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Marley G, Tan RKJ, Wu D, Wang T, Sun M, Sheng Q, Holly ME, Hlatshwako TG, Wang C, Tang W, Ramaswamy R, Yang L, Luo D, Sylvia SS, Gray K, Van Duin D, Zheng H, Tucker JD. Pay-it-forward gonorrhea and chlamydia testing among men who have sex with men and male STD patients in China: the PIONEER pragmatic, cluster randomized controlled trial protocol. BMC Public Health 2023; 23:1182. [PMID: 37337181 PMCID: PMC10280958 DOI: 10.1186/s12889-023-16095-8] [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] [Received: 10/24/2022] [Accepted: 06/09/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Gonorrhea and chlamydia are the most common sexually transmitted diseases (STDs) among men who have sex with men (MSM) in China. Previous studies have shown pay-it-forward (PIF) interventions to be associated with a substantial increase in gonorrhea and chlamydia test uptake compared to standard-of-care. We propose a 'pay-it-forward' gonorrhea and chlamydia testing randomized controlled trial (PIONEER). The trial would evaluate the effectiveness of two pay-it-forward strategies in promoting testing uptake compared to the standard of care (in which men pay for their tests out-of-pocket) among MSM and male STD patients in China. METHODS PIONEER will be a three-armed, pragmatic cluster randomized controlled trial (RCT), conducted across 12 clinics (six MSM-led and six public STD clinics) to compare the effectiveness of three implementation strategies. Each facility will be randomized to a standard pay-it-forward intervention of gonorrhea/ chlamydia testing with minimal encouragement for testing, a community-engaged pay-it-forward arm, or a control arm where men pay for their tests out-of-pockets. The primary outcome will be dual gonorrhea/chlamydia test uptake. Secondary outcomes will include syphilis testing, amount donated in pay-it-forward, number of positive gonorrhea and chlamydia tests, and measures of antimicrobial resistance. A sequential transformative mixed methods design will be used to evaluate the implementation process in type 2 effectiveness-implementation hybrid design. Data sources will include survey on acceptability, and feelings and attitudes towards the interventions among participants; testing and treatment uptake data from clinic records, WeChat records, and qualitative data to gain insights into men's perceptions and attitudes towards the pay-it-forward, mechanisms driving uptake, and donating behaviors. Implementers and organizers will be interviewed about fidelity and adherence to protocol, sustainability of pay-it-forward intervention, and barriers and facilitators of implementing the intervention. DISCUSSION PIONEER will substantially increase gonorrhea/chlamydia testing among MSM in China, providing an innovative and new financial mechanism to sustain STD screening among sexual minorities in low- and middle-income countries. This study will answer compelling scientific questions about how best to implement pay-it-forward and the individual and organizational characteristics that moderate it. TRIAL REGISTRATION The study with identification number NCT05723263 has been registered on clinicaltrials.gov/.
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Affiliation(s)
- Gifty Marley
- University of North Carolina Project-China, Guangzhou, China
| | | | - Dan Wu
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Tong Wang
- University of North Carolina Project-China, Guangzhou, China
| | - Murong Sun
- University of North Carolina Project-China, Guangzhou, China
| | - Qilei Sheng
- University of North Carolina Project-China, Guangzhou, China
| | | | | | - Cheng Wang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Weiming Tang
- Department of Medicine, University of North Carolina at Chapel-Hill, Chapel Hill, NC, USA
| | - Rohit Ramaswamy
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ligang Yang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Danyang Luo
- University of North Carolina Project-China, Guangzhou, China
| | - Sean S Sylvia
- Department of Medicine, University of North Carolina at Chapel-Hill, Chapel Hill, NC, USA
| | - Kurt Gray
- University of North Carolina at Chapel-Hill, Chapel Hill, NC, USA
| | - David Van Duin
- University of North Carolina at Chapel-Hill, Chapel Hill, NC, USA
| | - Heping Zheng
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Joseph D Tucker
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK.
- Department of Medicine, University of North Carolina at Chapel-Hill, Chapel Hill, NC, USA.
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2
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Iwelunmor J, Tucker JD, Obiezu-Umeh C, Gbaja-Biamila T, Oladele D, Nwaozuru U, Musa AZ, Airhihenbuwa CO, Muessig K, Rosenberg N, BeLue R, Xian H, Conserve DF, Ong JJ, Zhang L, Curley J, Nkengasong S, Mason S, Tang W, Bayus B, Ogedegbe G, Ezechi O. The 4 Youth by Youth (4YBY) pragmatic trial to enhance HIV self-testing uptake and sustainability: Study protocol in Nigeria. Contemp Clin Trials 2022; 114:106628. [PMID: 34800699 PMCID: PMC9358609 DOI: 10.1016/j.cct.2021.106628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/11/2021] [Accepted: 11/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The World Health Organization recommends HIV self-testing (HIVST) as an additional approach to HIV testing and the Nigerian government is supportive of this policy recommendation. However, effectively increasing uptake and sustainability among Nigerian youth is unknown. The goal of this study is to conduct a full-powered type I hybrid effectiveness-implementation trial to test the effectiveness of youth-friendly implementation science strategies in increasing uptake and sustainability of HIVST led by and for Nigerian youth. METHODS Our 4 Youth by Youth (4YBY) strategy combines four core elements: 1) HIVST bundle consisting of HIVST kits and photo verification system; 2) a participatory learning community; 3) peer to peer support and technical assistance; and 4) on-site supervision and performance feedback to improve uptake and sustainability of HIVST and enhance linkage to youth-friendly health clinics for confirmatory HIV testing where needed, sexually transmitted infection (STI) testing (i.e. syphilis, gonorrhea, chlamydia, and hepatitis, STI treatment, and PrEP referral. Utilizing a stepped-wedge, cluster-randomized controlled trial, a national cohort of youth aged 14-24 recruited from 32 local government areas across 14 states and four geo-political zones in Nigeria will receive the 4YBY implementation strategy. In addition, an economic evaluation will explore the incremental cost per quality adjusted life year gained. DISCUSSION This study will add to the limited "how-to-do it literature" on implementation science strategies in a resource-limited setting targeting youth population traditionally underrepresented in implementation science literature. Study findings will also optimize uptake and sustainability of HIVST led by and for young people themselves. TRIAL REGISTRATION This study is registered in ClinicalTrials.govNCT04710784 (on January 15, 2021).
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Affiliation(s)
- Juliet Iwelunmor
- College for Public Health & Social Justice, Saint Louis University, Saint Louis, MO, USA.
| | - Joseph D Tucker
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Chisom Obiezu-Umeh
- College for Public Health & Social Justice, Saint Louis University, Saint Louis, MO, USA
| | - Titilola Gbaja-Biamila
- College for Public Health & Social Justice, Saint Louis University, Saint Louis, MO, USA; Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - David Oladele
- College for Public Health & Social Justice, Saint Louis University, Saint Louis, MO, USA; Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Ucheoma Nwaozuru
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Adesola Z Musa
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Collins O Airhihenbuwa
- Heath Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Kathryn Muessig
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nora Rosenberg
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rhonda BeLue
- College for Public Health & Social Justice, Saint Louis University, Saint Louis, MO, USA
| | - Hong Xian
- College for Public Health & Social Justice, Saint Louis University, Saint Louis, MO, USA
| | - Donaldson F Conserve
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Jason J Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; Central Clinical School, Monash University, Melbourne, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Lei Zhang
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Jamie Curley
- College for Public Health & Social Justice, Saint Louis University, Saint Louis, MO, USA
| | - Susan Nkengasong
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Stacey Mason
- College for Public Health & Social Justice, Saint Louis University, Saint Louis, MO, USA
| | - Weiming Tang
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Barry Bayus
- Kenan-Flagler Business School, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gbenga Ogedegbe
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, New York University School of Medicine, NY, New York, USA
| | - Oliver Ezechi
- College for Public Health & Social Justice, Saint Louis University, Saint Louis, MO, USA; Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
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Chahine T. Toward an Understanding of Public Health Entrepreneurship and Intrapreneurship. Front Public Health 2021; 9:593553. [PMID: 33898370 PMCID: PMC8062749 DOI: 10.3389/fpubh.2021.593553] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 03/08/2021] [Indexed: 01/03/2023] Open
Abstract
This paper describes a framework used to understand public health entrepreneurship and intrapreneurship for the purpose of pedagogy and practice. To ground this framework in the academic literature, a scoping review of the literature was conducted with application of a snowball method to identify further articles from the bibliographies of the search results. Recurring themes were identified to characterize common patterns of public health entrepreneurship and intrapreneurship. These themes were design thinking, resource mobilization, financial viability, cross-disciplinary collaboration, and systems strengthening. Case examples are provided to illustrate key themes in both intrapreneurship and entrepreneurship. This framework is a starting point to further the discourse, teaching, and practice of entrepreneurship and intrapreneurship in public health. More research is needed to understand implications for power and privilege, capacity building, financing, scaling, and policy making related to entrepreneurship and intrapreneurship in public health.
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Affiliation(s)
- Teresa Chahine
- School of Management, Yale University, New Haven, CT, United States
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4
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Yang F, Janamnuaysook R, Boyd MA, Phanuphak N, Tucker JD. Key populations and power: people-centred social innovation in Asian HIV services. Lancet HIV 2020; 7:e69-e74. [PMID: 31818717 PMCID: PMC8211360 DOI: 10.1016/s2352-3018(19)30347-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/28/2019] [Accepted: 08/02/2019] [Indexed: 12/14/2022]
Abstract
Key populations increasingly lead the design, implementation, and evaluation of HIV services, which provides an opportunity to make them more people-centred. Despite many challenges, a strong argument that these populations must have a greater role in HIV service planning, development, and delivery worldwide exists. This Viewpoint focuses on Asia, where key populations have advocated for legal reform, engaged vulnerable groups to decrease stigma, co-created innovative HIV services, and developed new key population-led health services. Further research on key populations and their roles in HIV implementation and sustainable scale-up is needed in Asia and beyond.
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Affiliation(s)
- Fan Yang
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | | | - Mark A Boyd
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | | | - Joseph D Tucker
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China; Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
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5
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Borst RAJ, Hoekstra T, Muhangi D, Jonker I, Kok MO. Reaching rural communities through 'Healthy Entrepreneurs': a cross-sectional exploration of community health entrepreneurship's role in sexual and reproductive health. Health Policy Plan 2019; 34:676-683. [PMID: 31774511 PMCID: PMC6880333 DOI: 10.1093/heapol/czz091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2019] [Indexed: 11/19/2022] Open
Abstract
The purpose of the current study was to explore the association between community health entrepreneurship and the sexual and reproductive health status of rural households in West-Uganda. We collected data using digital surveys in a cluster-randomized cross-sectional cohort study. The sample entailed 1211 household members from 25 randomly selected villages within two subcounties, of a rural West-Ugandan district. The association between five validated sexual and reproductive health outcome indicators and exposure to community health entrepreneurship was assessed using wealth-adjusted mixed-effects logistic regression models. We observed that households living in an area where community health entrepreneurs were active reported more often to use at least one modern contraceptive method [odds ratios (OR): 2.01, 95% CI: 1.30-3.10] had more knowledge of modern contraceptive methods (OR: 7.75, 95% CI: 2.81-21.34), knew more sexually transmitted infections (OR: 1.86, 95% CI: 1.14-3.05), and mentioned more symptoms of sexually transmitted infections (OR: 1.83, 95% CI: 1.18-2.85). The association between exposure to community health entrepreneurship and communities' comprehensive knowledge of HIV/AIDS was more ambiguous (OR: 1.27, 95% CI: 0.97-1.67). To conclude, households living in areas where community health entrepreneurs were active had higher odds on using modern contraceptives and had more knowledge of modern contraceptive methods, sexually transmitted infections and symptoms of sexually transmitted infections. This study provides the first evidence supporting the role of community health entrepreneurship in providing rural communities with sexual and reproductive health care.
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Affiliation(s)
- Robert A J Borst
- Erasmus School of Health Policy & Management, Health Care Governance, Erasmus University Rotterdam, DR Rotterdam, The Netherlands
| | - Trynke Hoekstra
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, HV, Amsterdam, The Netherlands
| | - Denis Muhangi
- Department of Social Work and Social Administration, Makerere University, Kampala, Uganda
| | - Isis Jonker
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, HV, Amsterdam, The Netherlands
| | - Maarten Olivier Kok
- Erasmus School of Health Policy & Management, Health Care Governance, Erasmus University Rotterdam, DR Rotterdam, The Netherlands
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, HV, Amsterdam, The Netherlands
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Out of the Closet, Into the Clinic: Opportunities for Expanding Men Who Have Sex With Men-Competent Services in China. Sex Transm Dis 2019; 45:527-533. [PMID: 29465638 DOI: 10.1097/olq.0000000000000808] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Despite the high human immunodeficiency virus (HIV) burden among men who have sex with men (MSM), there is little research on health services provided to MSM in China and other low- and middle-income countries. Discrimination and inadequate services may discourage MSM from seeking health care services. This study examined essential services provided to MSM and health care discrimination among MSM in China. METHODS A nationwide cross-sectional online survey was conducted among MSM who saw a physician in the last 24 months in China. The survey included items on sociodemographic information, HIV testing, experiences from the last physician encounter, and history of perceived health care discrimination. We defined MSM-competent physicians as physicians who asked their patient about having sex with other men, asked about anal sex, and either asked about or recommended HIV testing at the most recent visit. RESULTS Among the 503 participants, 35.0% (176/503) saw an MSM-competent physician. In multivariate analyses, respondents who saw an MSM-competent physician were more likely to be younger (adjusted odds ratio [AOR], 0.87; 95% confidence interval [CI], 0.81-0.94), have a primary care physician (AOR, 3.24; 95% CI, 1.85-5.67), and be living with HIV (AOR, 2.01; 95% CI, 1.13-3.56). 61.2% (308/503) of MSM had ever experienced health care discrimination. CONCLUSIONS Our data suggest that there is variability in the extent to which physicians are meeting the needs of MSM in China. There is an urgent need to evaluate and expand MSM-competent services in China.
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Wei L, Chen L, Zhang H, Yang Z, Liu S, Tan W, Xie W, Liu L, Zhao J, Cheng J. Relationship between gay app use and HIV testing among men who have sex with men in Shenzhen, China: a serial cross-sectional study. BMJ Open 2019; 9:e028933. [PMID: 31446409 PMCID: PMC6721534 DOI: 10.1136/bmjopen-2019-028933] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 07/05/2019] [Accepted: 07/10/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To investigate the relationship between gay app use and HIV testing among men who have sex with men (MSM). DESIGN Serial cross-sectional study. SETTING A newly well-developed city in China. PARTICIPANTS 4935 MSM were recruited through offline sampling methods from 2015 to 2017. PRIMARY AND SECONDARY OUTCOMES The primary outcome is the difference in HIV testing between app and non-app users. RESULTS 2872 (58.2%) and 2159 (43.7%) participated MSM had been tested for HIV within lifetime and the past year, respectively. Compared with non-app-using MSM, app-using MSM had a significantly higher prevalence of HIV testing within lifetime (adjusted OR (AOR): 1.48, 95% CI 1.27 to 1.72) and the past year (AOR: 1.36, 95% CI 1.18 to 1.57). App-using MSM were more likely to take an HIV test at the Centers for Disease Control and Prevention (AOR: 1.48, 95% CI 1.24 to 1.76) and community-based organisations (AOR: 1.71, 95% CI 1.44 to 2.03), but less often at gay venues (AOR: 0.49, 95% CI 0.37 to 0.63). Meanwhile, app-using MSM were more likely to take self-testing (AOR: 1.61, 95% CI 1.21 to 2.14). Predictors of HIV testing in the past year were: having an education level of college or higher (AOR: 1.29, 95% CI 1.01 to 1.65), being self-identified as a homosexual (AOR: 1.23, 95% CI 1.02 to 1.46), being recruited through clinic-based sampling (AOR: 1.30, 95% CI 1.06 to 1.60), using gay app (AOR: 1.49, 95% CI 1.21 to 1.83), engaging in group sex (AOR: 1.64, 95% CI 1.23 to 2.19), having received HIV-related service (AOR: 5.49, 95% CI 4.57 to 6.60), having a high level of HIV-related knowledge (AOR: 1.33, 95% CI 1.10 to 1.61) and high-risk perception (AOR: 2.95, 95% CI 1.40 to 6.23). CONCLUSIONS Gay app use was significantly associated with increased HIV testing among MSM hard to reach by traditional outreach. Therefore, it is imperative to expand HIV testing among non-app-using MSM. Continued efforts, innovative strategies and increased resource are highly needed to realise the first '90' target.
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Affiliation(s)
- Lan Wei
- Department of AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lin Chen
- Department of AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Haibo Zhang
- Department of AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Zhengrong Yang
- Department of AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Shaochu Liu
- Department of AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Wei Tan
- Department of AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Wei Xie
- Department of AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Liegang Liu
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jin Zhao
- Department of AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Jinquan Cheng
- Department of AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
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8
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Abstract
Treponema pallidum subspecies pallidum (T. pallidum) causes syphilis via sexual exposure or via vertical transmission during pregnancy. T. pallidum is renowned for its invasiveness and immune-evasiveness; its clinical manifestations result from local inflammatory responses to replicating spirochaetes and often imitate those of other diseases. The spirochaete has a long latent period during which individuals have no signs or symptoms but can remain infectious. Despite the availability of simple diagnostic tests and the effectiveness of treatment with a single dose of long-acting penicillin, syphilis is re-emerging as a global public health problem, particularly among men who have sex with men (MSM) in high-income and middle-income countries. Syphilis also causes several hundred thousand stillbirths and neonatal deaths every year in developing nations. Although several low-income countries have achieved WHO targets for the elimination of congenital syphilis, an alarming increase in the prevalence of syphilis in HIV-infected MSM serves as a strong reminder of the tenacity of T. pallidum as a pathogen. Strong advocacy and community involvement are needed to ensure that syphilis is given a high priority on the global health agenda. More investment is needed in research on the interaction between HIV and syphilis in MSM as well as into improved diagnostics, a better test of cure, intensified public health measures and, ultimately, a vaccine.
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Affiliation(s)
- Rosanna W Peeling
- London School of Hygiene &Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - David Mabey
- London School of Hygiene &Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Mary L Kamb
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Xiang-Sheng Chen
- National Center for STD Control, Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Dermatology, Nanjing, China
| | - Justin D Radolf
- Department of Medicine, UConn Health, Farmington, Connecticut, USA
| | - Adele S Benzaken
- Department of Surveillance, Prevention and Control of STI, HIV/AIDS and Viral Hepatitis, Ministry of Health, Brasília, Brazil
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9
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Tucker JD. Crowdsourcing to promote HIV testing among MSM in China: study protocol for a stepped wedge randomized controlled trial. Trials 2017; 18:447. [PMID: 28969702 PMCID: PMC5625620 DOI: 10.1186/s13063-017-2183-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 09/08/2017] [Indexed: 11/13/2022] Open
Abstract
Background HIV testing for marginalized populations is critical to controlling the HIV epidemic. However, the HIV testing rate among men who have sex with men (MSM) in China remains low. Crowdsourcing, the process of shifting individual tasks to a group, has been increasingly adopted in public health programs and may be a useful tool for spurring innovation in HIV testing campaigns. We designed a multi-site study to develop a crowdsourced HIV test promotion campaign and evaluate its effectiveness against conventional campaigns among MSM in China. Methods This study will use an adaptation of the stepped wedge, randomized controlled trial design. A total of eight major metropolitan cities in China will be randomized to sequentially initiate interventions at 3-month intervals. The intervention uses crowdsourcing at multiple steps to sustain crowd contribution. Approximately 1280 MSM, who are 16 years of age or over, live in the intervention city, have not been tested for HIV in the past 3 months, and are not living with HIV, will be recruited. Recruitment will take place through banner advertisements on a large gay dating app along with other social media platforms. Participants will complete one follow-up survey every 3 months for 12 months to evaluate their HIV testing uptake in the past 3 months and secondary outcomes including syphilis testing, sex without condoms, community engagement, testing stigma, and other related outcomes. Discussion MSM HIV testing rates remain poor in China. Innovative methods to promote HIV testing are urgently needed. With a large-scale, stepped wedge, randomized controlled trial our study can improve understanding of crowdsourcing’s long-term effectiveness in public health campaigns, expand HIV testing coverage among a key population, and inform intervention design in related public health fields. Trial Registration ClinicalTrials.gov, NCT02796963. Registered on 23 May 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2183-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Joseph D Tucker
- University of North Carolina Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095, China.
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10
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Tucker JD, Ong J, Conserve D, Pan S, Tang W. Scaling up HIV self-testing in China and Africa. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30337-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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11
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Tucker JD, Ong J, Conserve D, Pan S, Tang W. Scaling up HIV self-testing in China and Africa. J Virus Erad 2017; 3:167. [PMID: 28758026 PMCID: PMC5518247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Joseph D Tucker
- Corresponding author: Joseph D Tucker,
University of North Carolina at Chapel Hill Project-ChinaNumber 2 Lujing Road,
Guangzhou,
China,
510095
| | - J Ong
- University of North Carolina at Chapel Hill Project-China,
Guangzhou,
China,London School of Hygiene and Tropical Medicine,
UK
| | - D Conserve
- Arnold School of Public Health,
Columbia, SC,
USA
| | - S Pan
- University of North Carolina at Chapel Hill Project-China,
Guangzhou,
China,University of North Carolina at Chapel Hill, Institute of Global Health and Infectious Diseases,
USA
| | - W Tang
- University of North Carolina at Chapel Hill Project-China,
Guangzhou,
China,University of North Carolina at Chapel Hill, Institute of Global Health and Infectious Diseases,
USA
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12
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Zhong F, Tang W, Cheng W, Lin P, Wu Q, Cai Y, Tang S, Fan L, Zhao Y, Chen X, Mao J, Meng G, Tucker JD, Xu H. Acceptability and feasibility of a social entrepreneurship testing model to promote HIV self-testing and linkage to care among men who have sex with men. HIV Med 2017; 18:376-382. [PMID: 27601301 PMCID: PMC5340630 DOI: 10.1111/hiv.12437] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES HIV self-testing (HIVST) offers an opportunity to increase HIV testing among people not reached by facility-based services. However, the promotion of HIVST is limited as a consequence of insufficient community engagement. We built a social entrepreneurship testing (SET) model to promote HIVST linkage to care among Chinese men who have sex with men (MSM) in Guangzhou. METHODS The SET model includes a few key steps. Each participant first completed an online survey, and paid a US$23 (refundable) deposit to receive an HIVST kit and a syphilis self-testing (SST) kit. After the testing, the results were sent to the platform by the participants and interpreted by Center for Disease Control and Prevention (CDC) staff. Meanwhile, the deposit was returned to each participant. Finally, the Community based organizations (CBO) contacted the participants to provide counselling services, confirmation testing and linkage to care. RESULTS During April-June 2015, a total of 198 MSM completed a preliminary survey and purchased self-testing kits. The majority were aged < 34 years (84.4%) and met partners online (93.1%). In addition, 68.9% of participants had ever been tested for HIV, and 19.5% had ever performed HIVST. Overall, feedback was received from 192 participants (97.0%). Of these participants, 14 people did not use the kits; among those who did use the kits, the HIV and syphilis prevalences were 4.5% (eight of 178) and 3.7% (six of 178), respectively. All of the screened HIV-positive individuals sought further confirmation testing and were linked to care. CONCLUSIONS Using an online SET model to promote HIV and syphilis self-testing among Chinese MSM is acceptable and feasible, and this model adds a new testing platform to the current testing service system.
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Affiliation(s)
- Fei Zhong
- Guangzhou Center for Disease Prevention and Control: FZ, WC, YC, LF, YZ, XC and HX; University of North Carolina Chapel Hill Project-China: WT, ST, JM and JT; Guangdong Center for Disease Prevention and Control: QW and PL; Lingnan Partners Community Support Center (Guangzhou Tongzhi): GM
| | - Weiming Tang
- Guangzhou Center for Disease Prevention and Control: FZ, WC, YC, LF, YZ, XC and HX; University of North Carolina Chapel Hill Project-China: WT, ST, JM and JT; Guangdong Center for Disease Prevention and Control: QW and PL; Lingnan Partners Community Support Center (Guangzhou Tongzhi): GM
| | - Weibin Cheng
- Guangzhou Center for Disease Prevention and Control: FZ, WC, YC, LF, YZ, XC and HX; University of North Carolina Chapel Hill Project-China: WT, ST, JM and JT; Guangdong Center for Disease Prevention and Control: QW and PL; Lingnan Partners Community Support Center (Guangzhou Tongzhi): GM
| | - Peng Lin
- Guangzhou Center for Disease Prevention and Control: FZ, WC, YC, LF, YZ, XC and HX; University of North Carolina Chapel Hill Project-China: WT, ST, JM and JT; Guangdong Center for Disease Prevention and Control: QW and PL; Lingnan Partners Community Support Center (Guangzhou Tongzhi): GM
| | - Qiongmiao Wu
- Guangzhou Center for Disease Prevention and Control: FZ, WC, YC, LF, YZ, XC and HX; University of North Carolina Chapel Hill Project-China: WT, ST, JM and JT; Guangdong Center for Disease Prevention and Control: QW and PL; Lingnan Partners Community Support Center (Guangzhou Tongzhi): GM
| | - Yanshan Cai
- Guangzhou Center for Disease Prevention and Control: FZ, WC, YC, LF, YZ, XC and HX; University of North Carolina Chapel Hill Project-China: WT, ST, JM and JT; Guangdong Center for Disease Prevention and Control: QW and PL; Lingnan Partners Community Support Center (Guangzhou Tongzhi): GM
| | - Songyuan Tang
- Guangzhou Center for Disease Prevention and Control: FZ, WC, YC, LF, YZ, XC and HX; University of North Carolina Chapel Hill Project-China: WT, ST, JM and JT; Guangdong Center for Disease Prevention and Control: QW and PL; Lingnan Partners Community Support Center (Guangzhou Tongzhi): GM
| | - Lirui Fan
- Guangzhou Center for Disease Prevention and Control: FZ, WC, YC, LF, YZ, XC and HX; University of North Carolina Chapel Hill Project-China: WT, ST, JM and JT; Guangdong Center for Disease Prevention and Control: QW and PL; Lingnan Partners Community Support Center (Guangzhou Tongzhi): GM
| | - Yuteng Zhao
- Guangzhou Center for Disease Prevention and Control: FZ, WC, YC, LF, YZ, XC and HX; University of North Carolina Chapel Hill Project-China: WT, ST, JM and JT; Guangdong Center for Disease Prevention and Control: QW and PL; Lingnan Partners Community Support Center (Guangzhou Tongzhi): GM
| | - Xi Chen
- Guangzhou Center for Disease Prevention and Control: FZ, WC, YC, LF, YZ, XC and HX; University of North Carolina Chapel Hill Project-China: WT, ST, JM and JT; Guangdong Center for Disease Prevention and Control: QW and PL; Lingnan Partners Community Support Center (Guangzhou Tongzhi): GM
| | - Jessica Mao
- Guangzhou Center for Disease Prevention and Control: FZ, WC, YC, LF, YZ, XC and HX; University of North Carolina Chapel Hill Project-China: WT, ST, JM and JT; Guangdong Center for Disease Prevention and Control: QW and PL; Lingnan Partners Community Support Center (Guangzhou Tongzhi): GM
| | - Gang Meng
- Guangzhou Center for Disease Prevention and Control: FZ, WC, YC, LF, YZ, XC and HX; University of North Carolina Chapel Hill Project-China: WT, ST, JM and JT; Guangdong Center for Disease Prevention and Control: QW and PL; Lingnan Partners Community Support Center (Guangzhou Tongzhi): GM
| | - Joseph D. Tucker
- Guangzhou Center for Disease Prevention and Control: FZ, WC, YC, LF, YZ, XC and HX; University of North Carolina Chapel Hill Project-China: WT, ST, JM and JT; Guangdong Center for Disease Prevention and Control: QW and PL; Lingnan Partners Community Support Center (Guangzhou Tongzhi): GM
| | - Huifang Xu
- Guangzhou Center for Disease Prevention and Control: FZ, WC, YC, LF, YZ, XC and HX; University of North Carolina Chapel Hill Project-China: WT, ST, JM and JT; Guangdong Center for Disease Prevention and Control: QW and PL; Lingnan Partners Community Support Center (Guangzhou Tongzhi): GM
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Zhang W, Schaffer D, Tso LS, Tang S, Tang W, Huang S, Yang B, Tucker JD. Innovation contests to promote sexual health in China: a qualitative evaluation. BMC Public Health 2017; 17:78. [PMID: 28088211 PMCID: PMC5237489 DOI: 10.1186/s12889-016-4006-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 12/27/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Innovation contests call on non-experts to help solve problems. While these contests have been used extensively in the private sector to increase engagement between organizations and clients, there is little data on the role of innovation contests to promote health campaigns. We implemented an innovation contest in China to increase sexual health awareness among youth and evaluated community engagement in the contest. METHODS The sexual health image contest consisted of an open call for sexual health images, contest promotion activities, judging of entries, and celebrating contributions. Contest promotion activities included in-person and social media feedback, classroom didactics, and community-driven activities. We conducted 19 semi-structured interviews with a purposive sample to ensure a range of participant scores, experts and non-expert participants, submitters and non-submitters. Transcripts of each interview were coded with Atlas.ti and evaluated by three reviewers. RESULTS We identified stages of community engagement in the contest which contributed to public health impact. Community engagement progressed across a continuum from passive, moderate, active, and finally strong engagement. Engagement was a dynamic process that appeared to have little relationship with formally submitting an image to the contest. Among non-expert participants, contest engagement increased knowledge, healthy attitudes, and empowered participants to share ideas about safe sex with others outside of the contest. Among experts who helped organize the contest, the process of implementing the contest fostered multi-sectoral collaboration and re-oriented public health leadership towards more patient-centered public health campaigns. CONCLUSION The results of this study suggest that innovation contests may be a useful tool for public health promotion by enhancing community engagement and re-orienting health campaigns to make them more patient-centered.
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Affiliation(s)
- Wei Zhang
- University of North Carolina Chapel Hill Project-China, No.2 Lujing Road, Guangzhou, 510095 China
| | - David Schaffer
- University of North Carolina Chapel Hill Project-China, No.2 Lujing Road, Guangzhou, 510095 China
| | - Lai Sze Tso
- University of North Carolina Chapel Hill Project-China, No.2 Lujing Road, Guangzhou, 510095 China
| | - Songyuan Tang
- University of North Carolina Chapel Hill Project-China, No.2 Lujing Road, Guangzhou, 510095 China
| | - Weiming Tang
- University of North Carolina Chapel Hill Project-China, No.2 Lujing Road, Guangzhou, 510095 China
| | - Shujie Huang
- Guangdong Provincial Dermatology Hospital, No.2 Lujing Road, Guangzhou, Guangdong China
| | - Bin Yang
- Guangdong Provincial Dermatology Hospital, No.2 Lujing Road, Guangzhou, Guangdong China
| | - Joseph D. Tucker
- University of North Carolina Chapel Hill Project-China, No.2 Lujing Road, Guangzhou, 510095 China
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14
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HIV epidemiology and responses among men who have sex with men and transgender individuals in China: a scoping review. BMC Infect Dis 2016; 16:588. [PMID: 27765021 PMCID: PMC5073436 DOI: 10.1186/s12879-016-1904-5] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 10/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite global efforts to control HIV among key populations, new infections among men who have sex with men (MSM) and transgender (TG) individuals are still increasing. The increasing HIV epidemic among MSM/TG in China indicates that more effective services are urgently needed. However, policymakers and program managers must have a clear understanding of MSM/TG sexual health in China to improve service delivery. To meet this need, we undertook a scoping review to summarize HIV epidemiology and responses among MSM and TG individuals in China. METHODS We searched MEDLINE, EMBASE and the Cochrane Library for recent studies on MSM/TG HIV epidemiology and responses. We also included supplemental articles, grey literature, government reports, policy documents, and best practice guidelines. RESULTS Overall, HIV prevalence among Chinese MSM was approximately 8 % in 2015 with a higher prevalence observed in Southwest China. TG are not captured in national HIV, STD, or other sexual health surveillance systems. There is limited data sharing between the public health authorities and community-based organizations (CBOs). Like other low and middle income countries, China is challenged by low rates of HIV testing, linkage, and retention. Several pilot interventions have been shown to be effective to increase HIV testing among MSM and TG individuals, but have not been widely scaled up. Data from two randomized controlled trials suggests that crowdsourcing contests can increase HIV testing, creating demand for services while engaging communities. CONCLUSION Improving HIV surveillance and expanding HIV interventions for Chinese MSM and TG individuals are essential. Further implementation research is needed to ensure high-quality HIV services for MSM and TG individuals in China.
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15
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Davis A, Meyerson BE, Aghaulor B, Brown K, Watson A, Muessig KE, Yang L, Tucker JD. Barriers to health service access among female migrant Ugandan sex workers in Guangzhou, China. Int J Equity Health 2016; 15:170. [PMID: 27741947 PMCID: PMC5064915 DOI: 10.1186/s12939-016-0453-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 09/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increased trade between China and Uganda has fueled trafficking of female Ugandans into China. These women may face challenges accessing health services. This study focused on examining barriers to health care access among female Ugandan sex workers in China. METHODS In 2014, we undertook in-depth interviews with 19 female Ugandan sex workers in Guangzhou, China. Interviews focused on barriers to health service access and were analyzed using an a priori coding framework followed by open-coding to capture emergent themes. RESULTS Out of 19 women, 12 women reported a history of being trafficked into China. None of the women had a valid Chinese visa. Fear of being arrested for lack of documentation discouraged women in this sample from accessing hospital services. Low pay, housing exploitation, and remittances contributed to participants' lack of financial resources, which further inhibited their ability to access health services. Participants expressed feeling social isolation from the local community and reported mistrust of local individuals and organizations, including hospitals. CONCLUSION Ugandan sex workers in China faced substantial structural barriers that limited health service access. Policy changes and the development of new programs are urgently needed to ensure these women have improved access to health services.
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Affiliation(s)
- Alissa Davis
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality & Health, Columbia University and the New York State Psychiatric Institute, 1051 Riverside Dr, Unit 15, New York, NY 10032 USA
- UNC-Project China, 2 Lujing Road, Guangzhou, China
| | - Beth E. Meyerson
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, 1025 E 7th St. Rm PH116, Bloomington, IN 47405 USA
- Rural Center for AIDS/STD Prevention, Indiana University School of Public Health-Bloomington, Bloomington, USA
| | - Blessing Aghaulor
- School of Medicine, University of North Carolina-Chapel Hill, 321 S Columbia Street, Chapel Hill, NC 27516 USA
| | - Katherine Brown
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco, 505 Parnassus Avenue, Rm. 1483, San Francisco, CA 94143 USA
| | | | - Kathryn E. Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, 306 Rosenau, Campus Box 7440, Chapel Hill, NC 27599 USA
| | - Ligang Yang
- Guangdong Provincial STD Control Center, 2 Lujing Road, 11th Floor, Guangzhou, 510095 China
| | - Joseph D. Tucker
- UNC-Project China, 2 Lujing Road, Guangzhou, China
- School of Medicine, University of North Carolina-Chapel Hill, 321 S Columbia Street, Chapel Hill, NC 27516 USA
- Guangdong Provincial STD Control Center, 2 Lujing Road, 11th Floor, Guangzhou, 510095 China
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16
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Palmer JJ, Gilbert A, Choy M, Blanchet K. Circumventing 'free care' and 'shouting louder': using a health systems approach to study eye health system sustainability in government and mission facilities of north-west Tanzania. Health Res Policy Syst 2016; 14:68. [PMID: 27612454 PMCID: PMC5017067 DOI: 10.1186/s12961-016-0137-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 08/09/2016] [Indexed: 11/21/2022] Open
Abstract
Background Little is known about the contributions of faith-based organisations (FBOs) to health systems in Africa. In the specialist area of eye health, international and domestic Christian FBOs have been important contributors as service providers and donors, but they are also commonly critiqued as having developed eye health systems parallel to government structures which are unsustainable. Methods In this study, we use a health systems approach (quarterly interviews, a participatory sustainability analysis exercise and a social network analysis) to describe the strategies used by eye care practitioners in four hospitals of north-west Tanzania to navigate the government, church mission and donor rules that govern eye services delivery there. Results Practitioners in this region felt eye care was systemically neglected by government and therefore was ‘all under the NGOs’, but support from international donors was also precarious. Practitioners therefore adopted four main strategies to improve the sustainability of their services: (1) maintain ‘sustainability funds’ to retain financial autonomy over income; (2) avoid granting government user fee exemptions to elderly patients who are the majority of service users; (3) expand or contract outreach services as financial circumstances change; and (4) access peer support for problem-solving and advocacy. Mission-based eye teams had greater freedom to increase their income from user fees by not implementing government policies for ‘free care’. Teams in all hospitals, however, found similar strategies to manage their programmes even when their management structures were unique, suggesting the importance of informal rules shared through a peer network in governing eye care in this pluralistic health system. Conclusions Health systems research can generate new evidence on the social dynamics that cross public and private sectors within a local health system. In this area of Tanzania, Christian FBOs’ investments are important, not only in terms of the population health outcomes achieved by teams they support, but also in the diversity of organisational models they contribute to in the wider eye health system, which facilitates innovation. Electronic supplementary material The online version of this article (doi:10.1186/s12961-016-0137-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer J Palmer
- Department of Infectious Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom.,Centre of African Studies, School of Political and Social Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Alice Gilbert
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom
| | - Michelle Choy
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Pl, London, WC1H 9SH, United Kingdom
| | - Karl Blanchet
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Pl, London, WC1H 9SH, United Kingdom.
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Hernández D, Carrión D, Perotte A, Fullilove R. Public health entrepreneurs: training the next generation of public health innovators. Public Health Rep 2015; 129:477-81. [PMID: 25364047 DOI: 10.1177/003335491412900604] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Diana Hernández
- Columbia University, Mailman School of Public Health, Department of Sociomedical Sciences, New York, NY
| | - Daniel Carrión
- Columbia University Medical Center, College of Physicians and Surgeons, New York, NY
| | - Adler Perotte
- Columbia University, Department of Biomedical Informatics and Center for Advanced Information Management, Columbia University Medical Center, New York, NY
| | - Robert Fullilove
- Columbia University, Mailman School of Public Health, Department of Sociomedical Sciences, New York, NY
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18
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Tucker JD, Wei C, Pendse R, Lo YR. HIV self-testing among key populations: an implementation science approach to evaluating self-testing. J Virus Erad 2015. [DOI: 10.1016/s2055-6640(20)31145-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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19
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Tucker JD, Wei C, Pendse R, Lo YR. HIV self-testing among key populations: an implementation science approach to evaluating self-testing. J Virus Erad 2015; 1:38-42. [PMID: 26005717 PMCID: PMC4439005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES To review methods for measuring HIV self-testing (HIVST) among key populations, including both conventional approaches and implementation science approaches. METHODS We reviewed the literature on evaluating HIVST among key populations. RESULTS Simple HIV self-tests have already entered markets in several regions, but metrics required to demonstrate the benefits and costs of HIVST remain simplistic. Conventional measurements of sensitivity, specificity, acceptability, and behavioural preferences must be supplemented with richer implementation science measurement tools and innovative research designs in order to capture data on the following components: how self-testing affects subsequent linkage to confirmatory testing, preventive services and onward steps in the HIV continuum of care; how self-testing can be marketed to reach untested subpopulations; and how self-testing can be sustained based on overarching organisational and financial models. We outline an implementation science research agenda that incorporates these components, drawing from evaluation study designs focused on HIVST and testing in general. CONCLUSION HIVST holds great promise for key populations, but must be guided by implementation research to inform programmes and scale up.
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Affiliation(s)
- Joseph D Tucker
- UNC Project China,
School of Medicine,
University of North Carolina at Chapel Hill,
Guangzhou,
China,Institute of Global Health and Infectious Diseases,
University of North Carolina at Chapel Hill,
Chapel Hill,
USA,Corresponding author: Joseph D. Tucker,
UNC Project-China,
2 Lujing Road,
Guangzhou,
China,
510095
| | - Chongyi Wei
- Department of Epidemiology and Biostatistics,
University of California San Francisco,
San Francisco,
USA
| | - Razia Pendse
- HIV AIDS Unit, Department of Communicable Diseases,
World Health Organization Regional Office for South-East Asia,
New Delhi,
India
| | - Ying-Ru Lo
- HIV and Sexually Transmitted Infection, Division Combating Communicable Diseases,
World Health Organization Regional Office for the Western Pacific,
Manila,
The Philippines
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Tucker JD, Muessig KE, Cui R, Bien CH, Lo EJ, Lee R, Wang K, Han L, Liu FY, Yang LG, Yang B, Larson H, Peeling RW. Organizational characteristics of HIV/syphilis testing services for men who have sex with men in South China: a social entrepreneurship analysis and implications for creating sustainable service models. BMC Infect Dis 2014; 14:601. [PMID: 25422065 PMCID: PMC4247875 DOI: 10.1186/s12879-014-0601-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 10/31/2014] [Indexed: 11/10/2022] Open
Abstract
Background UNAIDS has called for greater HIV/syphilis testing worldwide just as local HIV/syphilis testing programs are cut or altered. New models are needed to make HIV/syphilis testing services sustainable while retaining their essential public health function. Social entrepreneurship, using business principles to promote a social cause, provides a framework to pilot programs that sustainably expand testing. Drawing on fieldwork in two South Chinese cities, we examined organizational and financial characteristics of current HIV/syphilis testing systems for men who have sex with men (MSM) in addition to new pilot programs focused on revenue-generation for sustainability. Methods We undertook a qualitative study to explore organizational and financial characteristics of HIV/syphilis testing for MSM. Data were collected from men who have sex with men and policy stakeholders in Guangzhou and Hong Kong. Framework analysis was used to identify themes and then code the data. Results Our qualitative research study included MSM and policy stakeholders (n = 84). HIV/syphilis testing services were implemented at a wide range of organizations which we grouped broadly as independent community-based organizations (CBOs), independent clinics, and hybrid CBO-clinic sites. From an organizational perspective, hybrid CBO-clinic sites offered the inclusive environment of an MSM CBO linked to the technical capacity and trained staff of a clinic. From a financial perspective, stakeholders expressed concern about the sustainability and effectiveness of sexual health services reliant on external funding. We identified four hybrid CBO-clinic organizations that launched pilot testing programs in order to generate revenue while expanding HIV testing. Conclusion Many MSM CBOs are searching for new organizational models to account for decreased external support. Hybrid CBO-clinic organizations create a strong foundation to increase HIV/syphilis testing using social entrepreneurship models in China. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0601-5) contains supplementary material, which is available to authorized users.
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Saha S. 'More health for the money': an analytical framework for access to health care through microfinance and savings groups. COMMUNITY DEVELOPMENT JOURNAL 2014; 49:618-630. [PMID: 25364028 PMCID: PMC4214457 DOI: 10.1093/cdj/bsu037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The main contributors to inequities in health relates to widespread poverty. Health cannot be achieved without addressing the social determinants of health, and the answer does not lie in the health sector alone. One of the potential pathways to address vulnerabilities linked to poverty, social exclusion, and empowerment of women is aligning health programmes with empowerment interventions linked to access to capital through microfinance and self-help groups. This paper presents a framework to analyse combined health and financial interventions through microfinance programmes in reducing barriers to access health care. If properly designed and ethically managed such integrated programmes can provide more health for the money spent on health care.
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22
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Jennings L. Do men need empowering too? A systematic review of entrepreneurial education and microenterprise development on health disparities among inner-city black male youth. J Urban Health 2014; 91:836-50. [PMID: 25135594 PMCID: PMC4199443 DOI: 10.1007/s11524-014-9898-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Economic strengthening through entrepreneurial and microenterprise development has been shown to mitigate poverty-based health disparities in developing countries. Yet, little is known regarding the impact of similar approaches on disadvantaged U.S. populations, particularly inner-city African-American male youth disproportionately affected by poverty, unemployment, and adverse health outcomes. A systematic literature review was conducted to guide programming and research in this area. Eligible studies were those published in English from 2003 to 2014 which evaluated an entrepreneurial and microenterprise initiative targeting inner-city youth, aged 15 to 24, and which did not exclude male participants. Peer-reviewed publications were identified from two electronic bibliographic databases. A manual search was conducted among web-based gray literature and registered trials not yet published. Among the 26 papers retrieved for review, six met the inclusion criteria and were retained for analysis. None of the 16 registered microenterprise trials were being conducted among disadvantaged populations in the U.S. The available literature suggests that entrepreneurial and microenterprise programs can positively impact youth's economic and psychosocial functioning and result in healthier decision-making. Young black men specifically benefited from increased autonomy, engagement, and risk avoidance. However, such programs are vastly underutilized among U.S. minority youth, and the current evidence is insufficiently descriptive or rigorous to draw definitive conclusions. Many programs described challenges in securing adequate resources, recruiting minority male youth, and sustaining community buy-in. There is an urgent need to increase implementation and evaluation efforts, using innovative and rigorous designs, to improve the low status of greater numbers of African-American male youth.
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Affiliation(s)
- Larissa Jennings
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E5038, Baltimore, MD, 21205, USA,
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Abstract
Suboptimal HIV/STI testing uptake has a profound impact on morbidity and mortality. Incentives have been effective in other areas of medicine and may improve HIV/STI testing uptake rates. This study reviewed the effects of incentives on HIV/STI testing uptake. A systematic search of seven databases was undertaken. Testing uptake was defined as test implementation and/or test result retrieval. Incentives were defined as monetary or non-monetary rewards or free-of-charge testing vouchers. Seven studies were included. All seven studies demonstrated higher rates of uptake in an incentivized group. Incentives offered at a non-clinical setting demonstrated more significant differences in uptake rates compared to incentives offered at a clinical setting. Incentivizing HIV/STI testing uptake, especially testing at a non-clinical setting, may be a useful tool to modify health behavior. Further research is needed to understand how incentives could be an effective component within a comprehensive HIV/STI control strategy.
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Saha S, Annear PL, Pathak S. The effect of Self-Help Groups on access to maternal health services: evidence from rural India. Int J Equity Health 2013; 12:36. [PMID: 23714337 PMCID: PMC3673812 DOI: 10.1186/1475-9276-12-36] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 05/24/2013] [Indexed: 11/25/2022] Open
Abstract
Introduction The main challenge for achieving universal health coverage in India is ensuring effective coverage of poor and vulnerable communities in the face of high levels of income and gender inequity in access to health care. Drawing on the social capital generated through women’s participation in community organizations like SHGs can influence health outcomes. To date, evidence about the impact of SHGs on health outcomes has been derived from pilot-level interventions, some using randomised controlled trials and other rigorous methods. While the evidence from these studies is convincing, our study is the first to analyse the impact of SHGs at national level. Methods We analyzed the entire dataset from the third national District Level Household Survey from 601 districts in India to assess the impact of the presence of SHGs on maternal health service uptake. The primary predictor variable was presence of a SHG in the village. The outcome variables were: institutional delivery; feeding new-borns colostrum; knowledge about family planning methods; and ever used family planning. We controlled for respondent education, wealth, heard or seen health messages, availability of health facilities and the existence of a village health and sanitation committee. Results Stepwise logistic regression shows respondents from villages with a SHG were 19 per cent (OR: 1.19, CI: 1.13-1.24) more likely to have delivered in an institution, 8 per cent (OR: 1.08, CI: 1.05-1.14) more likely to have fed newborns colostrum, have knowledge (OR: 1.48, CI 1.39 – 1.57) and utilized (OR: 1.19, CI 1.11 – 1.27) family planning products and services. These results are significant after controlling for individual and village-level heterogeneities and are consistent with existing literature that the social capital generated through women’s participation in SHGs influences health outcome. Conclusion The study concludes that the presence of SHGs in a village is associated with higher knowledge of family planning and maternal health service uptake in rural India. To achieve the goal of improving public health nationally, there is a need to understand more fully the benefits of systematic collaboration between the public health community and these grassroots organizations.
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Affiliation(s)
- Somen Saha
- Nossal Institute for Global Health, The University of Melbourne, Level 4, Alan Gilbert Building, 161 Barry St, Carlton, Victoria 3010, Australia.
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Point-of-care testing for sexually transmitted infections: recent advances and implications for disease control. Curr Opin Infect Dis 2013; 26:73-9. [PMID: 23242343 DOI: 10.1097/qco.0b013e32835c21b0] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Sexually transmitted infections (STIs) remain a major global public health issue, with more than 448 million incident bacterial infections each year. We review recent advances in STI point-of-care (POC) testing and implications for STI prevention and control. RECENT FINDINGS Accurate immunochromatographic assays to detect HIV, hepatitis C virus (HCV) and syphilis antibodies have made home or supervised self-testing possible. Several studies have demonstrated feasibility and excellent test characteristics for HIV, HCV and syphilis POC tests. Rapid oral HIV tests are now available for purchase at retail sites across the United States. Combined HIV and syphilis tests using a single finger prick blood sample are under evaluation. SUMMARY Oral POC STI tests with comparable performance to blood-based POC tests are available for self-testing. POC tests can expand screening, improve syndromic management and reduce loss to follow up. POC STI tests have the potential to facilitate prompt treatment and partner services. POC STI tests create opportunities for new social and financial models of community-based testing services. Increasing equity and access to testing will create challenges in linkage to care, quality assurance, partner services and surveillance. These important developments warrant research to understand appropriate contexts for implementation.
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Tucker JD, Bien CH, Peeling RW. Point-of-care testing for sexually transmitted infections: recent advances and implications for disease control. Curr Opin Infect Dis 2013; 26:73-79. [PMID: 23242343 DOI: 10.1097/qc0.0b013e32835c21b0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE OF REVIEW Sexually transmitted infections (STIs) remain a major global public health issue, with more than 448 million incident bacterial infections each year. We review recent advances in STI point-of-care (POC) testing and implications for STI prevention and control. RECENT FINDINGS Accurate immunochromatographic assays to detect HIV, hepatitis C virus (HCV) and syphilis antibodies have made home or supervised self-testing possible. Several studies have demonstrated feasibility and excellent test characteristics for HIV, HCV and syphilis POC tests. Rapid oral HIV tests are now available for purchase at retail sites across the United States. Combined HIV and syphilis tests using a single finger prick blood sample are under evaluation. SUMMARY Oral POC STI tests with comparable performance to blood-based POC tests are available for self-testing. POC tests can expand screening, improve syndromic management and reduce loss to follow up. POC STI tests have the potential to facilitate prompt treatment and partner services. POC STI tests create opportunities for new social and financial models of community-based testing services. Increasing equity and access to testing will create challenges in linkage to care, quality assurance, partner services and surveillance. These important developments warrant research to understand appropriate contexts for implementation.
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Affiliation(s)
- Joseph D Tucker
- UNC Project-China, Guangdong Provincial STD Control Center, Guangzhou, China
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