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Bassi S, Bahl D, Maity H, Dringus S, Rizvi ZA, Kumar D, Raina A, Arora M. Engagement of Peer Educators from India's National Adolescent Health Programme for the COVID-19 response activities: Qualitative findings from i-Saathiya study. BMJ Open 2024; 14:e084416. [PMID: 39134439 DOI: 10.1136/bmjopen-2024-084416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic strained India's healthcare system and health workers unprecedentedly. PURPOSE The extent of the contribution by peer educators (PEs) from India's National Adolescent Health Programme-Rashtriya Kishor Swasthya Karyakram (RKSK) to COVID-19 response activities remains uncertain necessitating an imperative investigation. Within the overarching objective of the 'i-Saathiya' study ('i' signifies implementation science and Saathiya represents PEs in Madhya Pradesh), a key focus was to understand the role of PEs recruited under RKSK during COVID-19 in two Indian states, namely Madhya Pradesh and Maharashtra. The study states differ in sociodemographic characteristics and peer education implementation models. METHODS In-depth interviews (IDIs) were conducted with stakeholders (n=110, Maharashtra: 57; Madhya Pradesh: 53) engaged in the implementation of RKSK's peer education programme at state, district, block and village levels. Focus group discussions (FGDs) (n=16 adolescents, Maharashtra: 8; Madhya Pradesh: 8) were conducted with adolescents, part of the peer group of PEs (n=120 adolescents, Maharashtra: 66; Madhya Pradesh: 54). IDIs and FGDs were audio-recorded, translated, transcribed verbatim and analysed thematically. Adopting inductive and deductive approaches, a data-driven open coding framework was developed for thematic analysis. RESULTS The PE recruited under RKSK took a central role that extended beyond their predefined responsibilities within the RKSK. They provided crucial support to healthcare workers in curbing the spread of COVID-19. Their diverse contributions, including COVID-19 pandemic response support, addressing community and adolescent needs, role in COVID-19 vaccination efforts, navigating access to the health system and facilitating health workers in the implementation of various national health programmes and campaigns during COVID-19. CONCLUSION The findings underscore the potential of PEs in bolstering the health system. Despite their unpreparedness for the context (COVID-19), PEs demonstrated tenacity and adaptability, extending their roles beyond their predefined responsibilities. Recognising PEs through awards and incentives, skill courses and additional grades, can enhance their visibility, sustaining impactful work within RKSK and beyond.
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Affiliation(s)
| | - Deepika Bahl
- Public Health Foundation of India, New Delhi, India
| | - Heeya Maity
- Public Health Foundation of India, New Delhi, India
| | | | - Zoya Ali Rizvi
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Deepak Kumar
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Agrima Raina
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Monika Arora
- Public Health Foundation of India, New Delhi, India
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Khizar M, Ruel-Bergeron J, Zavala E, Chang K, Kang Y, de Pee S, Black RE, Christian P. Delivery platforms for reaching adolescents with nutrition interventions in low- and middle-income countries. Ann N Y Acad Sci 2024. [PMID: 39116286 DOI: 10.1111/nyas.15196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Adolescents in low- and middle-income countries (LMICs) are a vulnerable population given increased nutritional needs as puberty approaches. School-based nutrition programs exist in some settings, but the comprehensive provision of nutrition services requires knowledge of the mechanisms to reach out-of-school adolescents. A comprehensive scoping review was performed using formal and informal search strategies to landscape all potential delivery platforms with nutrition services to reach adolescents. Peer-reviewed studies, institutional strategies, program evaluations, and programmatic reports in LMICs were reviewed, including gray literature. A total of 87 out of 270 identified publications and reports describing nutrition programs for adolescents were identified. Although nutrition programs targeted at adolescents were sparse, various innovative and inclusive delivery platforms were included, such as school feeding programs, school-based anemia control, and nutrition-friendly school initiatives; health facility-based, youth-friendly health and nutrition services; social safety nets targeted at adolescents; community-based approaches targeting youth development and peer education within youth centers and faith-based settings; and technology-based platforms, including digital health services and mass media communication sensitization and mobilization efforts. Existing delivery mechanisms and platforms in health and other sectors that target adolescents offer great potential to extend nutrition interventions to this vulnerable yet hard-to-reach population.
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Affiliation(s)
- Mahum Khizar
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Eleonor Zavala
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Karen Chang
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yunhee Kang
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Saskia de Pee
- Nutrition Division, United Nations World Food Programme, Rome, Italy
| | - Robert E Black
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Parul Christian
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Benoni R, Malesani C, Sartorello A, Cardoso H, Chaguruca I, Alamo C, Putoto G, Brigadoi G, Zin A, Donà D, Giaquinto C, Gatta M. Assessing the impact of a community-based psychodrama intervention on mental health promotion of adolescents and young adults in Mozambique: A mixed-methods study. J Glob Health 2024; 14:04182. [PMID: 39051689 PMCID: PMC11271167 DOI: 10.7189/jogh.14.04182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
Background While mental health is an emerging issue in low-income countries, its promotion remains poor, with little context-oriented evidence available. Here we aimed to assess the impact and acceptability/feasibility of a community-based psychodrama intervention involving both adolescents and young adults (AYA) living with HIV (AYALHIV) and without HIV (AYAHIV-). Methods We used a mixed-methods approach, where the quantitative part was based on pre/post questionnaires and the qualitative one on content analysis of semi-structured interviews. Trained community health care workers delivered psychodrama sessions involving AYAs aged 15-24 years once a week between July and August 2023 in Beira, Mozambique. The baseline assessment involved a sociodemographic and three mental health questionnaires: the Mental Health Knowledge Schedule (MAKS), Community Attitudes toward People with Mental Illness (CAMI27), and the Toronto Alexithymia Scale (TAS). We repeated all questionnaires after the intervention and conducted semi-structured interviews. Results We enrolled 354 AYAs (50.8% female, 45.5% AYALHIV) at baseline; 315 (89.0%) attended the sessions, with a mean participation rate of 94.4%. Overall, 281 (89.2%) completed the post-intervention assessment. MAKS score improved from 44.5 (95% confidence interval (CI) = 44.0-45.0) to 47.1 (95% CI = 46.4-47.7, P < 0.001). Total CAMI27 score showed no significant variation (P = 0.855). Total TAS score decreased from 57.3 (95% CI = 56.1-58.5) to 54.3 (95% CI = 53.0-55.6, P < 0.001). We found no statistically significant interactions between time and sex, age, or HIV serostatus in all questionnaires. For the qualitative part of the study, we analysed 37 semi-structured interviews (43.2% with females, 40.5% with AYALHIV). We identified four areas of intervention impact: peer-to-peer support (30.3%), social empowerment (24.7%), resilience (23.0%), and emotional skills (21.9%). Regarding acceptability/feasibility, perceived scalability (37.2%) and affective attitude (34.5%) were the sub-areas most frequently retrieved in the SSIs. Conclusions The community-based psychodrama intervention proved to be an effective tool in AYAs' mental health promotion, increasing knowledge and improving emotional awareness through group experience and interpersonal learning. The intervention also showed good acceptability and feasibility in the context of our study.
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Affiliation(s)
- Roberto Benoni
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padua, Padua, Italy
- Doctors with Africa CUAMM, Beira, Mozambique
- Section of Hygiene, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Chiara Malesani
- Doctors with Africa CUAMM, Beira, Mozambique
- Child and Adolescent Neuropsychiatry Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Anna Sartorello
- Doctors with Africa CUAMM, Beira, Mozambique
- Section of Hygiene, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | | | | | - Giovanni Putoto
- Section of Operational Research, Doctors with Africa CUAMM, Padova, Italy
| | - Giulia Brigadoi
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Annachiara Zin
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Michela Gatta
- Child and Adolescent Neuropsychiatry Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
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Brooke-Sumner C, Machisa MT, Sikweyiya Y, Mahlangu P. Group-format, peer-facilitated mental health promotion interventions for students in higher education settings: a scoping review protocol. BMJ Open 2024; 14:e080629. [PMID: 38830731 PMCID: PMC11149131 DOI: 10.1136/bmjopen-2023-080629] [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: 10/06/2023] [Accepted: 05/16/2024] [Indexed: 06/05/2024] Open
Abstract
INTRODUCTION Young people in higher education face various stressors that can make them vulnerable to mental ill-health. Mental health promotion in this group therefore has important potential benefits. Peer-facilitated and group-format interventions may be feasible and sustainable. The scoping review outlined in this protocol aims to map the literature on group-format, peer-facilitated, in-person interventions for mental health promotion for higher education students attending courses on campuses in high and low/middle-income countries. METHODS AND ANALYSIS Relevant studies will be identified through conducting searches of electronic databases, including Medline, CINAHL, Scopus, ERIC and PsycINFO. Searches will be conducted using Boolean operators (AND, OR, NOT) and truncation functions appropriate for each database. We will include a grey literature search. We will include articles from student participants of any gender, and published in peer-reviewed journals between 2008 and 2023. We will include English-language studies and all study types including randomised controlled trials, pilot studies and descriptive studies of intervention development. A draft charting table has been developed, which includes the fields: author, publication date, country/countries, aims, population and sample size, demographics, methods, intervention type, comparisons, peer training, number of sessions/duration of intervention, outcomes and details of measures. ETHICS AND DISSEMINATION No primary data will be collected from research participants to produce this review so ethics committee approval is not required. All data will be collated from published peer-reviewed studies already in the public domain. We will publish the review in an open-access, peer-reviewed journal accessible to researchers in low/middle-income countries. This protocol is registered on Open Science Framework (https://osf.io/agbfj/).
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Affiliation(s)
- Carrie Brooke-Sumner
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Nursing and Public Health, College of Health Sciences, Howard College Campus, University of KwaZulu Natal, Durban, South Africa
| | - Mercilene T Machisa
- School of Nursing and Public Health, College of Health Sciences, Howard College Campus, University of KwaZulu Natal, Durban, South Africa
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Yandisa Sikweyiya
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Pinky Mahlangu
- School of Nursing and Public Health, College of Health Sciences, Howard College Campus, University of KwaZulu Natal, Durban, South Africa
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
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Ahmed CV, Doyle R, Gallagher D, Imoohi O, Ofoegbu U, Wright R, Yore MA, Brooks MJ, Flores DD, Lowenthal ED, Rice BM, Buttenheim AM. A Systematic Review of Peer Support Interventions for Adolescents Living with HIV in Sub-Saharan Africa. AIDS Patient Care STDS 2023; 37:535-559. [PMID: 37956242 DOI: 10.1089/apc.2023.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
Despite widespread availability of life-saving antiretroviral therapy (ART) in sub-Saharan Africa, AIDS remains one of the leading causes of death among adolescents living with HIV (ALHIV) in sub-Saharan Africa. The purpose of this article was to review the state of the science regarding interventions to improve ART adherence and/or HIV care retention among ALHIV throughout sub-Saharan Africa. The primary aim of this review was to describe the impact of peer support interventions in improving treatment outcomes (i.e., ART adherence and retention in HIV care) among ALHIV in sub-Saharan Africa. The secondary aim of this review was to determine whether these interventions may be efficacious at improving mental health outcomes. We identified 27 articles that met the eligibility criteria for our review, and categorized each article based on the type of peer support provided to ALHIV-individualized peer support, group-based support, and individualized plus group-based support. Results regarding the efficacy of these interventions are mixed and most of the studies included were deemed moderate in methodological quality. Although studies evaluating group-based peer support interventions were the most common, most of these studies were not associated with retention, adherence, or mental health outcomes. More robust, fully powered studies are needed to strengthen our knowledge base regarding peer support for ALHIV.
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Affiliation(s)
- Charisse V Ahmed
- National Clinician Scholars Program, Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
| | - Rebecca Doyle
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Darby Gallagher
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Olore Imoohi
- Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
| | - Ugochi Ofoegbu
- Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
| | - Robyn Wright
- Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
| | - Mackensie A Yore
- VA Los Angeles and UCLA National Clinician Scholars Program, VA Greater Los Angeles Healthcare System HSR&D Center of Innovation, Los Angeles, California, USA
| | - Merrian J Brooks
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Botswana UPENN Partnership, Gaborone, Botswana
| | | | - Elizabeth D Lowenthal
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Bridgette M Rice
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania, USA
| | - Alison M Buttenheim
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Mthiyane N, Rapulana AM, Harling G, Copas A, Shahmanesh M. Effect of multi-level interventions on mental health outcomes among adolescents in sub-Saharan Africa: a systematic review. BMJ Open 2023; 13:e066586. [PMID: 37788931 PMCID: PMC10551963 DOI: 10.1136/bmjopen-2022-066586] [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: 07/28/2022] [Accepted: 08/09/2023] [Indexed: 10/05/2023] Open
Abstract
OBJECTIVE In sub-Saharan Africa (SSA), multiple factors contribute to the considerable burden of mental health disorders among adolescents, highlighting the need for interventions that address underlying risks at multiple levels. We reviewed evidence of the effectiveness of community or family-level interventions, with and without individual level interventions, on mental health disorders among adolescents in SSA. DESIGN Systematic review using the Grades of Recommendation, Assessment, Development and Evaluation approach. DATA SOURCES A systematic search was conducted on Cochrane Library, MEDLINE, EMBASE, PSYCINFO and Web of Science up to 31 March 2021. ELIGIBILITY CRITERIA Studies were eligible for inclusion in the review if they were randomised controlled trials (RCTs) or controlled quasi-experimental studies conducted in sub-Saharan African countries and measured the effect of an intervention on common mental disorders in adolescents aged 10-24 years. DATA EXTRACTION AND SYNTHESIS We included studies that assessed the effect of interventions on depression, anxiety, post-traumatic stress disorder and substance abuse. Substance abuse was only considered if it was measured alongside mental health disorders. The findings were summarised using synthesis without meta-analysis, where studies were grouped according to the type of intervention (multi-level, community-level) and participants. RESULTS Of 1197 studies that were identified, 30 studies (17 RCTs and 3 quasi-experimental studies) were included in the review of which 10 delivered multi-level interventions and 20 delivered community-level interventions. Synthesised findings suggest that multi-level interventions comprise economic empowerment, peer-support, cognitive behavioural therapy were effective in improving mental health among vulnerable adolescents. Majority of studies that delivered interventions to community groups reported significant positive changes in mental health outcomes. CONCLUSIONS The evidence from this review suggests that multi-level interventions can reduce mental health disorders in adolescents. Further research is needed to understand the reliability and sustainability of these promising interventions in different African contexts. PROSPERO REGISTRATION NUMBER CRD42021258826.
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Affiliation(s)
- Nondumiso Mthiyane
- Africa Health Research Institute, Durban, South Africa
- Institute for Global Health, University College London, London, UK
| | - Antony M Rapulana
- Africa Health Research Institute, Durban, South Africa
- School of Laboratory Medicine and Medical Science, University of KwaZulu-Natal, Durban, South Africa
| | - Guy Harling
- Africa Health Research Institute, Durban, South Africa
- Institute for Global Health, University College London, London, UK
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology & Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | - Maryam Shahmanesh
- Africa Health Research Institute, Durban, South Africa
- Institute for Global Health, University College London, London, UK
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Magno L, Soares F, Zucchi EM, Eustórgio M, Grangeiro A, Ferraz D, Greco D, Escuder MM, Dourado I. Reaching Out to Adolescents at High Risk of HIV Infection in Brazil: Demand Creation Strategies for PrEP and Other HIV Combination Prevention Methods. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:703-719. [PMID: 35876978 PMCID: PMC9310684 DOI: 10.1007/s10508-022-02371-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 06/13/2022] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
Using baseline data from the PrEP1519 cohort, in this article we aimed to analyze: (i) the effectiveness of demand creation strategies (DCS) to enroll adolescent men who have sex with men (AMSM) and adolescent transgender women (ATGW) into an HIV combination prevention study in Brazil; (ii) the predictors of DCS for adolescents' enrollment; and (iii) the factors associated with DCS by comparing online and face-to-face strategies for enrollment. The DCS included peer recruitment (i.e., online and face-to-face) and referrals from health services and non-governmental organizations (NGOs). AMSM and ATGW who agreed to participate in the study could opt to enroll in either PrEP (PrEP arm) or to use other prevention methods (non-PrEP arm). Bivariate and multivariate analyses were conducted and logistic regression odds ratios were estimated. The DCS reached 4529 AMSM and ATGW, the majority of which were derived online (73.8%). Of this total, 935 (20.6%) enrolled to participate (76.6% in PrEP arm and 23.4% in non-PrEP arm). The effectiveness of enrolling adolescents into both arms was greater via direct referrals (235/382 and 84/382, respectively) and face-to-face peer recruitment (139/670 and 35/670, respectively) than online (328/3342). We found that a combination under DCS was required for successful enrollment in PrEP, with online strategies majorly tending to enroll adolescents of a higher socioeconomic status. Our findings reinforce the need for DCS that actively reaches out to all adolescents at the greatest risk for HIV infection, irrespective of their socioeconomic status.
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Affiliation(s)
- Laio Magno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Rua Silveira Martins, 2555, Cabula41.150-000, Salvador, Bahia, Brazil.
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
| | - Fabiane Soares
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Eliana Miura Zucchi
- Programa de Pós-Graduação em Saúde Coletiva, Mestrado Profissional em Psicologia e Políticas Públicas, Universidade Católica de Santos, São Paulo, Santos, Brazil
| | - Marcos Eustórgio
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Alexandre Grangeiro
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Dulce Ferraz
- Escola FIOCRUZ de Governo, Fundação Oswaldo Cruz, Brasília, Distrito Federal, Brazil
| | - Dirceu Greco
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Ines Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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Antelman G, Jahanpour O, Machalo T, Audi C, van de Ven R, Rutaihwa M, Lankiewicz E, Baird S. Adolescent support club attendance and self-efficacy associated with HIV treatment outcomes in Tanzania. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000065. [PMID: 36962483 PMCID: PMC10021176 DOI: 10.1371/journal.pgph.0000065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 09/07/2022] [Indexed: 06/18/2023]
Abstract
HIV treatment outcomes may be improved by ameliorating psychosocial challenges adolescents living with HIV (ALHIV) face. This analysis describes participation in existing facility-based adolescent clubs and the associations between club attendance, adolescent well-being and HIV treatment outcomes. Data were collected through interviews with a sub-sample of adolescents age 10-19 years and medical record abstraction of all adolescents attending HIV services at seven clinics in Tanzania. Independent variables included adolescent club attendance, self-esteem, self-efficacy, mental distress, social capital and other health utilization or HIV experience characteristics. Study outcomes included visit adherence, viral suppression (<1000 cp/ml), and retention. Of 645 adolescents attending HIV services, 75% attended clubs at least once with a median of eight club sessions attended over a two-year period. Mental distress was prevalent, with 67% of the adolescents scoring above a recognized cut-off of ≥5. Adolescents who attended 10 or more clubs, compared to those not attending any clubs over a two-year period were at an almost three-fold increased odds of having good visit adherence (odds ratio [OR] 2.72, 95% confidence interval [CI]: 1.25, 5.94). Club attendance was also associated with sustained retention in the following year: adolescents who attended some clubs (1-9) had three-times the odds of being retained (OR 3.01; 95%CI: 1.86, 4.87) while those who attended 10+ had over seven-times the odds (OR 7.29; 95%CI: 4.34, 12.22). Among the 154 adolescents who were interviewed, being in the top self-efficacy tertile was positively associated with viral suppression (OR 3.04, 95%CI: 1.08, 8.60) and retention (OR 4.44, 95%CI: 1.19, 17.40). Attending the HIV clinic with a guardian/treatment supporter (OR 3.29, 95%CI: 1.17, 9.22) was also associated with viral suppression. Self-efficacy, social capital and treatment support are associated with better health outcomes among adolescents. However, many ALHIV either never attended or did not regularly attend clubs.
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Affiliation(s)
| | - Ola Jahanpour
- Elizabeth Glaser Pediatric AID Foundation, Dar es Salaam, Tanzania
| | - Thomas Machalo
- Elizabeth Glaser Pediatric AID Foundation, Dar es Salaam, Tanzania
| | - Cosette Audi
- Elizabeth Glaser Pediatric AID Foundation, Washington, DC, United States of America
| | | | | | - Elise Lankiewicz
- Milken Institute School of Public Health, George Washington University, Washington, DC, United States of America
| | - Sarah Baird
- Milken Institute School of Public Health, George Washington University, Washington, DC, United States of America
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Effectiveness and implementation outcomes for peer-delivered mental health interventions in low- and middle-income countries: a mixed-methods systematic review. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1731-1747. [PMID: 35484436 DOI: 10.1007/s00127-022-02294-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE This review aimed to evaluate interventions led by peer counselors (PCs) for adults with common mental disorders in low- and middle-income countries (LMICs) along indices of overall effectiveness and key implementation outcomes (acceptability, feasibility, cost, fidelity, sustainability). METHODS This review followed a mixed-methods systematic review design. MEDLINE/PubMed, Embase, PsycINFO, and Global Health databases were searched for PC-led interventions for adults in LMICs targeting depressive and/or anxiety disorders or PTSD. Quantitative data was narratively synthesized, and qualitative data was thematically synthesized separately. The results from the qualitative and quantitative syntheses were then combined in a cross-study synthesis. RESULTS Twenty-four papers describing thirteen PC-led interventions were included for review. Narrative synthesis results indicated mixed effectiveness of PC-led interventions in reducing depressive, anxiety, PTSD symptoms and high PC competency. Thematic synthesis revealed five descriptive themes: (1) Preferred PC characteristics; (2) Incentives and motivation for PCs; (3) Barriers to PC-led intervention implementation; (4) Helpful supervision/training practices; and (5) Overall high acceptability of PC-led interventions. Cross-study synthesis revealed high acceptability, feasibility, and fidelity, but cost and sustainability outcomes were underreported in included papers. CONCLUSION PC-led interventions seem to show initial promise in terms of effectiveness, acceptability, feasibility, cost, fidelity, and sustainability. Future research should focus on standardizing measurements of implementation outcomes to facilitate cross-study analysis. Additional empirical attention should be paid to underrepresented implementation outcomes (e.g., cost, sustainability). Finally, researchers should adopt a participatory approach that elevates the perspectives of PCs throughout all stages of the implementation process.
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Topping KJ. Peer Education and Peer Counselling for Health and Well-Being: A Review of Reviews. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106064. [PMID: 35627601 PMCID: PMC9140904 DOI: 10.3390/ijerph19106064] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/09/2022] [Accepted: 05/16/2022] [Indexed: 02/04/2023]
Abstract
Peer education and peer counselling for health and wellbeing have been recognized as complementary approaches to professional intervention for over 50 years, but it is relatively recently that research into effects has become adequate. Potentially, they have advantages in reaching where professionals cannot, but it has not been clear if that potential is fulfilled, although the measurement of effects is difficult. The present paper examines 58 narrative and systematic reviews and meta-analyses on the topic. In peer education, there were many reviews of sexual health and of HIV/AIDS interventions, followed by reviews of various medical conditions and in the context of prisons. More general reviews covered a wider field. In peer counselling, there were several reviews of breast-feeding and mental health. Many early reviews complained of the lack of evaluation; then, later reviews found knowledge gains but not behavior gains; then, still later reviews found both knowledge and behavior gains. Thus, peer education and counselling appear effective but only if organizational factors are well managed and the cultural context of the country respected. The implications for future practice, policy and research were outlined.
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Harrison L, Sharma N, Irfan O, Zaman M, Vaivada T, Bhutta ZA. Mental Health and Positive Development Prevention Interventions: Overview of Systematic Reviews. Pediatrics 2022; 149:186940. [PMID: 35503329 DOI: 10.1542/peds.2021-053852g] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
CONTEXT Previous reviews of mental health interventions have focused on adolescents (10-19 years), with a paucity of comprehensive evidence syntheses on preventive interventions for school-aged children (5-10 years). OBJECTIVE To summarize and synthesize the available evidence from systematic reviews of mental health and positive development interventions for children aged 5-14.9 years in both high-income (HIC) and low- and middle-income countries (LMIC), with a focus on preventive and promotive strategies. DATA SOURCES This overview includes all relevant reviews from OVID Medline, The Cochrane Library, and Campbell Systematic Reviews through December 2020. STUDY SELECTION We included systematic reviews that synthesized empirical studies using experimental or quasi-experimental designs to evaluate the effectiveness of interventions in children aged 5-14.9 years. DATA EXTRACTION Data extraction and quality assessment were completed independently and in duplicate by two review authors. The AMSTAR2 tool was used to assess methodological quality. RESULTS We included 162 reviews. The greatest evidence was found in support of school-based universal and anti-bullying interventions in predominantly HIC. Moderate evidence was found for the use of substance abuse prevention, and early learning and positive development interventions in mixed settings. In LMIC-only contexts, the most promising evidence was found for positive youth development programs. LIMITATIONS The review was primarily limited by paucity of high-quality research due to methodological issues and high heterogeneity. CONCLUSIONS This overview of reviews highlights the need for further research to consolidate findings and understand the specific criteria involved in creating positive mental health and development outcomes from the various interventions considered.
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Affiliation(s)
- Leila Harrison
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Naeha Sharma
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Omar Irfan
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Michele Zaman
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Tyler Vaivada
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Center of Excellence in Women and Child Health, Institute for Global Health & Development, Aga Khan University Hospital, Karachi, Pakistan
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Peltonen K, Aalto S, Vänskä M, Lepistö R, Punamäki RL, Soye E, Watters C, de Wal Pastoor L, Derluyn I, Kankaanpää R. Effectiveness of Promotive and Preventive Psychosocial Interventions on Improving the Mental Health of Finnish-Born and Immigrant Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063686. [PMID: 35329374 PMCID: PMC8955200 DOI: 10.3390/ijerph19063686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 01/27/2023]
Abstract
Background: Schools are considered natural environments in which to enhance students’ social–emotional skills and mental health in general, but they can be especially important for students with refugee and immigrant backgrounds. The current study tested the effectiveness of two school-based interventions in enhancing the mental health and wellbeing of adolescents of native, refugee, and immigrant backgrounds. It further analyzed the role of age, gender, daily stressors, and discrimination in affecting the interventions’ effectiveness. Methods: A three-arm cluster RCT with parallel assignment was applied among the 16 schools. Schools were randomized to three conditions of two active interventions and a waiting-list control condition. Students (n = 1974) filled in an online questionnaire at baseline before the interventions, after the interventions, and at follow-up an average of 9 months after the interventions. The effectiveness criteria were internalizing and externalizing problems, resilience, and prosocial behavior. Results: Interventions were generally not effective in decreasing mental health problems and increasing psychosocial resources. The expected positive intervention effects were dependent on students’ age and gender and exposure to socioeconomic daily stressors. Conclusion: Interventions enhancing teacher awareness and peer relationships at school should be carefully tailored according to the strengths and vulnerabilities of participating students, especially their daily stress exposure, but also age and gender.
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Affiliation(s)
- Kirsi Peltonen
- Department of Child Psychiatry, University of Turku, 20014 Turku, Finland
- INVEST Research Flagship Center, University of Turku, 20014 Turku, Finland
- Faculty of Social Sciences/Psychology, Tampere University, 33100 Tampere, Finland; (S.A.); (M.V.); (R.L.); (R.-L.P.); (R.K.)
- Correspondence:
| | - Sanni Aalto
- Faculty of Social Sciences/Psychology, Tampere University, 33100 Tampere, Finland; (S.A.); (M.V.); (R.L.); (R.-L.P.); (R.K.)
| | - Mervi Vänskä
- Faculty of Social Sciences/Psychology, Tampere University, 33100 Tampere, Finland; (S.A.); (M.V.); (R.L.); (R.-L.P.); (R.K.)
| | - Riina Lepistö
- Faculty of Social Sciences/Psychology, Tampere University, 33100 Tampere, Finland; (S.A.); (M.V.); (R.L.); (R.-L.P.); (R.K.)
| | - Raija-Leena Punamäki
- Faculty of Social Sciences/Psychology, Tampere University, 33100 Tampere, Finland; (S.A.); (M.V.); (R.L.); (R.-L.P.); (R.K.)
| | - Emma Soye
- School of Education and Social Work, University of Sussex, Falmer Brighton BN1 9RH, UK; (E.S.); (C.W.)
| | - Charles Watters
- School of Education and Social Work, University of Sussex, Falmer Brighton BN1 9RH, UK; (E.S.); (C.W.)
| | - Lutine de Wal Pastoor
- Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen, 1353 Copenhagen, Denmark;
| | - Ilse Derluyn
- Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, 9000 Gent, Belgium;
| | - Reeta Kankaanpää
- Faculty of Social Sciences/Psychology, Tampere University, 33100 Tampere, Finland; (S.A.); (M.V.); (R.L.); (R.-L.P.); (R.K.)
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13
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Anvari MS, Belus JM, Kleinman MB, Seitz-Brown CJ, Felton JW, Dean D, Ciya N, Magidson JF. How to incorporate lived experience into evidence-based interventions: assessing fidelity for peer-delivered substance use interventions in local and global resource-limited settings. TRANSLATIONAL ISSUES IN PSYCHOLOGICAL SCIENCE 2022; 8:153-163. [PMID: 37900977 PMCID: PMC10611440 DOI: 10.1037/tps0000305] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Interventions led by peer recovery specialists (PRSs) have rapidly expanded in response to a global shortage of access to substance use treatment. However, there is a lack of guidance on how to incorporate PRSs' lived experience into the delivery of evidence-based interventions (EBIs). Moreover, few resources exist to assess fidelity that integrate both content fidelity, peer competence, and incorporation of lived experience (i.e., PRS role fidelity). This study aimed to: (1) describe a novel PRS fidelity monitoring approach to assess both content and PRS role fidelity; (2) compare independent rater and PRS-self-reported content fidelity; (3) examine associations between content and PRS role fidelity; and (4) assess whether the PRS role fidelity was associated with substance use at post-treatment. This study was conducted across two PRS-led behavioral intervention trials conducted in global resource-limited settings: Baltimore City, US, and Khayelitsha, South Africa. A significant difference was found between PRS- and independent rater content fidelity in both interventions, with PRSs reporting significantly higher content fidelity in both sites. PRS role and content fidelity were not significantly correlated, suggesting greater adherence to the PRS role is not associated with lower adherence to structured EBI content. PRS role fidelity was not significantly associated with substance use at post-treatment. This study provides an important step towards understanding how to assess PRS role fidelity in the context of EBIs for underserved individuals with SUD that also incorporates their lived experience.
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Affiliation(s)
| | | | | | - CJ Seitz-Brown
- Department of Psychology, University of Maryland, College Park
| | - Julia W. Felton
- Center for Health Policy & Health Services Research, Henry Ford Health Systems
| | - Dwayne Dean
- Department of Psychology, University of Maryland, College Park
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14
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Lowe H, Dobbin J, Kiss L, Mak J, Mannell J, Watson D, Devakumar D. Mechanisms for the prevention of adolescent intimate partner violence: A realist review of interventions in low- and middle-income countries. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001230. [PMID: 36962608 PMCID: PMC10022317 DOI: 10.1371/journal.pgph.0001230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/09/2022] [Indexed: 03/26/2023]
Abstract
Adolescent girls are among those at the greatest risk of experiencing intimate partner violence (IPV). Despite adolescence being widely regarded as a window of opportunity to influence attitudes and behaviours related to gender equality, evidence on what works to prevent IPV at this critical stage is limited outside of high-income, school-based settings. Even less is understood about the mechanisms of change in these interventions. We conducted a realist review of primary prevention interventions for adolescent IPV in low- and middle-income countries (LMICs) to synthesise evidence on how they work, for whom, and under which circumstances. The review took place in four iterative stages: 1) exploratory scoping, 2) developing initial programme theory, 3) systematic database search, screening and extraction, and 4) purposive searching and refinement of programme theory. We identified eleven adolescent IPV prevention interventions in LMICs, most of which demonstrated a positive impact on IPV experience and/or perpetration (n = 10). Most interventions (n = 9) implemented school- or community-based interactive peer-group education to transform attitudes and norms around gender and relationships for behaviour change. The central mechanism of change related to gender transformative content prompting adolescents to critically reflect on their attitudes and relationships, leading to a reconceptualisation of their values and beliefs. This central mechanism was supported by two secondary implementation mechanisms: 1) the design and delivery of interventions: interactive, age-appropriate education delivered in peer-groups provided adolescents a safe space to engage with content and build communication skills, and 2) the target group: social norms interventions targeting the wider community created enabling environments supportive of individual change. This review highlights the immense potential of gender transformative interventions during the critical period of adolescence for IPV prevention. Future interventions should consider the broader drivers of adolescent IPV and ensure intersectionality informed approaches to maximise their potential to capitalise on this window of opportunity.
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Affiliation(s)
- Hattie Lowe
- Institute for Global Health, University College London, London, United Kingdom
| | - Joanna Dobbin
- Primary Care and Population Health, University College London, London, United Kingdom
| | - Ligia Kiss
- Institute for Global Health, University College London, London, United Kingdom
| | - Joelle Mak
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jenevieve Mannell
- Institute for Global Health, University College London, London, United Kingdom
| | - Daniella Watson
- Global Health Research Institute, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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Chingono RMS, Mackworth-Young CRS, Ross DA, Tshuma M, Chiweshe T, Nyamayaro C, Sekanevana C, Doyle AM, Weiss HA, Kohl K, Mangombe A, Madzima B, McHugh G, Ferrand RA. Designing Routine Health Checkups for Adolescents in Zimbabwe. J Adolesc Health 2021; 69:940-947. [PMID: 34362647 PMCID: PMC7614877 DOI: 10.1016/j.jadohealth.2021.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 06/14/2021] [Accepted: 07/01/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The absence of routine health check-ups during adolescence in low- and middle-income countries is a missed opportunity for prevention, early identification, and treatment of health issues, and health promotion. We aimed to codesign the content and delivery for routine adolescent health checkups in Zimbabwe, with adolescents and key adults in their lives. METHODS We held participatory workshops with adolescents (16 workshops; 96 adolescents) and parents (8 workshops; 95 parents), and in-depth interviews with key informants including policymakers, programmers, and healthcare workers (n = 25). Analysis was iterative and the design of the checkups was refined based on participant preferences, document review of burden of disease data, and feasibility considerations. RESULTS Participants overwhelmingly supported the introduction of routine health checkups. Reported facilitators to attendance included free cost and desire to know one's health status. Barriers included tendencies for health service seeking only when ill, fear of diagnosis and judgment, and religious beliefs. Delivery preferences were by nonjudgmental medical professionals, in a youth friendly environment, and accompanied by youth engagement activities. Preferred location was schools for younger adolescents (10-14 years), and community settings for older adolescents (15-19 years). Prioritized content included sexual health, oral health, mental health, hearing, eyesight, growth and nutrition, anemia, immunization, and deworming, based on health burden and participant preferences. DISCUSSION This study resulted in an outline design of two routine health checkups with stakeholders in Zimbabwe, in schools for young adolescents, and in community settings for older adolescents. Evidence of feasibility, effectiveness, and cost-effectiveness of such checkups is required.
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Affiliation(s)
- Rudo M S Chingono
- Biomedical Research and Training Institute, Harare, Zimbabwe; Institute of Global Health, University College of London, London, United Kingdom
| | - Constance R S Mackworth-Young
- Biomedical Research and Training Institute, Harare, Zimbabwe; Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - David A Ross
- Maternal, Newborn, Child & Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland
| | - Maureen Tshuma
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tendai Chiweshe
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Chipo Nyamayaro
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Aoife M Doyle
- MRC International Statistics and Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helen A Weiss
- MRC International Statistics and Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kid Kohl
- Maternal, Newborn, Child & Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland
| | - Aveneni Mangombe
- Family Health Department, Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Grace McHugh
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Rashida A Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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16
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Nabisubi P, Kanyerezi S, Kebirungi G, Mboowa G. Knowledge and attitude of secondary school students in Nakaseke, Uganda towards HIV transmission and treatment. AAS Open Res 2021; 4:23. [PMID: 34458678 PMCID: PMC8370127 DOI: 10.12688/aasopenres.13210.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 11/20/2022] Open
Abstract
Background: One of the major health concerns in Nakaseke district, Uganda is the high prevalence of HIV/AIDS. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), as of March 2014, the prevalence rate of the disease in the district was estimated at about 8%, compared to the national average of 6.5%, making Nakaseke district have the sixth-highest prevalence rate of HIV/AIDS in the entire country. We set out to explore the knowledge and attitude of secondary school students in Nakaseke, Uganda on HIV transmission and treatment. Methods: This was a cross sectional survey-based study with data collected during the month of February 2020. Data were analyzed using R programming language version 3.6.2. Results: A total of 163 participants volunteered for the study, 53.37% males and 46.63% females with ages ranging from 12 - 20 years. Participants came from 5 senior classes (S1, S2, S3, S4 and S6). In total, 87.73% participants were aware of HIV/AIDS while 12.27% were not. The major source of information was through teachers/schools. 96.50% knew the mode of transmission of HIV/AIDS and 95.11% were conversant with HIV/AIDS prevention. 63.6% were aware of the terms DNA and genes whereas 36.36% were not. Discussion: Generally, the students in Nakaseke district, Uganda had a high level of awareness of HIV/AIDS based on Bloom's cut-off point. However, with regards to aspects such as the cause and modern prevention methods like taking prep and prevention of mother to child transmission were less known to them. Efforts to find a cure for HIV/AIDS are still in vain. Therefore, strong emphasis on up to date control and prevention methods should be implemented to fight the HIV/AIDS scourge .
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Affiliation(s)
- Patricia Nabisubi
- Department of Bioinformatics, The African Center of Excellence in Bioinformatics and Data-Intensive Sciences, the Infectious Diseases Institute, Makerere University, Kampala, Central, 256, Uganda
| | - Stephen Kanyerezi
- Department of Bioinformatics, The African Center of Excellence in Bioinformatics and Data-Intensive Sciences, the Infectious Diseases Institute, Makerere University, Kampala, Central, 256, Uganda
| | - Grace Kebirungi
- Department of Bioinformatics, The African Center of Excellence in Bioinformatics and Data-Intensive Sciences, the Infectious Diseases Institute, Makerere University, Kampala, Central, 256, Uganda
| | - Gerald Mboowa
- Department of Bioinformatics, The African Center of Excellence in Bioinformatics and Data-Intensive Sciences, the Infectious Diseases Institute, Makerere University, Kampala, Central, 256, Uganda.,Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Central, 256, Uganda
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17
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Asrat B, Lund C, Ambaw F, Schneider M. Acceptability and feasibility of peer-administered group interpersonal therapy for depression for people living with HIV/AIDS-a pilot study in Northwest Ethiopia. Pilot Feasibility Stud 2021; 7:147. [PMID: 34321104 PMCID: PMC8317371 DOI: 10.1186/s40814-021-00889-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 07/16/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Psychological treatments are widely tested and have been effective in treating depressive symptoms. However, implementation of psychological treatments in the real world and in diverse populations remains difficult due to several interacting barriers. In this study, we assessed the acceptability and feasibility of peer-administered group interpersonal therapy for depressive symptoms among people living with HIV/AIDS in Northwest Ethiopia. METHOD We conducted a single-arm, peer-administered, group interpersonal therapy intervention with eight weekly sessions from 15 August to 15 December 2019 among people living with HIV/AIDS in Northwest Ethiopia. Four interpersonal therapy groups were formed for the intervention with a total of 31 participants. RESULTS Of the 31 recruited participants, 29 completed the intervention providing a retention rate of 93.5%. The process of the intervention and its outcomes were highly acceptable as most participants expressed success in resolving their psychosocial problems, adjusting to life changes and coping with stigma. The intervention was also reported to be feasible despite anticipated barriers such as access to transportation, perceived stigma and confidentiality concerns. The post-intervention assessment revealed significant reduction in depressive symptoms (mean difference (MD) = 9.92; t = - 7.82; 95% CI, - 12.54, - 7.31; p < 0.001), improvement in perceived social support (MD = 0.79; t = 2.84; 95% CI, 0.22, 1.37; p = 0.009) and quality of life (MD = 0.39; t = 4.58; 95% CI, 0.21, 0.56; p < 0.001). CONCLUSION Group interpersonal therapy is feasible and acceptable, and people living with HIV/AIDS can benefit from group interpersonal therapy in managing depressive symptoms and in improving perceived social support and quality of life. Future studies should examine the effectiveness of group interpersonal therapy in this setting.
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Affiliation(s)
- Biksegn Asrat
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Centre for Global Mental Health, King's Global Health Institute, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Fentie Ambaw
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Marguerite Schneider
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Edwards KM, Changilwa P, Waterman E, Bikeri C, Mweru C, Khayanje N, Obel P. A Promising Approach to Preventing Gender-Based Violence and HIV Among Slum-Dwelling Youth in Nairobi, Kenya. Violence Against Women 2021; 28:1379-1397. [PMID: 34247565 DOI: 10.1177/10778012211014562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Gender-based violence (GBV) and HIV are interrelated public health problems affecting numerous global communities. To date, few prevention initiatives have demonstrated reductions in GBV and HIV, and thus there is an urgency to identify effective strategies to prevent these interconnected public health crises. The purpose of the current article is to describe a gender-enhanced life skills training curriculum (GE-LSTC) currently being developed in Nairobi, Kenya. We discuss previous research relevant to the GE-LSTC; the theoretical underpinnings of the GE-LSTC; the history and context of the GE-LSTC; preliminary implementation, feasibility, and acceptability data on the GE-LSTC; and plans for further refinement and rigorous evaluation of the GE-LSTC.
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Affiliation(s)
| | | | | | | | - Cecelia Mweru
- Life Skills for Behavior Change Center, Nairobi, Kenya
| | - Noel Khayanje
- Life Skills for Behavior Change Center, Nairobi, Kenya
| | - Patrick Obel
- Life Skills for Behavior Change Center, Nairobi, Kenya
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19
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Abu Hamad B, Jones N, Gercama I. Adolescent access to health services in fragile and conflict-affected contexts: The case of the Gaza Strip. Confl Health 2021; 15:40. [PMID: 34020683 PMCID: PMC8139118 DOI: 10.1186/s13031-021-00379-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 05/12/2021] [Indexed: 12/04/2022] Open
Abstract
Background Enjoyment of physical and mental health is not only recognized as a human right but also as an integral part of development, as reflected in Sustainable Development Goal 3 to ensure healthy lives and promote well-being for all at all ages. The rapid physical and psychosocial changes that take place during adolescence have a strong influence on the rest of a persons life course, so investments in adolescent health services constitute a unique opportunity to reap inter-generational dividends. Yet the evidence base on adolescents access to health services, particularly in conflict-affected contexts, remains thin. This article explores adolescents access to health services in the Gaza Strip, and their experiences and perceptions of those services. Methods The article draws on mixed methods research in the Gaza Strip conducted in 2016 and 2017 as part of the Gender and Adolescence: Global Evidence research programme. Data were collected from 240 male and female adolescents combining in-depth interviews, focus group discussions and a tablet-based survey. This study also draws on a participatory action pilot project engaging 12 boys and 23 adolescent girls aged 1519years old. Results The findings underscore that gender normsespecially those pertaining to adolescent girls sexual purityshape adolescent health in multiple ways. Girls face increasing restrictions on their mobility, leaving them with limited opportunities for leisure or exercise, socializing with peers or seeking health services and information. Adolescent boys in Gaza do not face the same restrictions, but given the multiple political, economic and familial stressors, they are at high risk of substance abuse including smoking and involvement in peer violence. Moreover, our findings suggest that a range of socioeconomic, cultural and structural barriers prevent adolescents in Gaza from accessing quality and appropriate health care. Study participants cited the main challenges being an absence of preventive adolescent health initiatives and limited information on sexual and reproductive health, as well as drug shortages, high treatment costs, and inappropriate interactions with service providers. Conclusions The article highlights the importance of designing and implementing conflict-sensitive and age- and gender-appropriate adolescent services and information and promoting preventive services targeted at adolescents.
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Affiliation(s)
- Bassam Abu Hamad
- Faculty of Public Health, Al-Quds University/ GAGE MENA Regional Director, 101, Tel El Hawa, Gaza, Palestine.
| | - Nicola Jones
- ODI Principal Research Fellow and Director of Gender and Adolescence: Global Evidence (GAGE), Overseas Development Institute, 203 Blackfriars Bridge Road, London, SE1 8NJ, UK
| | - Ingrid Gercama
- Applied Anthropologist, Anthrovision, Overhoeksplein 2, 1031, KS, Amsterdam, the Netherlands
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20
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Oketah N, Wokoma C, Klein JD, Galagali P, Simpson T, Offutt L. International Adolescent Health Week: Nothing About Them Without Them. J Adolesc Health 2021; 68:646-647. [PMID: 33582016 DOI: 10.1016/j.jadohealth.2021.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Ngozi Oketah
- Department of Pediatrics, Royal Belfast Hospital for Sick Children, Belfast, United Kingdom
| | | | - Jonathan D Klein
- Department of Pediatrics, The University of Illinois at Chicago, Chicago, Illinois
| | - Preeti Galagali
- Bengaluru Adolescent Care and Counselling Centre, Bengaluru, Karnataka, India
| | - Tina Simpson
- Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Laura Offutt
- Real Talk with Dr. Offutt, LLC; International Adolescent Health Week, Wayne, Pennsylvania.
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21
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Casale M, Cluver L, Boyes M, Toska E, Gulaid L, Armstrong A, Shenderovich Y, Rudgard WE, Zhou S, Langwenya N. Bullying and ART Nonadherence Among South African ALHIV: Effects, Risks, and Protective Factors. J Acquir Immune Defic Syndr 2021; 86:436-444. [PMID: 33196550 DOI: 10.1097/qai.0000000000002574] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Identifying risk and protective factors for adolescent antiretroviral therapy (ART) adherence is a public health priority, given high HIV-related mortality in this population. An area that merits further investigation is the relationship between bullying victimization, mental health problems, and ART nonadherence among adolescents living with HIV (ALHIV). However, no known studies assess effects of bullying on adolescent nonadherence or risk and protective factors that could moderate this relationship. SETTING This study investigates (1) the direct longitudinal relationship between bullying exposure and ART nonadherence, and the indirect relationship via psychological distress, and (2) potential risk and modifiable protective factors moderating these pathways, among vertically and horizontally infected ALHIV who initiated treatment across 53 public health care facilities in a South African health district. METHODS Survey data were collected at 2 time points, between 2014 and 2017, with 1046 ALHIV (94% retention). Various mediation and moderated mediation models were run as part of a staged analysis approach. RESULTS A significant longitudinal relationship was found between bullying victimization and nonadherence, operating indirectly through psychological distress [B = 0.07; 95% confidence interval (CI): (0.03 to 0.13)]. Moderation analyses indicated that older adolescents exposed to bullying are more at risk of nonadherence [B = 0.52; 95% CI: (0.07 to 0.97) P < 0.05], and parental monitoring is a potential protective factor buffering indirect effects of bullying on nonadherence [B = -0.22; 95% CI: (-0.42 to -0.02) P < 0.05]. CONCLUSIONS These findings underscore the importance of interventions that address bullying and psychological distress, and strengthen parental monitoring, particularly among older ALHIV.
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Affiliation(s)
- Marisa Casale
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Mark Boyes
- School of Public Health and School of Psychology, Curtin University, Australia
| | - Elona Toska
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Laurie Gulaid
- UNICEF Eastern and Southern Africa Regional Office, Kenya; and
| | - Alice Armstrong
- UNICEF Eastern and Southern Africa Regional Office, Kenya; and
| | - Yulia Shenderovich
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - William E Rudgard
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Siyanai Zhou
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Nontokozo Langwenya
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Oxford Research South Africa, East London, South Africa
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22
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Mekonnen Munea A, Alene GD, Debelew GT. <p>Does Youth-Friendly Service Intervention Reduce Risky Sexual Behavior in Unmarried Adolescents? A Comparative Study in West Gojjam Zone, Northwest Ethiopia</p>. Healthc Policy 2020; 13:941-954. [PMID: 32801968 PMCID: PMC7402857 DOI: 10.2147/rmhp.s254685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/25/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Alemtsehay Mekonnen Munea
- School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
- Correspondence: Alemtsehay Mekonnen Munea Email
| | - Getu Degu Alene
- School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gurmesa Tura Debelew
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia
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23
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He J, Wang Y, Du Z, Liao J, He N, Hao Y. Peer education for HIV prevention among high-risk groups: a systematic review and meta-analysis. BMC Infect Dis 2020; 20:338. [PMID: 32398032 PMCID: PMC7218508 DOI: 10.1186/s12879-020-05003-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 03/30/2020] [Indexed: 12/23/2022] Open
Abstract
Background Peer education has become a strategy for health promotion among high-risk groups for HIV infection worldwide. However, the extent to which peer education could have an impact on HIV prevention or the long-term effect of this impact is still unknown. This study thus quantifies the impact of peer education over time among high-risk HIV groups globally. Method Following the PRISMA guidelines, a systematic review and meta-analysis was used to assess the effects and duration of peer education. A thorough literature search of PubMed, Web of Science, Embase and Cochrane Library was performed, and studies about peer education on high-risk HIV groups were reviewed. Pooled effects were calculated and the sources of heterogeneity were explored using meta-regression and subgroup analysis. Results A total of 60 articles with 96,484 subjects were identified, and peer education was associated with 36% decreased rates of HIV infection among overall high risk groups (OR: 0.64; 95%CI: 0.47–0.87). Peer education can promote HIV testing (OR = 3.19; 95%CI:2.13,4.79) and condom use (OR = 2.66, 95% CI: 2.11–3.36) while reduce equipment sharing (OR = 0.50; 95%CI:0.33,0.75) and unprotected sex (OR = 0.82; 95%CI: 0.72–0.94). Time trend analysis revealed that peer education had a consistent effect on behavior change for over 24 months and the different follow-up times were a source of heterogeneity. Conclusion Our study shows that peer education is an effective tool with long-term impact for behavior change among high-risk HIV groups worldwide. Low and middle-income countries are encouraged to conduct large-scale peer education.
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Affiliation(s)
- Jiayu He
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China.,Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200032, China.,The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China
| | - Ying Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | - Zhicheng Du
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | - Jing Liao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | - Na He
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200032, China.,The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China
| | - Yuantao Hao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China.
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24
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How can schools be integrated in promoting well-being, preventing mental health problems and averting substance-use disorders in urban populations? Curr Opin Psychiatry 2020; 33:255-263. [PMID: 32049765 DOI: 10.1097/yco.0000000000000591] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Mental health and substance use problems are among the most prevalent and challenging problems faced by both high-income and low-income countries worldwide. This review will focus on summarizing scattered evidence of school-based interventions to promote well-being and prevent mental health problems and substance use disorders in children and adolescents. RECENT FINDINGS We focus on two main areas of research: promotion of healthy school climate and prevention of bullying. Choosing among available interventions might be challenging, both because of the difficulties in assessing their efficacy and tailoring interventions to specific needs, but also because of the scarcity of intervention in low-resource settings. We provide some guidance on principles encompassed by the available evidence that can be used for policymakers and local communities aiming to integrate mental health promotion and prevention into their schools. SUMMARY Developing, implementing, scaling and sustaining school-based interventions is a necessity of our field if we want to move closer to sustainable development goals.
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25
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Voluntary Vs Nominated Peer Educators: a Randomized Trial within the NoTrap! Anti-Bullying Program. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 21:639-649. [PMID: 32221819 PMCID: PMC7305073 DOI: 10.1007/s11121-020-01108-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
There is a debate in scientific literature about the effectiveness of a peer-led approach to anti-bullying interventions. In order to understand which circumstances and for whom these approaches work best, the present study was carried out within the NoTrap! anti-bullying program. Using a cluster design, classes were randomly assigned into two different peer educator recruitment strategies: volunteering (N = 500; 48% females; mean age = 13.5 years, ds = 1.3) vs peer nominated (N = 466; 38% females; mean age = 13.9 years, ds = 1.3). Results showed that voluntary peer educators suffered a higher level of victimization, while the nominated ones tended to be more popular and likable. Furthermore, a set of linear mixed-effect models showed that the program was effective in reducing bullying and victimization, and in increasing defending behaviour only in the voluntary recruitment condition. On the contrary, in classrooms under the peer nominated recruitment condition, bullying and victimization remained stable, and defending behaviour increased only for peer educators, but not for their classmates. This implies that the step of peer selection and recruitment must be kept into consideration in developing and validating an intervention, because of its possible impact on the effectiveness of the whole intervention.
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26
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Rath S, Prost A, Samal S, Pradhan H, Copas A, Gagrai S, Rath S, Gope RK, Nair N, Tripathy P, Bhatia K, Rose-Clarke K. Community youth teams facilitating participatory adolescent groups, youth leadership activities and livelihood promotion to improve school attendance, dietary diversity and mental health among adolescent girls in rural eastern India: protocol for a cluster-randomised controlled trial. Trials 2020; 21:52. [PMID: 31915039 PMCID: PMC6950906 DOI: 10.1186/s13063-019-3984-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving the health and development of adolescents aged 10-19 years is a global health priority. One in five adolescents globally live in India. The Rashtriya Kishor Swasthya Karyakram (RKSK), India's national adolescent health strategy, recommends supporting community-based peer educators to conduct group meetings with boys and girls. Groups aim to give adolescents a space to discuss the social and health issues affecting them and build their capacity to become active community members and leaders. There have been no evaluations of the community component of RKSK to date. In this protocol, we describe the evaluation of the Jharkhand Initiative for Adolescent Health (JIAH), a community intervention aligned with RKSK and designed to improve school attendance, dietary diversity and mental health among adolescent girls aged 10-19 years in rural Jharkhand, eastern India. METHODS The JIAH intervention is delivered by a community youth team consisting of yuva saathis (friends of youth), youth leadership facilitators and livelihood promoters. Teams conduct (a) peer-led Participatory Learning and Action meetings with girls and boys, mobilising adolescents, parents, health workers, teachers and the wider community to make changes for adolescent health and development; (b) group-based youth leadership activities to build adolescents' confidence and resilience; and (c) livelihood promotion with adolescents and their families to provide training and practical skills. We are evaluating the JIAH intervention through a parallel-group, two-arm, superiority, cluster-randomised controlled trial. The unit of randomisation is a geographic cluster of ~1000 people. A total of 38 clusters covering an estimated population of 40,676 have been randomised to control or intervention arms. Nineteen intervention clusters have adolescent groups, youth leadership activities and livelihood promotion. Nineteen control clusters receive livelihood promotion only. Study participants are adolescent girls aged 10-19 years, married or unmarried, in or out of school, living in the study area. Intervention activities are open to all adolescent boys and girls, regardless of their participation in surveys. We will collect data through baseline and endline surveys. Primary trial outcomes are school attendance, dietary diversity and internalising and externalising mental health problems. Secondary outcomes include access to school-related entitlements, emotional or physical violence, self-efficacy and resilience. TRIAL REGISTRATION ISRCTN17206016. Registered on 27 June 2018.
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Affiliation(s)
| | - Audrey Prost
- Institute for Global Health, University College London, London, UK
| | | | | | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | | | | | | | | | | | - Komal Bhatia
- Institute for Global Health, University College London, London, UK
| | - Kelly Rose-Clarke
- Department of Global Health and Social Medicine, King's College London, Bush House NE Wing, London, WC2B 4BG, UK.
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