This article proposes a strategy for Switzerland to change the goal from HIV control to HIV elimination. In Switzerland, HIV treatment is well organized and available for all with good access. An important challenge that obstructs prevention is the new infections originating from people who are unaware of their status. Since the majority of new infections in Switzerland are within the group of men who have sex with men (MSM), this strategy targets MSM who do not know their HIV status and engage in risky sexual behavior.
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Background: In the Netherlands, general practitioners (GPs) play a key role in provider-initiated HIV testing, but opportunities for timely diagnosis are regularly missed. We implemented an educational intervention to improve HIV testing by GPs from 2015 to 2020, and observed a 7% increase in testing in an evaluation using laboratory data. The objective for the current study was to gain a deeper understanding of whether and how practices and perceptions of GPs’ HIV/sexually transmitted infection (STI) testing behaviour changed following the intervention. Methods: We performed a mixed-methods study using questionnaires and semi-structured interviews to assess self-reported changes in HIV/STI testing by participating GPs. Questionnaires were completed by participants at the end of the final educational sessions from 2017 through 2020, and participating GPs were interviewed from January through March 2020. Questionnaire data were analysed descriptively, and open question responses were categorised thematically. Interview data were analysed following thematic analysis methods. Results: In total, 101/103 participants completed questionnaires. Of 65 participants that were included in analyses on the self-reported effect of the programme, forty-seven (72%) reported it had changed their HIV/STI testing, including improved STI consultations, adherence to the STI consultation guideline, more proactive HIV testing, and more extragenital STI testing. Patients’ risk factors, patients’ requests and costs were most important in selecting STI tests ordered. Eight participants were interviewed and 15 themes on improved testing were identified, including improved HIV risk-assessment, more proactive testing for HIV/STI, more focus on HIV indicator conditions and extragenital STI testing, and tools to address HIV during consultations. However, several persistent barriers for optimal HIV/STI testing by GPs were identified, including HIV-related stigma and low perceived risk. Conclusions: Most GPs reported improved HIV/STI knowledge, attitude and testing, but there was a discrepancy between reported changes in HIV testing and observed increases using laboratory data. Our findings highlight challenges in implementation of effective interventions, and in their evaluation. Lessons learned from this intervention may inform follow-up initiatives to keep GPs actively engaged in HIV testing and care, on our way to zero new HIV infections.
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Background In the Netherlands, general practitioners (GPs) play a key role in HIV testing. However, the proportion of people diagnosed with late-stage HIV remains high, and opportunities for earlier diagnosis are being missed. We implemented an educational intervention to improve HIV and STI testing in primary care in Amsterdam, the Netherlands. Methods GPs were invited to participate in an educational program between 2015 and 2020, which included repeat sessions using audit and feedback and quality improvement plans. Data on HIV, chlamydia and gonorrhoea testing by GPs were collected from 2011 through 2020. The primary outcome was HIV testing frequency, which was compared between GPs before and after participation using Poisson regression. Secondary outcomes were chlamydia and gonorrhoea testing frequencies, and positive test proportions. Additional analyses stratified by patient sex and age were done. Findings GPs after participation performed 7% more HIV tests compared to GPs before participation (adjusted relative ratio [aRR] 1.07, 95%CI 1.04–1.09); there was no change in the proportion HIV positive tests (aRR 0.87, 95%CI 0.63–1.19). HIV testing increased most among patients who were female and ≤19 or 50–64 years old. After participation, HIV testing continued to increase (aRR 1.02 per quarter, 95%CI 1.01–1.02). Chlamydia testing by GPs after participation increased by 6% (aRR 1.06, 95%CI 1.05–1.08), while gonorrhoea testing decreased by 2% (aRR 0.98, 95%CI 0.97–0.99). We observed increases specifically in extragenital chlamydia and gonorrhoea testing. Conclusions The intervention was associated with a modest increase in HIV testing among GPs after participation, while the proportion positive HIV tests remained stable. Our results suggest that the intervention yielded a sustained effect.
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In de openbare les van mijn collega lector Raymond Pieters, is het domein van het lectoraat ‘Innovative Testing in Life Sciences & Chemistry’ toegelicht. Kort samengevat richt dit lectoraat zich op de ontwikkeling en toepassing van innovatieve teststrategieën om geneesmiddelen, voedingsmiddelen of chemicaliën (stoffen) te beoordelen op hun werkzaamheid (effectiviteit) en veiligheid. De nadruk ligt op de ontwikkeling van snelle, kosteneffectieve testmethoden die een relevante voorspelling van effecten op de gezondheid van de mens en het milieu opleveren én waarbij geen of minder proefdieren worden gebruikt. In mijn les zal ik u laten zien waar proefdieren voor gebruikt worden. Hierbij zal ik mij voornamelijk richten op de Nederlandse situatie. Ik zal ingaan op de wetenschappelijke en maatschappelijke wens om minder proefdieren te gebruiken en op de vraag wat we verstaan onder ‘alternatieven voor dierproeven’. Daarna zal ik bespreken waarom er in Nederland en Europa recentelijk meer aandacht is voor dit onderwerp. Het overzicht zal niet uitputtend zijn, maar zal u een goede indruk geven van het landschap. Ook zal ik stil staan bij de vraag: Waarom zijn we tot nog toe zo weinig succesvol geweest op het gebied van alternatieven voor dierproeven? Wat zijn de obstakels en wat kunnen we hier van leren? Hoe zouden we in de praktijk de toepassing van alternatieven kunnen stimuleren? Wat moet er beter, en hoe gaan we dat doen? Als we slimmer willen testen moeten we de huidige grenzen verleggen, of beter over de grenzen van ons vakgebied heen kijken. Ik zal aangeven waar prioriteiten liggen en hoe we de meeste ‘winst’ kunnen behalen in termen van proefdiervermindering in relatie tot productinnovatie. Tot slot zal ik aangeven welke bruggen we moeten bouwen en wat de rol is van de Hogeschool Utrecht
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Artikel gepubliceerd in Nurse Academy O&T | nummer 3 | 2024: Steeds vaker meten patiënten hun eigen gezondheid. Deze metingen zijn voorbeelden van ‘point of care’-testen (POCT), een voorbeeld is de COVID-19-test. De ontwikkeling en inzet van POCT dragen bij aan betaalbare en toegankelijke gezondheidszorg. POCT kan een belangrijk instrument zijn voor het monitoren van veranderingen in de gezondheid. Het kan thuiswonende ouderen helpen bij het versterken van hun zelfmanagement LEERDOELEN Na het lezen van dit artikel: •weet u wat de kenmerken van ‘point of care’-testen (POCT) zijn en kent u een aantal voorbeelden van POCT; • heeft u inzicht in de voordelen van het gebruik van POCT in gezondheidsbevordering van oudere cliënten; • kent u een aantal uitdagingen die samenhangen met het gebruik van POCT in de praktijk; • heeft u inzicht in de betekenis van verpleegkundigen voor de inzet van POCT bij de ondersteuning van ouderen
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In September 2010, Hanze University of Applied Sciences in Groningen (the Netherlands) started a 20-week international program titled GameOn! The object of this program is for students to develop serious games, that aim to help the youth become aware of social and/or health related issues. Since the start of GameOn! students have worked on a number of different projects, all related to education through the use of interactive media. Topics were malaria, hiv/aids and personal hygiene. In all these projects, specific knowledge about the target region, domain knowledge of the subject of the game, and the target group was brought in by specialists and local representatives. The lessons drawn, in development and production, from these projects are: 1. The importance of an agile game development method that allows for regular testing, feedback moments and changes. 2. The importance of a user/player centred design and the context of playful experiences. 3. Cultural awareness in game design and development: consider and adapt to the values and beliefs of the target audience. 4. Collaboration and co-creation with local representatives in game development adds to game acceptance. 5. A very positive attitude towards the use of computers in education in the targeted areas. Addressing and incorporating these aspects into projects may contribute in more effective and adequate (social) health games or, in a broader sense, more effective interactive media applications aimed at facilitating educational learning.
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Abstract: Clinicians find it challenging to engage with patients who engage in self-harm. Improving the self-efficacy of professionals who treat self-harm patients may be an important step toward accomplishing better treatment of self-harm. However, there is no instrument available that assesses the self-efficacy of clinicians dealing with self-harm. The aim of this study is to describe the development and validation of the Self-Efficacy in Dealing with Self-Harm Questionnaire (SEDSHQ). This study tests the questionnaire’s feasibility, test-retest reliability, internal consistency, content validity, construct validity (factor analysis and convergent validity) and sensitivity to change. The Self-Efficacy in Dealing with Self-Harm Questionnaire is a 27-item instrument which has a 3-factor structure, as found in confirmatory factor analysis. Testing revealed high content validity, significant correlation with a subscale of the Attitude Towards Deliberate Self-Harm Questionnaire (ADSHQ), satisfactory test-retest correlation and a Cronbach’s alpha of 0.95. Additionally, the questionnaire was able to measure significant changes after an intervention took place, indicating sensitivity to change. We conclude that the present study indicates that the Self-Efficacy in Dealing with Self-Harm Questionnaire is a valid and reliable instrument for assessing the level of self-efficacy in response to self-harm.
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The ENWHP project and campaign Promoting Healthy Work for Employees with Chronic Illness (PH Work) should contribute towards the implementation of effective workplace health practices within corporate policies of enterprises in Europe. More specific the project should stimulate activities and policies in companies for: -retaining and encouraging return to work (RTW) of chronically ill employees. -preventing employees of moving into disability or early retirement. To contribute to an improvement of social and economic outcomes, like better quality of life and functioning, reduced costs because of lower absence rate, etc. PH Work campaign will look into current good practices, as to motivate and stimulate employers and employees on the promotion of healthy work for all. Running time of ENWHP PH Work project is from April 2011 till February 2013
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Background: Patients with chronic obstructive pulmonary disease (COPD) demonstrate reduced levels of daily physical activity (DPA) compared to healthy controls. This results in a higher risk of hospital admission and shorter survival. Performing regular DPA reduces these risks. Objective: To develop an eHealth intervention that will support patients with COPD to improve or maintain their DPA after pulmonary rehabilitation. Methods: The design process consisted of literature research and the iterative developing and piloting phases of the Medical Research Council (MRC) model for complex clinical interventions and the involvement of end users. Participants were healthy adults and persons with COPD. Results: The mobile phone interface met all the set requirements. Participants found that the app was stimulating and that reaching their DPA goals was rewarding. The mean (SD) scores on a 7-point scale for usability, ease of use, ease of learning, and contentment were 3.8 (1.8), 5.1 (1.1), 6.0 (1.6), and 4.8 (1.3), respectively. The mean (SD) correlation between the mobile phone and a validated accelerometer was 0.88 (0.12) in the final test. The idea of providing their health care professional with their DPA data caused no privacy issues in the participants. Battery life lasted for an entire day with the final version, and readability and comprehensibility of text and colors were favorable. Conclusions: By employing a user-centered design approach, a mobile phone was found to be an adequate and feasible interface for an eHealth intervention. The mobile phone and app are easy to learn and use by patients with COPD. In the final test, the accuracy of the DPA measurement was good. The final version of the eHealth intervention is presently being tested by our group for efficacy in a randomized controlled trial in COPD patients.
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