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Ogbuoji, Osondu

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Ogbuoji

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Osondu

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Ogbuoji, Osondu
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    A systematic review of interventions to improve postpartum retention of women in PMTCT and ART care
    (International AIDS Society, 2016) Geldsetzer, Pascal; Yapa, H Manisha N; Vaikath, Maria; Ogbuoji, Osondu; Fox, Matthew P; Essajee, Shaffiq M; Negussie, Eyerusalem K; Bärnighausen, Till
    Introduction: The World Health Organization recommends lifelong antiretroviral therapy (ART) for all pregnant and breastfeeding women living with HIV. Effective transitioning from maternal and child health to ART services, and long-term retention in ART care postpartum is crucial to the successful implementation of lifelong ART for pregnant women. This systematic review aims to determine which interventions improve (1) retention within prevention of mother-to-child HIV transmission (PMTCT) programmes after birth, (2) transitioning from PMTCT to general ART programmes in the postpartum period, and (3) retention of postpartum women in general ART programmes. Methods: We searched Medline, Embase, ISI Web of Knowledge, the regional World Health Organization databases and conference abstracts for data published between 2002 and 2015. The quality of all included studies was assessed using the GRADE criteria. Results and Discussion After screening 8324 records, we identified ten studies for inclusion in this review, all of which were from sub-Saharan Africa except for one from the United Kingdom. Two randomized trials found that phone calls and/or text messages improved early (six to ten weeks) postpartum retention in PMTCT. One cluster-randomized trial and three cohort studies found an inconsistent impact of different levels of integration between antenatal care/PMTCT and ART care on postpartum retention. The inconsistent results of the four identified studies on care integration are likely due to low study quality, and heterogeneity in intervention design and outcome measures. Several randomized trials on postpartum retention in HIV care are currently under way. Conclusions: Overall, the evidence base for interventions to improve postpartum retention in HIV care is weak. Nevertheless, there is some evidence that phone-based interventions can improve retention in PMTCT in the first one to three months postpartum.
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    Factors Affecting Patient Perceptions of Quality and Health-Seeking Behavior
    (2018-01-25) Ogbuoji, Osondu; Atun, Rifat; Bårnighausen, Till; Salomon, Joshua A.; Kruk, Margaret E.
    In this dissertation, I address three issues related to patient-perceived quality of care: the impact of switching to the new World Health Organization (WHO) HIV treatment guidelines on patient perception of quality of care, the impact of rolling-out a quality improvement (QI) training intervention on mothers’ perception of the quality of postnatal care, and the association between patient perceptions of quality and their decisions to bypass healthcare facilities for care. Chapter one presents an overview as well as key insights form all three papers. In chapter two, I investigated the impact of early access to antiretroviral therapy (ART) versus national standard of care on patient satisfaction using data from a stepped-wedge cluster randomized controlled trial in Swaziland. The outcomes of interest included, patient ratings of perceptions of overall quality of care, wait time, consultation time, level of involvement in treatment decision-making, and respect received from the health worker. The results show no evidence of a causal impact of early initiation of ART on patient perception of overall quality of care, or perception of quality of care in the other domains measured. The results also showed a time trend of increasing negative perception of quality as the study progressed. In chapter three, I investigated the impact of a quality improvement training intervention on women’s perception of the quality of postnatal care using data from a stepped-wedge cluster randomized controlled trial in primary health care (PHC) clinics in rural South Africa. Results show no evidence of a causal impact of the QI training on patient perception of quality of postnatal care in any of the domains assessed. The results also showed time trends with increasing positive perception of quality over time in three out of the five domains assessed: patient-provider communication, consultation-time, and level of involvement in treatment decision making. In chapter four, I explored the associations between perceptions of quality of antenatal care and sick-child care on patients’ decisions to bypass healthcare facilities in nine low- and middle-income countries. The results showed that measures of structural quality were more consistent predictors of patients’ bypassing behavior compared to measures of technical quality.