ARV-based pre-exposure prophylaxis (PrEP) has the potential to avert many new HIV infections, yet little is known about how to reach women at high risk for HIV infection and motivate them to initiate ...PrEP. Clinical trials have succeeded in recruiting at-risk participants, evidenced by control arm HIV incidence ≥3% (defined by the World Health Organization as "substantial risk"). We examined experiences from HIV prevention trials to document recruitment strategies and identify practical, potentially effective strategies for reaching women in real-world PrEP delivery.
We conducted semi-structured qualitative phone interviews with 31 staff from five countries who had worked on one or more of seven ARV-based HIV prevention clinical trials. Questions explored recruitment strategies used to reach women at risk of HIV and to successfully communicate about PrEP (inclusive of oral and vaginal formulations). We structurally coded data in NVivo and analyzed codes to derive themes. We conducted results interpretation webinars with research and programmatic stakeholders to validate findings and develop recommendations.
Clinical trial researchers employed a range of recruitment strategies to recruit at-risk women. They recommended engaging the local community and potential PrEP users via community events, meetings with gatekeepers, and use of community advisory boards; and they encouraged interpersonal communication like presentations in waiting rooms and door-to-door recruitment to address personal concerns and prevent misinformation. Participants also stressed the importance of addressing the challenges that already exist within the health system to create a more enabling environment and delivering positive messages through a variety of communication channels to normalize PrEP.
Findings from this study provide important insights into potentially effective ways for countries currently rolling out oral PrEP to reach at-risk women with information about PrEP and promote uptake.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background Despite the positive characteristics of the levonorgestrel-releasing intrauterine device (IUD)-a long-acting, highly effective contraceptive with important non-contraceptive attributes-the ...method has not been widely available in low- and middle-income countries. This study of hormonal IUD, copper IUD, implant and injectable users in Nigeria compares their characteristics, reasons for method choice, and experiences obtaining their method. Methods We conducted a phone survey with 888 women who received a hormonal IUD, copper IUD, contraceptive implant or injectable from 40 social franchise clinics across 18 states in Nigeria. We analyzed survey data descriptively by method and assessed factors associated with hormonal IUD use through multivariate logistic regression models. Follow-up in-depth interviews conducted with 32 women were analyzed thematically. Results There were few differences by method used in the socio-demographic profiles and contraceptive history of participants. Among users choosing a long-acting, reversible method, the top reasons for method choice included perceptions that the method was "right for my body," long duration, recommended by provider, recommended by friends/family, few or manageable side effects, and high effectiveness. Among hormonal IUD users, 17% mentioned reduced bleeding (inclusive of lighter, shorter, or no period), and 16% mentioned treatment of heavy or painful periods. Qualitative data supported these findings. Among survey respondents, between 25% and 33% said they would have chosen no method if the method they received had not been available. Both quantitative and qualitative data indicated that partner support can affect contraceptive use, with in-depth interviews revealing that women typically needed partner permission to use contraception, but men were less influential in method choice. Conclusions Expanding access to the hormonal IUD as part of a full method mix provides an opportunity to expand contraceptive choice for women in Nigeria. Findings are timely as the government is poised to introduce the method on a wider scale.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Open Doors, an HIV prevention project targeting key populations in Zambia, recorded low HIV positivity rates (9%) among HIV testing clients, compared to national adult prevalence (12.3%), suggesting ...case finding efficiency could be improved. To close this gap, they undertook a series of targeted programmatic and management interventions. We share the outcomes of these interventions, specifically changes in testing volume, HIV positivity rate, and total numbers of key populations living with HIV identified.
The project implemented a range of interventions to improve HIV case finding using a Total Quality Leadership and Accountability (TQLA) approach. We analyzed program data for key populations who received HIV testing six months before the interventions (October 2017-March 2018) and 12 months after (April 2018-March 2019). Interrupted time series analysis was used to evaluate the impact on HIV positivity and total case finding and trends in positivity and case finding over time, before and after the interventions.
While the monthly average number of HIV tests performed increased by only 14% post-intervention, the monthly average number of HIV positive individuals identified increased by 290%. The average HIV positivity rate rose from 9.7% to 32.4%. Positivity rates and case finding remained significantly higher in all post-intervention months. Similar trends were observed among FSW and MSM.
The Open Doors project was able to reach large numbers of previously undiagnosed key populations by implementing a targeted managerial and technical intervention, resulting in a significant increase in the HIV positivity rate sustained over 12 months. These results demonstrate that differentiated, data-driven approaches can help close the 95-95-95 gaps among key populations.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract
Background
In Kenya, South Africa, and Zimbabwe, oral pre-exposure prophylaxis (PrEP) is recommended for adolescent girls and young women (AGYW) at high risk of HIV. Health providers play a ...critical role in the uptake and effective use of sexual and reproductive health services; however, few published studies have explored providers’ attitudes toward and experiences delivering PrEP to AGYW.
Methods
We conducted a cross-sectional qualitative study, interviewing 113 providers at 36 public, private, and nongovernmental health facilities in Kenya, South Africa, and Zimbabwe that were offering PrEP during the research period or were likely to offer PrEP in the future. Data were coded in NVivo 11, and an applied thematic analysis was conducted.
Results
Most providers preferred that adolescent girls wait until age 18 to have sex but acknowledged that many girls younger than 18 could benefit from oral PrEP. Their primary concern was whether adolescent girls would be able to take PrEP daily, especially if they do not tell their parents or partners they are using it. Providers reported that it was more challenging to deliver PrEP and other HIV services to girls younger than 18. Those with experience providing PrEP pointed to stigma and lack of PrEP awareness in communities as two primary barriers to PrEP uptake and use.
Conclusions
Providers were generally accepting of oral PrEP as an HIV prevention option for AGYW; however, many had negative attitudes about adolescent girls being sexually active and concerns about whether they could take PrEP daily. Results were used to update national PrEP training materials to address negative provider attitudes about PrEP use by AGYW.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The levonorgestrel-releasing intrauterine device (IUD)-also known as the hormonal IUD-is a highly effective contraceptive method that has not been widely available in the public sector in Zambia. ...Early introduction efforts can provide critical insights into the characteristics of users, reasons for method choice, and experiences getting their method.
We conducted a survey with 710 public sector clients who received a hormonal IUD, copper IUD, implant or injectable in two provinces of Zambia, and additional in-depth interviews with 29 women. We performed descriptive analyses of survey data and fitted multivariable logistic regression models to assess factors associated with hormonal IUD use. Qualitative interviews were analyzed thematically.
Factors associated with hormonal IUD use included full-time or self-employment (relative to both implant and copper IUD use), as well as being older, wealthier, and partner not being aware of method use (relative to implant use only). Common reasons for choosing long-acting methods were duration, perception that the method was "right for my body," and convenience. In addition, a portion of hormonal IUD acceptors mentioned effectiveness, potential for discreet use, few or manageable side effects, and treatment for heavy or painful periods. Between 83 and 95% of women said that they were counseled about menstrual changes and/or non-bleeding side effects; however, more hormonal IUD acceptors recalled being counseled on the possibility of experiencing reduced bleeding (88%) than amenorrhea (43%). Qualitative interviews indicate that women seek methods with minimal or tolerable side effects. While most women reported their partner was aware of method use, men may be more consistently involved in the decision to use contraception rather than in the choice of a particular method. Qualitative results show an appreciation of the lifestyle benefits of reduced bleeding (especially lighter bleeding), although amenorrhea can be cause for concern.
Initial efforts to introduce the hormonal IUD can provide valuable learnings that can inform broader method introduction to expand choice and better suit women's needs in Zambia and elsewhere. Scale-up plans should include emphasis on high quality counseling and demand generation. The government of Zambia is committed to increasing access to high-quality contraception and making more choices available to users. To date, the hormonal IUD, a highly effective, long-lasting contraceptive has not been widely available in the country. A study in pilot introduction settings provided insights into why women chose the methods, their characteristics, and their experiences getting their methods. The 710 women in the study received family planning services in public sector settings in two provinces in Zambia. Women in the study who received a hormonal IUD, copper IUD, implant, or injectable completed a quantitative survey; in-depth interviews were also conducted with 29 women. Results showed common reasons for choosing the long-acting methods (hormonal IUD, copper IUD or implants) were their duration, perception that the method was "right for my body," and convenience. In addition, some hormonal IUD acceptors indicated that they were attracted to the method's effectiveness, potential for discreet use, few or manageable side effects, and treatment for heavy or painful periods. Qualitative interviews with women also showed that women want contraceptive methods that lead to minimal or tolerable side effects. Male partners were typically aware of contraceptive use; however, men were less involved with decisions about the particular method women selected. Use of the hormonal IUD can lead to reduced menstrual bleeding, and in the interviews, women indicated that they liked reduced bleeding (especially lighter bleeding), although amenorrhea (paused bleeding) can be cause for concern. The results can help inform broader method introduction.
Background
Viral load (VL) testing of patients on antiretroviral therapy (ART) is critical to suppressing HIV. Timely transport of VL samples from health facilities to the laboratory for testing is ...often problematic in Turkana County, Kenya, and transportation barriers cause delays that can negatively impact the health of ART patients. Unmanned Aerial Vehicles (UAVs), or drones, are being promoted as a potential, novel way to reduce transportation times for laboratory samples and medical commodities. Our study models the use of UAVs in a remote area of Kenya to estimate costs and feasibility of their application for the Afya Nyota ya Bonde project, a large HIV service delivery program.
Methods
We gathered data from 12 Afya-supported facilities on VL sample transportation and turnaround time, ART drug transportation, and transportation practices and costs. The annual cost and average turnaround time for the transportation of VL samples and ART drugs was calculated using baseline data from the program to establish a comparison for scenarios that use a UAV. We then designed and costed four transportation scenarios that used UAVs to pick up VL samples and deliver ART drugs through a logistics company that will be adding UAV services.
Results
The modeled scenarios demonstrate that UAVs could transport nearly 100% of VL samples to the lab within the three-day goal compared to the 3% that are transported under the current system. Additionally, using UAVs could reduce the burden on health workers who must personally transport the samples, reducing opportunity costs resulting from facility closures due to provider absence. However, the UAV scenario cost more than three times the current costs (US$ 56,350/Kenyan Shillings (KSh) 5,635,000 per year compared to between US$ 172,878/Ksh 17,287,800 and US$ 200,208/Ksh 20,020,800), and the consolidation of VL testing days required to accommodate the UAV may be problematic for ART patients.
Conclusions
As the cost of UAV transport declines, this technology could be an important tool for optimizing the transport of lab samples and medications.
Background: Rubber production is an important component of the Sri Lankan economy. Prior reports have raised concerns about poverty and poor physical and social living conditions among rubber ...tappers.Objective: To assess rubber tappers’ psychological health and distress.Methods and Material: A cross-sectional survey was conducted among 300 rubber tappers in two large rubber plantations in southern Sri Lanka from September to November 2014. Structured questionnaires including the Peradeniya Depression Scale (PDS) and the 10-item Perceived Stress Scale (PSS-10) were administered. The prevalences of depression and stress were calculated, including across sociodemographic and work history variables of interest.Results: Each plantation contributed 150 of the 300 participants. The majority were women (n = 183, 61%) with a median age of 47 years (range 21 to 89). Based on the PDS, 9% of the rubber tappers screened positive for depression. While on the PSS-10, 10% demonstrated a high level of perceived stress. On log-binomial regression, persons who were widowed, divorced, or separated compared to being married had a higher prevalence of depression and high stress. A higher prevalence of stress was found in Tamil versus Sinhalese as well as Christian versus Buddhist participants. A higher prevalence of depression was seen in workers with over 30 years of experience compared to less experienced counterparts.Conclusions: Depression was more common in rubber tappers in this study than among other non-plantation Sri Lankan populations. Further research is needed to elucidate factors associated with psychological distress and to foster support mechanisms for the rubber tappers.
We developed an unmanned aerial vehicle (UAV) Delivery Decision Tool to help health system decision makers identify their transport challenges and explore the potential utility and impact of UAVs on ...the broader health system.
We developed an unmanned aerial vehicle (UAV) Delivery Decision Tool to help health system decision makers identify their transport challenges and explore the potential utility and impact of UAVs on the broader health system.
OBJECTIVE:The aim of this study was to appropriately plan for rollout and monitor impact of oral preexposure prophylaxis (PrEP). It is important to understand PrEP continuation and come to a ...consensus on how best to measure PrEP continuation. This study reviews data on PrEP continuation to document how it is reported, and to compare continuation over time and across populations.
DESIGN:A systematic review and meta-analysis.
METHODS:We searched MEDLINE, Embase and Global Health and reviewed abstracts from HIV conferences from 2017 to 2018 for studies reporting primary data on PrEP continuation. Findings were summarized along a PrEP cascade and continuation was presented by population at months 1, 6 and 12, with random-effects meta-analysis.
RESULTS:Of 2578 articles and 596 abstracts identified, 41 studies were eligible covering 22 034 individuals. Continuation data were measured and reported inconsistently. Results showed high discontinuation at month 1 and persistent discontinuation at later time points in many studies. Pooled continuation estimates were 66% at month 1 n = 5348; 95% confidence interval (95% CI)48–82, 63% at month 6 (n = 13 629; 95% CI48–77) and 71% at month 12 (n = 14 933; 95% CI60–81; higher estimate than previous timepoints due to inclusion of different studies). Adequate data were not available to reliably compare estimates across populations.
CONCLUSION:This review found that discontinuation at one month was high, suggesting PrEP initiations may be a poor measure of effectiveness. Continuation declined further over time in many studies, indicating existing cross-sectional indicators may not be adequate to understand PrEP use patterns. Studies do not measure continuation consistently, and consensus is needed.
The aim of this study was to examine the relationship between body mass index (BMI) and occupational musculoskeletal (MSK) injury rates, and the statistical interaction between BMI and occupational ...exposure to MSK hazards (measured by level of MSK injury risk based on job category).
Using 17 years of data from 38,214 university and health system employees, multivariate Poisson regression modeled the interaction between BMI and MSK injury risk on injury rates.
A significant interaction between BMI and MSK injury risk was observed. Although the effect of BMI was strongest for 'low' MSK injury risk occupations, absolute MSK injury rates for 'mid'/'high' MSK injury risk occupations remained larger.
To address the occupational MSK injury burden, initiatives focused on optimal measures of workers' BMI are important but should not be prioritized over (or used in lieu of) interventions targeting job-specific MSK injury hazards.
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