Gates Open Research最新文献

Background: Men living with HIV in sub-Saharan Africa have sub-optimal engagement in antiretroviral therapy (ART) programs. Generic ART counselling in Malawi does not meet men's needs.

Methods: We developed a male-specific ART counselling curriculum, adapted from the Malawi Ministry of Health curriculum, based on literature review of men's needs and motivations for treatment. We piloted the curriculum with men in six communities, with focus group discussions to assess knowledge of ART, motivators and barriers to care, and perceptions of the male-specific curriculum (n=85). We analysed data in Atlas.ti using grounded theory. We finalised the curriculum in a half-day meeting with Ministry and partner stakeholders (n=5) and implemented it in two randomized trials (IDEaL and ENGAGE). We describe the steps to develop, test and finalize the curriculum.

Results: We adapted three existing topics (status disclosure, treatment as prevention, and ART side effects) and added four new topics (how treatment contributes to men's goals, feeling healthy on treatment, navigating health systems, and self-compassion for the cyclical nature of lifelong treatment). Key motivators included: family wellbeing, having additional children, being financially stability, and earning/keeping respect. Men reported little prior understanding of how ART contributed to their personal goals, and were most interested in treatment as prevention, benefits of disclosure/social support, how to navigate health systems, and side effects with new regimens. Respondents stated that the male-specific counselling challenged the idea that men were incapable of overcoming treatment barriers to lifelong medication.

Conclusion: Men need male-specific ART counselling curriculum to address their needs and increase access to and retention in HIV care. In the Malawi context, topics should include how treatment contributes to men's goals, navigating health systems, self-compassion for lifelong treatment, and taking treatment while healthy. Other countries with high HIV burdens and limited resources could follow the steps outlined in this paper. This curriculum is being evaluated within the two randomized trials.

Understanding and mapping the time to travel among locations is useful for many activities from urban planning to public health and myriad others. Here we present a software package - traveltime - written in and for the language R. traveltime enables a user to create a raster map of the travel time over an area of interest from a user-specified set of locations defined by geographic coordinates. The result is a raster of the area of interest where the value in each cell is the lowest travel time in minutes to the nearest of the supplied locations. We envisage this software having diverse applications including: estimating sampling bias, allocating defibrillators, setting health districts, or mapping access to vehicle chargers and agricultural facilities. The work-flow requires two key steps: preparing a friction surface for the area of interest, and then calculating travel time over that surface for the points of interest. traveltime is available from R-Universe and GitHub, and documented at https://idem-lab.github.io/traveltime/.

Malaria causes around 250 million cases and over 600,000 deaths annually, with the heaviest burden falling on young children living in sub-Saharan Africa. Molecular surveillance of Plasmodium parasites and Anopheles mosquito vectors are key components of effective malaria control decision-making. Previously, we have designed and implemented a nanopore-based workflow for targeted P. falciparum molecular surveillance in Ghana, which we call DRAG1 (drug resistance + antigen multiplex PCR). Here, we describe an updated and expanded multiplex assay ('DRAG2') with additional amplicon targets that incorporate more antimalarial drug resistance markers, the polymorphic surface antigen merozoite surface protein 2 ( msp2), and the 18S ribosomal RNA (rRNA) gene for Plasmodium species detection. We describe the performance of the DRAG2 assay over a range of parasitaemias and sample types (venous blood and dried blood spots), with suggested systems of quality control including the use of synthetic plasmids for positive controls and recommended coverage thresholds. The plasmids are highly economical, and engineered to include both 'test' single nucleotide polymorphisms (SNPs), such as known drug resistance markers, and 'control' SNPs, which are not found in nature and thus signal contamination if detected in clinical samples. We provide standard operating procedures (SOPs) for use by teams aiming to implement the assay in their laboratory. In summary, we describe an updated nanopore-based method for malaria molecular surveillance, including detailed consideration of quality control processes and SOPs. These are important steps in the transition from research tool to diagnostic assay, which will require further testing in endemic settings and regulatory processes and approvals.

Background: Anemia among women of reproductive age has remained highly prevalent globally. Intravenous (IV) iron is well tolerated and proven effective for treating postpartum iron deficiency anemia in high-income countries, but evidence from LMICs, where oral iron is standard treatment, is limited. The PRIORITY trial will test the effectiveness of IV iron compared to oral iron for postpartum women with moderate anemia in eight LMIC sites. An implementation research (IR) study will be conducted alongside the PRIORITY trial in India and Pakistan to gather information on the intervention characteristics and the implementation process, and to assess feasibility, acceptability, fidelity, and cost of implementation for providing IV iron to postpartum women with moderate iron deficiency anemia.

Methods: The PRIORITY IR study will use a mixed methods convergent parallel design guided by two frameworks: the Consolidated Framework for Implementation Research and Proctor's implementation outcomes. The IR study will be conducted in the Belagavi, India and Karachi, Pakistan PRIORITY trial sites. Participants will include postpartum women in the IV iron intervention arm of the trial, family members, health workers administering IV iron, hospital administrators, postpartum women who refuse to be part of the trial (Pakistan only), and postpartum women in the oral iron arm of the trial (India only). Data collection methods will include surveys, in-depth interviews, a supervision checklist, and a cost assessment. Survey and supervision checklist data will be analyzed descriptively. Interview data will be analyzed using a directed content analysis approach.

Discussion: The PRIORITY IR study will contribute important information about implementation processes and strategies and feasibility, acceptability, fidelity, and costs for postpartum IV iron implementation. Results of the study can provide guidance for implementing effective anemia treatment in LMIC contexts with a high anemia burden.

Registration: NCT05590260 (21/10/2022), CTRI/2022/10/046632 (19/10/2022), CTRI/2023/05/053302 (31/05/2023).

Background: Contextualizing childhood immunization in the context of children of working mothers can boost coverage and completion interventions. This study examines how informal working mothers perceive post-day-one routine immunization, and vaccines not covered under the National Program on Immunization (NPI), immunization schedules, timing, and duration.

Methods: The study utilized a mixed methods approach, including in-depth interviews and semi-structured questionnaire to capture immunization experiences and assess the context of post-day one. The study was conducted in Ibadan, Nigeria and involved 1,044 quantitative and 73 qualitative samples of working nursing mothers. Data were analyzed using descriptive statistics, chi-square test for proportions, and t-test for means (p<0.05), while qualitative data were subjected to content and thematic analysis.

Results: The average age of mothers participating in this study was 31.39±6.52 years. The mean age of children of mothers recruited into this study is 19.26 ±16.14 months. Majority of these mothers (95%) are married. Around three-quarters of women in this population ensured immediate immunization for their infants after birth, but less than a third achieved the complete age-specific vaccination series due to livelihood related causes, long waiting time spent in conventional immunization clinic. Around 40% of interviewed mothers vaccinated their children up to the third DPT dose, and just over 30% achieved full vaccination. Many informal working mothers, have practice of adding 'supplements' to their children's immunization, driven by a lack of sufficient information about the vaccines. Some mothers also seemed unaware of these specialized vaccines.

Conclusions: Promoting complete immunization requires more than just raising awareness about childhood vaccinations but close and quick immunization service delivery is required. It is crucial for mothers to possess comprehensive knowledge about the mechanics and operation of immunization. Achieving this understanding could involve translating vaccine names and functions into indigenous terms, enhancing clarity and comprehension. Furthermore, a firm grasp of the immunization schedule significantly contributes to successful immunization completion.

Background: Wastewater (WW) -based epidemiology is the detection of pathogens and chemicals from wastewater, typically sewage systems. Its use gained popularity during the COVID-19 pandemic as a rapid and non-invasive way to assess infection prevalence in a population. Public facing dashboards for SARS-CoV-2 were developed in response to the discovery that RNA biomarkers were being shed in faeces before symptoms. However, there is not a standard template or guidance for countries to follow. The aim of this research is to reflect on how currently available dashboards evolved during the pandemic and identify suitable content and rationale from these experiences.

Methods: Interviews were carried out with implementers and users of dashboards for SARS-CoV-2 WW data across Europe and North America. The interviews addressed commonalities and inconsistencies in displaying epidemiological data of SARS-CoV-2, clinical parameters of COVID-19, data on variants, and data transparency.

Results: The thematic analysis identified WW dashboard elements that can facilitate standardization, or at least interoperability. These elements emphasise communication among developers under the same organization, open access for identified stakeholders, and data summarized with a time-intensive graphic analysis through normalizing at least by population. Simultaneous communication of clinical surveillance is recommended. More research is needed on flow and faecal indicators for normalization of WW data, and on the analysis and representation of variants.

Discussion: WW dashboard development between 2020-2023 provided a 'real-time' iterative process of data representation, and several recommendations have been identified. Communication of data through dashboards has the potential to support early warning systems for infectious diseases.

Background: Lateral flow assays (LFAs) for the rapid detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) provide an affordable, rapid and decentralised mean for diagnosing coronavirus disease 2019 (COVID-19). Concentrating on urban areas in low- and middle-income countries, the aim of this analysis was to estimate the degree to which 'dynamic' screening algorithms, that adjust the use of confirmatory polymerase chain reaction (PCR) testing based on epidemiological conditions, could reduce cost without substantially reducing the impact of testing.

Methods: Concentrating on a hypothetical 'second wave' of COVID-19 in India, we modelled the potential impact of testing 0.5% of the population per day at random with LFA, regardless of symptom status. We considered dynamic testing strategies where LFA positive cases are confirmed with PCR when LFA positivity rates are below a given threshold (10%, 50% and 90% of the peak positivity rate at the height of the epidemic wave), compared to confirming all positive LFA results or confirming no results. Benefit was estimated based on cumulative incidence of infection, and resource requirements, based on the cumulative number of PCR tests used and the cumulative number of unnecessary isolations.

Results: A dynamic strategy of discontinuing PCR confirmation when LFA positivity exceeded 50% of the peak positivity rate in an unmitigated epidemic would achieve comparable impact to one employing PCR confirmation throughout (9.2% of cumulative cases averted vs 9.8%), while requiring 35% as many PCR tests. However, the dynamic testing strategy would increase the number of false-positive results substantially, from 0.07% of the population to 1.1%.

Conclusions: Dynamic diagnostic strategies that adjust to epidemic conditions could help maximise the impact of testing at a given cost. Generally, dynamic strategies reduce the number of confirmatory PCR tests needed, but increase the number of unnecessary isolations. Optimal strategies will depend on whether greater priority is placed on limiting confirmatory testing or false-positive diagnoses.

Background: Gender norms against adolescent girls and young women (AGYW)'s having pre-marital sex and using condoms in marriage are included as barriers to motivation to use condoms in HIV prevention cascades. Representative data on gender norms are needed to test this assumption.

Methods: General-population survey participants in Manicaland, Zimbabwe (ages≥15, N=9803) reported agreement/disagreement with statements on gender norms. AGYW at risk of HIV infection reported whether community views discouraged condom use. Multivariable logistic regression was used to measure associations between AGYW's perceiving negative gender norms and condom HIV prevention cascades.

Results: 57% of men and 70% of women disagreed that 'If I have a teenage daughter and she has sex before marriage, I would be ok with this'; and 41% of men and 57% of women disagreed that 'If I have a teenage daughter, I would tell her about condoms'. 32% and 69% of sexually-active HIV-negative unmarried AGYW, respectively, said negative community views were important in their decisions to use condoms and their friends were not using condoms. In each case, those who agreed had lower motivation to use condoms. Fewer unmarried AGYW with friends not using condoms used condoms themselves (39% vs. 68%; age- and site-adjusted odds ratios (aOR)=0.29, 95%CI, 0.15-0.55). 21% of men and 32.5% of women found condom use in marriage acceptable. 74% and 93% of married AGYW at risk, respectively, said negative community views influenced their decisions to use condoms and their friends did not use condoms. Fewer married AGYW reporting friends not using condoms were motivated to use condoms but no difference was found in their own condom use (4.1% vs. 6.9%; aOR=0.57, 95%CI, 0.08-2.66).

Conclusions: Negative gender norms can form a barrier to motivation to use condoms in unmarried and married AGYW at risk of HIV infection, and, for unmarried AGYW, to condom use.

Globally, the annual economic impact of foot-and-mouth disease (FMD) is estimated at USD 11 billion in endemic settings, with the impact most profound among smallholder farmers. Farmers and the agro-veterinary stores that supply them are marginalized populations with limited to no access to veterinary care, and paucity of information on the availability and accessibility of vaccines. The objective of this study was to assess the accessibility and distribution channels of FMD vaccine, and the challenges related to the FMD vaccine market in these regions where livestock farming is highest and is an important component of livelihoods. A cross-sectional study was carried out, where at least one state was selected from five geopolitical zones of Nigeria. The locations were selected because of their high concentrations of livestock farmers. We interviewed 290 agro-veterinary store owners in these locations who directly supply smallholder farmers with animal health products. Data from the interviews were collected through the Kobocollect App ^®. Almost all of the agro-veterinary stores in rural and peri-urban areas (96.4%) had direct patronage from livestock farmers. Out of these agro-veterinary stores, relatively few (29%) sold vaccines and among these, 81% did not sell FMD vaccines. More than half (60%) of the stores selling FMD vaccines did not always have the vaccine in stock. Furthermore, maintenance of the cold chain during storage and logistics of the vaccine topped the challenges faced with stocking and sales of livestock vaccines. It was recommended that to ensure FMD control by the livestock farmers in rural and peri-urban areas through the use of FMD vaccines sold by agro-veterinary stores located in their communities, there is a need to adopt some, if not all, of the suggestions provided by the agro-veterinary store owners. This will ultimately improve animal productivity, and farmer livelihoods, and contribute to national food security.

Rationale: Virtual exchanges are emerging as innovative educational tools with the potential to foster collaboration between High-Income Countries (HICs) and Low- and Middle-Income Countries (LMICs). These initiatives hold the potential to enhance intercultural competencies, promote equitable partnerships, and address resource disparities. Understanding the pedagogical underpinnings, challenges, and best practices of virtual exchanges is vital for developing scalable and sustainable integration into healthcare education.

Research question: To what extent have virtual exchanges in global health been reported in the literature to date, including their frameworks, impact and sustainability?

Inclusion criteria: Studies involving a global health virtual exchange between at least one HIC and one LMIC will be included. Sources in all healthcare contexts will be included. Non-English language publications and those solely using secondary data will be excluded.

Methods: The review will be conducted in line with the Joanna Briggs Institute guidance for scoping reviews (1). The following electronic databases will be searched: Medline Ovid, Embase, CINAHL & ERIC. A search of the grey literature will also be conducted. Three reviewers will independently screen the titles and abstracts and full texts for eligibility. Data extraction will be conducted independently by three reviewers. A narrative summary and tables will be presented. Key stakeholders will be consulted throughout the review.

Discussion: This scoping review will provide a comprehensive understanding of virtual exchanges in global health, outlining frameworks, outcomes, content and best practices. The findings will inform the development of evidence-based models to design and sustain virtual exchanges between HIC and LMICs, enhancing their impact in global health education and practice.

Registration: This protocol was registered to the Open Science Framework (OSF): DOI 10.17605/OSF.IO/MWHBP.