ETD Collection

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    Improving STI/HIV passive partner notification using quality improvement methods in Malawi
    (2018) Matoga, Mitch Mirichi
    Introduction Human Immunodeficiency Virus (HIV) and other curable Sexually Transmitted Infections (STIs) constitute a large public health burden world-wide. The control of HIV and STIs is incomplete if sexual partners of individuals with HIV and STIs are not identified and treated. The proportion of sexual partners that present to health facilities for screening and treatment is low in the sub-Saharan African (SSA) region. A recent study in Malawi reported a sexual partner referral proportion of 24% through passive partner notification. Several other approaches to partner notification (PN) have been shown to be feasible, acceptable and cost-effective for SSA. However, passive PN is widely used as the standard of care (SOC) and is the most preferred approach for resource-limited settings including Malawi. The low proportion of sexual partner referral points to the need to improve the efficiency and effectiveness of the SOC method of PN in order to realize a better yield of sexual partners in Malawi and SSA. Methods A pre- and post-intervention quasi-experimental study was conducted at Bwaila STI Unit (BSU) in Lilongwe Malawi from January to June 2017. At baseline, we estimated the proportion of sexual partner referral and identified health system-related factors that influenced PN at BSU through interviews with health workers and clinic observations. Based on the baseline findings, a three-prong intervention was designed through expert consultation and implemented with a quality improvement (QI) team using the model for improvement (MFI). The intervention included: early start time of the clinic; shortening of the group health talk and expedited clinic flow for sexual partners. Each intervention was tested twice through 1-week long test cycles and then combined into one package and tested twice. Process data were collected and monitored using run charts. We used run charts to assess for non-random signals of change in the PN process and assessed for a 10% increase in the sexual partner referral proportion between the pre- and post-intervention periods at 95% power and at α=0.05. Results At baseline, the proportion of sexual partner referral was 15.6%. Experts included BSU staff, research staff and Ministry of Health officials who were involved in the selection of interventions based on findings from the interviews and clinic observations. The QI team consisted of the investigator, a nurse-in-charge, a counselor, a clinic receptionist and a clinic aide who championed implementation of the intervention. In the post intervention period, we assessed 267 patient records. The median age was 29 years and 56% were female. Out of the three interventions, the team managed to shorten the duration of the group health talks from 56 minutes to less than 40 minutes and expedited the clinic flow for partners by reducing the duration of clinic stay by 45 minutes. However, the target clinic start time of 08:00 hours was not achieved. The post-intervention proportion of sexual partner referral was 21.4% representing a statistically significant increase of 37% (P=0.04). There was an upward trend in data points on the run chart which was indicative of a non-random signal of improvement in the proportion of sexual partners. Discussion Our results demonstrate that passive PN can be successfully improved through use of the model for improvement in Malawi and suggest that our intervention was highly effective at increasing the proportion of sexual partner referral. However, despite this increase, the proportion of sexual partner referral remains suboptimal. More effort is required to increase the proportion of sexual partner referral in Malawi.
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    The determinants of multiple sexual partnerships among men in Zimbabwe
    (2012) Mutenheri, Enard
    Introduction The burden of HIV/AIDS is higher in the sub-Saharan region and multiple sexual partnerships are among the sexual behaviors that put people at risk of HIV transmission. The main aim of this study was to determine the prevalence and associated demographic, socio-economic and behavioral factors of multiple sexual partnerships among men in Zimbabwe. Materials and Methods This was an analytical cross-sectional study that used data from the Zimbabwe Demographic Health Survey 2005-06. Negative binomial regressions were fitted to identify factors associated with multiple sexual partnerships among men in Zimbabwe. Results The prevalence of multiple sexual partnerships was 13.5 %, 12.9%, and 11.2% among the formerly, never and currently married men respectively. Among the formerly married men, the risk factors significantly associated with multiple sexual partnerships included access to newspapers (RR= 1.28; 95% CI:1.02 , 1.60). Formerly married men aged 35-44 years had lower risk of engaging in multiple sex partnerships (RR = 0.59, 95%CI: 0.42, 0.83) than the other age groups. Relative to formerly married men in Manicaland, formerly married men in Mashonaland East region had lower risks of having more sexual partners. Age at first intercourse and sexual attitude were also significantly associated with multiple sexual partnerships among the formerly married men iv Among the never married men, the risk factors associated with multiple sexual partnerships included employment status (RR = 1.33%; 95%CI: 1.17, 1.52), Watching TV (RR = 1.33%; 95%CI: 1.05, 1.69) and sexual attitude (RR = 1.37%; 95% CI: 1.05, 1.79). Relative to never married men in Manicaland, the never married men in Mashonaland East and Mashonaland West had lower risks of having multiple sexual partners. Among the married men, the risk factors associated with multiple sexual partnerships included first intercourse at the age of 19 years or below (RR = 1.07%; 95% CI: 1.04, 1.11) and sexual attitude (RR = 1.16%; 95% CI: 1.09, 1.23). Protective factors included higher level of education (RR = 0.87%; 95% CI: 0.77, 0.98), being 35-44 (RR = 0.94%; 95% CI: 0.89, 0.99) or 45-54 years old (RR = 0.93%; 95% CI: 0.88, 0.99) and being from Mashonaland East (RR= 0.89%; 95%CI: 0.85, 0.93) region. Discussion and Conclusions The results show that after adjusting for potential confounders in the multivariate negative binomial regression analysis; age, geographical region, education, working status, frequency of reading newspapers/magazines/TV, age at first intercourse and sexual attitude remained significantly associated with MSP. However, the extent to which each of these factors was associated with multiple sex partnership varied among marital status groups, therefore HIV/AIDS intervention programs should be designed accordingly.