Browsing by Author "Yego, Faith"

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    Acceptability and feasibility of community-based provision of urine pregnancy tests to support linkages to reproductive health services in Western Kenya: a qualitative analysis
    (BMC, 2022-09-01) Kibel, Mia; Thorne, Julie; Kerich, Caroline; Naanyu, Violet; Yego, Faith; Christoffersen‑Deb, Astrid; Bernard, Caitlin; Obstetrics and Gynecology, School of Medicine
    Background: The majority of women living in rural Kenya access antenatal care (ANC) late in pregnancy, and approximately 20% have an unmet need for family planning (FP). This study aimed to determine whether training community health volunteers (CHVs) to deliver urine pregnancy testing (UPT), post-test counselling, and referral to care was an acceptable and feasible intervention to support timely initiation of ANC and uptake of FP. Methods: We applied community-based participatory methods to design and implement the pilot intervention between July 2018 and May 2019. We conducted qualitative content analysis of 12 pre-intervention focus group discussions (FGDs) with women, men, and CHVs, and of 4 post-intervention FGDs with CHVs, each with 7-9 participants per FGD group. Using a pragmatic approach, we conducted inductive line-by-line coding to generate themes and subthemes describing factors that positively or negatively contributed to the intervention's acceptability and feasibility, in terms of participants' views and the intervention aims. Results: We found that CHV-delivered point of care UPT, post-test counselling, and referral to care was an acceptable and feasible intervention to increase uptake of ANC, FP, and other reproductive healthcare services. Factors that contributed to acceptability were: (1) CHV-delivery made UPT more accessible; (2) UPT and counselling supported women and men to build knowledge and make informed choices, although not necessarily for women with unwanted pregnancies interested in abortion; (3) CHVs were generally trusted to provide counselling, and alternative counselling providers were available according to participant preference. A factor that enhanced the feasibility of CHV delivering UPT and counselling was CHV's access to appropriate supplies (e.g. carrying bags). However, factors that detracted from the feasibility of women actually accessing referral services after UPT and counselling included (1) downstream barriers like cost of travel, and (2) some male community members' negative attitudes toward FP. Finally, improved financial, educational, and professional supports for CHVs would be needed to make the intervention acceptable and feasible in the long-term. Conclusion: Training CHVs in rural western Kenya to deliver UPT, post-test counselling, and referral to care was acceptable and feasible to men, women, and CHVs in this context, and may promote early initiation of ANC and uptake of FP. Additional qualitative work is needed to explore implementation challenges, including issues related to unwanted pregnancies and abortion, the financial burden of volunteerism on CHVs, and educational and professional supports for CHVs.
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    Towards Achieving the 95% Treatment Coverage for Hard-to-Reach Populations Living with HIV and AIDS in Lusaka, Zambia Using Community Retail Pharmacies to Improve Access to Antiretroviral Therapy
    (2023-08) Magomana, Trymore; Tierney, William M.; Yego, Faith; Kamanga, Gift; Pastakia, Sonak D.
    Objective: The HIV and AIDS epidemic still contributes to high mortality and morbidity in Zambia. Antiretroviral (ART) is the backbone of HIV epidemic control. Current ART delivery models have multiple barriers to access and availability. This study explored the feasibility of implementing ART delivery through private retail community pharmacies in Zambia's urban settings based on key stakeholders' perceptions. Methods: This qualitative study utilized a mix of focus group discussions and key informant interviews. Three focus group discussions were conducted with pharmacists practicing in Zambia. Three key informant interviews were conducted with NGO representatives whose primary work is in HIV and AIDS treatment, testing, and prevention. Two key informant interviews were conducted with government representatives from the Zambia MOH involved in HIV and AIDS treatment, testing, and prevention. Deductive theme generation based on research questions was used to analyze the data collected from key informant interviews and focus group discussions. Results: Implementation of ART delivery through private retail community pharmacies in urban settings in Zambia is feasible. Participant perceptions focused on mechanisms, policies, and considerations that must be addressed to implement ART delivery through private retail community pharmacies successfully. Participants indicated that implementing ART delivery through private retail pharmacies requires funding continuing education for participating pharmacists, capacity building for pharmacy infrastructure, and linkage of ART delivery to other HIV and AIDS services like counseling, dieting and nutrition, and viral load monitoring. Conclusion: This study generated new information on the attitudes and perspectives of stakeholders about implementing ART delivery through private retail community pharmacies in Zambia. Implementing ART distribution in private retail community pharmacies in Zambia is feasible, provided key implementation determinants are addressed. The implementation of ART delivery through private retail community pharmacies will help address challenges associated with Zambia's current ART delivery models and improve ART access and coverage.