Global Public Health最新文献

Despite being widely implemented, little information exists on the effect of Value Clarification and Attitude Transformation (VCAT) workshops on health care provider knowledge and attitudes and abortion provision. Between 2019 and 2021, we conducted a cluster-randomised controlled trial among 101 private abortion-providing healthcare facilities in Ethiopia. We surveyed 217 providers prior to a VCAT workshop and again at 2 weeks, 6 months, and one year following VCAT workshop participation to understand abortion knowledge and attitudes, examined service statistics to assess abortion client volumes, and conducted in-depth interviews with 30 providers. We found that a VCAT workshop for providers increased abortion service provision. In the year following the workshop, intervention facilities served 13% more abortion clients than expected based on the control group trend (95% CI: 6%-21%, p = .01). VCAT workshops moderately improved knowledge and supportive attitudes about abortion in the short-term. The VCAT workshop worked to change providers' attitudes by highlighting the importance of abortion in protecting clients from potential death and harm, but providers were less comfortable providing care to patients in situations deemed to be less socially justified (e.g. for married clients). Results support implementing ongoing VCAT refreshers with additional emphasis on client autonomy, cultural norms, and person-centred care.Trial registration: ClinicalTrials.gov identifier: NCT04181021.

HIV pandemic continues to affect key populations more than the general population, namely young men who have sex with men (MSM) [UNAIDS. (2023). The path that ends AIDS: UNAIDS global AIDS update 2023. Joint United Nations Programme on HIV/AIDS. https://www.unaids.org/sites/default/files/media_asset/2023-unaids-global-aids-update_en.pdf]. This study aimed to identify and better understand the attitudes and behaviours associated with HIV transmission in young MSM, and their awareness and motivation to use pre-exposure prophylaxis (PrEP). In 2022 and 2023, we interviewed 23 MSM between 20 and 30 years old. A hybrid methodology - inductive and deductive - was used for content analysis. Trust in partners, drug use, fetishisation regarding condomless sex and yielding to a partner's desire due to lack of assertiveness were highlighted as motivations for unprotected sex. Shame and fear of stigma were identified as potential inhibitory factors for HIV testing. Some concerns and lack of awareness regarding PrEP were noted, along with barriers to access, due to long waiting times for consultations and lack of knowledge or judgment by healthcare professionals. This study reinforces the need to invest in sex education and empowerment strategies, through a sexual orientation-sensitive approach, in the context of health education and care provision, as well as the need for training and streamlining PrEP fast-track protocols.

In Uganda, where HIV prevalence remains high, innovative strategies are sought to achieve 95-95-95 targets in combating the epidemic. In 2020, Uganda joined the Activity-Based Costing and Management (ABC/M) Initiative, a multi-country effort to monitor resource allocation and funding for HIV services. As part of this Initiative, data collectors generated process maps, specific to each facility, from the data collected by observing patients as they navigated the healthcare system. This study assessed clinical providers' perceptions of process maps used in the ABC/M Initiative in Uganda to identify the benefits and limitations in informing service delivery. Clinical providers from 14 purposively selected facilities participated in key informant (KI) interviews to review and discuss process map impressions. Thematic content analysis revealed: (1) KIs were enthusiastic about process maps, recognising their value in quality and efficiency; (2) KIs perceived opportunities for improvements, including revising how process maps depicted the staff and infrastructure; and (3) KIs expressed confusion in interpreting specific facets of process maps. Our study highlights the nuanced perspectives of clinical providers regarding process maps' functions within their facilities. These findings underscore the importance of ongoing review and analysis of process maps within the ABC/M initiative, facilitating a culture of continuous quality improvement and enhanced resource allocation.

Pakistan has 40 Super High Risk Union Councils (SHRUCs) where polio has been persistently endemic, and community relationships have been a persistent challenge due to campaign fatigue and violent, organised resistance. This study aimed to gather perspectives from frontline workers in these areas to improve community engagement. We conducted participant observation, over 100 interviews, and held Human-centred Design inspired sessions with 171 teams of frontline polio staff from 2020 to 2022 in the SHRUCs of a major city in Pakistan. The results show that frontline polio workers repeatedly visited households broadly neglected by government services in SHRUCs, but some households refused the vaccine due to fatigue from multiple visits and fear of government surveillance. Others refused the vaccine to draw attention to their more pressing needs. Frontline polio workers suggested that decreasing touchpoints and providing additional services, such as food, medicines, primary health care, and sanitation services, would improve vaccine uptake. We discuss several implications for vaccine communications, including the importance of quality engagement, the legitimacy of rumours surrounding vaccination, the limited applicability of 'vaccine hesitancy', and the critical role of service provision in improving vaccine acceptability.

Oral pre-exposure prophylaxis (PrEP) for HIV prevention promises women more control over HIV prevention. To alleviate low PrEP uptake, rolling out long-acting PrEP methods could increase uptake in women's preferred ways. The study sought to determine injectable PrEP service delivery characteristics that effectively meet young women's service needs. In 2023, we conducted a discrete choice experiment in South African tertiary institutions. We recruited and interviewed 400 female students mostly queuing for sexual health services. Data were analysed using mixed logit and latent class models.Young women strongly prefer using campus clinics to non-campus clinics and returning to the facility for product information and its side effects to using a chatbot [OR  = 1.07, CI: 1.02, 1.13]. Also, compared to getting a free service, students were prepared to pay R50 ($2.90) [OR = 1.14, CI: 1.05, 1.25]. Three classes emerged from the latent class model and these differed by background characteristics like age group and study year. Receiving PrEP through campus services from sensitive, PrEP providers and providing accurate information on side effects was preferred by students over community-based primary health care clinics with public health nurses. PrEP-trained providers should provide PrEP services as young people prefer returning to facilities for further youth-friendly support.

Housing insecurity (HI) is inextricably linked to poor health outcomes. Evidence suggests people living with HIV are more likely to experience poor psychological, physical, and nutritional health challenges. However, how housing insecurity might impact treatment outcomes among people living with HIV is under-explored. We examined the consequences of HI on treatment outcomes among people living with HIV in rural Kenya. Between July and August 2023. we purposively recruited and conducted 30 in-depth interviews and four focus group discussions (n = 35) with adult men and women living with HIV. Guided by grounded theory, the data were analyzed in Dedoose and organised into themes. The structural violence framework was then used to contextualise the findings. We found that HI exacerbated poor health outcomes through perceived adherence challenges and increased occurrence of opportunistic diseases such as malaria, diarrhoea, and cough due to housing conditions. Additionally, we found that the cost of rebuilding and maintaining took away resources from other household needs. Improving HI thus may play a critical role in enhancing HIV treatment outcomes. Given the variety of ways housing, food, water, and HIV affect health, gaining insight into the relationships between these factors has tremendous implications for care and treatment.

An emerging body of literature misinterprets and misrepresents the scholarship on African maternal mortality to advance the political agenda of anti-abortion advocates. The African region accounts for 70% of global maternal deaths, a figure that has justified a regional, evidence-based movement to loosen restrictive abortion laws. Anti-abortion activists have reacted by working to cast doubt on the scientific consensus that accessible legal abortion saves lives. The misinformation they produce justifies abortion restrictions—including criminalization—that worsen maternal mortality and morbidity, undermine gender equity by constraining women's reproductive rights, and exacerbate risks especially for young, rural, unmarried, and poor women. As an anthropologist who studies global anti-abortion strategies and a physician-anthropologist who has practiced obstetrics and gynecology in Malawi, respectively, we write to identify the deceptive tactics and debunk the false claims featured in recent publications by abortion opponents. Our goal is to prepare readers who care about reducing maternal mortality—no matter their moral perspectives on abortion—to recognize and refute misinformation. We conclude with suggestions for how researchers might move beyond ideological disagreements to improve maternal health.

Individuals with stigmatised health conditions face adverse attitudes, social exclusion and discrimination, stemming from preconceived notions about the condition and its associated symptoms or links to disability. Culture plays a role in shaping stigma manifestations. By employing the 'what matters most' framework, this study sought to capture perspectives of men and women living with leprosy, lymphatic filariasis or depressive disorder, and of their families and healthcare providers, regarding key cultural capabilities that 'matter most' for men and women in Cirebon Regency, Indonesia. A total of 91 respondents participated in 45 interviews and 10 focus group discussions. Data were analysed using thematic content analysis and the analysis generated three core cultural themes defined as 'what matters most' in Cirebon Regency: personal responsibilities, marriage and family responsibilities, and community responsibilities. Specifically, recovery-oriented attitudes, family support and community engagement were identified as key cultural engagements that could help people with stigmatised conditions to maintain personhood and mitigate health-related stigma. In conclusion, our findings highlight it is important to consider these cultural capabilities in stigma research, particularly in the design of stigma assessment and stigma-reduction interventions.

Evidence is emerging that long COVID is at least as prevalent in the Global South as the Global North, but literature on long COVID healthcare in the Global South is in its infancy. Brazil is seeing significant levels of debility due to long COVID but a limited national evidence-base. long COVID shares symptomatology and appropriate care with a wider category of infection-associated chronic conditions (IACCs). This article reviews literature published between 2000 and 2023 addressing healthcare for long COVID and IACCs in Brazil, in the interest of exploring challenges and opportunities for the SUS (Brazil's universal health system) to offer appropriate long COVID healthcare. We find that long COVID and IACCs collectively are subject to erasure from Brazilian healthcare knowledge, through lack of expertise, a resource-limited health system prioritising urgent care, and the concentration of poor health in marginalised populations with limited decision-making power. A nascent intellectual will to address long COVID, and a tradition of social participation in healthcare governance present potential opportunities. We call for ignition of a global step-change in tackling healthcare for long COVID and IACCs. Global equity in long COVID healthcare requires the development and sharing of expertise regarding its universal and context-specific features.

The Canadian public healthcare system faces significant challenges in performance. While the formal healthcare system addresses funding, access and policy, there is a critical need to prioritise the informal system of community-oriented networks. This integration aligns with the World Health Organization's primary health care approach, emphasising a whole-of-society strategy for health equity. Canada's healthcare, harmonised through the Canada Health Act of 1984, focuses on need over ability to pay. Despite successes, the system struggles with social determinants of health and widening health inequities, especially among Indigenous peoples. Historical policies of forced assimilation have led to poor health outcomes and lower life expectancies for Indigenous populations. The Truth and Reconciliation Commission's Calls to Action stress removing barriers at multiple levels to improve Indigenous health. Indigenous perspectives on health, emphasising holistic wellness, contrast with Western healthcare's acute-illness focus. The emergence of parallel systems, informal networks within healthcare, reflects dissatisfaction with traditional approaches. Recognising the parallel system within Indigenous health, as proposed, can transform healthcare to better meet population needs. Systems mapping of Indigenous PHC in Alberta revealed numerous entities providing healthcare access, highlighting the importance of adequately funding and integrating these parallel systems to advance health equity.