| 1. |
- Amogne, Minilik Demissie, et al.
(författare)
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Condom failure and pre-exposure prophylaxis use experience among female sex workers in Ethiopia : a qualitative study
- 2022
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Female sex workers (FSW) remain a highly exposed group for HIV/STIs due to different factors including condom failure. In Ethiopia, pre-exposure prophylaxis (PrEP) has recently been introduced as an intervention strategy to prevent new HIV infections, but knowledge about FSWs' experiences of condom failure and PrEP use remains scarce. Therefore, this study explores FSWs' experiences concerning condom failure and their attitudes towards, and experiences of, PrEP uptake.METHOD: A qualitative study using in-depth interviews was conducted among FSWs in Addis Ababa. A manifest and latent content analysis method was applied to identify categories and emerging themes.RESULT: Seventeen FSWs (10 who started on PrEP, 1 who discontinued, and 6 who didn't start) were interviewed. FSWs described the reasons behind condom failure, the mechanisms they used to minimize the harm, and their attitudes towards PrEP use. FSWs struggled with the continuous risk of condom failure due to factors related to clients' and their own behavior. PrEP was mentioned as one the strategies FSWs used to minimize the harm resulting from condom failure, but PrEP use was compounded with doubts that deterred FSWs from uptake. FSWs' misconceptions, their lack of confidence, and PrEP side effects were also mentioned as the main challenges to start taking PrEP and/or to maintain good adherence.CONCLUSION: The demands and behavior of the clients and FSWs' own actions and poor awareness were factors that increased the exposure of FSWs to condom failure. In addition, the challenges associated with PrEP uptake suggest the need for user-friendly strategies to counteract these barriers and facilitate PrEP uptake.
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| 2. |
- Belihu, Wudinesh Belete, et al.
(författare)
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Risky sexual behavior and associated factors among university students in Ethiopia : a cross-sectional national survey
- 2024
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Ingår i: BMC Public Health. - 1471-2458. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Risky sexual behavior (RSB) is one of the major youth sexual and reproductive health problems globally, including in Ethiopia. RSB among youth increases the risk of HIV infection, other sexually transmitted infections (STIs), unintended pregnancy, and unsafe abortion. Therefore, the aim of this study was to examine RSB and its associated factors among university students in Ethiopia. Methods: A cross-sectional study was employed in six randomly selected public universities in Ethiopia from August 2021 to February 2022. A stratified two-stage sampling technique was applied to reach the required number of study participants, and a structured self-administered questionnaire was used. RSB was defined as having had sexual relationships with more than one partner and using condoms with a new sexual partner irregularly or not at all in the last 12 months. Bivariable and multivariable logistic regression analyses were used to identify factors associated with RSB among those participants who were sexually active. Results: The prevalence of RSB among those who had had sexual intercourse in the last 12 months (n = 523) was 19.5% (n = 102). One hundred forty-four (29.9%) students had multiple sexual partners, and 325 (69.3%) students did not always use condoms with a new sexual partner. Adjusted odds ratios (AOR) showed that those students aged 21–24 years had lower odds of RSB than those aged above 25 years AOR 0.18 (95% CI 0.03–0.98). The adjusted odds of RSB were 6.7 times higher (95% CI 1.26–35.30) among students who started sex at the age of 10–17 years than those who started sex at 21 years and above and 3.9 times higher (95% CI 1.33–11.39) among students who had experienced emotional violence. Conclusion: RSB continues to be a problem among university students in Ethiopia. Those students who started sex at an early age and those who experienced emotional violence were more likely to engage in RSB. Therefore, universities in Ethiopia should implement strategies such as RSB targeted health education programs that consider early sexual debut, experiences of emotional violence, and safe sexual practices.
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| 3. |
- Bergman, Rachel, et al.
(författare)
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Results-Based Financing for Health : A Case Study of Knowledge and Perceptions Among Stakeholders in a Donor-Funded Program in Zambia
- 2021
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Ingår i: Global Health Science and Practice. - 2169-575X. ; 9:4, s. 936-947
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Forskningsöversikt (refereegranskat)abstract
- In 2015, the Zambian government and the Swedish International Development Cooperation Agency (Sida) signed an agreement in which Sida committed to funding a program for Reproductive, Maternal, Newborn, Child, Adolescent Health and Nutrition (RMNCAH). The program includes a results-based financing (RBF) model that aims to reward Zambian districts for improved district-wide results on relevant indicators with additional funding. We aimed to describe stakeholders' knowledge of the RBF model and perceptions of the incentive structure during the first 18 months of the program's implementation. This study illuminates the possible pitfalls of implementing an RBF scheme without giving attention to all necessary steps of the process. A qualitative case study was used and included a review of documents, in-depth interviews, and observations. From February-April 2017, we conducted 37 in-depth interviews, representing the views of 12 development partner agencies, government departments, and health facility staff throughout Zambia. We used a qualitative framework analysis. Findings show that the Zambian government and Sida had different perceptions on what levels of the health system RBF will incentivize and that most districts and hospital administrators interviewed were unaware of the indicators that the RBF was part of the RMNCAH program at all. The lack of knowledge about the RBF scheme among respondents suggests the possibility that the model did not ultimately have the necessary preconditions to create an effective incentive structure. These results demonstrate the need for improved communication between stakeholders and the importance of sufficiently planning an RBF model before implementation.
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| 4. |
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| 5. |
- Hepburn, Jasmine Sprague, et al.
(författare)
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Review of the inclusion of SRHR interventions in essential packages of health services in low- and lower-middle income countries
- 2021
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Ingår i: Sexual and Reproductive Health Matters. - : Informa UK Limited. - 2641-0397. ; 29:1
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Tidskriftsartikel (refereegranskat)abstract
- Sexual and reproductive health and rights (SRHR) and universal health coverage (UHC) are fundamental to health as a human right. One way that countries operationalise UHC is through the development of an essential package of health services (EPHS), which describes a list of clinical and public health services that a government aspires to provide for their population. This study reviews the contents of 46 countries’ EPHS against the standard of the Guttmacher-Lancet Report’s (GLR) nine essential SRHR interventions. The analysis is conducted in two steps; EPHS are first categorised according to the level of specificity of their contents using a case classification scheme, then the most detailed EPHS are mapped onto the GLR’s nine essential SRHR interventions. The results highlight the variations of EPHS and provide information on the inclusion of the GLR nine essential SRHR interventions in low- and lower-middle income countries’ EPHS. This study also proposes a case classification scheme as an analytical tool to conceptualise how EPHS fall along a spectrum of specificity and defines a set of keywords for evaluating the contents of policies against the standard of the GLR. These analytical tools and findings can be relevant for policymakers, researchers, and organisations involved in SRHR advocacy to better understand the variations in detail among countries’ EPHS and compare governments’ commitment to SRHR as a human right.
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| 6. |
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| 7. |
- Kaiser, Andrea Hannah, et al.
(författare)
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Assessing progress towards universal health coverage in Cambodia : Evidence using survey data from 2009 to 2019
- 2023
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Ingår i: Social Science and Medicine. - : Elsevier BV. - 0277-9536. ; 321
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Tidskriftsartikel (refereegranskat)abstract
- Over the past decades, many low- and middle-income countries have implemented health financing and system reforms to progress towards universal health coverage (UHC). In the case of Cambodia, out-of-pocket expenditure (OOPE) remains the main source of current health expenditure after several decades of reform, exposing households to financial risks when accessing healthcare and violating UHC's key tenet of financial protection. We use pre-pandemic data from the nationally representative Cambodia Socio-Economic Surveys of 2009 to 2019 to assess progress in financial protection to evaluate the reforms and obtain internationally comparable estimates. We find that following strong improvements in financial protection between 2009 and 2017, there was a reversal in the trend thereafter. The OOPE budget share rose, and the incidence of catastrophic spending and impoverishment increased in nearly all geographical and socioeconomic strata. For example, 17.7% of households experienced catastrophic health expenditure in 2019 at the threshold of 10% of total household consumption expenditure, and 3.9% of households were pushed into poverty by OOPE. The distribution of all financial protection indicators varied strongly across socioeconomic and geographical strata in all years. Fundamentally, the demonstrated trend reversal may jeopardize Cambodia's ability to progress towards UHC. To improve financial protection in the short term, there is a need to address the burden created by OOPE through targeted interventions to household groups that are most affected. In the medium term, our findings emphasize the importance of expanding health pre-payment schemes to currently uncovered vulnerable groups, specifically the near-poor. The government also needs to consider extending the scope of services covered and the range of providers to include the private sector under these schemes to reduce reliance on OOPE.
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| 8. |
- Kaiser, Andrea Hannah, et al.
(författare)
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Availability, prices and affordability of essential medicines for treatment of diabetes and hypertension in private pharmacies in Zambia
- 2019
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 14:12
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To explore availability, prices and affordability of essential medicines for diabetes and hypertension treatment in private pharmacies in three provinces of Zambia. Methods: A cross-sectional survey was conducted in 99 pharmacies across three Zambian provinces. Methods were based on a standardized methodology by the World Health Organization and Health Action International. Availability was analysed as mean availability per pharmacy and individual medicine. Median prices were compared to international reference prices and differences in price between medicine forms (original brand or generic product) were computed. Affordability was assessed as number of days' salaries required to purchase a standard treatment course using the absolute poverty line and mean per capita provincial household income as standard. An analysis identifying medicines considered both available and affordable was conducted. Results: Two antidiabetics and nine antihypertensives had high-level availability (≥80%) in all provinces; availability levels for the remaining surveyed antidiabetics and antihypertensives were largely found below 50%. Availability further varied markedly across medicines and medicine forms. Prices for most medicines were higher than international reference prices and great price variations were found between pharmacies, medicines and medicine forms. Compared to original brand products, purchase of generics was associated with price savings for patients between 21.54% and 96.47%. No medicine was affordable against the absolute poverty line and only between four and eleven using mean per capita provincial incomes. Seven generics in Copperbelt/Lusaka and two in Central province were highly available and affordable. Conclusions: The study showed that the majority of surveyed antidiabetic and antihypertensive medicines was inadequately available (<80%). In addition, most prices were higher than their international reference prices and that treatment with these medicines was largely unaffordable against the set affordability thresholds. Underlying reasons for the findings should be explored as a basis for targeted policy initiatives.
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| 9. |
- Kaiser, Andrea Hannah, et al.
(författare)
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Extending universal health coverage to informal workers : A systematic review of health financing schemes in low- and middle-income countries in Southeast Asia
- 2023
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Ingår i: PLoS ONE. - 1932-6203. ; 18:7 JULY
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Tidskriftsartikel (refereegranskat)abstract
- Achieving universal health coverage (UHC) is a priority of most low- and middle-income countries, reflecting governments’ commitments to improved population health. However, high levels of informal employment in many countries create challenges to progress toward UHC, with governments struggling to extend access and financial protection to informal workers. One region characterized by a high prevalence of informal employment is Southeast Asia. Focusing on this region, we systematically reviewed and synthesized published evidence of health financing schemes implemented to extend UHC to informal workers. Following PRISMA guidelines, we systematically searched for both peer-reviewed articles and reports in the grey literature. We appraised study quality using the Joanna Briggs Institute checklists for systematic reviews. We synthesized extracted data using thematic analysis based on a common conceptual framework for analyzing health financing schemes, and we categorized the effect of these schemes on progress towards UHC along the dimensions of financial protection, population coverage, and service access. Findings suggest that countries have taken a variety of approaches to extend UHC to informal workers and implemented schemes with different revenue raising, pooling, and purchasing provisions. Population coverage rates differed across health financing schemes; those with explicit political commitments toward UHC that adopted universalist approaches reached the highest coverage of informal workers. Results for financial protection indicators were mixed, though indicated overall downward trends in out-of-pocket expenditures, catastrophic health expenditure, and impoverishment. Publications generally reported increased utilization rates through the introduced health financing schemes. Overall, this review supports the existing evidence base that predominant reliance on general revenues with full subsidies for and mandatory coverage of informal workers are promising directions for reform. Importantly, the paper extends existing research by offering countries committed to progressively realizing UHC around the world a relevant updated resource, mapping evidence-informed approaches toward accelerated progress on the UHC goals.
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| 10. |
- Kaiser, Andrea Hannah, et al.
(författare)
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The cost-effectiveness of sexual and reproductive health and rights interventions in low- and middle-income countries : a scoping review
- 2021
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Ingår i: Sexual and Reproductive Health Matters. - : Informa UK Limited. - 2641-0397. ; 29:1
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Forskningsöversikt (refereegranskat)abstract
- Sexual and reproductive health and rights (SRHR) are an essential component of universal health coverage (UHC). In determining which SRHR interventions to include in their UHC benefits package, countries are advised to evaluate each service based on robust and reliable data, including cost-effectiveness data. We conducted a scoping review of full economic evaluations of the essential SRHR interventions included in the comprehensive package presented by the Guttmacher-Lancet Commission on SRHR. Of the 462 economic evaluations that met the inclusion criteria, the quantity of publications varied across regions, countries, and the components of the SRHR package, with the majority of publications reporting on HIV/AIDS, reproductive cancer, as well as antenatal care, childbirth, and postnatal care. Systematic reviews are needed for these components in support of more conclusive findings and actionable recommendations for programmes and policy. Further evaluations for interventions included in the remaining components are needed to provide a stronger evidence base for decision-making. The economic evaluations reviewed for this article were inherently varied in their applied methodologies, SRHR interventions and comparators, cost and effectiveness data, and cost-effectiveness thresholds, among others. Despite these differences, the vast majority of publications reported the evaluated SRHR interventions to be cost-effective.
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