Browsing by Author "Torpey, K."

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Adapted tool for the assessment of domestic violence against women in a low-income country setting: a reliability analysis
(International Journal of Women's Health, 2019-01) Semahegn, A.; Torpey, K.; Manu, A.; Assefa, N.; Ankomah, A.
Background: One-in-three women has experienced domestic violence, which is a serious public health problem and a human right violation. Domestic violence is a common life experience among women in Ethiopia. The tool used to assess violence against women (VAW) has not been validated to assess its consistency. Cronbach’s alpha (α, or coefficient alpha) is a measure of internal consistency, or reliability, that is, how closely a set of items are related as a group. Reliability is how well a test measures what it should. Therefore, the aim of this study was to estimate the inter-item correlation (reliability) of the tool adapted from literature. Methods: A community-based study was conducted in Northwestern Ethiopia between November 15, 2017 and December 31, 2017. A total of 1,269 women at their permanent place of residence (specifically at their households) were recruited using the multistage stratified systematic sampling method. A structured questionnaire was adapted from literature. Also, 12 trained female data collectors collected the data using the face-to-face interview method. Data were entered into EpiData 3.1.0 and exported to SPSS 23.0 for analysis. Descriptive statistical analysis was carried out to estimate the reliability of the response(s). Results: Overall, Cronbach’s alpha was higher than the minimum recommended value of 0.70. Cronbach’s alpha for specific sections were 0.764 for women’s decision-making autonomy (13 items); women’s accepting attitude toward justified wife-beating (five items, 0.894); physical violence (seven items, 0.876); psychological violence (15 items, 0.925); sexual violence (five items, 0.812); and inequitable gender-norms (seven items, 0.867). Conclusion: The tool used to assess domestic VAW in Northwestern Ethiopia had a high reliability. Therefore, researchers can adapt the tool and further assess its reliability in other settings to have a common and validated tool to study VAW in a low-income countries.
Akwa Ibom AIDS indicator survey: Key findings and lessons learnt
(PLoS ONE, 2020) Adedokun, O.; Badru, T.; Torpey, K.; et al.
Background The burden of HIV/AIDS epidemic is huge, but this varies widely by population in Nigeria. Data that could be used to guide the scale up of HIV prevention and control strategies has significant gaps. The study sought to estimate the prevalence of HIV and its associated determinants in Akwa Ibom state. Methods Akwa Ibom AIDS Indicator Survey (AKAIS) is a population based cross-sectional survey, with a two-stage probability sampling. The survey had both behavioural and biological com ponents. Tablet-based questionnaire was used to collect data on participant’s household information, demographics, socio-economic, and behavioral risk factors associated with HIV; while the biological component involved collection of venous blood samples for partici pants who were over 19months. For children aged 18months on less, capillary blood from finger prick sample was used. Participants were tested for HIV. Other biomarker tests for HIV positive participants included CD4, HIV-1 RNA viral load and incidence assays. Results In all 15,609 people (8,963 adults aged 15 years and older (55% females), 6,646 individuals less than 15 years (51% males), from 4,313 households, participated in AKAIS. Overall, 2.8% (423 persons; 422 HIV-1 and 1 HIV-2) were found to be HIV positive. HIV prevalence was 4.8% in adults (15 years and above) and 0.4% in pediatric (< = 14 years) participants. HIV prevalence was significantly higher in females (5.6%) than males (3.7%) aged 15 years and older (p <0.001). Overall HIV incidence was 0.41% Conclusions HIV prevalence among adults was 4.8% with an overall incidence of 0.41%. These esti mates are essential to inform strategic control and prevention of HIV epidemic in Akwa Ibom state targeting the affected populations.
Analysis of HIV Early Infant Diagnosis Data to Estimate Rates of Perinatal HIV Transmission in Zambi
(PLOS ONE, 2012) Torpey, K.; Mandala, J.; Kasonde, P.; et al.
Background: Mother-to-child transmission of HIV (MTCT) remains the most prevalent source of pediatric HIV infection. Most PMTCT (prevention of mother-to-child transmission of HIV) programs have concentrated monitoring and evaluation efforts on process rather than on outcome indicators. In this paper, we review service data from 28,320 children born to HIV positive mothers to estimate MTCT rates. Method: This study analyzed DNA PCR results and PMTCT data from perinatally exposed children zero to 12 months of age from five Zambian provinces between September 2007 and July 2010. Results: The majority of children (58.6%) had a PCR test conducted between age six weeks and six months. Exclusive breastfeeding (56.8%) was the most frequent feeding method. An estimated 45.9% of mothers were below 30 years old and 93.3% had disclosed their HIV status. In terms of ARV regimen for PMTCT, 32.7% received AZT+single dose NVP (sdNVP), 30.9% received highly active antiretroviral treatment (HAART), 19.6% received sdNVP only and 12.9% received no ARVs. Transmission rates at six weeks when ARVs were received by both mother and baby, mother only, baby only, and none were 5.8%, 10.5%, 15.8% and 21.8% respectively. Transmission rates at six weeks where mother received HAART, AZT+sd NVP, sdNVP, and no intervention were 4.2%, 6.8%, 8.7% and 20.1% respectively. Based on adjusted analysis including ARV exposures and non ARV-related parameters, lower rates of positive PCR results were associated with 1) both mother and infant receiving prophylaxis, 2) children never breastfed and 3) mother being 30 years old or greater. Overall between September 2007 and July 2010, 12.2% of PCR results were HIV positive. Between September 2007 and January 2009, then between February 2009 and July 2010, proportions of positive PCR results were 15.1% and 11% respectively, a significant difference. Conclusion: The use of ARV drugs reduces vertical transmission of HIV in a program setting. Non-chemoprophylactic factors also play a significant role in HIV transmission. The overall change in the proportions of positive PCR results over time is more likely an indication of better PMTCT implementation. Determination of the outcomes of PMTCT in program settings is feasible but requires accurate documentation and analysis.
An application of the ADAPT-ITT model to an evidence-based behavioral HIV prevention intervention for men who have sex with men in Ghana
(International Health Trends and Perspectives, 2021) Abubakar, G.M.; Turner, D.; Torpey, K.; et al.
Despite constituting only about 1% of Ghana’s population, men who have sex with men (MSM) carry a disproportionate burden of HIV infections, constituting 18% of the population of people living with HIV in the country. Scholars have associated the disproportionate infection rates of HIV among MSM with existing structural factors(such as criminalization and stigma against MSM), and individual-level factors(such assex without a condom, and transactional sex). Nonetheless, only a few scholars consider intervention as an approach to reducing HIV and other STD risk among MSM in the country. As such, in collaboration with community partners, we engaged MSM through the use of the ADAPT-ITT model to adapt the Many Men Many Voices (3MV) to address the needs of MSM. We addressed STD risk factors and ways to reduce HIV infections. In this paper, we describe the use of the ADAPT ITT model in the adoption and adaptation of the 3MV with MSM in Ghana. Whereas the 3MV was a good fit for our target population, we made modifications to fit the Ghanaian cultural setting by examining HIV and other STD risk in the context of bisexuality, insisting on discretion in choosing our location, and on incorporating a historical colonial setting in contextualizing sexuality and stigma in the Ghanaian sociocultural context. Our implementation process shows the efficacy of collaboration with community partners to implement culturally relevant interventions in HIV and STD prevention efforts in highly stigmatized environments.
Are interventions focused on gender-norms effective in preventing domestic violence against women in low and lower-middle income countries? A systematic review and meta-analysis
(Reproductive Health, 2019-04-24) Torpey, K.; Semahegn, A.; Manu, A.; Assefa, N.; Tesfaye, G.; Ankomah, A.
Background: One in three women experience intimate partner violence worldwide, according to many primary studies. However, systematic review and meta-analysis of intimate partner violence is very limited. Therefore, we set to summarize the findings of existing primary studies to generate evidence for informed decisions to tackle domestic violence against women in low and lower-middle income countries. Methods: Studies were searched from main databases (Medline via PubMed, EMBASE, CINAHL, PopLine and Web of Science), Google scholar and other relevant sources using electronic and manual techniques. Published and unpublished studies written in English and conducted among women aged (15–49 years) from 1994 to 2017 were eligible. Data were extracted independently by two authors, and recorded in Microsoft Excel sheet. Heterogeneity between included studies was assessed using I2, and publication bias was explored using visual inspection of funnel plot. Statistical analysis was carried out to determine the pooled prevalence using Comprehensive Meta-Analysis software. In addition, sub-group analysis was carried out by study-setting and types of intimate partner violence. Results: Fifty two studies were included in the systematic review. Of these, 33 studies were included in the meta-analysis. The pooled prevalence of lifetime intimate partner violence was 55% (95% CI: 52, 59%). Of these, main categories were lifetime physical violence [39% (95% CI: 33, 45%); psychological violence [45% (95% CI: 40, 52%)] and sexual violence [20% (95% CI: 17, 23%)]. Furthermore, the pooled prevalence of current intimate partner violence was 38% (95% CI: 34, 43%). Of these, physical violence [25% (95% CI: 21, 28%)]; psychological violence [30% (95% CI: 24, 36%)] and sexual violence [7.0% (95% CI: 6.6, 7.5%)] were the pooled prevalence for the major types of intimate partner violence. In addition, concurrent intimate partner violence was 13% (95% CI: 12, 15%). Individual, relationship, community and societal level factors were associated with intimate partner violence. Traditional community gender-norm transformation, stakeholders’ engagement, women’s empowerment, intervention integration and policy/legal framework were highly recommended interventions to prevent intimate partner violence. Conclusion: Lifetime and current intimate partner violence is common and unacceptably high. Therefore, concerned bodies will need to design and implement strategies to transform traditional gender norms, engage stakeholders, empower women and integrate service to prevent violence against women
Are respectful maternity care (RMC) interventions effective in reducing intrapartum mistreatment against adolescents? A systematic review
(Frontiers Global. Women's Health, 2023) Habib, H.H.; Mwaisaka, J.; Torpey, K.; Maya, E.T.; Ankomah, A.
Intrapartum mistreatment of women by health professionals is a widespread global public health challenge. It leads to a decreased quality of maternity care and is evinced to precipitate detrimental maternal and neonatal outcomes, especially among adolescents. Relatedly, research indicates that Respectful Maternity Care (RMC) interventions are especially effective in mitigating intrapartum mistreatment and improving birth outcomes. However, evidence on the success of RMC, specifically for adolescents, is insufficient and unaggregated. Accordingly, this review specifically aims to synthesize existing evidence on RMC care provision to adolescent parturients. This review searched for relevant literature from published and gray sources including PubMed, ScienceDirect, Cochrane, CINAHL, PsycINFO, Scopus, as well as Population Council, WHO and White Ribbon Alliance data sources published between January 1990 and December 2021. Based on eligibility, studies were selected and quality appraised after which thematic analysis and narrative synthesis was conducted. Twenty nine studies were included in the systematic review. Due to paucity and heterogeneity of quantitative studies, the review was limited to a thematic analysis. Adolescent and health provider perspectives alike underscored the burden and outcomes of mistreatment. Need for RMC interventions to improve quality of maternity care was recommended by majority of studies
Behavioural Risk for HIV, Hepatitis B, and Hepatitis C Infections among a Population of Drug Users and Injectors across Four Regions in Ghana
(Interdisciplinary Perspectives on Infectious Diseases, 2022) Guure, C.; Laryea, S.M. O-Y.; Dery, S.; da Silva, C.B.; Asamoah-Adu, C.; Ayisi-Addo, S.; Loglo, M.-G.; Torpey, K.
Background. Blood borne infections such as HIV, Hepatitis B (HBV), and Hepatitis C (HCV) are of great importance to governments and their implementing partners, especially among people who use drugs (PWUD) and people who inject drugs (PWID). Prevalence and determinants of HIV, HBV, and HCV among PWUD and PWID in Ghana are not well established, the signi cance of this study. Method. is assessment was a cross-sectional study implemented via the respondent driven sampling approach. A team of community advisory boards that comprised former users, current users, and civil society organizations were constituted to help in the implementation of the study. e study was conducted in four regions in Ghana. e assessment was based on a representation of populations of PWID and PWUD from the four regions. E orts were made by the team to ensure adequate representation of women where feasible. A quantitative questionnaire was developed and used to obtain information on the respondents’ sociodemographics, sexual behavior, substance use, and biological characteristics. e prevalence of HIV, HBV, and HCV among PWID and PWUD was determined using blood samples. First response and oral quick test for con rmation of HIV positivity were carried out, while SD bioline was used to test for the presence of HBV and HBC. Data were analyzed using the Bayesian generalized linear model via the binomial family of distributions under the logit link function with weak Cauchy and Normal distribution as prior. Results. A total of 323 PWUD and PWID participants were interviewed across four regions of Ghana. e overall median age of the respondents was 36 (28, 43) years. e prevalence of HIV, HBV, and HCV infection in the study was 2.5%, 4.6%, and 5.9%, respectively. e prevalence of HIV, HBV, and HCV among drug users was 2.5% (95% CI: 0.7%– 4.2%), 4.1% (95% CI: 1.8%–6.2%), and 6.7% (95% CI: 3.9%–9.4%), respectively. Most drug injectors and users started using and injecting drugs at ages less than 20 years and between 20 and 29 years, respectively. Drug users who identi ed themselves as part of the general population were 66% less likely to be tested HIV positive (POR 0.34, CrI: 0.12–0.81) compared to sex workers. Part time employment respondents had vefold odds (POR 5.50, CrI: 1.20–16.16) of being HBV positive as against full-time employment. Conclusion. Most of the injectors and users started drugs at an early age. Drug users and injectors are at higher risk of these infections because of associated risky sexual behaviors and risky injection practices. Harm reduction programs to help addicts who are willing to quit the practice are recommended.
Bridging the HIV treatment gap in Nigeria: examining community antiretroviral treatment models
(Journal of the International AIDS Society, 2018) Oladele, E.A.; Badejo, O.A.; Torpey, K.; et al.
Introduction: Significant gaps persist in providing HIV treatment to all who are in need. Restricting care delivery to healthcare facilities will continue to perpetuate this gap in limited resource settings. We assessed a large-scale community-based pro gramme for effectiveness in identifying people living with HIV and linking them to antiretroviral treatment. Methods: A retrospective secular trend study of 14 high burden local government areas of Nigeria was conducted in which two mod els of community antiretroviral treatment delivery were implemented: Model A (on-site initiation) and Model B (immediate referral) clusters. Model A cluster offered services within communities, from HIV diagnosis to immediate antiretroviral therapy initiation and some follow-up. Model B cluster offered services for HIV diagnosis up to baseline evaluation and provided referral for antiretroviral therapy initiation to nearest health facility providing HIV services. For controls, we selected and cluster-matched 34 local government areas where community antiretroviral treatment delivery was not implemented. Outcomes of interest were: the number of people identified as HIV positive and the number of HIV-positive individuals started on antiretroviral treatment; from June 2014 to May 2016. We used interrupted time-series analysis to estimate outcome levels and trends across the pre-and post-intervention periods. Results: Before community antiretrovial treatment introduction, Model A cluster identified, per 100,000 catchment popula tion, 500 HIV-positives (95% CI: 399.66 to 601.41) and initiated 216 HIV-positives on antiretroviral treatment (95% CI: 152.72 to 280.10). Model B cluster identified 32 HIV-positives (95% CI: 25.00 to 40.51) and initiated 8 HIV-positives on antiretroviral treatment (95% CI: 5.54 to 10.33). After commART introduction, Model A cluster showed an immediate signifi cant increase in 744 HIV-positive persons (p = 0.00, 95% CI: 360.35 to 1127.77) and 560 HIV-positives initiated on treat ment (p = 0.00, 95% CI: 260.56 to 859.64). Model B cluster showed an immediate significant increase in 30 HIV-positive persons identified (p = 0.01, 95% CI: 8.38 to 51.93) but not in the number of HIV-positives initiated on treatment. Model B cluster showed increased month-on-month trends of both outcomes of interest (3.4, p = 0.02, 95% CI: 0.44 to 6.38). Conclusion: Both community-models had similar population-level effectiveness for rapidly identifying people living with HIV but differed in effectively transitioning them to treatment. Comprehensiveness, integration and attention to barriers to care are important in the design of community antiretroviral treatment delivery
Case study From project aid to sustainable HIV services: a case study from Zambia
(Journal of the International AIDS Society, 2010) Torpey, K.; Mwenda, L.; Thompson, C.; et al.
Introduction: Sustainable service delivery is a major challenge in the HIV response that is often not adequately addressed in project implementation. Sustainable strategies must be built into project design and implementation to enable HIV efforts to continue long after donor-supported projects are completed. Case description: This paper presents the experiences in operational sustainability of Family Health International's Zambia Prevention, Care and Treatment Partnership in Zambia, which is supported by the US President's Emergency Plan for AIDS Relief through United States Agency for International Development (October 2004 to September 2009). The partnership worked with Zambia's Ministry of Health to scale up HIV clinical services in five of the country's nine provinces, reaching 35 districts and 219 facilities. It provided technical and financial support from within the ministry's systems and structures. By completion of the project, 10 of the 35 districts had graduated beyond receiving ongoing technical support. Discussion and evaluation: By working within the ministry's policies, structures and systems, the partnership was able to increase the ministry's capacity to add a comprehensive HIV service delivery component to its health services. Ministry structures were improved through renovations of health facilities, training of healthcare workers, procurement of essential equipment, and establishment of a quality assurance plan to ensure continued quality of care. The quality assurance tools were implemented by both the ministry and project staff as the foundation for technical graduation. Facilities that met all the quality criteria for more than six months were graduated from project technical support, as were districts where most supported facilities met the criteria. The district health offices then provided ongoing supervision of services. This predetermined "graduation" exit strategy, with buy in of the provincial and district health offices, set the stage for continued delivery of high-quality HIV services. Conclusions: Achieving operational sustainability in a resource-limited setting is feasible. Developing and institutionalizing a quality assurance/quality improvement system is the basis on which facilities and districts can move beyond project support and, therefore, sustain services. Quality assurance/quality improvement tools should be based on national standards, and project implementation should use and improve existing health system structures.
Community-Based Interventions as Opportunities to Increase HIV Self-Testing and Linkage to Care Among Men Who Have Sex With Men – Lessons From Ghana, West Africa
(Frontiers in Public Health, 2021) Abubakarig, G.M.; Turner, D.; Torpey, K.; et al.
MSM in Ghana encounter challenges in accessing HIV services and may experience barriers to HIV self-testing due to multiple forms of stigma present in health care settings. We worked with community-based organization partners to implement three interventions that successfully engaged and retained MSM which provides an opportunity for linkage to self-testing and medical care. These interventions were (1) Many Men Many Voices (3MV) a locally-led culturally grounded group-level HIV prevention program, (2) Auntie’s Corner: a mobile-app based connecting MSM to health monitoring by a registered nurse and (3) HIV Education, Empathy, & Empowerment (HIVE3): a mobile-app based peer support intervention for MSM living with HIV. The 3MV intervention may be effective in improving HIV self-testing due to its effectiveness in engaging MSM, increasing HIV testing, and improving MSM understanding of the need for HIV testing. The utilization of apps like Auntie’s Corner could positively impact HIV self-testing among MSM because it increases contact with nurses and reporting of symptoms. In HIVE3, participants expressed appreciation of the security and privacy that protects their identities as MSM and the peer mentors’ abilities to make referrals to the nurses in Auntie’s Corners. The confidentiality component has proven key among MSM and connecting MSM to self-testing through apps to report their process and receive care could increase utilization. Together, we show the efficacy of using the community-engaged process in reaching and engaging highly stigmatized populations like Ghana and sub-Saharan Africa, and its potential in increasing HIV self-testing and linkage to HIV care.
Correlates of prevalent HIV infection among adolescents, young adults, and older adult female sex workers in Ghana: Analysis of data from the Ghana biobehavioral survey
(PLOS ONE, 2023) Guure, C.; Dery, S.; Afagbedzi, S.; Maya, T.; da-Costa Vroom, F.B.; Torpey, K.
Background Human immunodeficiency virus infection remains a high burden among key populations such as female sex workers in the world. We aimed to provide distribution of prevalence and correlates of Human immunodeficiency virus infection among adolescent, young, and older adult FSWs in Ghana. Methods This data was obtained from the biobehavioral survey of female sex workers (2020) in Ghana based on a time location sampling approach for the selection of respondents. A sam pling frame was developed taking into consideration list of venues, days, and time that sex workers operate across all the regions of Ghana. These lists were derived from a sampling universe which was obtained during a mapping exercise. All sex workers aged 16 years and above and eligible on the day of visit participated. Human immunodeficiency virus testing was done based on First Response and Oraquick. To obtain estimates for sex workers, sampling weights were calculated and applied to the dataset. Inferential analyses using Bayesian regression models were applied with interaction effects. Results A total of 5,990 participants completed both the biological and behavioral aspects of the study. The HIV prevalence among female sex workers in Ghana was 4.67% (CI: 4.05%, 5.40%). About 70% of the respondents who tested positive for Human immunodeficiency virus were among the older adults (= >25 years) group. Generally, there was a high preva lence variation across the 16 regions of Ghana, from 0.00% to 8.40%. Respondents’ age was a significant contributor to the prevalence of HIV. Respondents who were forced into having sex had higher odds (38%) of being positive in the combined analysis. Respondents who had comprehensive knowledge of HIV had lower odds (39%) of testing positive. Conclusion The findings suggest a low prevalence of HIV among sex workers in 2020 compared to the 2011 and 2015 biobehavioral survey results but higher than the general population. Specifi cally, older adults have a higher prevalence of HIV. There is generally low level of compre hensive knowledge among sex workers. Interventions geared towards increasing FSW knowledge on risky behavior should be vigorously pursued.
Correlates of uptake of HIV testing among children and young adolescents in Akwa- Ibom state, Nigeria: a secondary data analysis of the Akwa-Ibom aids indicator survey, 2017
(BMC Pediatrics, 2021) Adetoro, D.; Khamofu, H.; Badru, T.; Markson, J.; Adedokun, O.; Sandah-Abubakar, N.; Dafa, I.; Chen, M.; Chiegil, R.; Torpey, K.
Background: In order to end the AIDS epidemic by 2030, there is a need to significantly reduce the rate of new infection among children and young adolescents. Identifying the correlates of testing behaviour is necessary to improve HIV testing campaigns by refining messages that target individuals in this age group. The objective of this study was to determine the correlates of HIV testing among children and young adolescents in Akwa-Ibom, Nigeria. Methods: The outcome was a secondary data analysis of the 2017 Akwa-Ibom AIDS Indicator Survey. Data of 4037 children and young adolescents aged 0–14 years was assessed in this study. Analysis was done using STATA version 16. Chi-squared test and logistic regression models were used to measure association and its strength between uptake of HIV testing and some independent variables (child/caregiver’s age, sex, educational status, child’s location, caregiver’s knowledge of HIV and caregiver ever tested for HIV) at 5% significance level. Results: Result showed that only 14.2% of the children and young adolescents have been tested for HIV. Previous history of blood transfusion (AOR = 5.33, 95%C.I = 2.60–10.92, P = < 0.001), caregiver’s level of education (AOR = 2.67, 95%C.I = 1.30–5.51, P = 0.008) and caregiver ever tested for HIV (AOR = 8.31, 95%C.I = 5.67–12.19, P = < 0.001) were significantly associated with uptake of HIV testing. Conclusion: This study concludes that a large proportion of children and young adolescents in Akwa-Ibom state have never been tested for HIV. There is a need for HIV testing interventions to be targeted towards this age groups and their parents/guardian. Addressing the knowledge gap amongst caregivers especially in rural areas is crucial towards improving the effectiveness of HIV testing interventions.
Cost-Effectiveness of HIV Screening of Blood Donations in Accra (Ghana)
(International Society for Pharmacoeconomics and Outcomes Research (ISPOR), 2008) Hulst, M.V; Sagoe, K.W.C.; Torpey, K.; et al.
Objectives: Areas with high HIV-incidence rates compared to the developed world may benefit from additional testing in blood banks and may show more favorable cost-effectiveness ratios. We evaluated the cost-effectiveness of adding p24 antigen, mini pool nucleic acid amplification testing (MP NAT), or individual donation NAT (ID-NAT) to the HIV antibody screening at the Korle Bu Teaching Hospital (Accra, Ghana), where currently only HIV-antibody screening is undertaken. Methods: The residual risk of HIV transmission was derived from blood donations to the blood bank of the Korle Bu Teaching Hospital in 2004. Remaining life expectancies of patients receiving blood transfusion were estimated using the World Health Organization life expectancies. Cost effectiveness ratios for adding the tests to HIV-antibody screening only were determined using a decision tree model and a Markov model for HIV. Results: The prevalence of HIV was estimated at 1.51% in 18,714 donations during 2004. The incremental cost per disability-adjusted life-year (DALY) averted was US$1237 for p24 antigen, US$3142 for MP-NAT and US$7695 com pared to the next least expensive strategy. HIV-antibody screening itself was cost-saving compared to no screening at all, gaining US$73.85 and averting 0.86 DALY per transfused patient. Up to a willingness-to-pay of US$2736 per DALY averted, HIV-antibody screening without additional testing was the most cost-effective strategy. Over a willingness-to pay of US$11,828 per DALY averted, ID-NAT was signifi cantly more cost-effective than the other strategies. Conclusions: Adding p24 antigen, MP-NAT, or ID-NAT to the current antibody screening cannot be regarded as a cost effective health-care intervention for Ghana
Costs of HIV⁄AIDS outpatient services delivered through Zambian public health facilities
(Tropical Medicine and International Health, 2011) Bratt, J.H.; Torpey, K.; Kabaso, M.; Gondwe, Y.
objective To present evidence on unit and total costs of outpatient HIV ⁄ AIDS services in ZPCT supported facilities in Zambia; specifically, to measure unit costs of selected outpatient HIV ⁄ AIDS services, and to estimate total annual costs of antiretroviral therapy (ART) and prevention of mother-to child transmission (PMTCT) in Zambia. methods Cost data from 2008 were collected in 12 ZPCT-supported facilities (hospitals and health centres) in four provinces. Costs of all resources used to produce ART, PMTCT and CT visits were included, using the perspective of the provider. All shared costs were distributed to clinic visits using appropriate allocation variables. Estimates of annual costs of HIV ⁄ AIDS services were made using ZPCT and Ministry of Health data on numbers of persons receiving services in 2009. results Unit costs of visits were driven by costs of drugs, laboratory tests and clinical labour, while variability in visit costs across facilities was explained mainly by differences in utilization. First-year costs of ART per client ranged from US$278 to US$523 depending on drug regimen and facility type; costs of a complete course of antenatal care (ANC) including PMTCT were approximately US$114. Annual costs of ART provided in ZPCT-supported facilities were estimated at US$14.7–$40.1 million depending on regimen, and annual costs of antenatal care including PMTCT were estimated at US$16 million. In Zambia as a whole, the respective estimates were US$41.0–114.2 million for ART and US$57.7 million for ANC including PMTCT. conclusions Consistent with the literature, total costs of services were dominated by drugs, labora tory tests and clinical labour. For each visit type, variability across facilities in total costs and cost components suggests that some potential exists to reduce costs through greater harmonization of care protocols and more intensive use of fixed resources. Improving facility-level information on the costs of resources used to produce services should be emphasized as an element of health systems strengthening.
COVID-19 and medical education: an opportunity to build back better
(Ghana Medical Journal, 2020) Agyei-Nkansah, A.; Adjei, P.; Torpey, K.
The coronavirus disease 2019 (COVID-19) outbreak in the Hubei province of China has rapidly transformed into a global pandemic. In response to the first few reported cases of COVID-19, the government of Ghana implemented comprehensive social and public health interventions aimed at containing the disease, albeit its effect on medical education is less clear. Undoubtedly, the COVID-19 has brought changes that may impact the plan of career progres sion for both students and faculty. Hitherto, medical education had students getting into contact with patients and faculty in a facility setting. Their physical presence in both in-and outpatients’ settings has been a tradition of early clinical immersion experiences and the clerkship curriculum. Rotating between departments makes the students po tential vectors and victims for COVID-19. COVID-19 has the potential to affect students throughout the educational process. The pandemic has led to a complete paradigm shift in the mode of instruction in a clinical care setting. In person training has either been reduced or cancelled in favour of virtual forms of pedagogy. The clinics have also seen a reduction in a variety of surgical and medical cases. This situation may result in potential gaps in their training. Outpatient clinics have transitioned mainly to telemedicine, thus minimizing students’ exposure to clinic encounters. Faced with this pandemic, medical educators are finding ways to best ensure rigorous training that will produce com petent physicians. This article discusses the status of medical education and the effect of COVID-19 and explores potential future effects in a resource-limited country.
Determinants of health facility delivery among young mothers in Ghana; insights from the 2014 Ghana Demographic and Health Survey
(BMC Pregnancy and Childbirth, 2022) Anaba, E.A.; Alangea, D.O.; Addo‑Lartey, A.; Modey, E.J.; Manu, A.; Alor, S.K.; Torpey, K.
Background: Globally, young women deliver at home, often under unhygienic conditions and without skilled birth attendants. This study identifed the determinants of health facility delivery among young mothers in Ghana. Methods: We analysed secondary data from the 2014 Ghana Demographic and Health Survey, which collected data across the former ten administrative regions of Ghana. This study analysed data from the ‘women fle’ by adjusting for the sample weight. STATA/SE version 16 was employed to analyse the data by computing descriptive statistics, Chi square, and Binary Logistic Regression. Results: Seven in ten young mothers gave birth in a health facility. Young mothers who had secondary school education were over three-fold more likely to deliver in a health facility (AOR=3.5, 95% CI: 1.33–9.23) compared with young mothers with no formal education. Young mothers who resided in rural areas had lower odds (73%) of deliver‑ ing in a health facility (AOR=0.27; 95% CI: 0.14–0.514) compared with those in urban areas. Young mothers within the richest wealth quintile also had higher odds (8 times) of delivering in a health facility (AOR=8.24; 95% CI: 0.95–71.77) compared with those within the poorest wealth quintile. Young mothers who obtained four to seven antenatal visits (AOR=0.53; 95% CI: 0.27–1.03) had lower odds of delivering in a health facility compared with those who obtained eight or more antenatal visits. Conclusion: The majority of young mothers in Ghana gave birth in a health facility. The likelihood of delivering in a health facility was infuenced by socio-demographic factors, economic factors and utilization of antenatal care ser‑ vices. Therefore, interventions aimed at increasing utilization of skilled delivery among young women should focus on promoting girl child education, economic status and antenatal care visits
Determinants of induced abortion among women of reproductive age: evidence from the 2013 and 2019 Sierra Leone Demographic and Health Surve
(BMC Women’s Health, 2023) Sesay, F.R.; Anaba, E.A.; Manu, A.; Maya, E.; Torpey, K.; Adanu, R.M.K.
Background Worldwide, pregnancy termination due to unintended pregnancy is crucial in maternal health, par ticularly in settings where abortion laws are restrictive. Presently, there is a paucity of literature on determinants of induced abortion among women of reproductive age in Sierra Leone. The study fndings could be used to improve the country’s maternal mortality indices and inform health programs and reproductive health policies geared toward tackling induced abortion. Methods We analyzed secondary data from the 2013 and 2019 Sierra Leone Demographic and Health Surveys. The surveys were nationally representative, with weighted samples comprising 16,658 (2013) and 15,574 (2019) women of reproductive age. Descriptive statistics, including frequencies and percentages, were computed, while Chi-square and Binomial Logistics Regression were employed to identify correlates of induced abortion. Results The results showed that a minority (9%) of the participants had induced abortion in both surveys. Abor tion was signifcantly associated with age, marital status, employment status, education, parity, and frequency of listening to the radio and watching television (p<0.05). For instance, women aged 45–49 years (AOR=7.91; 95% CI: 5.76–10.87), married women (AOR=2.52; 95% CI: 1.95–3.26), and working women (AOR=1.65; 95% CI: 1.45–1.87) had a higher likelihood of induced abortion compared to their counterparts. Moreover, women with primary educa tion (AOR=1.27; 95% CI:1.11–1.46) and those who watch television once a week (AOR=1.29; 95% CI: 1.11–1.49) were more likely to terminate a pregnancy. Women with six or more children (AOR=0.40; 95% CI: 0.31–0.52) were less likely to terminate a pregnancy compared to those with no child. Conclusion The study revealed that a minority of the women had induced abortions. The prevalence of induced abortion did not change over time. Induced abortion was infuenced by age, marital status, employment status, edu cation, parity, and exposure to mass media. Therefore, policies and programs to reduce unwanted pregnancies should focus on increasing access to modern contraceptives among women of lower socio-economic status
Determinants of induced abortion among women of reproductive age: evidence from the 2013 and 2019 Sierra Leone Demographic and Health Survey
(BMC Women’s Health, 2023) Sesay, F.R.; Anaba, E.A.; Manu, A.; Maya, E.; Torpey, K.; Adanu, R.M.K.
Background Worldwide, pregnancy termination due to unintended pregnancy is crucial in maternal health, particularly in settings where abortion laws are restrictive. Presently, there is a paucity of literature on determinants of induced abortion among women of reproductive age in Sierra Leone. The study findings could be used to improve the country’s maternal mortality indices and inform health programs and reproductive health policies geared toward tackling induced abortion. Methods We analyzed secondary data from the 2013 and 2019 Sierra Leone Demographic and Health Surveys. The surveys were nationally representative, with weighted samples comprising 16,658 (2013) and 15,574 (2019) women of reproductive age. Descriptive statistics, including frequencies and percentages, were computed, while Chi-square and Binomial Logistics Regression were employed to identify correlates of induced abortion. Results The results showed that a minority (9%) of the participants had induced abortion in both surveys. Abortion was significantly associated with age, marital status, employment status, education, parity, and frequency of listening to the radio and watching television (p<0.05). For instance, women aged 45–49 years (AOR=7.91; 95% CI: 5.76–10.87), married women (AOR=2.52; 95% CI: 1.95–3.26), and working women (AOR=1.65; 95% CI: 1.45–1.87) had a higher likelihood of induced abortion compared to their counterparts. Moreover, women with primary education (AOR=1.27; 95% CI:1.11–1.46) and those who watch television once a week (AOR=1.29; 95% CI: 1.11–1.49) were more likely to terminate a pregnancy. Women with six or more children (AOR=0.40; 95% CI: 0.31–0.52) were less likely to terminate a pregnancy compared to those with no child. Conclusion The study revealed that a minority of the women had induced abortions. The prevalence of induced abortion did not change over time. Induced abortion was influenced by age, marital status, employment status, education, parity, and exposure to mass media. Therefore, policies and programs to reduce unwanted pregnancies should focus on increasing access to modern contraceptives among women of lower socio-economic status.
Do peer educators make a difference? An evaluation of a youth-led HIV prevention model in Zambian Schools
(Health Education Research, 2012) Denison, J.A.; Tsui1, S.; Bratt, J.; Torpey, K.; Weave, M.A.; Kabaso, M.
Restless Development’s youth-led model places trained Volunteer Peer Educators (VPEs), aged 18–25 years, in schools to teach HIV prevention and reproductive health (RH). VPEs also run youth centers, extracurricular and community based activities. This evaluation assesses (i) pro gram effects on students’ HIV/RH knowledge, attitudes and behaviors using a non-randomized quasi-experimental design among 2133 eighth and ninth grade students in 13 intervention versus 13 matched comparison schools and (ii) program costs. Intervention students had significantly higher levels of knowledge related to HIV [odds ratio (OR) 1.61, 95% confidence interval (CI) 1.18–2.19; P < 0.01] and RH (OR 1.71; 95% CI 1.21–2.49; P < 0.01), more positive attitudes toward people living with HIV and greater self-efficacy to refuse unwanted sex and access condoms. No evidence of differences in ever having had sex was found (28% in the intervention; 29% in the comparison schools). However, intervention students were more likely not to have had sex in the previous year (OR 1.26, 95% CI 1.03–1.56; P < 0.05) and to have had only one sex partner ever (OR 1.43, 95% CI 1.00–2.03; P < 0.05). The average an nual cost of the program was US$21 per benefi ciary. In conclusion, the youth-led model iassociated with increased HIVand RH knowledge and self-efficacy and lowered levels of stigma and sexual risk-taking behaviors
Effect of HIV infection on TB treatment outcomes and time to mortality in two urban hospitals in Ghana-a retrospective cohort study
(Pan African Medical Journal (PAMJ), 2019-04-26) Ogyiri, L.; Lartey, M.; Ojewale, O.; Adjei, A.A.; Kwara, A.; Adanu, R.M.; Torpey, K.
Introduction: Tuberculosis (TB) is currently causing more deaths than Human Immunodeficiency Virus (HIV) globally. Ghana as one of the 30 high burden TB/HIV countries has a high annual TB case-fatality rate of 10%. The study sought to assess the effect of HIV infection on TB treatment outcomes and assess the time to mortality after treatment onset. Methods: we conducted a review of treatment files of TB patients who were treated from January 2013 to December 2015 in two urban hospitals in the Accra Metropolis. Modified Poisson regression analysis was used to measure the association between HIV infection and TB treatment outcomes. Kaplan-Meier survival estimates were used to plot survival curves. Results: seventy-seven percent (83/107) of HIV infected individuals had successful treatment, compared to 91.2% (382/419) treatment success among HIV non-infected individuals. The proportion of HIV-positive individuals who died was 21.5% (23/107) whilst that of HIV-negative individuals was 5.5% (23/419). Being HIV-positive increased the risk of adverse outcome relative to successful outcome by a factor of 2.89(95% CI 1.76-4.74). The total number of deaths recorded within the treatment period was 46; of which 29(63%) occurred within the first two months of TB treatment. The highest mortality rate observed was among HIV infected persons (38.6/1000 person months). Of the 107 TB/HIV co-infected patients, 4(3.7%) initiated ART during TB treatment. Conclusion: the uptake of ART in co-infected individuals in this study was very low. Measures should be put in place to improve ART coverage among persons with TB/HIV co-infection to help reduce mortality.