Browsing by Person "Cataldo, Fabian"

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Barriers and facilitators to the uptake of Test and Treat in Mozambique: A qualitative study on patient and provider perceptions
(2018-12-26) Nhassengo, Pedroso; Cataldo, Fabian; Magaço, Amilcar; Hoffman, Risa M.; Nerua, Lucas; Saide, Mohomede; Cuco, Rosa; Hoek, Roxanne; Mbofana, Francisco; Couto, Aleny; Gudo, Eduardo; Chicumbe, Sergio; Dovel, Kathryn; Garcia, Jonathan
BACKGROUND:In mid-2016, Mozambique began phased implementation of the 'Test-and-Treat' policy, which enrolls HIV positive clients into antiretroviral treatment (ART) immediately regardless of CD4 cell count or disease stage. Novel insights into barriers and facilitators to ART initiation among healthy clients are needed to improve implementation of Test and Treat. METHODS AND FINDINGS:A cross-sectional qualitative study was conducted across 10 health facilities in Mozambique. In-depth interviews (IDIs) were conducted with HIV-positive clients (60 who initiated/20 who did not initiate ART within Test and Treat) and 9 focus group discussion (FGDs) were conducted with health care workers (HCWs; n = 53). Data were analyzed using deductive and inductive analysis strategies. Barriers to ART initiation included: (1) feeling 'healthy'; (2) not prepared to start ART for life; (3) concerns about ART side effects; (4) fear of HIV disclosure and discrimination; (5) poor interactions with HCWs; (6) limited privacy at health facilities; and (7) perceptions of long wait times. Facilitators included the motivation to stay healthy and to take care of dependents, as well as new models of ART services such as adaptation of counseling to clients' specific needs, efficient patient flow, and integrated HIV/primary care services. CONCLUSIONS:ART initiation may be difficult for healthy clients in the context of Test-and-Treat. Specific strategies to engage this population are needed. Strategies could include targeted support for clients, community sensitization on the benefits of early ART initiation, client-centered approaches to patient care, and improved efficiency through multi-month scripting and increased workforce.
‘Deep down in their heart, they wish they could be given some incentives’: A qualitative study on the changing roles and relations of care among home-based caregivers in Zambia
(2015-01-28) Cataldo, Fabian; Kielmann, Karina; Kielmann, Tara; Mburu, Gitau; Musheke, Maurice
Background Across Sub-Saharan Africa, the roll-out of antiretroviral treatment (ART) has contributed to shifting HIV care towards the management of a chronic health condition. While the balance of professional and lay tasks in HIV caregiving has been significantly altered due to changing skills requirements and task-shifting initiatives, little attention has been given to the effects of these changes on health workers' motivation and existing care relations. Methods This paper draws on a cross-sectional, qualitative study that explored changes in home-based care (HBC) in the light of widespread ART rollout in the Lusaka and Kabwe districts of Zambia. Methods included observation of HBC daily activities, key informant interviews with programme staff from three local HBC organisations (n = 17) and ART clinic staff (n = 8), as well as in-depth interviews with home-based caregivers (n = 48) and HBC clients (n = 31). Results Since the roll-out of ART, home-based caregivers spend less time on hands-on physical care and support in the household, and are increasingly involved in specialised tasks supporting their clients' access and adherence to ART. Despite their pride in gaining technical care skills, caregivers lament their lack of formal recognition through training, remuneration or mobility within the health system. Care relations within homes have also been altered as caregivers' newly acquired functions of monitoring their clients while on ART are met with some ambivalence. Caregivers are under pressure to meet clients and their families' demands, although they are no longer able to provide material support formerly associated with donor funding for HBC. Conclusions As their responsibilities and working environments are rapidly evolving, caregivers' motivations are changing. It is essential to identify and address the growing tensions between an idealized rhetoric of altruistic volunteerism in home-based care, and the realities of lay worker deployment in HIV care interventions that not only shift tasks, but transform social and professional relations in ways that may profoundly influence caregivers' motivation and quality of care.
Engaging with HIV care systems: why space, time and social relations matter (editorial)
(BMJ, 2017-07-23) Kielmann, Karina; Cataldo, Fabian
Qualitative research to enhance the evaluation of results-based financing programmes: The promise and the reality
(The World Bank, 2016-02) Cataldo, Fabian; Kielmann, Karina
This Discussion Paper presents the approach, findings, and recommendations from a desk review of the qualitative research conducted within Results-Based Financing programmes (RBF) under the Health Results Innovations Trust Fund (HRITF). The review included 17 studies conducted in Benin, Burundi, Cameroon, DRC, Ethiopia, Haiti, Kenya, Kyrgyzstan, Nigeria, Rwanda, Tajikistan, Tanzania, Zambia, and Zimbabwe. The studies reveal a body of high quality work that is consistent with the conceptual framework of RBF schemes, supported by political will, resources, and research capacity. Strengthening the added value of qualitative inquiry in on-going and future qualitative studies may be enabled by small shifts in thinking and practice, in line with a qualitative research paradigm. First, in order to better ground research in an existing country and system specific context, some interrogation of constructs and posited relationships in the existing conceptual framework for intervention/evaluation may be required. Second, to enable more in-depth and richer data that documents working practices and relations under RBF schemes, training of local researchers should place stronger emphasis on entry to the field, gaining trust, building rapport, and sustaining a dialogue with key informants. Third, smaller, more intensive and focused studies targeting fewer sites and smaller samples - but addressing a wider range of methods and informants within the health system - are likely to yield richer data that can support the understanding of how health workers and managers are responding to schemes, and what impact schemes have on service volumes and outputs.
Understanding the linkages between informal and formal care for people living with HIV in sub-Saharan Africa
(Taylor & Francis, 2012-11-01) Lees, Shelley; Kielmann, Karina; Cataldo, Fabian; Gitau-Mburu, D.
In response to the human resource challenges facing African health systems, there is increasing involvement of informal care providers in HIV care. Through social and institutional interactions that occur in the delivery of HIV care, linkages between formal and informal systems of care often emerge. Based on a review of studies documenting the relationships between formal and informal HIV care in sub-Saharan Africa, we suggest that linkages can be conceptualised as either 'actor-oriented' or 'systems-oriented'. Studies adopting an actor-oriented focus examine hierarchical working relationships and communication practices among health systems actors, while studies focusing on systems-oriented linkages document the presence, absence or impact of formal inter-institutional partnership agreements. For linkages to be effective, the institutional frameworks within which linkages are formalised, as well as the ground-level interactions of those engaged in care, ought to be considered. However, to date, both actor- and system-oriented linkages appear to be poorly utilised by policy makers to improve HIV care. We suggest that linkages between formal and informal systems of care be considered across health systems, including governance, human resources, health information and service delivery in order to improve access to HIV services, enable knowledge transfer and strengthen health systems.