Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-16 (of 16 Records) |
Query Trace: Cham H[original query] |
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Model-based prioritization of adolescent girls and young women for HIV prevention services based on data from 13 Sub-Saharan African Countries
Gutreuter S , Denhard L , Logan JE , Blanton J , Cham HJ . J Acquir Immune Defic Syndr 2024 ![]() BACKGROUND: Adolescent girls and young women (AGYW) aged 15-24 years are more likely to acquire HIV than their male counterparts, and well-targeted prevention interventions are needed. We developed a method to quantify the risk of HIV acquisition based on individual risk factors and population viral load (PVL) to improve targeting of prevention interventions. SETTING: This study is based on household health survey data collected in 13 sub-Saharan African countries, 2015-2019. METHODS: We developed a Bayesian spatial model which jointly estimates district-level PVL and the probability of infection among individual AGYW, aged 15-24 years, based on individual behavioral/demographic risk factors and area-level PVL. The districts (second subnational level) typically comprise the areas of estimation. The model borrows strength across countries by incorporating random effects which quantify country-level differences in HIV prevalence among AGYW. RESULTS: The combined survey data provided 52,171 questionnaire responses and blood tests from AGYW, and 280,323 blood samples from all respondents from which PVL was estimated. PVL was-by far-the most important predictor of test positivity (aOR = 70.6; 0.95-probability credible interval 20.7‒240.5). Having a partner with HIV increased the odds of testing positive among AGYW who were never (aOR = 12.1; 7.5‒19.6) and ever pregnant (aOR = 32.1; 23.7-43.4). The area under the cross-validated receiver-operating characteristic curve for classification of test positivity was 82%. CONCLUSION: The fitted model provides a statistically principled basis for priority enrollment in HIV prevention interventions of those AGYW most at risk of HIV infection and geographic placement of prevention services. |
Prevalence and associated factors of shisha smoking among students in Senegal: Global Youth Tobacco Survey 2020
Cham B , Weaver SR , Jones CK , Popova L , Jacques N . Tob Induc Dis 2024 22 INTRODUCTION: Although shisha smoking is banned in Senegal, it has become increasingly popular, especially among youth. Despite the health risks associated with shisha smoking, there are few studies on shisha smoking in West Africa and none in Senegal. Our study assessed the prevalence and factors associated with shisha smoking among students aged 13-15 years in Senegal. METHODS: We used the 2020 Global Youth Tobacco Survey (GYTS) Senegal data from 2524 students aged 13-15 years. We calculated the weighted prevalence of ever and current (past 30 days) shisha smoking. Multivariable logistic regression analyses identified factors associated with ever and current shisha smoking among students. RESULTS: The prevalences of ever and current shisha smoking were 9.8% (95% CI: 7.7-12.3) and 2.2% (95% CI: 1.5-3.1), respectively. Ever shisha smoking was significantly associated with being male (AOR=1.97; 95% CI: 1.33-2.92), current cigarette smoking (AOR=7.54; 95% CI: 2.95-19.29), higher class grade (AOR=2.27; 95% CI:1.10-4.67), more weekly pocket money (AOR=3.29; 95% CI:1.36-7.95), current use of smokeless tobacco (AOR=11.53; 95% CI: 4.98- 26.72), and exposure to secondhand cigarette smoke in public (AOR=1.55; 95% CI: 1.00-2.41). Current shisha smoking was significantly associated with current cigarette smoking (AOR=21.75; 95% CI: 6.08-77.78), more weekly pocket money (AOR=8.91; 95% CI: 1.75-45.40), current use of smokeless tobacco (AOR=8.26; 95% CI: 2.07-33.04), and fathers' smoking (AOR=3.34; 95% CI: 1.24-8.96). CONCLUSIONS: One in 10 students aged 13-15 years have ever smoked shisha and 2.2% were currently smoking it, suggesting that shisha smoking is a public health concern in Senegal. Senegal might consider offering students more education on the harms of shisha, both in schools and through comprehensive media campaigns that address all tobacco products. |
Cost-outcome analysis of HIV testing and counseling, linkage, and defaulter tracing services in Bukoba, Tanzania
Suraratdecha C , MacKellar D , Steiner C , Rwabiyago OE , Cham HJ , Msumi O , Maruyama H , Kundi G , Byrd J , Weber R , Mkemwa G , Kazaura K , Justman J , Rwebembera A . AIDS Care 2023 1-8 Effective services along the HIV continuum of care from HIV testing and counseling to linkage, and from linkage to antiretroviral therapy (ART) initiation and retention, are key to improved health outcomes of persons living with HIV. A comprehensive analysis of the costs and outcomes of cascade services is needed to help allocate and prioritize resources to achieve UNAIDS targets. We evaluated the costs and population-level impact of a community-wide, integrated scale-up of testing, linkage, and defaulter-tracing programs implemented in Bukoba Municipal Council, Tanzania. Costs per identified HIV-positive client for provider-initiated, and home- and venue-based testing and counseling were $92.64 United States dollars (USD), $256.33 USD, and $281.57 USD, respectively. Costs per patient linked to HIV care and ART were $47.69 USD and $74.12 USD, respectively, during all ART-eligibility periods combined. Costs per defaulter traced and returned to HIV care were $47.56 USD and $206.77 USD, respectively. The provider-initiated testing and counseling was the most cost-effective modality. Testing approaches targeted to populations groups and geographic location with high testing positivity rates may improve the overall efficiency of testing services. The expansion of ART eligibility criteria and high linkage rate also result in efficiency gains and economies of scale of linkage services. |
Understanding gender-based violence service delivery in CDC-supported health facilities: 15 Sub-Saharan African Countries, 2017-2021
Kanagasabai U , Valleau C , Cain M , Chevalier MS , Hegle J , Patel P , Benevides R , Trika JB , Angumua C , Mpingulu M , Ferdinand K , Sida F , Galloway K , Kambona C , Oluoch P , Msungama W , Katengeza H , Correia D , Duffy M , Cossa RMV , Coomer R , Ayo A , Ukanwa C , Tuyishime E , Dladla S , Drummond J , Magesa D , Kitalile J , Apondi R , Okuku J , Chisenga T , Cham HJ . AIDS Educ Prev 2023 35 39-51 Gender-based violence (GBV) is a complex issue deeply rooted in social structures, making its eradication challenging. GBV increases the risk of HIV transmission and is a barrier to HIV testing, care, and treatment. Quality clinical services for GBV, which includes the provision of HIV postexposure prophylaxis (PEP), vary, and service delivery data are lacking. We describe GBV clinical service delivery in 15 countries supported by the President's Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention. Through a descriptive statistical analysis of PEPFAR Monitoring, Evaluation, and Reporting (MER) data, we found a 252% increase in individuals receiving GBV clinical services, from 158,691 in 2017 to 558,251 in 2021. PEP completion was lowest (15%) among 15-19-year-olds. Understanding GBV service delivery is important for policy makers, program managers, and providers to guide interventions to improve the quality of service delivery and contribute to HIV epidemic control. |
National burden of influenza-associated hospitalizations in Cambodia, 2015 and 2016
Ieng V , Tolosa MX , Tek B , Sar B , Sim K , Seng H , Thyl M , Dara C , Moniborin M , Stewart RJ , Bell LC , Theocharopoulos G , Chin S , Chau D , Iuliano AD , Moen A , Tsuyuoka R , Dueger EL , Sullivan SG , Ly S . Western Pac Surveill Response J 2018 9 44-52 INTRODUCTION: The burden of influenza in Cambodia is not well known, but it would be useful for understanding the impact of seasonal epidemics and pandemics and to design appropriate policies for influenza prevention and control. The severe acute respiratory infection (SARI) surveillance system in Cambodia was used to estimate the national burden of SARI hospitalizations in Cambodia. METHODS: We estimated age-specific influenza-associated SARI hospitalization rates in three sentinel sites in Svay Rieng, Siem Reap and Kampong Cham provinces. We used influenza-associated SARI surveillance data for one year to estimate the numerator and hospital admission surveys to estimate the population denominator for each site. A national influenza-associated SARI hospitalization rate was calculated using the pooled influenza-associated SARI hospitalizations for all sites as a numerator and the pooled catchment population of all sites as denominator. National influenza-associated SARI case counts were estimated by applying hospitalization rates to the national population. RESULTS: The national annual rates of influenza-associated hospitalizations per 100 000 population was highest for the two youngest age groups at 323 for < 1 year and 196 for 1-4 years. We estimated 7547 influenza-associated hospitalizations for Cambodia with almost half of these represented by children younger than 5 years. DISCUSSION: We present national estimates of influenza-associated SARI hospitalization rates for Cambodia based on sentinel surveillance data from three sites. The results of this study indicate that the highest burden of severe influenza infection is borne by the younger age groups. These findings can be used to guide future strategies to reduce influenza morbidity. |
Engaging Parents in Zimbabwe to Prevent and Respond to Child Sexual Abuse: A Pilot Evaluation
Shaw S , Cham HJ , Galloway E , Winskell K , Mupambireyi Z , Kasese C , Bangani Z , Miller K . J Child Fam Stud 2021 30 (5) 1314-1326 Data from the Violence Against Children Surveys reveal alarming rates of child sexual abuse (CSA) in sub-Saharan Africa, highlighting the critical need for public health programming to prevent and respond to this issue. This paper describes the results of the Families Matter! Program (FMP) pilot evaluation study conducted in two urban suburbs of Harare, Zimbabwe to measure the effect of a new FMP session about preventing and responding to CSA. FMP is an evidence-based intervention for parents of adolescents designed to promote positive parenting practices and effective parent–child communication about sexual risk reduction and HIV prevention. We applied a pre/post-prospective study design to assess changes in CSA-related indicators such as parental monitoring, parent–child communication about CSA, and ability to respond to instances of CSA. Parents and their children (ages 9–12) enrolled in the study as dyads and participated in two assessments administered via ACASI prior to and three months following the intervention, with 248 dyads completing both assessments. Parents and children reported significantly higher levels of parental monitoring (p < 1.001) and communication about CSA after the intervention (p < 0.001). Significantly more parents also reported conversations with people in their community about CSA (p < 0.001) and knowledge of where to access services if their child was abused (p < 0.001). The pilot evaluation suggests that FMP equipped parents with skills and knowledge to prevent and respond to CSA, and increased communication regarding CSA within communities, further normalizing the need to address and talk about child abuse, CSA in particular. © 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature. |
Community-wide HIV testing, linkage case management, and defaulter tracing in Bukoba, Tanzania: pre-intervention and post-intervention, population-based survey evaluation
Steiner C , MacKellar D , Cham HJ , Rwabiyago OE , Maruyama H , Msumi O , Pals S , Weber R , Kundi G , Byrd J , Kazaura K , Madevu-Matson C , Morales F , Justman J , Rutachunzibwa T , Rwebembera A . Lancet HIV 2020 7 (10) e699-e710 BACKGROUND: Community randomised trials have had mixed success in implementing combination prevention strategies that diagnose 90% of people living with HIV, initiate and retain on antiretroviral therapy (ART) 90% of those diagnosed, and achieve viral load suppression in 90% of those on ART (90-90-90). The Bukoba Combination Prevention Evaluation (BCPE) aimed to achieve 90-90-90 in Bukoba Municipal Council, Tanzania, by scaling up new HIV testing, linkage, and retention interventions. METHOD: We did population-based, cross-sectional surveys before and after our community-wide intervention in Bukoba-a mixed urban and rural council of approximately 150 000 residents located on the western shore of Lake Victoria in Tanzania. BCPE interventions were implemented in 11 government-supported health-care facilities throughout Bukoba from Oct 1, 2014, to March 31, 2017, when national ART-eligibility guidelines expanded from CD4 counts of less than 350 cells per μL (Oct 1, 2014-Dec 31, 2015) and 500 or less cells per μL (Jan 1, 2016-Sept 30, 2016) to any CD4 cell count (test and treat, Oct 1, 2016-March 31, 2017). We used pre-intervention (Nov 4, 2013-Jan 25, 2014) and post-intervention (June 21, 2017-Sept 20, 2017) population-based household surveys to assess population prevalence of undiagnosed HIV infection and ART coverage, and progress towards 90-90-90, among residents aged 18-49 years. FINDINGS: During the 2·5-year intervention, BCPE did 133 695 HIV tests, diagnosed and linked 3918 people living with HIV to HIV care at 11 Bukoba facilities, and returned to HIV care 604 patients who had stopped care. 4795 and 5067 residents aged 18-49 years participated in pre-intervention and post-intervention surveys. HIV prevalence before and after the intervention was similar: pre-intervention 8·9% (95% CI 7·5-10·4); post-intervention 8·4% (6·9-9·9). Prevalence of undiagnosed HIV infection decreased from 4·7% to 2·0% (prevalence ratio 0·42, 95% CI 0·31-0·57), and current ART use among all people living with HIV increased from 32·2% to 70·9% (2·20, 1·82-2·66) overall, 23·0% to 62·1% among men (2·70, 1·84-3·96), and 16·7% to 64·4% among people aged 18-29 years (3·87, 2·54-5·89). Of 436 and 435 people living with HIV aged 18-49 years who participated in pre-intervention and post-intervention surveys, previous HIV diagnosis increased from 47·4% (41·3-53·4) to 76·2% (71·8-80·6), ART use among diagnosed people living with HIV increased from 68·0% (60·9-75·2) to 93·1% (90·2-96·0), and viral load suppression of those on ART increased from 88·7% (83·6-93·8) to 91·3% (88·6-94·1). INTERPRETATION: BCPE findings suggest scaling up recommended HIV testing, linkage, and retention interventions can help reduce prevalence of undiagnosed HIV infection, increase ART use among all people living with HIV, and make substantial progress towards achieving 90-90-90 in a relatively short period. BCPE facility-based testing and linkage interventions are undergoing national scale up to help achieve 90-90-90 in Tanzania. FUNDING: US Presidents' Emergency Plan for AIDS Relief. |
Anti-PfGARP activates programmed cell death of parasites and reduces severe malaria.
Raj DK , Das Mohapatra A , Jnawali A , Zuromski J , Jha A , Cham-Kpu G , Sherman B , Rudlaff RM , Nixon CE , Hilton N , Oleinikov AV , Chesnokov O , Merritt J , Pond-Tor S , Burns L , Jolly G , Ben Mamoun C , Kabyemela E , Muehlenbachs A , Lambert L , Orr-Gonzalez S , Gnadig NF , Fidock DA , Park S , Dvorin JD , Pardi N , Weissman D , Mui BL , Tam YK , Friedman JF , Fried M , Duffy PE , Kurtis JD . Nature 2020 582 (7810) 104-108 ![]() ![]() Malaria caused by Plasmodium falciparum remains the leading single-agent cause of mortality in children1, yet the promise of an effective vaccine has not been fulfilled. Here, using our previously described differential screening method to analyse the proteome of blood-stage P. falciparum parasites2, we identify P. falciparum glutamic-acid-rich protein (PfGARP) as a parasite antigen that is recognized by antibodies in the plasma of children who are relatively resistant—but not those who are susceptible—to malaria caused by P. falciparum. PfGARP is a parasite antigen of 80 kDa that is expressed on the exofacial surface of erythrocytes infected by early-to-late-trophozoite-stage parasites. We demonstrate that antibodies against PfGARP kill trophozoite-infected erythrocytes in culture by inducing programmed cell death in the parasites, and that vaccinating non-human primates with PfGARP partially protects against a challenge with P. falciparum. Furthermore, our longitudinal cohort studies showed that, compared to individuals who had naturally occurring anti-PfGARP antibodies, Tanzanian children without anti-PfGARP antibodies had a 2.5-fold-higher risk of severe malaria and Kenyan adolescents and adults without these antibodies had a twofold-higher parasite density. By killing trophozoite-infected erythrocytes, PfGARP could synergize with other vaccines that target parasite invasion of hepatocytes or the invasion of and egress from erythrocytes. |
Threefold increases in population HIV viral load suppression among men and young adults - Bukoba Municipal Council, Tanzania, 2014-2017
MacKellar D , Steiner C , Rwabiyago OE , Cham HJ , Pals S , Maruyama H , Msumi O , Kundi G , Byrd J , Weber R , Madevu-Matson C , Kazaura K , Rutachunzibwa T , Mmari E , Morales F , Justman J , Cain K , Rwebembera A . MMWR Morb Mortal Wkly Rep 2019 68 (30) 658-663 Reducing HIV-related morbidity and mortality, and effectively eliminating HIV transmission risk, depends on use of antiretroviral therapy (ART) to achieve and maintain viral load suppression (VLS)* (1,2). By 2020, sub-Saharan African countries are working to achieve VLS among 90% of persons using ART and 73% of all persons living with HIV infection (1). In Tanzania, a country with 1.4 million persons with HIV infection, 49.6% of HIV-positive persons aged 15-49 years had achieved VLS in 2017, including only 21.5% of men and 44.6% of women aged 25-29 years (3). To identify interventions that might increase VLS in Tanzania, and reduce VLS-associated sex and age-group disparities, the Bukoba Combination Prevention Evaluation (BCPE) scaled up new HIV testing, linkage to care, and retention on ART interventions throughout Bukoba Municipal Council (Bukoba), Tanzania, during October 2014-March 2017 (4,5). Located on the western shore of Lake Victoria, Bukoba is a mixed urban and rural municipality of 150,000 persons and capital of Kagera Region. Of the 31 regions of Tanzania, Kagera has the fourth highest prevalence of HIV infection (6.8%) among residents aged 15-49 years (3). CDC analyzed data from BCPE preintervention and postintervention surveys and found that VLS prevalence among HIV-positive Bukoba residents aged 18-49 years increased approximately twofold overall (from 28.6% to 64.8%) and among women (33.3% to 67.8%) and approximately threefold among men (20.5% to 59.1%) and young adults aged 18-29 years (15.6% to 56.7%). During 2017, BCPE facility-based testing and linkage interventions were approved as new service delivery models by the Tanzania Ministry of Health, Community Development, Gender, Elderly and Children (4,5). After a successful rollout to 208 facilities in 11 regions in 2018, BCPE interventions are being scaled up in all regions of Tanzania in 2019 with support from the United States President's Emergency Plan for AIDS Relief (PEPFAR). |
Methods, outcomes, and costs of a 2.5 year comprehensive facility-and community-based HIV testing intervention in Bukoba Municipal Council, Tanzania, 2014-2017
Cham HJ , MacKellar D , Maruyama H , Rwabiyago OE , Msumi O , Steiner C , Kundi G , Weber R , Byrd J , Suraratdecha C , Mengistu T , Churi E , Pals S , Madevu-Matson C , Alexander G , Porter S , Kazaura K , Mbilinyi D , Morales F , Rutachunzibwa T , Justman J , Rwebembera A . PLoS One 2019 14 (5) e0215654 To diagnose >/=90% HIV-infected residents (diagnostic coverage), the Bukoba Combination Prevention Evaluation (BCPE) implemented provider-initiated (PITC), home- (HBHTC), and venue-based (VBHTC) HIV testing and counseling (HTC) intervention in Bukoba Municipal Council, a mixed urban and rural lake zone community of 150,000 residents in Tanzania. This paper describes the methods, outcomes, and incremental costs of these HTC interventions. PITC was implemented in outpatient department clinics in all eight public and three faith-based health facilities. In clinics, lay counselors routinely screened and referred eligible patients for HIV testing conducted by HTC-dedicated healthcare workers. In all 14 wards, community teams offered HTC to eligible persons encountered at 31,293 home visits and at 79 male- and youth-frequented venues. HTC was recommended for persons who were not in HIV care or had not tested in the prior 90 days. BCPE conducted 133,695 HIV tests during the 2.5 year intervention (PITC: 88,813, 66%; HBHTC: 27,407, 21%; VBHTC: 17,475, 13%). Compared with other strategies, PITC conducted proportionally more tests among females (65%), and VBHTC conducted proportionally more tests among males (69%) and young-adults aged 15-24 years (42%). Of 5,550 (4.2% of all tests) HIV-positive tests, 4,143 (75%) clients were newly HIV diagnosed, including 1,583 males and 881 young adults aged 15-24 years. Of HIV tests conducted 3.7%, 1.8%, and 2.1% of PITC, HBHTC, and VBHTC clients, respectively, were newly HIV diagnosed; PITC accounted for 79% of all new diagnoses. Cost per test (per new diagnosis) was $4.55 ($123.66), $6.45 ($354.44), and $7.98 ($372.67) for PITC, HBHTC, and VBHTC, respectively. In a task-shifting analysis in which lay counselors replaced healthcare workers, estimated costs per test (per new diagnosis) would have been $3.06 ($83.15), $ 4.81 ($264.04), and $5.45 ($254.52), for PITC, HBHTC, and VBHTC, respectively. BCPE models reached different target groups, including men and young adults, two groups with consistently low coverage. Implementation of multiple models is likely necessary to achieve >/=90% diagnostic coverage. |
Implementing the package of CDC and WHO recommended linkage services: Methods, outcomes, and costs of the Bukoba Tanzania Combination Prevention Evaluation peer-delivered, linkage case management program, 2014-2017
MacKellar D , Maruyama H , Rwabiyago OE , Steiner C , Cham H , Msumi O , Weber R , Kundi G , Suraratdecha C , Mengistu T , Byrd J , Pals S , Churi E , Madevu-Matson C , Kazaura K , Morales F , Rutachunzibwa T , Justman J , Rwebembera A . PLoS One 2018 13 (12) e0208919 Although several studies have evaluated one or more linkage services to improve early enrollment in HIV care in Tanzania, none have evaluated the package of linkage services recommended by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). We describe the uptake of each component of the CDC/WHO recommended package of linkage services, and early enrollment in HIV care and antiretroviral therapy (ART) initiation among persons with HIV who participated in a peer-delivered, linkage case management (LCM) program implemented in Bukoba, Tanzania, October 2014 -May 2017. Of 4206 participants (88% newly HIV diagnosed), most received recommended services including counseling on the importance of early enrollment in care and ART (100%); escort by foot or car to an HIV care and treatment clinic (CTC) (83%); treatment navigation at a CTC (94%); telephone support and appointment reminders (77% among clients with cellphones); and counseling on HIV-status disclosure and partner/family testing (77%), and on barriers to care (69%). During three periods with different ART-eligibility thresholds [CD4<350 (Oct 2014 -Dec 2015, n = 2233), CD4</=500 (Jan 2016 -Sept 2016, n = 1221), and Test & Start (Oct 2016 -May 2017, n = 752)], 90%, 96%, and 97% of clients enrolled in HIV care, and 47%, 67%, and 86% of clients initiated ART, respectively, within three months of diagnosis. Of 463 LCM clients who participated in the last three months of the rollout of Test & Start, 91% initiated ART. Estimated per-client cost was $44 United States dollars (USD) for delivering LCM services in communities and facilities overall, and $18 USD for a facility-only model with task shifting. Well accepted by persons with HIV, peer-delivered LCM services recommended by CDC and WHO can achieve near universal early ART initiation in the Test & Start era at modest cost and should be considered for implementation in facilities and communities experiencing <90% early enrollment in ART care. |
Formative work and community engagement approaches for implementing an HIV intervention in Botswana schools
Miller KS , Cham HJ , Taylor EM , Berrier FL , Duffy M , Vig J , Chipazi L , Chakalisa C , Sidibe S , Swart K , Tau NS , Clark LF . Am J Public Health 2016 106 (8) e1-e3 Providing adolescents with evidence-based sexual risk reduction interventions is critical to addressing the HIV/AIDS epidemic among adolescents in sub-Saharan Africa. Project AIM (Adult Identity Mentoring) is an innovative, evidence-based, youth development intervention that is being evaluated for the first time in Botswana through a 3-year (2015-2017), 50-school cluster randomized controlled trial, including testing for herpes simplex virus type 2 as a sexual activity biomarker. Conducting a trial of this magnitude requires the support and collaboration of government and community stakeholders. All school staff, including teachers, must be well informed about the study; dedicated staff placed at each school can help to improve school and community familiarity with the study, improve the information flow, and relieve some of the burden study activities places on schools. (Am J Public Health. Published online ahead of print May 19, 2016: e1-e3. doi:10.2105/AJPH.2016.303225). |
Parents' reactions to testing for herpes simplex virus type 2 as a biomarker of sexual activity in Botswana junior secondary school students
Cham HJ , Lasswell SM , Miller KS . Sex Health 2016 13 (2) 148-154 Background: Use of sexual activity biomarkers in HIV prevention trials has been widely supported to validate self-reported data. When such trials involve minors, researchers may face challenges in obtaining parental buy-in, especially if return of results procedures uphold the confidentiality and privacy rights of minors and preclude parental access to test results. In preparation for a randomised controlled trial (RCT) with junior secondary school (JSS) students in Botswana, a formative assessment was conducted to assess parents' opinions and concerns about testing for herpes simplex virus type 2 (HSV-2) (biomarker of sexual activity) as part of the RCT. Methods: Six focus groups were held with parents (n≤32) of JSS students from urban, peri-urban and rural communities. Parents were asked their opinions of students being tested for HSV-2 and procedures for blood sample collection and return of results. Results: Overall, parents were supportive of HSV-2 testing, which they thought was a beneficial sexual health resource for adolescents and parents, and a motivation for parent-child communication about HSV-2, sexual activity and sexual abuse. Some parents supported the proposed plan to disclose HSV-2 test results to adolescents only, citing the importance of adolescent privacy and the possibility of HSV-2 positive adolescents being stigmatised by family members. Conversely, opposing parents requested parental access to results. These parents were concerned that adolescents may experience distress following a positive result and withhold this information thereby reducing parents' abilities to provide support. Parents were also concerned about support for victims of sexual abuse. Conclusion: Although the present study demonstrates that parents can be accepting of sexual activity biomarker testing of adolescents, more research is needed to identify best approaches for returning test results. |
Monitoring of early warning indicators for HIV drug resistance in antiretroviral therapy clinics in Zimbabwe
Dzangare J , Gonese E , Mugurungi O , Shamu T , Apollo T , Bennett DE , Kelley KF , Jordan MR , Chakanyuka C , Cham F , Banda RM . Clin Infect Dis 2012 54 Suppl 4 S313-6 Monitoring human immunodeficiency virus drug resistance (HIVDR) early warning indicators (EWIs) can help national antiretroviral treatment (ART) programs to identify clinic factors associated with HIVDR emergence and provide evidence to support national program and clinic-level adjustments, if necessary. World Health Organization-recommended HIVDR EWIs were monitored in Zimbabwe using routinely available data at selected ART clinics between 2007 and 2009. As Zimbabwe's national ART coverage increases, improved ART information systems are required to strengthen routine national ART monitoring and evaluation and facilitate scale-up of HIVDR EWI monitoring. Attention should be paid to minimizing loss to follow-up, supporting adherence, and ensuring clinic-level drug supply continuity. |
Helmet use among motorcyclists in Cambodia: a survey of use, knowledge, attitudes, and practices
Bachani AM , Tran NT , Sann S , Ballesteros MF , Gnim C , Ou A , Sem P , Nie X , Hyder AA . Traffic Inj Prev 2012 13 Suppl 1 31-6 OBJECTIVE: Road traffic injuries (RTIs) are a leading cause of disability and fatality globally. Motorcycle-related injuries, mainly head injuries, and related deaths and disabilities are a significant contributor to the burden of disease in low- and middle-income countries (LMICs). Helmets have been proven to be an effective way to reduce the risk of head injury. As motorcycle use continually increases in Cambodia, head injuries and related deaths and disabilities are expected to rise. This article aims to assess the current status of helmet use in Cambodia, as well as the knowledge, attitudes, and practices among motorcyclists, in order to assist with better planning and implementation of injury prevention strategies. METHODS: Two separate methodologies were employed for this study. Helmet observations were conducted in Phnom Penh, Kandal, Kampong Speu, Siem Reap, and Kampong Cham to assess the current status of helmet use during the day and at night. Roadside knowledge, attitudes, and practice (KAP) interviews were also conducted in Phnom Penh, Kandal, and Kampong Speu to determine the prevailing beliefs around helmet use in Cambodia. RESULTS: Based on observations, the proportion of helmet wearing across all study sites was 25 percent at night and 43 percent during the day among all motorcyclists. The observed proportion was up to 10 times higher among drivers compared to passengers. The top 3 reasons for always wearing a helmet were lifesaving potential, legal duty, and police fines. Almost 60 percent of respondents said that their use or nonuse of a helmet depended on where they were driving. Helmet quality, price, style, and color were important factors influencing the decision to purchase a helmet. CONCLUSIONS: A paradox appears to exist in Cambodia; though awareness of the benefits of wearing a helmet is high, actual helmet use remains low in the country. Daytime usage is higher than nighttime, and these proportions are significantly higher among drivers compared to passengers. There is a continuing need to improve the proportion of all-day helmet wearing, especially at night and among motorcycle passengers in Cambodia. |
The World Health Organization African region laboratory accreditation process: improving the quality of laboratory systems in the African region
Gershy-Damet GM , Rotz P , Cross D , Belabbes el H , Cham F , Ndihokubwayo JB , Fine G , Zeh C , Njukeng PA , Mboup S , Sesse DE , Messele T , Birx DL , Nkengasong JN . Am J Clin Pathol 2010 134 (3) 393-400 Few developing countries have established laboratory quality standards that are affordable and easy to implement and monitor. To address this challenge, the World Health Organization Regional Office for Africa (WHO AFRO) established a stepwise approach, using a 0- to 5-star scale, to the recognition of evolving fulfillment of the ISO 15189 standard rather than pass-fail grading. Laboratories that fail to achieve an assessment score of at least 55% will not be awarded a star ranking. Laboratories that achieve 95% or more will receive a 5-star rating. This stepwise approach acknowledges to laboratories where they stand, supports them with a series of evaluations to use to demonstrate improvement, and recognizes and rewards their progress. WHO AFRO's accreditation process is not intended to replace established ISO 15189 accreditation schemes, but rather to provide an interim pathway to the realization of international laboratory standards. Laboratories that demonstrate outstanding performance in the WHO-AFRO process will be strongly encouraged to enroll in an established ISO 15189 accreditation scheme. We believe that the WHO-AFRO approach for laboratory accreditation is affordable, sustainable, effective, and scalable. |
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