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Fetene N.W.,EngenderHealth | Feleke A.D.,Health Science University
BMC Public Health | Year: 2010

Background. For patients in all health-care settings HIV screening is recommended after the patient is notified that testing will be performed unless the patient declines. The nation's physicians and other health care providers should assume a much more active role in promoting HIV testing. The aim of this study was to investigate the extent to which missed opportunities for earlier HIV testing and diagnosis occur in the health facilities of north east Ethiopia. Methods. A confidential client exit interview and medical record review was made on 427 clients who attended health facilities of Dessie town between November-December 2008. Data collection was done by counselors trained on Provider Initiated Counseling and Testing (PICT) and data collection tool included demographics, reason for visit to health facilities, HIV test initiation by service providers, clients self risk perception, clients willingness and acceptance of HIV test, HIV test result and review of client medical records. Results. Among 427 clients, missed opportunities for HIV testing were found in 76.1% (325) of clients. HIV test initiation was made by data collecting counselors during interview period and 80.0% (260) of clients not initiated by service providers were found to be willing to have HIV test. Large number, 43.0% (112), of the willing clients actually tested for HIV. Of the tested clients, 13.4% (15) were found to be HIV positive. Most, 60% (9), of HIV positive clients who lost the opportunities of diagnosis felt themselves as having no risk for HIV infection. Missed opportunities for HIV diagnosis of 51.7% (15), overall HIV test acceptance rate of 36.5% (154) and positivity rate of 6.9% (29) were found. Conclusions. The missed opportunities for earlier HIV test and diagnosis of patients attending health facilities were found to be high and frequent. Testing only clients with HIV risk misses large number of HIV positive patients. Asking clients' willingness for HIV testing should be conducted by all service providers irrespective of the clients' risk behaviors for HIV infection or the type of services they need. © 2010 Fetene and Feleke; licensee BioMed Central Ltd. Source

Subramanian L.,EngenderHealth | Cisek C.,URS Corporation | Kanlisi N.,Ghana R3M Project | Pile J.M.,EngenderHealth
Patient Education and Counseling | Year: 2010

Objective: In 2003-2004 and 2007-2008, an initiative was implemented to improve client and provider knowledge and acceptance of no-scalpel vasectomy (NSV) in Ghana. Methods: At eight facilities, physicians were trained in NSV and staff received training in the provision of " male-friendly" services. Health promotion activities provided NSV information to prospective clients. Client-provider communication was assessed via a mystery client study (n=6). Knowledge and acceptance of NSV among potential clients were assessed with baseline and follow-up surveys (each n=200) in 2003-2004 and three follow-up panel surveys in 2008 (each n=240). Results: Trained health staff exhibited improved attitudes and knowledge regarding NSV. Mystery clients reported receiving accurate, nonjudgmental NSV counseling. Awareness of NSV among panel respondents doubled from 31% to 59% in 2003-2004 and remained high (44%) in 2008. The proportion of men who would consider NSV increased from 10% to 19% in 2007-2008. NSV procedures increased three-fold from 2003 (n=26) to 2004 (n=83) and 2007 (n=18) to 2008 (n=53). Conclusion: Provider training in client-centered services, coupled with targeted health promotion, improved client and provider knowledge and acceptance of NSV in an African context. Practice implications: Complementary, sustained provider training and health promotion are needed to maintain NSV service quality and acceptance. © 2010 Elsevier Ireland Ltd. Source

Ngongo C.,Entrance | Christie K.,Aberdeen Womens Center | Holden J.,Aberdeen Womens Center | Ford C.,Aberdeen Womens Center | Pett C.,EngenderHealth
Midwifery | Year: 2013

Midwives provide critical, life-saving care to women and babies. Effective midwives must be clinically competent, with the required knowledge, skills, and attitudes to provide quality care. Their success depends on an environment of supportive supervision, continuing education, enabling policies, and access to equipment and referral facilities.In Freetown, Sierra Leone, the Aberdeen Women's Centre launched a maternity unit with an emphasis on striving for excellence and providing ongoing professional development to its staff midwives. Its success was built upon fostering a sense of responsibility and teamwork, providing necessary resources, conforming to evidence-based standards, and building partnerships. An explicit philosophy of care was crucial for guiding clinical decision making.In its first two years of operation, the Aberdeen Women's Centre assisted 2076 births with two maternal deaths and 92 perinatal deaths. In-service education and supportive supervision facilitated the midwives' professional growth, leading to capable future leaders who are providing exemplary care to delivering mothers and their newborns in Freetown. © 2013 Elsevier Ltd. Source

Masson P.,Cornell University | Li P.S.,Cornell University | Barone M.A.,EngenderHealth | Goldstein M.,Cornell University
Nature Reviews Urology | Year: 2010

Adult male circumcision reduces HIV transmission through vaginal intercourse and is being promoted in areas where HIV is widespread. Conventional surgical circumcision involves suturing and thus requires practitioners with surgical skills. It is also associated with complications, including bleeding and infection, especially in resource-poor settings. The ShangRing (Wuhu Snnda Medical Treatment Appliance Technology Co. Ltd, Wuhu City, China) has been used to perform thousands of circumcisions in adult men, principally in China. It consists of two concentric plastic rings that sandwich the foreskin of the penis, allowing circumcision without stitches or notable bleeding. As well as substantially reduced operative times, ShangRing adult male circumcision is associated with a low complication rate, and the technique can easily be taught to both physician and nonphysician personnel. The simple technique and successful outcomes associated with the ShangRing procedure mean that the device could enable standardization of adult male circumcision, helping HIV prevention efforts throughout the developing world. © 2010 Macmillan Publishers Limited. All rights reserved. Source

Sokal D.C.,Clinical science Unit | Li P.S.,New York Medical College | Zulu R.,University of Lusaka | Awori Q.D.,Engender Health | And 10 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2014

Objective: To compare clinical profiles of Shang Ring versus conventional circumcisions. Design: Parallel group open-label randomized controlled trial with one-to-one allocations in 2 sites. Methods: We enrolled HIV-negative men aged 18-54 years in Homa Bay, Kenya, and Lusaka, Zambia and followed them at 2, 7, 14, 21, 28, 42, and 60 days after Shang Ring versus conventional circumcision. We compared the duration of surgery, postoperative pain using a visual analog scale, adverse events rates, time to complete wound healing by clinical assessment, participant acceptability, and provider preferences between circumcision groups. Results: We randomized 200 men to each group; 197 and 201 contributed to the Shang Ring and conventional surgery analyses, respectively. Adverse event rates were similar between groups. Pain scores at most time points were similar, however, the Shang Ring group reported higher scores for worst pain during erections (3.5 ± 1.9 vs. 2.3 ± 1.7; P > 0.001). Significantly more men were satisfied with the cosmetic appearance following Shang Ring male circumcision (MC), 95.7% versus 85.9% (P = 0.02) in Kenya, and 96.8% versus 71.3% (P > 0.01) in Zambia. Although median time to complete wound healing was 43 days in both groups, conventional circumcisions healed on average 5.2 days sooner (P > 0.001). Shang Ring procedures took one-third the time of conventional MC, 7 versus 20 minutes. All circumcision providers preferred the Shang Ring. Conclusions: Safety profiles of the 2 techniques were similar, all MC providers preferred the Shang Ring technique, and study participants preferred the Shang Ring's cosmetic results. The Shang Ring should be considered for adult MC as programs scale-up. © 2013 by Lippincott Williams & Wilkins. Source

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