosure and providing support and guidelines for healthcare workers.
This document outlines plans to establish the Upstate Coalition for Adolescents and Young Adults (UCAYA) in the Upstate region of South Carolina. It notes high rates of health risk behaviors among adolescents and a lack of adolescent-focused care in the region. UCAYA would take a holistic, multidisciplinary approach to address physical, mental, and social health needs through education, empowerment, collaboration, and connection of patients, families, providers and communities. It proposes a three-phase plan to first gather input, then develop an online presence, and finally open a physical center to integrate services and provide comprehensive adolescent care.
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Background: Adolescents are exposed to several reproductive health challenges including early marriage, unwanted pregnancies, unsafe abortions and sexually transmitted infections. An estimated 14 million adolescents give birth annually of which more than 90% of these occurs in developing countries. Adolescents in the Sub-Saharan Africa have low family planning utilization rates, limited knowledge of reproductive health services and very high pregnancy rates which is not unrelated to the negative attitude of some health care providers towards the provision of Sexual and Reproductive Health (SRH) services and information to adolescents.
The goals of the workshop were to develop evidence-based strategies for improving, monitoring, and evaluating adherence support for HIV prevention, care, and treatment and to set a sustainable adherence agenda. The objectives were to review current adherence levels, share lessons learned and acquire new skills, identify strategies for improved monitoring and evaluation of adherence interventions, and develop country-specific work plans. Key topics included adult and pediatric care and treatment and PMTCT. Key adherence strategies to discuss were appointment systems, tracking patients, integrated counseling, peer education, and community linkages. The workshop would include presentations, breakout sessions, and action planning to help all ICAP sites implement functional appointment systems and counseling/assessment strategies by 2010.
This document discusses measuring adherence within PMTCT programs. It begins by defining PMTCT as a care and treatment program for pregnant HIV-positive women and their exposed infants, noting activities occur across antenatal care, maternity wards, exposed infant clinics and HIV treatment centers. Routinely collected data only provides a general idea of adherence. New tools are needed to assess adherence at different points, like antenatal adherence and infant follow-up. These tools should reflect PMTCT as a long-term program, not just delivery. Strong systems are required to retain families in care, like functioning appointment systems and linkage between services.
This document summarizes collaboration between ICAP Ethiopia and the Psychosocial Unit at Adama Hospital. The Psychosocial Unit provides psychological support for abused children, cares for abandoned children, and facilitates services for children in conflict with the law. ICAP and the Psychosocial Unit collaborate to meet the special needs of HIV-infected children enrolled in care at Adama Hospital, who face issues like orphanhood, mental health problems, child abuse, and homelessness. The multi-disciplinary team from both organizations provides psychological support, counseling, and medical support to referred children. This collaboration aims to establish a model pediatric psychosocial unit and expand services to other facilities.
Assessing Adherence to Treatment: A Partnershipicapclinical
This document summarizes a presentation on assessing adherence to HIV treatment. It defines adherence to care and treatment, describes various methods to measure adherence including patient recall, pill counts, and qualitative assessments. Program examples from Swaziland, South Africa, and Mozambique are provided. Visual, qualitative, and partnership-based approaches aim to facilitate patient understanding and ongoing monitoring to support optimal adherence. Barriers to implementation include staff time constraints and ensuring clinical interpretation and follow-up on assessment results.
Assessing Adherence to Treatment: A Partnershipicapclinical
This document summarizes a presentation on assessing adherence to HIV treatment. It defines adherence to care and treatment, describes various methods to measure adherence including patient recall, pill counts, and qualitative assessments. Program examples from Swaziland, South Africa, and Mozambique are provided. Visual, qualitative, and partnership-based approaches aim to facilitate patient understanding and ongoing monitoring to support optimal adherence. Barriers to and facilitators of adherence are identified to guide interventions.
Peer Educators for Adherence, Referral, and Linkages: The ICAP Rwanda Modelicapclinical
The document describes the PEARL program in Rwanda, which aims to enhance HIV patient adherence and linkages to care through peer education. The program trains and equips peer educators to conduct home visits and community outreach. It is implemented through local organizations in several districts. Peer educators provide counseling, referral, and psychosocial support. The program has strengthened services and reduced loss to follow up, though challenges include maintaining peer motivation and reaching mobile patients.
The document summarizes ICAP Tanzania's peer education program which aims to increase adherence and psychosocial support for people living with HIV. The program trains people living with HIV to serve as peer educators who provide counseling, health talks, and community outreach. Peer educators help 180 people across 35 sites and have established over 100 support groups. Evaluation found the program increased clients' adherence, reduced stigma, and improved tracing of patients lost to follow up. Challenges include a lack of health worker support and no formal policy to institutionalize the peer education role in health facilities.
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GIPA/MIPA is a principle that aims to involve people living with HIV in decision-making processes that affect their lives and enhance the effectiveness of the AIDS response. People living with HIV have expertise from experiencing vulnerability to HIV and managing HIV-related illnesses. They can play important roles in advocacy, campaigns, policy-making, leadership, treatment programs, and personal health. Involving people living with HIV in these areas can help ensure community well-being, treatment scale-up, and universal access to HIV services.
Opportunities and Challenges to Adherence: A Field Experienceicapclinical
The document outlines the opportunities and challenges to adherence in prevention of mother-to-child transmission (PMTCT) programs in Rwanda. It describes the follow-up procedures for PMTCT women in the ante-partum, intra-partum, and post-partum periods. It also outlines the follow-up procedures for PMTCT infants in the intra-partum and post-partum periods. Lastly, it identifies opportunities such as the large proportion of clients tested for HIV and availability of CD4 count machines, and challenges such as the number of visits required and lack of reporting on refills and CD4 count indicators.
Presentation: Results of National Adherence PHEicapclinical
1. Rwanda's national HIV prevention, care, and treatment program has seen significant progress between 2004-2008, with HIV testing rates, ART coverage, and health facility participation all increasing substantially.
2. While barriers to PMTCT participation like fear of testing positive and partner disclosure remain challenges, programs have addressed issues like breastfeeding support and improving ANC attendance.
3. Clinical outcomes of ART have been positive, with high retention and adherence rates and significant CD4 count increases showing the effectiveness of treatment. Continued decentralization and integration of services is planned to further improve coverage.
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This document discusses the expanding role of pharmacists in supporting HIV treatment adherence. It provides examples of how pharmacists in Cote d'Ivoire, Kenya, and South Africa work to enhance adherence through patient education, integrated appointment and pill count systems, visual analogue scales to assess adherence, and task-shifting some responsibilities to peer educators. The document also presents case studies demonstrating pharmacist interventions around medication counseling, drug interactions, pediatric dosing, and adherence barriers.
Clinical Systems Mentorship and Adherence: The ICAP Approachicapclinical
Clinical Systems Mentorship (CSM) is a methodology developed by ICAP that broadens the principles of clinical mentorship to public health programming and health systems strengthening. It focuses on continuous data-driven assessment, intervention, and re-assessment to implement high quality programs and build long-term capacity. CSM utilizes both "microskills" like interpersonal communication as well as "macroskills" related to implementation and quality improvement. The strategies employed by CSM change depending on the context and stage of development from start-up to maturity. CSM can be applied to adherence work by developing standards of care based on measuring and monitoring adherence, using data to prioritize issues, and ensuring interventions address the root causes in a
The goals of the workshop were to develop evidence-based strategies for improving, monitoring, and evaluating adherence support for HIV prevention, care, and treatment and to set a sustainable adherence agenda. The objectives were to review current adherence levels, share lessons learned, identify strategies for improved monitoring and evaluation of adherence interventions, and develop country-specific work plans. Key topics included adult and pediatric care and treatment and PMTCT. Key adherence strategies to be discussed were appointment systems, tracking patients, integrated counseling, peer education, and community linkages. The workshop would include presentations, group work, and action planning to help all sites implement functional appointment systems and counseling/assessment strategies by the end of 2010.
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This document summarizes adherence data from ICAP-supported HIV care and treatment programs in resource-limited settings. It finds that around 40% of patients were lost to follow up after 2 years of antiretroviral therapy, similar to other large ART programs. However, ICAP programs have high coverage of adherence support services like counseling, outreach workers, and patient tracking. The document calls for strengthening these services to improve long-term adherence and retention in HIV care.
Keynote – Framing Sustainable Adherence to HIV Prevention, Care & Treatment: ...icapclinical
This document discusses the importance of adherence to HIV treatment and challenges to achieving sustainable adherence. It notes that while high quality care is necessary, other factors like how patients internalize and use care in their daily lives are also important for good outcomes. Poor adherence can lead to negative individual and public health outcomes. Adherence is complex, multidimensional and needs to be maintained over a lifetime. The document calls for understanding adherence as both a clinical and psychosocial issue requiring a team approach and support programs sensitive to social and structural barriers patients face.
APS and Measurement (ICAP Annual Meeting 2007)icapclinical
The document discusses the importance of psychosocial support for patient adherence to HIV treatment. It suggests integrating psychosocial support throughout the continuum of care and measuring aspects of adherence support offered at facilities. Specifically, it recommends measuring the percentage of patients receiving counseling, adherence assessments, and support services. Measuring these adherence support factors along with patient-level adherence data would provide a more comprehensive view of programs and ways to improve patient outcomes.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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Adherence for Pediatrics: Plenary
1. PEDIATRIC PLENARY: Special Issues in Adherence for Children and Adolescents Ruby FayorseyPediatric Clinical AdvisorICAP-NY Supporting Sustainable Adherence to HIV Prevention, Care & Treatment ICAP Technical Workshop October 19-22, 2009Kigali, Rwanda
2. Outline Review ICAP adherence data for children Review the pediatric adherence literature, compare LRS and HRS Developmental approach to adherence to care and treatment in pediatrics Country Examples S2S Kenya Ethiopia
3. Cumulative Pediatric ART Enrollment, as of June 2009, N=30,859 n=3,460 n=3,217 n=3,604 n=5,600 n=2,570 n=874 n=4,047 n=1,590 n=4,161 n=30,859 n=1,651 n=85 % pediatric patients on ART
4. Status of Pediatric ART Patients at ICAP HIV Care and Treatment Programs (June 2009 n=23,267*) *Excludes Cote d’Ivoire, Swaziland and Zambia due to incomplete data on status variables. ** Includes patients who transferred out while on ART.
5. Proportion of Pediatric Patients (5-15 yrs) with CD4 Count at Baseline, 6, and 12 months after ART Initiation (June 2009 PLD)
6. Cumulative Pediatric HIV Care Enrollment, as of June 2009, N =69,575 n=152 n=4,688 n=6,790 n=9,654 n=3,404 n=1,478 n=3,786 n=16,355 n=5,830 n=10,411 n=69,575 n=7,027 % pediatric patients in HIV care
7. Adolescent Enrolled in Care: The Tip of the Iceberg? (PLD June 2009 ) Total # of active children < 19 years in PLD on ART= 4428 Total/% 0-5 yrs= 2302 (52%) Total/% 6-10yrs=1179 (26%) Total/% 11-19 yrs=947 (22%) Includes data from Rwanda, Kenya, Tz and Mz, n=98 sites
8. SOCs and Pediatric Adherence Provides more detailed assessment of adherence Adherence to care and treatment % of children reporting taking > 90% of medication % of children with documented contact with HCW within 2 weeks of missed appointment % of children with CD4 done every six months Root case analysis
9. Significant Decrease in LTFU at the 13 ICAP Sites with SOCs Implementation, Sep 07 - Sep 08 P=0.003 Tene et al. Implementers Meeting 2009
10. In Summary what does the ICAP Data tell us about Adherence in Children? Programmatic data not individual data Adherence to care not treatment Clinic attendance, lost to F/U, death and stopped ART Indirect measures of adherence (CD4 change over time) Increasing population of perinatally infected adolescents Importance of SOCs to complement routinely collected data
11. What do we know about Pediatric Adherence Non-adherence is prevalent (20-50%), increases with age (Watson, 2000, Gibb 2003, Mellins 2004, Williams 2006, Martin 2007) Range of factors that influence adherence (Reddington 2000, Pontalli 2001, Steele 2003, Williams 2006, Mellins 2006, Barack 2007) Child Caregiver/family Medication Related Factors Healthcare system (Provider-patient/family relationships) Structural/Community
12. Comparing Adherence in HRS and LRS (1) Vreeman RC et al Ped Infect Dis J 2008, Simoni J M et al, Pediatrics , 2007
13. Comparing Adherence in HRS and LRS (2) Vreeman RC et al Ped Infect Dis J 2008, Simoni JM et al, Pediatrics 2007
14. Comparing Adherence in HRS and LRS (3) Vreeman RC, et al., Peds Infect Dis J 2008, Simoni JM, et al., Pediatrics 2007
15. Comparing Adherence in HRS and LRS (4) Vreeman RC et al Peds Infect Dis J 2008, Simoni JM et al, Pediatrics 2007
16. Barriers Reported by Adolescents VAS to assess adherence in adolescents in Uganda: 49% reported missing a dose in the past 30 days Age 12-18 Barriers cited were: Forgetting 39% Staying away from home 30% Sleeping through dose time 22.5% Side effect of medication 10% Focus group sessions with adolescents in Western Kenya Age10-16 Barriers to adherence Just forgetting Delaying dose because of school or work Tired of taking medications Not having food Travelling to the clinic to get meds Needing to hide the meds from others in the house hold, neighborhood and school Bakeera-Kitaka S et al. IAS 2009 Vreeman R et al. IAS 2009
17. What About Disclosure and Adherence? Inconsistent relationship between disclosure and adherence in HRS, most studies are confounded by age Studies in LRS seem to suggest improved adherence with disclosure of HIV status In Kenya, N=37(Akolo , IAS 2009) < 12 years not disclosed to (90-100% adherence) Early disclosure with ongoing support from parents/guardians (90-100% adherence) Late disclosure with ongoing support from family (80-89% adherence) In Uganda, N=42 Complete disclosure and strong parental relationships were related to good adherence (Bikaako-Kajura 2006) Study from Mulago, N=170 Disclosure of HIV diagnosis to only caregiver associated with low adherence (Nabueera-Barungi 2007)
30. Adherence Assessment Caregiver/Self-report is the least expensive and most frequently used (tends to over estimate) Concerns about social desirability and recall bias Child report accurate when developmentally appropriate Non judgmental attitude: trust, partnership and honesty MDT approach- its everyone's responsibility
31. Strategies Evaluated in the Literature to Improve Adherence in Children Few strategies for improving adherence in children have been reported in the literature Directly Observed Therapy- Gigliotti 2001, Roberts 2004 Educational Program using treatment buddies- Lyon 2003 Insertion of G tube- Shingadia 2000 Behavioral Change-Rogers 2001 Home based care/Nursing- Ellis 2006, Berrien 2004 Most are descriptive with small sample sizes Recently more data from LRS Psychosocial and treatment literacy activities- Van Winghem 2008 Family based interventions –Alicea IAS 2009 Community partnerships- Owiso IAS 2009
32. Strategies and Interventions to Facilitate Adherence (1) Child/Caregiver and Family Intensive education before starting therapy, provision of educational materials (visual and written ) Use of reminders, link to daily activities Share responsibility for remembering medication within household Small incentives for children when they take their medicines Psychosocial support services (family support/family based interventions, treatment buddies, individualized and family counseling Adherence aides (pill boxes, adherence calendar, alarms) Developmentally appropriate HIV disease education and disclosure DOT Social support/community linkages
33. Strategies and Interventions to Facilitate Adherence (2) Health care system Establish long term relationship with child, family and clinic staff Child friendly clinics Family centered care Functioning appointment systems Efficient patient defaulter tracing mechanisms Clearly defined ways to assess, monitor and provide adherence support Support groups (children, adolescents and caregivers) Mentoring of providers and counselors MDT approach to adherence Use data for quality improvement
34. Strategies and Interventions to Facilitate Adherence (3) Medication Reduce number of pills (FDC) and frequency of administration Switching large volumes to pills Labeling syringes, color coding medications Blister packs Adapt treatment to child and families lifestyle Use the most tolerable combinations Minimize side effects & drug interactions
35. Summary Adherence in children in LRS is equal or may be better than children in HRS Adherence estimates vary depending on measurement strategy self/caregiver report is most commonly used Factors affecting adherence in children and adolescents are complex and change over time Need to have the appropriate systems to facilitate adherence (appointment systems, defaulter tracing etc.) Strategies that work must be multifocal and broad, developmentally appropriate for the child, should also include caregiver, family, health system and community
37. S2S-Adherence Support for Adolescents Kenya-Pediatric Appointment and Adherence Systems Ethiopia- MDT Approach to Adherence COUNTRY EXAMPLES
38. Supporting Sustainable Adherence to HIV Prevention, Care & Treatment ICAP Technical Workshop October 19-22, 2009Kigali, Rwanda Adherence Support for Adolescents Marina Rifkin, Program Monitoring Advisor South 2 South – South Africa Partnership for Comprehensive Family HIV Care and Treatment Programs
39. Adolescents in Care at Tygerberg Children’s Hospital Currently a total of 60 (25%) of the approximately 240 children on ART are between the ages of 10 and 17 Clinical services are offered on different days for different age groups (10-11 years, 12-13 years, 14+ years) At age 18 patients are transferred to the adult clinic, based on developmental readiness 39
42. Allow for a less abrupt transition into adult care
43. Provide a holistic approach geared at adolescents, the issues they are faced with and providing tools and support structures to ensure that they are nurtured through this difficult period of their lives
55. Arts and crafts“I like the way the information was delivered. How to teach children about HIV/AIDS and the importance of giving meds as well. How to help them with their schoolwork, and I really enjoy the day and the way we were treated” - Grandma 42
60. Thanks to: 44 Sr. Vivian O’Brian Sonja Oberholse Staff of the Tygerberg Family Clinic Patients and their families
61. PEDIATRIC APPOINTMENT & ADHERENCE SYSTEMS Frida Njogu, MD, MPH ICAP Kenya Supporting Sustainable Adherence to HIV Prevention, Care & Treatment ICAP Technical Workshop October 19-22, 2009Kigali, Rwanda
62. Challenges in Pediatric Appointments, Adherence and Retention Integration of other child survival mechanisms e.g. IMCI, Immunization Change of caretaker – death of parent Elderly caretakers – literacy, ill health Dependent on ‘others’ to bring them to clinic Difficulty quantifying syrup used (compared to pill count)
63. Systems To Support Pediatric Adherence Appointment system Diary integrates appointments and assessment Integrated services Adherence support tools:
65. Integration... Dedicated peds clinic day Same day appointments for mother/caretaker and family (family care clinic concept) Integrated TB/HIV clinic for co-infected Integrated with immunization schedule On same day receive/are linked to nutrition supplementation in some sites (Machakos, UNICEF linkage) Same day have caretaker and pedpsychososcial support groups Bi-annual RBS and 3 monthly BP checks in MtitoAndei to improve retention and adherence
66. Colour Coding System Rationale: elderly caregivers Early stages of pilot SOP developed Waterproof coloured strip on syringe, corresponding coloured label on bottle Top edge on syringe marks the dose Demonstrated during dispensing, reverse demonstration at adherence assessment
68. Plans Further and more complete integration of services Roll out Color Coding system Treatment Supporter system for elderly caretakers
69. Collaboration BetweenCU-ICAP Ethiopia and The Psychosocial Unit at Adama Hospital Yoseph GutemaPediatric/PMTCT Advisor ICAP Ethiopia Kigali, RwandaOctober 21,2009 Supporting Sustainable Adherence to HIV Prevention, Care & Treatment ICAP Technical Workshop October 19-22, 2009Kigali, Rwanda
77. Cumulative no of Infants & Children Ever Started and Ever Enrolled in Care at Adama Hospital
78. UTCSA at Adama Hospital Psychologist is hired to attend to needs of children in community Provides psychological support for abused children Provides care and support for abandoned children Facilitate age determination service for children in conflict with the law
87. Next Steps Establishment of Pediatric Peer support Group/ buddies Expanding the service to other ICAP supported facilities Adama Pediatric Psychosocial unit will be model center
Source: ICAP URS, June 2009Note: Includes sites currently supported by ICAP and reporting. Note: Swaziland was unable to report Apr-June; Numbers from Jan-Mar 09 were carried over Take home message:There is large variability for proportion of <1 year enrolled in ART across countries. This is likely a reflection of the variation in the availability of early infant diagnosis. Note that the proportion of patients <1 year in ART care is about half of that in HIV care (23% v.s. 39% from previous slide).
Source: ICAP URS, March 2009Note1: Includes sites currently supported by ICAP and reporting. Take home message:Among those discontinued ART (14%), the majority (57%) had not had contact with the clinic for by at least 90 days (Lost to follow up), 39% had been reported dead and 4% stopped treatment stopped ART but continued in care.Person time:ART discontinuation per 1000 person years can capture the time element that is not captured by cumulative discontinuation rate reported each quarter. Two sites may have the same cumulative discontinuation rate at 20% but one site may have started providing ART 6 months ago while the other site may have started 2 years ago. Calculating the rate in person-time will show that the first site is losing patients at a greater rate than in the second site. Below, is a step-by-step explanation of how the rates were calculated:A. Assume patients starting ART on average started at “mid-point” of the quarter (i.e., at 1.5 months).100 patients started on ART during the quarter are assumed to have contributed 100 persons x 1.5 months or 150 person-months on ART during the quarterB. Number on ART at the beginning of the quarter is used to calculate the number of person-years of ART use that could be contributed if there were no deaths, transfers, stopping, or LTF during the quarter.500 patients enrolled as of the end of the previous quarter are assumed to contribute 500 persons x 3 months, or 1500 person-months of ART during the quarterC. Patients who stop ART during the quarterPatients who stop ART (die, transfer, are LTF, or otherwise stopped ART) are assumed to have done so at the midpoint of the quarter.35 people stop ART for any of the above reasons, they are assumed to contribute 35 persons x 1.5 months, or about 82 person-months.This person time must be subtracted from that in B in order to correct for the assumption of no stoppages during the quarter.Person-time on ART during the quarter= A + (B – C)=150+1500-82=1568 pm
Indirect measure of adherence. Under estimate of children who have received CD4. due to missing and undocumented data. data is from Jan 2005- June 2009Window periods:Baseline (1 month before and 1 month after)6 months (2 month before and 2 month after)12 months (2 month before and 2 month after)Dataset includes only the results of CD4 counts so if it’s not in the dataset we cannot know if it is missing (the test was done but not entered in the dataset) or if it was ordered but not done.This slide is a bit misleading. Probably because of undocumented or missing data? However the take home message is this. Children are not getting CD4 counts as recommended.
Source: ICAP URS, June 2009Note: Swaziland was unable to report Apr-June; Numbers from Jan-Mar 09 were carried over Take home message:Large majority of pediatric patients receiving HIV care were under 5 years of age (62%). In Nigeria and Zambia, the majority of pediatric patients were under 1. This is because of varying reporting requirements. On average kids between 0-2 should account for no more than 1/5 th and with improved and scale upof PMTCT services we should expect this number to decrease over time.
Adolescents are increasing and currently account for 1/5 of children in the PLD on ART. With time we expect this number to increase if we continue to implement strong PMTCT programs
Two systemic reviews of pediatric adherence in the literatureOne published in 2007 primarily HRSThe second published in 2008 was a review of Pediatric adherence n low and middle income countries.CaveatsVery early in scale-up experienceMostly smaller, non-representative samplesGenerally involving treatment-naïve patients
Study done in adolescents patients attending HIV clinic at Mulago Hospital. Used visual analogue scale to assess adherence. There were 76 adolescents who had been on HAART for at least 15 daysMedian age 13.7 (12-18 years)68% attending school27% lived in a HH where another parent was taking ARVsStudy form Kenya-Small numbers 23 adolescents , 3 focus group discussions with kids in 2 ART clinicsAge range 10-16 years only 2 had biological parents alive Voiced concerns about disclosing non adherence to their health care providersConcerned about secrecy in procurement, administration storage and disposal of medications
Looks at adherence to treatmentAkolo- small study only 37 participants half were disclosed to.Uganda- small study only 42 children ( 5-17 years median age 12 yearsMulago large study (170 children)- used self report, clinic based pill counts and unannounced pill counts at home.
What are the developmental characteristics that impact adherenceWhat are some of the adherence challenges you can expect in each developmental stage?How would you provide developmentally appropriate adherence education and preparation? How will you monitor and support adherence?
ARV treatment is rarely an emergencyTake time to prepare the child and the caregiver Personalize medication administration to match the specific aspects of a child’s and family’s lifeAddress the WHO, WHAT, WHEN, WHERE and HOW of medication administration
There is no perfect measure. Each method had advantages , disadvantages and trade offs.Emphasize the importance of honest reportingImportance of multidisciplinary approach to monitoringEmphasize need for communication with health care team (Trust, Partnership, Honesty)
Only one randomized study by Berrien evaluated Home nursing as a means of increasing adherence with 67 families. Designed to identify and resolve barriers to adherence. Used pill swallowing, and education. In the treatment group knowledge scores improved but self reported adherence marginally improved.