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Abdulla S. Decolonising research and folk media: a methodology for Exploring narratives of HIV and AIDS in rural Malawi. Arts Health 2024:1-17. [PMID: 38733156 DOI: 10.1080/17533015.2024.2346103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 04/17/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND In Malawi, well-meaning HIV and AIDS interventions imagined in the "Global North" continue to ignore how local people construct the world. This paper explores how folk media can be used to enable research on HIV and AIDS to be positioned within localised cultural paradigms. METHODS Drawing on Chewa epistemology, I used folk media methods supported by participant observation. The research was conducted in three phases over 15 days in two rural communities and captured the workshop processes, participants' process reviews, verbal journals and creative outputs through pictures, audio and video recordings, field notes and reflections. Data was analysed thematically. FINDING Folk media can be used to structure research, to facilitate a conducive environment for research practice, as data and as a method for the generation of data/knowledge. CONCLUSIONS Folk media can be a strong, replicable, culturally grounded, decolonizing research methodology that promotes collaboration and the deconstruction of power relations.
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Affiliation(s)
- Sharifa Abdulla
- Theatre Studies, School of Culture and Creative Arts, University of Glasgow, Glasgow, Scotland
- Department of Drama and Theatre Studies, University of Malawi, Zomba, Malawi
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Hungwe FTT, Laycock KM, Ntereke TD, Mabaka R, Paganotti GM. A historical perspective on arboviruses of public health interest in Southern Africa. Pathog Glob Health 2024; 118:131-159. [PMID: 38082563 PMCID: PMC11141323 DOI: 10.1080/20477724.2023.2290375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024] Open
Abstract
Arboviruses are an existing and expanding threat globally, with the potential for causing devastating health and socioeconomic impacts. Mitigating this threat necessitates a One Health approach that integrates vector surveillance, rapid disease detection, and innovative prevention and control measures. In Southern Africa, limited data on the epidemiology of arboviruses, their vectors, and their hosts prevent an effective response. We reviewed the current knowledge on arboviruses in Southern Africa and identified opportunities for further research. A literature search was conducted to identify studies published on arboviruses in 10 tropical and temperate countries of the Southern African Development Community (SADC) from 1900 onward. We identified 280 studies, half (51.1%) originating from South Africa, that described 31 arboviral species, their vectors, and their clinical effects on hosts reported in the region. Arboviral research flourished in the SADC in the mid-20th century but then declined, before reemerging in the last two decades. Recent research consists largely of case reports describing outbreaks. Historical vector surveillance and serosurveys from the mid-20th century suggest that arboviruses are plentiful across Southern Africa, but large gaps remain in the current understanding of arboviral distribution, transmission dynamics, and public health impact.
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Affiliation(s)
- Faith T. T. Hungwe
- School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm, Sweden
- Department of Molecular Medicine, Karolinska Institute, Stockholm, Sweden
- Department of Biochemistry and Biophysics, Stockholm University, Stockholm, Sweden
| | - Katherine M. Laycock
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Rorisang Mabaka
- School of Allied Health Sciences, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Giacomo M. Paganotti
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biomedical Sciences, University of Botswana, Gaborone, Botswana
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3
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Kizito S, Namuwonge F, Nabayinda J, Nabunya P, Nattabi J, Sensoy Bahar O, Kiyingi J, Magorokosho N, Ssewamala FM. Using Hierarchical Regression to Examine the Predictors of Sexual Risk-Taking Attitudes among Adolescents Living with Human Immunodeficiency Virus in Uganda. J Adolesc Health 2023; 73:244-251. [PMID: 37074235 PMCID: PMC10523903 DOI: 10.1016/j.jadohealth.2023.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE We explored the factors influencing sexual risk-taking attitudes-defined as beliefs and values regarding sexual activity-among adolescents living with human immunodeficiency virus (ALHIV) in Uganda. METHODS The study used baseline data from a five-year cluster-randomized control trial (2012-2018) among 702 ALHIV in Uganda. Participants were aged 10-16 years, HIV-positive, taking antiretroviral therapy, and living within a family. We fitted hierarchical regression models to assess the demographic, economic, psychological, and social predictors of sexual risk-taking attitudes. Using R2, the final model explained 11.4% of the total variance. RESULTS Under economic factors, caregiver being formally employed (β = -0.08, 95% confidence interval [CI]: -0.10-0.06, p < .001), and the ALHIV working for pay (β = 1.78, 95% CI: 0.28-3.29, p = .022), were associated with sexual risk-taking attitudes. Among the psychological factors, more depressive symptoms (β = 0.22, 95% CI: 0.11-0.32, p < .001) were associated with more approving attitudes toward sexual risk-taking. Family and social factors including communicating with the caregiver about HIV (β = 1.32, 95% CI: 0.56-2.08, p = .001), sex (β = 1.09, 95% CI: 0.20-1.97, p = .017), and experiencing peer pressure (β = 3.37, 95% CI: 1.85-4.89, p < .001) were also associated with more approving attitudes toward sexual risk-taking. The final model explained 11.54% of the total variance. DISCUSSION Economic, psychological, and social factors influence sexual risk-taking attitudes among ALHIV. There is a need for more research to understand why discussing sex with caregivers improves adolescents' positive attitudes toward sexual risk-taking. These findings have significant ramifications in preventing sexual transmission of HIV among adolescents in low-income settings.
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Affiliation(s)
- Samuel Kizito
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, Missouri
| | - Flavia Namuwonge
- International Center for Child Health and Development, Masaka, Uganda
| | - Josephine Nabayinda
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, Missouri
| | - Proscovia Nabunya
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, Missouri
| | - Jennifer Nattabi
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, Missouri
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, Missouri
| | - Joshua Kiyingi
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, Missouri
| | - Natasja Magorokosho
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, Missouri
| | - Fred M Ssewamala
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, Missouri.
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Johnson K, Pinchuk I, Melgar MIE, Agwogie MO, Salazar Silva F. The global movement towards a public health approach to substance use disorders. Ann Med 2022; 54:1797-1808. [PMID: 35792721 PMCID: PMC9262358 DOI: 10.1080/07853890.2022.2079150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Drug misuse is a global problem. Markets that supply illegal drugs often span international borders. However, each country has different primary drugs of use, populations that are using and consequences of use. The policy approach of each country to addressing substance use disorders can be characterized along a continuum between purely public health approaches and purely law enforcement approaches. Historically, a law enforcement approach has been the primary strategy in much of the world. However, there is a growing movement towards use of a public health approach. This article provides four case examples, Ukraine, Philippines, Nigeria and Peru, where there is movement to develop addiction public health infrastructure. The work varies by country, but includes regulatory changes, workforce development and resource allocation all of which are supported by the United Nations Office on Drugs and Crime (UNODC) and multi-national organizations that provide training and technical assistance, funded primarily by the European Union and United States governments. All four countries highlighted have barriers to moving towards a more public health approach which may include popularity of the law enforcement approach, turbulent government environments, and economics of being a drug producing nation. However, whether starting from the top down with changed policies, such as Ukraine or from the bottom up with training community members as in the Philippines, each country provides an example of how donor resources can be applied to make the transition towards a more humane and evidence-based approach to addressing substance use disorders.Key MessagesWhile the primary approach to addressing drug use has focussed resources on law enforcement for over 100 years, many countries are adopting elements of a public health approach including prevention and treatment of the harms of drug use including substance use disorders.There is a growing global movement to make policy towards drugs and drug users more humane and evidence-based.Donor nation resources can be applied in a variety of combinations to improve care and outcomes for people who use drugs in low- and middle-income countries.
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Affiliation(s)
- Kimberly Johnson
- International Consortium of Universities for Drug Demand Reduction, University of South Florida, Tampa, FL, USA
| | - Irina Pinchuk
- Institute of Psychiatry of Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
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Khanakwa S, Mbonigaba J. Institutional Arrangements for Providing HIV and AIDS Services in Uganda: A Transaction Cost Economics Analysis. Health Serv Insights 2022; 15:11786329221096046. [PMID: 35571583 PMCID: PMC9092571 DOI: 10.1177/11786329221096046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 04/04/2022] [Indexed: 11/17/2022] Open
Abstract
Transaction cost economics (TCE) theory predicts that features of institutional arrangements determine the intensity of their governance instruments. Consequently, institutional features link to transaction costs, but the linkages have received little attention in the public health literature. This study sought to address this gap. It examined the governance features of institutional arrangements and their transaction cost implications for providing HIV prevention and social support services in Uganda. The analysis was based on 4 proposed TCE governance instruments: administrative controls, adaptation, incentives and contract laws. These governance instruments were assessed in 3 modes of delivery( institutional arrangments) for HIV and AIDS Services in Uganda: Contracting-Out – the case of DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe); a Public-Non-Governmental Organisation (NGO) partnership – the case of the CHAI (Community-led HIV/AIDS Initiative); and direct Public Sector Delivery. These assessed delivery modes follow Williamson’s TCE framework of 3 institutional arrangements to deliver goods and services, notably market, hybrid (partnership) and internal (hierarchy) delivery, with related governance features. Within this framework, the discriminating alignment hypothesis guided the analysis. According to the hypothesis, the delivery modes of goods and services result in smaller transaction costs when their governance features are as predicted by TCE. The hypothesis was assessed by analysing, with qualitative methods, the differences in HIV and AIDS services characteristics across the 3 arrangements and their differences with theory prediction, and hence the difference in transaction cost implications. The study found that the delivery arrangements that minimised cost are those whose HIV and AIDS services were aligned with the TCE theory prediction. The aligned ‘public-NGO partnership’ arrangement (CHAI) had fewer sources of transactional costs than the misaligned arrangements – ‘contracting-out’ (DREAMS) and ‘public sector’. The analysis revealed that the DREAMS and public sector delivery models suffered some flaws in efficiencies. DREAMS had high administrative controls, high-powered tangible incentive intensity and intensive monitoring mechanisms for performance adaptation due to the lack of ‘trust’ on the part of the financing agency, contrary to the TCE prediction. In contrast with the TCE prediction, low administrative controls in the public sector arose from the failure to invest in performance monitoring systems. The high-powered incentive intensity and low administrative controls observed in the CHAI arrangement primarily stemmed from the reliance on informal institutions (trust, social expectations and reputation) rather than principal-agent arms-length sanctions. These results suggest that the level of transaction costs is associated with features of institutional arrangements. The valuable insights from TCE could contribute to policymaking during the design of institutional arrangements to efficiently deliver HIV and AIDS services.
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Affiliation(s)
- Sarah Khanakwa
- Health Economics and HIV/AIDS Research Division, Westville Campus, University of KwaZulu-Natal, Durban, South Africa, and Uganda AIDS Commission
| | - Josue Mbonigaba
- School of Accounting, Economics, and Finance, Westville Campus, University of KwaZulu-Natal, Durban, South Africa
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Viljoen L, Hoddinott G, Malunga S, Vanqa N, Mhlakwaphalwa T, Marthinus A, Mcimeli K, Bond V, Seeley J, Bock P, Hayes R, Reynolds L. Women's sexual scripting in the context of universal access to antiretroviral treatment-findings from the HPTN 071 (PopART) trial in South Africa. BMC Womens Health 2021; 21:370. [PMID: 34689783 PMCID: PMC8543855 DOI: 10.1186/s12905-021-01513-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 10/14/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND HIV treatment-based prevention modalities present new opportunities for women to make decisions around sex, intimacy, and prevention. The Universal test and treat (UTT) strategy, where widespread HIV testing is implemented and all people with HIV can access treatment, has the potential to change how sex is understood and HIV prevention incorporated into sexual relationships. We use the frame of sexual scripting to explore how women attribute meaning to sex relative to UTT in an HIV prevention trial setting. Exploring women's sexual narratives, we explored how HIV prevention feature in the sexual scripts for women who had access to UTT in South Africa (prior to treatment guideline changes) and increased HIV prevention messaging, compared to places without widespread access to HIV testing and immediate access to treatment. METHODS We employed a two-phased thematic analysis to explore longitudinal qualitative data collected from 71 women (18-35 years old) between 2016 and 2018 as part of an HIV prevention trial in the Western Cape Province, South Africa. Of the participants, 58/71 (82%) were from intervention communities while 13/71 (18%) lived in control communities without access to UTT. Twenty participants self-disclosed that they were living with HIV. RESULTS We found no narrative differences between women who had access to UTT and those who did not. HIV and HIV prevention, including treatment-based prevention modalities, were largely absent from women's thinking about sex. In their scripts, women idealised romantic sex, positioned sex as 'about relationships', and described risky sex as 'other'. When women were confronted by HIV risk (for example, when a partner disclosed his HIV-positive status) this created a point of disjuncture between this new perception of risk and their accepted relationship scripts. CONCLUSION These findings suggest that HIV-negative women did not include their partners' use of antiretroviral therapy in their sexual partnership choices. For these women, the preventive benefits of UTT are experienced passively-through community-wide viral suppression-rather than through their own behaviour change explicitly related to the availability of treatment as prevention. We propose that prevention-based modalities should be made available and supported and framed as an intervention to promote relationship well-being.
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Affiliation(s)
- Lario Viljoen
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
- Department of Sociology and Social Anthropology, Stellenbosch University, Stellenbosch, South Africa.
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Samantha Malunga
- AIDS and Society Research Unit, Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Nosivuyile Vanqa
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Tembeka Mhlakwaphalwa
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Arlene Marthinus
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Khanyisa Mcimeli
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Virginia Bond
- Zambart, School of Public Health, Ridgeway Campus, University of Zambia, Lusaka, Zambia
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Janet Seeley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Richard Hayes
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Lindsey Reynolds
- Department of Sociology and Social Anthropology, Stellenbosch University, Stellenbosch, South Africa
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Risher KA, Cori A, Reniers G, Marston M, Calvert C, Crampin A, Dadirai T, Dube A, Gregson S, Herbst K, Lutalo T, Moorhouse L, Mtenga B, Nabukalu D, Newton R, Price AJ, Tlhajoane M, Todd J, Tomlin K, Urassa M, Vandormael A, Fraser C, Slaymaker E, Eaton JW. Age patterns of HIV incidence in eastern and southern Africa: a modelling analysis of observational population-based cohort studies. Lancet HIV 2021; 8:e429-e439. [PMID: 34197773 PMCID: PMC8258368 DOI: 10.1016/s2352-3018(21)00069-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/10/2021] [Accepted: 03/23/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND As the HIV epidemic in sub-Saharan Africa matures, evidence about the age distribution of new HIV infections and how this distribution has changed over the epidemic is needed to guide HIV prevention. We aimed to assess trends in age-specific HIV incidence in six population-based cohort studies in eastern and southern Africa, reporting changes in mean age at infection, age distribution of new infections, and birth cohort cumulative incidence. METHODS We used a Bayesian model to reconstruct age-specific HIV incidence from repeated observations of individuals' HIV serostatus and survival collected among population HIV cohorts in rural Malawi, South Africa, Tanzania, Uganda, and Zimbabwe, in a collaborative analysis of the ALPHA network. We modelled HIV incidence rates by age, time, and sex using smoothing splines functions. We estimated incidence trends separately by sex and study. We used estimated incidence and prevalence results for 2000-17, standardised to study population distribution, to estimate mean age at infection and proportion of new infections by age. We also estimated cumulative incidence (lifetime risk of infection) by birth cohort. FINDINGS Age-specific incidence declined at all ages, although the timing and pattern of decline varied by study. The mean age at infection was higher in men (cohort mean 27·8-34·6 years) than in women (24·8-29·6 years). Between 2000 and 2017, the mean age at infection per cohort increased slightly: 0·5 to 2·8 years among men and -0·2 to 2·5 years among women. Across studies, between 38% and 63% (cohort medians) of the infections in women were among those aged 15-24 years and between 30% and 63% of infections in men were in those aged 20-29 years. Lifetime risk of HIV declined for successive birth cohorts. INTERPRETATION HIV incidence declined in all age groups and shifted slightly to older ages. Disproportionate new HIV infections occur among women aged 15-24 years and men aged 20-29 years, supporting focused prevention in these groups. However, 40-60% of infections were outside these ages, emphasising the importance of providing appropriate HIV prevention to adults of all ages. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Kathryn A Risher
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK; Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Anne Cori
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Georges Reniers
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK; Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Milly Marston
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Clara Calvert
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Amelia Crampin
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK; Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Tawanda Dadirai
- The Manicaland Centre for Public Health Research, Harare, Zimbabwe
| | - Albert Dube
- Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi
| | - Simon Gregson
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK; Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Kobus Herbst
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; Department of Science and Innovation-Medical Research Council South African Population Research Infrastructure Network, Durban, South Africa
| | - Tom Lutalo
- Rakai Health Sciences Program, Kalisizo, Uganda
| | - Louisa Moorhouse
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Baltazar Mtenga
- National Institute for Medical Research, Kisesa HDSS, Mwanza, Tanzania
| | | | - Robert Newton
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda; Department of Health Sciences, University of York, York, UK
| | - Alison J Price
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Malebogo Tlhajoane
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jim Todd
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Keith Tomlin
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Mark Urassa
- National Institute for Medical Research, Kisesa HDSS, Mwanza, Tanzania
| | - Alain Vandormael
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; KwaZulu-Natal Research Innovation and Sequencing Platform, UKZN, Durban, South Africa; Heidelberg Institute of Global Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Christophe Fraser
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Emma Slaymaker
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jeffrey W Eaton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK; Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
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HIV Incidence Among Women in Sub-Saharan Africa: A Time Trend Analysis of the 2000-2017 Period. J Assoc Nurses AIDS Care 2021; 32:662. [PMID: 33989245 DOI: 10.1097/jnc.0000000000000254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The aim of this study was to use data from the United Nations Global Indicators Database to analyze the trends in the HIV incidence rate among women in sub-Saharan African countries between 2000 and 2017. The HIV incidence rate is defined as the number of new HIV infections per 1,000 uninfected population, aged 15 to 49 years old. Joinpoint regression analysis was applied to identify periods when there were significant changes in the HIV incidence rate. The results show that there was a global decrease trend in the HIV incidence rates among women in sub-Saharan Africa, decreasing in all sub-Saharan African countries, except in Angola, Equatorial Guinea, and Sudan, which have remained the same, and Madagascar, where the overall trend is increasing. The joinpoint regression statistical method offers an in-depth analysis of the incidence of HIV among women in sub-Saharan Africa.
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Abbas S, Al-Abrrow H, Abdullah HO, Alnoor A, Khattak ZZ, Khaw KW. Encountering Covid-19 and perceived stress and the role of a health climate among medical workers. CURRENT PSYCHOLOGY 2021; 41:9109-9122. [PMID: 33519147 PMCID: PMC7823189 DOI: 10.1007/s12144-021-01381-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2021] [Indexed: 12/23/2022]
Abstract
Due to the outbreak of Covid-19 epidemic, work stress among health sector employees has risen too high. The study aims at determining the effect of the current coronavirus epidemic in the form of stress perceived among the medical workers in Pakistan and to discover the moderating role played by a healthy climate in offsetting it. The data was collected from 255 medical workers through a self-administered online questionnaire. Multiple Hierarchical Regression was used as a tool to test the hypotheses of the study. The results obtained indicate a correlation between the pandemic and the stress caused by it among the health workers, whereas, the role of a wholesome climate in the reduction of stress among them was found lacking. Sub-hypotheses indicate that the healthy environment provided by supervisors is effective in reducing the impact of workers' handling of the Covid-19 epidemic and perceived stress, while the healthy environment provided by hospitals in general or by workgroups fails to cause such positive change. This revelation necessitates the adoption of compulsory precautionary measures on the part of relevant authorities, because increase in stress caused by the pandemic can prove more lethal than the pandemic itself. The threat of the coronavirus pandemic has emerged as a massive socio-economic challenge for the global community, especially for the developing countries like Pakistan which faces serious socio-economic challenges in the current scenario. On account of the similarity of situations, the results obtained through this study can be safely generalized to other developing countries, particularly from the South Asian region.
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Affiliation(s)
- Sammar Abbas
- Institute of Business Studies, Kohat University of Science and Technology, Kohat, Pakistan
| | - Hadi Al-Abrrow
- Department of Business Administration, College of Administration and Economic, University of Basrah, Basrah, Iraq
| | - Hasan Oudah Abdullah
- Department of Business Administration, Basrah University College for Science and Technology, Basrah, Iraq
| | - Alhamzah Alnoor
- Southern Technical University, Management Technical College, Universiti Sains Malaysia, School of Management, George Town, Penang Malaysia
| | - Zeeshan Zaib Khattak
- Institute of Business Studies, Kohat University of Science and Technology, Kohat, Pakistan
| | - Khai Wah Khaw
- School of Management, Universiti Sains Malaysia, 11800 George Town, Pulau Pinang Malaysia
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Salifu Y, Atout M, Shivji N, Khalid DS, Bardi JN. COVID-19: time to rethink palliative care strategy in resource-poor settings. Int J Palliat Nurs 2020; 26:268-271. [PMID: 32841083 DOI: 10.12968/ijpn.2020.26.6.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yakubu Salifu
- Lecturer in Palliative Care, International Observatory on End of Life Care (IOELC), Division of Health Research, Faculty of Health and Medicine; Lancaster University, UK
| | - Maha Atout
- Assistant Professor, Nursing School, Philadelphia University, Jordan
| | - Noureen Shivji
- Research Associate, Applied Qualitative Health Research, Keele University, Staffordshire, UK
| | - Dalhat Sani Khalid
- Lecturer/Head of Department, Department of Nursing Science, Ahmadu Bello University, Zaria, Nigeria
| | - Josephine NwaAmaka Bardi
- Principal Investigator, Mental Health Research, Raising Awareness of Mental Health in Higher Education (RAMHHE), School of Health, Sport and Bioscience, University of East London, UK
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Coleman-Eghan AA, Michelow P. The effect of antiretroviral therapy on fine-needle aspiration of salivary gland masses in HIV-infected patients. Diagn Cytopathol 2020; 48:1217-1223. [PMID: 32692863 DOI: 10.1002/dc.24546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 05/16/2020] [Accepted: 06/10/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND South Africa has a very high prevalence of HIV/AIDS. Salivary gland lesions are common in HIV-infected patients. The aim of this study was to determine the pathologic entities diagnosed on fine-needle aspiration (FNA) of salivary gland masses in an HIV-infected study population that now has free access to antiretroviral (ARV) therapy and how this differs from the pathologic entities before the advent of widespread ARV availability, and if the Milan system for reporting salivary gland cytopathology (MSRSGC) can be applied to HIV-infected patients. METHODS A retrospective review was performed on confirmed HIV-infected patients who underwent FNA of salivary gland masses over a two-year period. RESULTS A total of 360 patients underwent FNA of salivary gland masses within the designated time frame, 58.3% (210) females and 41.7% (150) males. Patient ages ranged from 7 months to 67 years with a mean age of 36.9 years. The parotid gland was the most biopsied salivary gland at 55.3% (199). The most common diagnosis made in patients on antiviral therapy was lymphoepithelial cyst while that in patients not on antiviral therapy was infectious (including abscess and mycobacterial infection). The most frequent neoplasms were non-Hodgkin lymphoma, pleomorphic adenoma and squamous-cell carcinoma. CONCLUSION Patients on ARV therapy had higher CD4 counts, fewer infectious lesions, and more reactive and benign salivary gland lesions. Patients not on treatment had significantly lower CD4 counts and were frequently diagnosed with infectious processes. The MSRSGC is well-suited for use in HIV-infected patients.
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Affiliation(s)
- Amanda Ama Coleman-Eghan
- Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
| | - Pamela Michelow
- Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
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Thami PK, Chimusa ER. Population Structure and Implications on the Genetic Architecture of HIV-1 Phenotypes Within Southern Africa. Front Genet 2019; 10:905. [PMID: 31611910 PMCID: PMC6777512 DOI: 10.3389/fgene.2019.00905] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/26/2019] [Indexed: 12/12/2022] Open
Abstract
The interesting history of Southern Africa has put the region in the spotlight for population medical genetics. Major events including the Bantu expansion and European colonialism have imprinted unique genetic signatures within autochthonous populations of Southern Africa, this resulting in differential allele frequencies across the region. This genetic structure has potential implications on susceptibility and resistance to infectious diseases such as human immunodeficiency virus (HIV) infection. Southern Africa is the region affected worst by HIV. Here, we discuss advances made in genome-wide association studies (GWAS) of HIV-1 in the past 12 years and dissect population diversity within Southern Africa. Our findings accentuate that a plethora of factors such as migration, language and culture, admixture, and natural selection have profiled the genetics of the people of Southern Africa. Genetic structure has been observed among the Khoe-San, among Bantu speakers, and between the Khoe-San, Coloureds, and Bantu speakers. Moreover, Southern African populations have complex admixture scenarios. Few GWAS of HIV-1 have been conducted in Southern Africa, with only one of these identifying two novel variants (HCG22rs2535307 and CCNG1kgp22385164) significantly associated with HIV-1 acquisition and progression. High genetic diversity, multi-wave genetic mixture and low linkage disequilibrium of Southern African populations constitute a challenge in identifying genetic variants with modest risk or protective effect against HIV-1. We therefore posit that it is compelling to assess genome-wide contribution of ancestry to HIV-1 infection. We further suggest robust methods that can pin-point population-specific variants that may contribute to the control of HIV-1 in Southern Africa.
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Affiliation(s)
- Prisca K Thami
- Division of Human Genetics, Department of Pathology, University of Cape Town, Cape Town, South Africa.,Research Laboratory, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Emile R Chimusa
- Division of Human Genetics, Department of Pathology, University of Cape Town, Cape Town, South Africa
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Ruggles KV, Patel AR, Schensul S, Schensul J, Nucifora K, Zhou Q, Bryant K, Braithwaite RS. Betting on the fastest horse: Using computer simulation to design a combination HIV intervention for future projects in Maharashtra, India. PLoS One 2017; 12:e0184179. [PMID: 28873452 PMCID: PMC5584966 DOI: 10.1371/journal.pone.0184179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 08/18/2017] [Indexed: 11/18/2022] Open
Abstract
Objective To inform the design of a combination intervention strategy targeting HIV-infected unhealthy alcohol users in Maharashtra, India, that could be tested in future randomized control trials. Methods Using probabilistic compartmental simulation modeling we compared intervention strategies targeting HIV-infected unhealthy alcohol users on antiretroviral therapy (ART) in Maharashtra, India. We tested interventions targeting four behaviors (unhealthy alcohol consumption, risky sexual behavior, depression and antiretroviral adherence), in three formats (individual, group based, community) and two durations (shorter versus longer). A total of 5,386 possible intervention combinations were tested across the population for a 20-year time horizon and intervention bundles were narrowed down based on incremental cost-effectiveness analysis using a two-step probabilistic uncertainty analysis approach. Results Taking into account uncertainty in transmission variables and intervention cost and effectiveness values, we were able to reduce the number of possible intervention combinations to be used in a randomized control trial from over 5,000 to less than 5. The most robust intervention bundle identified was a combination of three interventions: long individual alcohol counseling; weekly Short Message Service (SMS) adherence counseling; and brief sex risk group counseling. Conclusions In addition to guiding policy design, simulation modeling of HIV transmission can be used as a preparatory step to trial design, offering a method for intervention pre-selection at a reduced cost.
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Affiliation(s)
- Kelly V. Ruggles
- Department of Medicine, New York University School of Medicine, New York, NY, United States of America
- * E-mail:
| | - Anik R. Patel
- Department of Experimental Medicine, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - Stephen Schensul
- Department of Community Medicine and Health Care, University of Connecticut Health Center, Farmington, CT, United States of America
| | - Jean Schensul
- Institute for Community Research, Hartford, CT, United States of America
| | - Kimberly Nucifora
- Department of Population Health, New York University School of Medicine, New York, NY, United States of America
| | - Qinlian Zhou
- Department of Population Health, New York University School of Medicine, New York, NY, United States of America
| | - Kendall Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States of America
| | - R. Scott Braithwaite
- Department of Population Health, New York University School of Medicine, New York, NY, United States of America
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