Browsing by Author "Knettel, Brandon A"

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    ItemOpen Access
    Does Antiretroviral Therapy Packaging Matter? Perceptions and Preferences of Antiretroviral Therapy Packaging for People Living with HIV in Northern Tanzania.
    (Patient preference and adherence, 2020-01-23) Muiruri, Charles; Jazowski, Shelley A; Semvua, Seleman K; Karia, Francis P; Knettel, Brandon A; Zullig, Leah L; Ramadhani, Habib O; Mmbaga, Blandina T; Bartlett, John A; Bosworth, Hayden B

    Introduction

    Despite improvements in treatment (eg, reduction in pill intake), antiretroviral therapy (ART) is dispensed in socially inefficient and uneconomical packaging. To make pills less conspicuous and decrease the risk of being stigmatized, people living with HIV (PLWH) often engage in self-repackaging - the practice of transferring ART from original packaging to alternative containers. This behavior has been associated with ART nonadherence and failure to achieve viral load suppression. While much of the literature on ART packaging has centered around medication adherence, patients stated preferences for ART packaging and packaging attributes that influence the observed ART nonadherence are understudied.

    Methods

    We conducted a qualitative study to elucidate perceptions of ART packaging among PLWH at two large referral hospitals in Northern Tanzania. Interviews were conducted until thematic saturation was reached. Interviews were audio-recorded, transcribed and coded.

    Results

    Of the 16 participants whose data were used in the final analysis, a majority were between 36 and 55 years of age (Mean 45.5 years SD: 11.1), had primary-level education (n=11, 68.8%), were self-employed (n=9, 56.3%), reported that they had self-repacked ART (n=14, 88%), and were taking ART for more than 6 years (n=11, 68.8%). Participants identified three attributes of ART packaging that increased anticipated HIV stigma and prompted self-repackaging, including visual identification, bulkiness, and the rattling noise produced by ART pill bottles.

    Conclusion

    Given the drastic reduction in the number of pills required for HIV treatment, there is an opportunity to not only assess the cost-effectiveness of innovative ART packaging but also evaluate the acceptability of such packaging among PLWH in order to address stigma and improve ART adherence.
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    ItemOpen Access
    “Everyone is fighting their own battles”: A qualitative study to explore the context of suicidal ideation among people living with HIV in Kilimanjaro, Tanzania
    (2024) Shekibula, Ismail Amiri

    AbstractBackground: In 2020, Tanzania struggled with significant HIV-related challenges, including 1.4 million people living with HIV (PLWH), 33,000 new infections, and 22,000 AIDS-related deaths. Suicide emerged as a main cause of mortality among PLWH, accounting for over a quarter of all suicides. Despite these alarming statistics, mental health resources remained scarce, with only 55 psychologists and psychiatrists in the country. Clinic staff in HIV care were tasked with providing counseling despite limited mental health training, primarily focusing on HIV education. This study aimed to delve into the lived experiences of PLWH with recent suicidal ideation to inform tailored mental health interventions. Methods: Participants were screened for suicidal ideation during routine HIV clinic visits, with qualitative interviews conducted thereafter. Data was analyzed using thematic analysis facilitated by NVivo 12 software. Results: PLWH experiencing suicidal ideation encounter significant mental health challenges originating from factors such as their HIV diagnosis, societal stigma, financial stress, and broader social determinants. Death is sometimes perceived as an escape from the challenges associated with HIV. Coping mechanisms include seeking assistance from religious leaders. While participants expressed openness to counseling, limited treatment options hinder access. Conclusion: Suicide is an urgent public health challenge among PLWH in Tanzania, exacerbated by unique stressors like socioeconomic challenges, stigma, discrimination, and psychological distress. Despite the seriousness of these challenges, options for mental health treatment are scarce and not tailored to the needs of PLWH. Our findings can inform the improvement of mental health care for PLWH in Tanzania and other low-resource settings.

    Key Words: Tanzania, HIV, Suicide, Suicidal ideation, Mental health, lived experience, Qualitative research, Stigma, Coping mechanisms, Counseling intervention, Socioeconomic challenges, Discrimination, Psychological distress, Treatment options and Low-resource settings.