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Rotenberg S, Chen S, Hanass‐Hancock J, Davey C, Banks LM, Kuper H. HIV knowledge and access to testing for people with and without disabilities in low- and middle-income countries: evidence from 37 Multiple Indicator Cluster Surveys. J Int AIDS Soc 2024; 27:e26239. [PMID: 38566480 PMCID: PMC10988115 DOI: 10.1002/jia2.26239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Disability and HIV are intricately linked, as people with disabilities are at higher risk of contracting HIV, and living with HIV can lead to impairments and disability. Despite this well-established relationship, there remains limited internationally comparable evidence on HIV knowledge and access to testing for people with disabilities. METHODS We used cross-sectional data from 37 Multiple Indicator Cluster Surveys. Surveys were from six UNICEF regions, including East Asia and Pacific (n = 6), East and Central Asia (n = 7), Latin America and the Caribbean (n = 6), Middle East and North Africa (n = 4), South Asia (n = 2) and sub-Saharan Africa (n = 12). A total of 513,252 people were eligible for inclusion, including 24,695 (4.8%) people with disabilities. We examined risk ratios and 95% confidence intervals for key indicators on HIV knowledge and access to testing for people with disabilities by sex and country. We also conducted a meta-analysis to get a pooled estimate for each sex and indicator. RESULTS Men and women with disabilities were less likely to have comprehensive knowledge about HIV prevention (aRR: 0.74 [0.67, 0.81] and 0.75 [0.69, 0.83], respectively) and to know of a place to be tested for HIV (aRR: 0.95 [0.92, 0.99] and 0.94 [0.92, 0.97], respectively) compared to men and women without disabilities. Women with disabilities were also less likely to know how to prevent mother-to-child transmission (aRR: 0.87 [0.81, 0.93]) and ever have been tested for HIV (aRR: 0.90 [0.85, 0.94]). CONCLUSIONS Men and women with disabilities have lower overall HIV knowledge and in particular women with disabilities also indicate lower testing rates. Governments must include people with disabilities in HIV programmes by improving disability-inclusion and accessibility to HIV-related information, education and healthcare services.
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Affiliation(s)
- Sara Rotenberg
- International Center for Evidence in Disability, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonUK
| | - Shanquan Chen
- International Center for Evidence in Disability, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonUK
| | - Jill Hanass‐Hancock
- South African Medical Research Council, Gender and Health Research UnitDurbanSouth Africa
- School of Health Science, University of KwaZulu‐NatalDurbanSouth Africa
| | - Calum Davey
- International Center for Evidence in Disability, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonUK
| | - Lena Morgon Banks
- International Center for Evidence in Disability, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonUK
| | - Hannah Kuper
- International Center for Evidence in Disability, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonUK
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Kipchumba E, Davey C, Marks S, Mugeere A, Chen S, Banks LM, Islam KE, Shakespeare T, Kuper H, Sulaiman M. Evaluation of a disability-inclusive ultra-poor graduation programme in Uganda: study protocol for a cluster-randomised controlled trial with process evaluation. Trials 2024; 25:206. [PMID: 38515150 PMCID: PMC10956226 DOI: 10.1186/s13063-024-08040-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 03/07/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND There is little evidence on how to support ultra-poor people with disabilities to adopt sustainable livelihoods. The Disability-Inclusive Graduation (DIG) programme targets ultra-poor people with disabilities and/or women living in rural Uganda. The programme is an adaptation of an ultra-poor graduation model that has been shown to be effective in many contexts but not evaluated for people with disabilities. METHODS The DIG programme works with project participants over a period of 18 months. Participants receive unconditional cash transfers for 6 months, training, access to savings-and-loans groups, and a capital asset that forms the basis of their new livelihood. The programme is also adapted to address specific barriers that people with disabilities face. Eligible households are clustered by geographical proximity in order to deliver the intervention. Eligibility is based on household screening to identify the 'ultra-poor' based on proxy means testing-both households with and without people with disabilities are included in the programme. Clusters are randomly selected prior to implementation, resulting in 96 intervention and 89 control clusters. The primary outcome of the trial is per-capita household consumption. Before the start of the intervention, a baseline household survey is conducted (November 2020) among project participants and those not offered the programme, a similar endline survey is conducted with participants with disabilities at the end of programme implementation in July 2022, and a second endline survey for all participants in October 2023. These activities are complemented by a process evaluation to understand DIG programme implementation, mechanisms, and context using complementary qualitative and quantitative methods. Ethical approval for the research has been received from Mildmay Uganda Research Ethics Committee and London School of Hygiene and Tropical Medicine. DISCUSSION DIG is a promising intervention to evaluate for people with disabilities, adapted to be disability inclusive across programme components through extensive consultations and collaboration, and has proven efficacy at reducing poverty in other marginalised groups. However, evaluating a well-evidenced intervention among a new target group poses ethical considerations. TRIAL REGISTRATION Registry for International Development Impact Evaluations, RIDIE-STUDY-ID-626008898983a (20/04/22). ISRCTN registry, ISRCTN78592382 . Retrospectively registered on 17/08/2023.
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Affiliation(s)
- Elijah Kipchumba
- Independent Evaluation and Research Cell (IERC), BRAC International, Kampala, Uganda
- Trinity College Dublin, Dublin, Ireland
| | - Calum Davey
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Evaluation, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Marks
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Anthony Mugeere
- Department of Sociology and Anthropology, Makerere University, Kampala, Uganda
| | - Shanquan Chen
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Lena Morgon Banks
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Tom Shakespeare
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK.
| | - Munshi Sulaiman
- BRAC Institute of Governance and Development, BRAC University, Dhaka, Bangladesh
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Marks S, Arogundade E, Carew MT, Chen S, Banks LM, Kuper H, Adegoke F, Davey C. Improving access to family planning for women with disabilities in Kaduna city, Nigeria: study protocol for a pragmatic cluster-randomized controlled trial with integrated process evaluation. Trials 2024; 25:28. [PMID: 38183143 PMCID: PMC10768103 DOI: 10.1186/s13063-023-07892-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 12/18/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Globally, women with disabilities are less likely to have access to family planning services compared to their peers without disabilities. However, evidence of effective interventions for promoting their sexual and reproductive health and rights remains limited, particularly in low- and middle-income settings. To help address disparities, an inclusive sexual and reproductive health project was developed to increase access to modern contraceptive methods and reduce unmet need for family planning for women of reproductive age with disabilities in Kaduna city, Nigeria. The project uses demand-side, supply-side and contextual interventions, with an adaptive management approach. This protocol presents a study to evaluate the project's impact. METHODS A pragmatic cluster-randomized controlled trial design with surveys at baseline and endline will be used to evaluate interventions delivered for at least 1 year at health facility and community levels in comparison to 'standard' state provision of family planning services, in the context of state-wide and national broadcast media and advocacy. Randomization will be conducted based on the health facility catchment area, with 19 clusters in the intervention arm and 18 in the control arm. The primary outcome measure will be access to family planning. It was calculated that at least 950 women aged 18 to 49 years with disabilities (475 in each arm) will be recruited to detect a 50% increase in access compared to the control arm. For each woman with disabilities enrolled, a neighbouring woman without disabilities in the same cluster and age group will be recruited to assess whether the intervention has a specific effect amongst women with disabilities. The trial will be complemented by an integrated process evaluation. Ethical approval for the study has been given by the National Health Research Ethics Committee of Nigeria and London School of Hygiene & Tropical Medicine. DISCUSSION Defining access to services is complex, as it is not a single variable that can be measured directly and need for family planning is subjectively defined. Consequently, we have conceptualized 'access to family planning' based on a composite of beliefs about using services if needed. TRIAL REGISTRATION ISRCTN registry ISRCTN12671153. Retrospectively registered on 17/04/2023.
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Affiliation(s)
- Sarah Marks
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK.
| | | | - Mark T Carew
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Shanquan Chen
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Lena Morgon Banks
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Calum Davey
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Evaluation, London School of Hygiene & Tropical Medicine, London, UK
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Banks LM, Kepha S, Zinke-Allmang A, Gichuki PM, Scherer N, Mwandawiro C, Carew M, Njomo D, Chen S, Okoyo C, Davey C, Shakespeare T, Pereira MA, Goyal D, Kuper H. Impact of a disability-targeted microentrepreneurship programme in Kenya: study protocol for a randomised controlled trial of the InBusiness programme. Trials 2023; 24:802. [PMID: 38082314 PMCID: PMC10712187 DOI: 10.1186/s13063-023-07848-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND There is a lack of evidence on the effectiveness of livelihood interventions amongst people with disabilities. In many countries, self-employment or microentrepreneurship is a dominant source of livelihoods for people with disabilities and their caregivers. However, this group may face heightened barriers to successful microentrepreneurship, including discrimination, exclusion from training or inaccessible transport, infrastructure and communication systems. The InBusiness programme is a livelihoods programme targeted to microentrepeneurs with disabilities or their caregivers delivered by a consortium of non-governmental organisations. The programme focuses on improving the skills, practices and opportunities of microentrepreneurs while linking them with procurement opportunities with private and public institutions. This protocol describes a randomised controlled trial of the InBusiness programme in eight counties of Kenya. METHODS The randomised controlled trial will involve 495 microentrepreneurs who have been verified as eligible for InBusiness by programme implementers. Individuals will be randomised within counties, either being invited to enrol in InBusiness in March 2023 or allocated to a control group. Participants in the control arm will receive information about compliance with business-related laws and available social protection programmes. The trial will assess the impact of InBusiness on household consumption and individual economic empowerment (primary outcomes) as well as food security, well-being, social attitudes, unmet need for disability-related services and microenterprise profits (secondary outcomes). Baseline was conducted in March 2023, and follow-up will be 24 months from baseline (12 months from completion of the programme). Analysis will be through intention to treat. A process evaluation will explore fidelity, mechanisms of impact and the role of context, and complementary qualitative research with participants will be used to triangulate findings across the trial. DISCUSSION This study will provide evidence on the impact of a large-scale disability-targeted livelihood programme on household and individual financial security and well-being. Currently, there is a lack of evidence on the effectiveness of livelihood programmes amongst people with disabilities, and so this trial can help inform the design and delivery of InBusiness as well as other livelihood programmes targeted to people with disabilities. TRIAL REGISTRATION ClinicalTrials.gov ISRCTN13693137. Registered on April 24, 2023.
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Affiliation(s)
- Lena Morgon Banks
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK.
| | - Stella Kepha
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Anja Zinke-Allmang
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Nathaniel Scherer
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Mark Carew
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Doris Njomo
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Shanquan Chen
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Calum Davey
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Tom Shakespeare
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Divya Goyal
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
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Prynn JE, Davey C, Davis D, Kuper H, Mugisha J, Seeley J. Cognition in older adults in Uganda: Correlates, trends over time and association with mortality in prospective population study. PLOS Glob Public Health 2023; 3:e0001798. [PMID: 37922221 PMCID: PMC10624290 DOI: 10.1371/journal.pgph.0001798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 09/11/2023] [Indexed: 11/05/2023]
Abstract
Dementia is an important and growing issue in sub-Saharan Africa, but epidemiological data are lacking. Risk factors may differ from other regions due to high stroke incidence and HIV prevalence. Understanding the epidemiology of cognition in older adults in Africa is crucial for informing public health strategies to improve the lives of people with dementia and their carers. The Wellbeing of Older People Study in Uganda is an open cohort of adults aged 50+ with and without HIV, established in 2009. Detailed socio-demographic and health data have been collected at four waves spanning 10 years, including cognitive assessment using internationally validated WHO-recommended tests: verbal recall, digit span, and verbal fluency. Mortality data was collected until the end of the fourth wave (2019). We examined associations of low baseline cognition scores and changes in cognition score over time using random effects modelling, care needs of people with lower cognition scores, and the relationship between cognition score and mortality. Data were collected on 811 participants. Older age, lower educational attainment, lower socio-economic position, and extremes of BMI were associated with lower cognition scores. Cognition scores declined faster at older ages, but rate of decline was not associated with cardiovascular disease or HIV at baseline. People with lower cognition scores required more assistance with Activities of Daily Living, but mortality rates were similar across the range of cognition scores. The crucial next step will be to investigate types and presentation of clinical dementia in this cohort, so we can better understand the clinical relevance of these findings to inform public health planning.
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Affiliation(s)
- Josephine E. Prynn
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Calum Davey
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
| | - Hannah Kuper
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Janet Seeley
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Pongutta S, Ferguson E, Davey C, Tangcharoensathien V, Limwattananon S, Borghi J, Wong CKH, Lin L. The impact of a complex school nutrition intervention on double burden of malnutrition among Thai primary school children: a 2-year quasi-experiment. Public Health 2023; 224:51-57. [PMID: 37734276 DOI: 10.1016/j.puhe.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/22/2023] [Accepted: 08/18/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE This study assessed the impacts of the Dekthai Kamsai programme on overweight/obesity, underweight and stunting among male and female primary school students. STUDY DESIGN A quasi-experiment was conducted in 16 intervention and 19 control schools across Thailand in 2018 and 2019. In total, 896 treated and 1779 control students from grades 1 to 3 were recruited. In intervention schools, a set of multifaceted intervention components were added into school routine practices. Anthropometric outcomes were measured at baseline and at the beginning and end of every school term. METHODS Propensity score matching with linear and Poisson difference-in-difference analyses were used to adjust for the non-randomisation and to analyse the intervention's effects over time. RESULTS Compared with controls, the increases in mean BMI-for-age Z-score (BAZ) and the incidence rate of overweight/obesity were lower in the intervention schools at the 3rd, 4th and 8th measurements and the 3rd measurement, respectively. The decrease in mean height-for-age Z-score (HAZ) was lower at the 4th measurement. The decrease in the incidence rate of wasting was lower at the 5th, 7th and 8th measurements. The favourable impacts on BAZ and HAZ were found in both sexes, while the favourable impact on overweight/obesity and unfavourable impact on wasting were found in girls. CONCLUSIONS This intervention might be effective in reducing BAZ, overweight/obesity, poor height gain, but not wasting. These findings highlight the benefits of a multifaceted school nutrition intervention and a need to incorporate tailor-made interventions for wasting to comprehensively address the double burden of malnutrition.
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Affiliation(s)
- S Pongutta
- International Health Policy Program, Tiwanon Rd, Muang, Nonthaburi 11000, Thailand; London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E7HT, UK.
| | - E Ferguson
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E7HT, UK
| | - C Davey
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E7HT, UK.
| | - V Tangcharoensathien
- International Health Policy Program, Tiwanon Rd, Muang, Nonthaburi 11000, Thailand.
| | - S Limwattananon
- International Health Policy Program, Tiwanon Rd, Muang, Nonthaburi 11000, Thailand.
| | - J Borghi
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E7HT, UK.
| | - C K H Wong
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Science Park, Hong Kong SAR, China; Department of Family Medicine and Primary Care, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Science Park, Hong Kong SAR, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong SAR, China.
| | - L Lin
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E7HT, UK; Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong SAR, China; WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
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Bhatia A, Davey C, Bright T, Rotenberg S, Eldred E, Cappa C, Kuper H, Devries K. Inequities in birth registration, violent discipline, and child labour by disability status and sex: Evidence from the Multiple Indicator Cluster Surveys in 24 countries. PLOS Glob Public Health 2023; 3:e0001827. [PMID: 37224158 DOI: 10.1371/journal.pgph.0001827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/24/2023] [Indexed: 05/26/2023]
Abstract
Nearly 240 million children are estimated to have a disability globally. We describe inequities by disability status and sex in birth registration, child labour, and violent discipline outcomes. Data come from Round 6 of the Multiple Indicator Cluster Survey programme and includes 323,436 children, aged 2-17 years in 24 countries. We estimated non-registration of birth, child labour, and violent discipline, stratified by sex and disability in each country. We estimated age-adjusted prevalence ratios and prevalence differences, accounting for survey design, to calculate inequities by disability. There was large variation across countries in the percentage of children with disabilities (range: 4% to 28%), in non-registration (range: 0% to73%), child labour (range: 2% to 40%), and violent discipline (range: 48% to 95%). We found relative inequities by disability in birth registration in two countries among girls and one country among boys, and in birth certification in two countries among girls and among boys. Child labour was higher among girls with disabilities in two countries and among boys in three countries. We found larger and more prevalent inequities by disability in hazardous labour in six countries among girls (aPR range: 1.23 to 1.95) and in seven countries among boys (aPR range: 1.24 to 1.80). Inequities in the prevalence of violent discipline by disability were significant in four countries among girls (aPR range: 1.02 to 1.18) and among boys (aPRs: 1.02 to 1.15) and we found inequities in severe punishment nine countries among girls (aPR range: 1.12 to 2.27) and in 13 countries among boys (aPRs: 1.13 to 1.95). Context specific research is needed to understand the large variations in inequities by disability status and sex within and across countries. Monitoring inequities in child rights by disability status and sex is important to achieve the SDGs and ensure child protection programs reduce inequities.
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Affiliation(s)
- Amiya Bhatia
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Calum Davey
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tess Bright
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sara Rotenberg
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, United Kingdom
| | - Emily Eldred
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Claudia Cappa
- Data and Analytics Section, UNICEF, New York, NY, United States of America
| | - Hannah Kuper
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Karen Devries
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Rotenberg S, Davey C, McFadden E. Association between disability status and health care utilisation for common childhood illnesses in 10 countries in sub-Saharan Africa: a cross-sectional study in the Multiple Indicator Cluster Survey. EClinicalMedicine 2023; 57:101870. [PMID: 36895804 PMCID: PMC9989629 DOI: 10.1016/j.eclinm.2023.101870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Approximately 70 million children in sub-Saharan Africa (SSA) are disabled, yet little is known about the prevalence of and care-seeking patterns for common childhood illnesses, such as acute respiratory infection (ARI), diarrhoea, and fever. METHODS Data were from 10 SSA countries with data available from 2017 to 2020 in the UNICEF-supported Multiple Indicator Cluster Survey (MICS) online repository. Children aged 2-4 years who completed the child functioning module were included. Using logistic regression, we examined the association between disability and ARI, diarrhoea and fever in the past two weeks and care-seeking behaviour for these illnesses. Using multinomial logistic regression, we examined the association between disability and the type of health care providers from which caregivers sought care. FINDINGS There were 51,901 children included. Overall, there were small absolute differences in illnesses between disabled and non-disabled children. However, there was evidence disabled children had a greater odds of ARI (aOR = 1.33, 95% C.I 1.16-1.52), diarrhoea (aOR = 1.27, 95% C.I. 1.12-1.44), and fever (aOR = 1.19 95% CI 1.06-1.35) compared to non-disabled children. There was no evidence that caregivers of disabled children had a greater odds of seeking care for ARI (aOR = 0.90, 95% C.I 0.69-1.19), diarrhoea (aOR = 1.06, 95% C.I. 0.84-1.34), and fever (aOR = 1.07, 95% C.I 0.88-1.30) compared to caregivers of non-disabled children. Caregivers of disabled children had a higher odds of seeking care from a trained health worker for ARI (aOR = 1.76, 95% C.I. 1.25-2.47) and fever (aOR = 1.49, 95% C.I. 1.03-2.14) or non-health professional (aOR = 1.89, 95% C.I. 1.19-2.98) for ARI than from an unspecified health facility worker compared to caregivers of non-disabled children, but no associations were not seen for diarrhoea. INTERPRETATION While the data showed relatively small absolute differences, disability was associated with ARI, diarrhoea and fever and caregivers of disabled children sought care from trained health workers for ARI and fever more than non-disabled children. The overall small absolute differences show closing gaps in illness and access to care may be possible, but highlights that more research on illness severity, care quality, and outcomes should be conducted to further assess health inequities for disabled children. FUNDING SR receives funding from the Rhodes Trust.
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Affiliation(s)
- Sara Rotenberg
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
- Corresponding author.
| | - Calum Davey
- International Center for Evidence in Disability, London School of Hygiene and Tropical Medicine, UK
| | - Emily McFadden
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
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Auerbach JD, Forsyth AD, Davey C, Hargreaves JR. Living with COVID-19 and preparing for future pandemics: revisiting lessons from the HIV pandemic. Lancet HIV 2023; 10:e62-e68. [PMID: 36370713 PMCID: PMC9764384 DOI: 10.1016/s2352-3018(22)00301-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/22/2022] [Accepted: 10/06/2022] [Indexed: 11/11/2022]
Abstract
In April, 2020, just months into the COVID-19 pandemic, an international group of public health researchers published three lessons learned from the HIV pandemic for the response to COVID-19, which were to: anticipate health inequalities, create an enabling environment to support behavioural change, and engage a multidisciplinary effort. We revisit these lessons in light of more than 2 years' experience with the COVID-19 pandemic. With specific examples, we detail how inequalities have played out within and between countries, highlight factors that support or impede the creation of enabling environments, and note ongoing issues with the scarcity of integrated science and health system approaches. We argue that to better apply lessons learned as the COVID-19 pandemic matures and other infectious disease outbreaks emerge, it will be imperative to create dialogue among polarised perspectives, identify shared priorities, and draw on multidisciplinary evidence.
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Affiliation(s)
- Judith D Auerbach
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Calum Davey
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - James R Hargreaves
- Department of Epidemiology and Evaluation, London School of Hygiene & Tropical Medicine, London, UK
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Banks LM, Das N, Davey C, Adiba A, Ali MM, Shakespeare T, Fleming C, Kuper H. Impact of a disability-targeted livelihoods programme in Bangladesh: study protocol for a cluster randomised controlled trial of STAR. Trials 2022; 23:1022. [PMID: 36527117 PMCID: PMC9758025 DOI: 10.1186/s13063-022-06987-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION There is little evidence on the impact of livelihood interventions amongst people with disabilities. Effective programmes are critical for reducing the heightened risk of poverty and unemployment facing persons with disabilities. STAR+ is a skills development and job placement programme targeted to out-of-school youth with disabilities (ages 14-35) living in poverty. It is a disability-targeted adaptation to an existing, effective intervention (STAR), which has been designed to address barriers to decent work for people with disabilities. This protocol describes the design of a cluster randomised controlled trial of STAR+ in 39 of the 64 districts of Bangladesh. METHODS BRAC has identified 1500 youth with disabilities eligible for STAR+ across its 91 branch offices (typically a geographical areas covering about 8 km radius from local BRAC office) catchment areas (clusters). BRAC has limited funding to deliver STAR+ and so 45 of the 91 branches have been randomly allocated to implement STAR+ (intervention arm). The remaining 46 branches will not deliver STAR+ at this time (control arm). Participants in the control-arm will receive usual care, meaning they are free to enrol in any other livelihood programmes run by BRAC or other organisations including standard STAR (being run in 15 control branches). The cRCT will assess the impact of STAR+ after 12 months on employment status and earnings (primary outcomes), as well as poverty, participation and quality of life (secondary outcomes). Analysis will be through intention-to-treat, with a random mixed effect at cluster level to account for the clustered design. Complementary qualitative research with participants will be conducted to triangulate findings of the cRCT, and a process evaluation will assess implementation fidelity, mechanisms of impact and the role of contextual factors in shaping variations in outcomes. DISCUSSION This trial will provide evidence on the impact of a large-scale, disability-targeted intervention. Knowledge on the effectiveness of programmes is critical for informing policy and programming to address poverty and marginalisation amongst this group. Currently, there is little robust data on the effectiveness of livelihood programmes amongst people with disabilities, and so this trial will fill an important evidence gap. TRIAL REGISTRATION This study has been registered with the Registry for International Development Impact Evaluations, (RIDIE Study ID: 6238114b481ad ) on February 25, 2022, and the ISRCTN Registry (ID: ISRCTN15742977 ).
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Affiliation(s)
- Lena Morgon Banks
- grid.8991.90000 0004 0425 469XInternational Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Narayan Das
- grid.52681.380000 0001 0746 8691BRAC Institute of Governance and Development, BRAC University, Dhaka, Bangladesh
| | - Calum Davey
- grid.8991.90000 0004 0425 469XInternational Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK ,grid.8991.90000 0004 0425 469XCentre for Evaluation, London School of Hygiene & Tropical Medicine, London, UK
| | - Afsana Adiba
- grid.52681.380000 0001 0746 8691BRAC Institute of Governance and Development, BRAC University, Dhaka, Bangladesh
| | - M. Mahzuz Ali
- grid.501438.b0000 0001 0745 3561BRAC Bangladesh, Dhaka, Bangladesh
| | - Tom Shakespeare
- grid.8991.90000 0004 0425 469XInternational Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Hannah Kuper
- grid.8991.90000 0004 0425 469XInternational Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
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Baltaci A, Hurtado Choque GA, Davey C, Reyes Peralta A, Alvarez de Davila S, Zhang Y, Gold A, Larson N, Reicks M. Padres Preparados, Jóvenes Saludables: intervention impact of a randomized controlled trial on Latino father and adolescent energy balance-related behaviors. BMC Public Health 2022; 22:1932. [PMID: 36258168 PMCID: PMC9578196 DOI: 10.1186/s12889-022-14284-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 09/27/2022] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Studies have shown associations among food and activity behaviors and body weight of Latino fathers and adolescents. However, few Latino father-focused interventions have been designed to improve energy balance-related behaviors (EBRBs) and weight status among early adolescents. Thus, this efficacy study aims to evaluate the Padres Preparados, Jóvenes Saludables (Padres) youth obesity prevention program for positive changes in EBRBs (fruit, vegetable, sugar-sweetened beverage (SSB), sweet/salty snack, and fast-food consumption, physical activity, and screen time) and weight status among low-income Latino fathers and adolescents (10-14 years). METHODS A two-arm (treatment versus delayed-treatment control group) randomized controlled trial was conducted to evaluate the efficacy of 8 weekly experiential learning sessions (2.5 hours each) based on social cognitive theory. The sessions included food preparation, parenting skills, nutrition, and physical activity. The program was delivered to father-adolescent dyads (mothers were encouraged to attend) in trusted community-based settings in a Midwest metropolitan area between 2017 and 2019. In March 2020, in-person implementation was discontinued due to COVID-19 pandemic restrictions, which limited the sample size. Father/adolescent dyads were randomized to treatment or control group within each site. Surveys and measurements were completed by fathers and adolescents to assess changes in food and activity behaviors from baseline to post-intervention. Adolescents also completed 24-hour dietary recall interviews at baseline and post-intervention. Intervention effects were assessed using linear regression mixed models adjusted for covariates and accounting for clustering of participants within sites. RESULTS Data from 147 father/adolescent dyads who completed at least the baseline data collection were used. No significant differences were observed for baseline to post-intervention changes in adolescents' and fathers' EBRBs or weight status between treatment and control groups. Fathers' SSB and fast food intakes were not statistically significant (p = 0.067 and p = 0.090, respectively). CONCLUSIONS The Padres program resulted in no significant improvements in adolescent and father EBRBs and weight status. Additional Latino father-focused interventions are needed to examine intervention effects on EBRBs among Latino adolescents. TRIAL REGISTRATION The Padres Preparados, Jóvenes Saludables study is registered with the U.S. National Library of Medicine, ClinicalTrials.gov Identifier: NCT03469752 (19/03/2018).
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Affiliation(s)
- A. Baltaci
- grid.17635.360000000419368657Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S Second St, Suite 300, Minneapolis, MN 55454 USA
| | - G. A. Hurtado Choque
- grid.164295.d0000 0001 0941 7177School of Public Health, University of Maryland, 4200 Valley Dr, College Park, MD 20742 USA
| | - C. Davey
- grid.17635.360000000419368657Clinical and Translational Science Institute, University of Minnesota, 717 Delaware Street SE, Minneapolis, MN 55414 USA
| | - A. Reyes Peralta
- grid.17635.360000000419368657Center for Family Development, University of Minnesota Extension, 1420 Eckles Ave, St. Paul, MN 55108 USA
| | - S. Alvarez de Davila
- grid.17635.360000000419368657Center for Family Development, University of Minnesota Extension, Robert J. Jones Urban Research and Outreach-Engagement Center, 2001 Plymouth Ave N, Minneapolis, MN 55411 USA
| | - Y. Zhang
- grid.263761.70000 0001 0198 0694Department of Child and Adolescent Health and Social Medicine, School of Public Health, Medical College of Soochow University, 199 Ren Ai Road, Building 401, Room 1411, Suzhou, 215123 Jiangsu China
| | - A. Gold
- grid.17635.360000000419368657Center for Family Development, University of Minnesota Extension, 1420 Eckles Ave, St. Paul, MN 55108 USA
| | - N. Larson
- grid.17635.360000000419368657Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S Second St, Suite 300, Minneapolis, MN 55454 USA
| | - M. Reicks
- grid.17635.360000000419368657Department of Food Science and Nutrition, University of Minnesota, 1334 Eckles Ave, St. Paul, MN 55108 USA
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Kuper H, Heydt P, Davey C. A focus on disability is necessary to achieve HIV epidemic control. The Lancet HIV 2022; 9:e293-e298. [DOI: 10.1016/s2352-3018(21)00345-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/30/2021] [Accepted: 12/13/2021] [Indexed: 10/18/2022]
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Napierala S, Chabata ST, Davey C, Fearon E, Busza J, Mushati P, Mugurungi O, Hatzold K, Cambiano V, Phillips A, Hargreaves JR, Cowan FM. Engagement in HIV services over time among young women who sell sex in Zimbabwe. PLoS One 2022; 17:e0270298. [PMID: 35763532 PMCID: PMC9239457 DOI: 10.1371/journal.pone.0270298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/07/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Young female sex workers (FSW) are disproportionately vulnerable to HIV. Zimbabwe data show higher HIV incidence and lower engagement in services compared to older FSW. Utilizing data from a combination HIV prevention and treatment intervention, we describe engagement in the HIV services over time among FSW 18-24 years, compared to those ≥25 years of age. MATERIALS AND METHODS Data were collected via respondent-driven sampling (RDS) surveys in 14 communities in 2013 and 2016, with >2500 FSW per survey. They included blood samples for HIV and viral load testing. As the intervention had no significant impact on HIV care cascade outcomes, data were aggregated across study arms. Analyses used RDS-II estimation. RESULTS Mean age in 2013 and 2016 was 31 and 33 years, with 27% and 17% aged 18-24 years. Overall HIV prevalence was 59% at each timepoint, and 35% and 36% among younger FSW. From 2013 to 2016 there was an increase in young HIV-positive FSW knowing their status (38% vs 60%, OR = 2.51, p<0.01). Outcomes for all FSW improved significantly over time at all steps of the cascade, and the relative change over time was similar among older versus younger FSW for most cascade variables. DISCUSSION Young FSW had improvements in care cascade outcomes, and proportionate improvements similar to older FSW, yet they remain less engaged in services overall. This implies that the dedicated FSW services in Zimbabwe are having a comparably positive impact across age groups, however more is likely required to address young FSW's unique vulnerabilities and needs.
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Affiliation(s)
- Sue Napierala
- Women’s Global Health Imperative, RTI International, Berkeley, California, United States of America
- * E-mail:
| | - Sungai T. Chabata
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Calum Davey
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Elizabeth Fearon
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Joanna Busza
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Phillis Mushati
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe
| | | | - Karin Hatzold
- Population Services International, Cape Town, South Africa
| | - Valentina Cambiano
- Institute for Global Health, University College London, London, United Kingdom
| | - Andrew Phillips
- Institute for Global Health, University College London, London, United Kingdom
| | - James R. Hargreaves
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Frances M. Cowan
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Bosworth ML, Ayoubkhani D, Nafilyan V, Foubert J, Glickman M, Davey C, Kuper H. Deaths involving COVID-19 by self-reported disability status during the first two waves of the COVID-19 pandemic in England: a retrospective, population-based cohort study. The Lancet Public Health 2021; 6:e817-e825. [PMID: 34626547 PMCID: PMC8494502 DOI: 10.1016/s2468-2667(21)00206-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022] Open
Abstract
Background People with learning disabilities are at substantially increased risk of COVID-19 mortality, but evidence on risks of COVID-19 mortality for disabled people more generally is limited. We aimed to use population-level data to estimate the association between self-reported disability and death involving COVID-19 during the first two waves of the COVID-19 pandemic in England. Methods We conducted a retrospective, population-based cohort study of adults aged 30–100 years living in private households or communal establishments in England, using data from the Office for National Statistics Public Health Data Asset. Participants were present at the 2011 Census and alive on Jan 24, 2020. Participants reported being limited a lot in their daily activities, limited a little, or not limited at all, in response to a question from the 2011 Census. The outcome was death involving COVID-19, occurring between Jan 24, 2020, and Feb 28, 2021. We used Cox proportional hazards regression to calculate hazard ratios (HRs) for the association between disability and death involving COVID-19, sequentially adjusting for age, residence type (private household, care home, or other communal establishment), geographical characteristics (local authority district and population density), sociodemographic characteristics (ethnicity, highest qualification, Index of Multiple Deprivation decile, household characteristics [National Statistics Socio-economic Classification of the household reference person, tenure of household, household size, family status, household composition, and key worker in household], key worker type, individual and household exposure to disease, and individual and household proximity to others), and health status (pre-existing health conditions, body-mass index, and number of admissions to hospital and days spent in hospital over the previous 3 years). Findings 29 293 845 adults were included in the study (13 806 623 [47%] men, 15 487 222 [53%] women), of whom 3 038 772 (10%) reported being limited a little and 2 011 576 (7%) reported being limited a lot. During follow-up, 105 213 people died from causes involving COVID-19 in England, 61 416 (58%) of whom were disabled. Age-adjusted analyses showed higher mortality involving COVID-19 among disabled people who were limited a lot (HR 3·05 [95% CI 2·98–3·11] for men; 3·48 [3·41–3·56] for women) and disabled people who were limited a little (HR 1·88 [1·84–1·92] for men; 2·03 [1·98–2·08] for women) than among non-disabled people. Adjustment for residence type, geography, sociodemographics, and health conditions reduced but did not eliminate the associations between disability and death involving COVID-19 (HR 1·35 [1·32–1·38] for men who were limited a lot; 1·21 [1·18–1·23] for men who were limited a little; 1·55 [1·51–1·59] for women who were limited a lot; and 1·28 [1·25–1·31] for women who were limited a little). Interpretation Given the association between disability and mortality involving COVID-19, verification of these findings and consideration of recommendations for protective measures are now required. Funding None.
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Affiliation(s)
| | | | - Vahé Nafilyan
- Office for National Statistics, Newport, UK; The Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Calum Davey
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
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Abstract
BACKGROUND The intrauterine environment is a key determinant for long-term health outcomes. Adverse fetal environments, such as maternal diabetes, obesity and placental insufficiency are strongly associated with long-term health risks in children. Little is known about differences in fetal cardiac output hemodynamics of diabetic mothers (DM) vs. non-diabetic mothers (NDM). Our study aims to investigate the left-sided, right-sided, and combined cardiac output (CCO) in fetuses of DM vs. NDM. METHODS Retrospective data were collected in fetuses of DM (N = 532) and NDM (103) at mean gestational age 24 weeks. Examination included 2D echo and pulse wave Doppler. Wilcoxon rank sum tests and Chi-square tests were used to test for distribution difference of maternal and fetal continuous and categorical measures respectively between DM and NDM. Intraclass correlation coefficients were calculated to assess intra-observer reliability of fetal cardiac measurements. RESULTS DM mothers had higher mean weight (89.7±22.2 kg) than NDM (76.8±19.8 kg), p < 0.0001 and higher mean BMI (33.4±7.5) than NDM (28.3±5.8), p < 0.0001. C-section delivery occurred in 66% of DM vs. 35% of NDM fetuses. Fetuses of DM mothers had significantly larger semilunar valve diameter, higher left ventricular (LV) output, higher combined cardiac output and lower right ventricle /left ventricle ratio compared to NDM. CONCLUSION The greater CCO (adjusted for fetal weight), left sided cardiac output in the fetuses of DM, compared to NDM, represent differences in cardiac adaptation to the diabetic environment.
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Affiliation(s)
- S L Narasimhan
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A Eid
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A Bhatia
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - C Davey
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J Steinberger
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
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Banks LM, Davey C, Shakespeare T, Kuper H. Disability-inclusive responses to COVID-19: Lessons learnt from research on social protection in low- and middle-income countries. World Dev 2021; 137:105178. [PMID: 32904300 PMCID: PMC7455235 DOI: 10.1016/j.worlddev.2020.105178] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The one billion people living with disabilities globally already face a heightened risk of poverty, which will likely be exacerbated by the COVID-19 pandemic unless interventions to address its economic impacts are disability-inclusive. This paper draws on the literature on disability, poverty and social protection in low- and middle-income countries to explore the pathways through which the current pandemic may increase the risk of poverty amongst people with disabilities, such as loss of income from disruptions to work, particularly in the informal sector, and higher future spending and productivity losses from disruptions to healthcare and other key services (e.g. rehabilitation, assistive devices). It also explores how social protection and other initiatives to mitigate the economic impacts of the pandemic should consider the needs of people with disabilities, with recommendations for disability-inclusive actions in the design and implementation of eligibility criteria and application procedures, as well as the delivery and content of benefits. Across recommendations, meaningful consultations with people with disabilities, leadership at the program and policy level, appropriate budgeting and monitoring of progress through routine collection of data on disability are key for improving access to and impact of economic responses amongst people with disabilities.
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Affiliation(s)
- Lena Morgon Banks
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, UK
| | - Calum Davey
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, UK
| | - Tom Shakespeare
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, UK
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Shaw M, Kenny J, Alves A, Davey C, Keehan S, Supple J, Brown R, Cole A, Kadeer F, Lye J. OC-0475: Cranial SRS dosimetry audits of complex treatments of multiple brain metastases. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00497-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Bonell C, Prost A, Melendez-Torres GJ, Davey C, Hargreaves JR. Will it work here? A realist approach to local decisions about implementing interventions evaluated as effective elsewhere. J Epidemiol Community Health 2020; 75:46-50. [PMID: 32907917 DOI: 10.1136/jech-2020-214287] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/02/2020] [Accepted: 08/24/2020] [Indexed: 11/04/2022]
Abstract
There is increasing interest in what evidence is needed to inform decisions about transporting interventions evaluated as effective to new settings. There has been less attention to how local decision-makers decide whether to implement such interventions immediately or subject to further evaluation. Using the example of school-based social and emotional learning, we consider this drawing on realist methods. We suggest decisions need to assess existing evaluations not merely in terms of whether the intervention was effective but also: how the intervention was implemented and what contextual factors affected this (drawing on process evaluation); and for whom the intervention was effective and through what mechanisms (drawing on mediation, moderation and qualitative comparative analyses from primary studies and/or systematic reviews). We contribute new insights to local needs assessments, suggesting that these should assess: the potential, capability, contribution and capacity present in the new setting for implementation; and whether similar 'aetiological mechanisms' underlie adverse outcomes locally as in previous evaluations. We recommend that where there is uncertainty concerning whether an intervention can feasibly be implemented this indicates the need for piloting of implementation. Where there is uncertainty concerning whether implementation of the intervention will trigger intended mechanisms, this suggests the need for a new effectiveness trial. Where there is uncertainty concerning whether intervention mechanisms, even if triggered, will generate the intended outcomes, this suggests that decision-makers may need to look to other types of intervention as being needed for their setting instead.
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Affiliation(s)
- Chris Bonell
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Calum Davey
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - James R Hargreaves
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
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Prakash R, Beattie TS, Cislaghi B, Bhattacharjee P, Javalkar P, Ramanaik S, Thalinja R, Davey C, Gafos M, Watts C, Collumbien M, Moses S, Isac S, Heise L. Changes in Family-Level Attitudes and Norms and Association with Secondary School Completion and Child Marriage Among Adolescent Girls: Results from an Exploratory Study Nested Within a Cluster-Randomised Controlled Trial in India. Prev Sci 2020; 21:1065-1080. [PMID: 32720188 DOI: 10.1007/s11121-020-01143-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We evaluated the impact of Samata, a 3-year multilayered intervention among scheduled caste/scheduled tribe (SC/ST) adolescent girls in rural northern Karnataka, on family-level (parents or guardian) attitudes and direct and indirect norms related to child marriage and girl's education. Endline data from 1840 family members were used to assess the effect of Samata on attitudes and norms related to schooling and child marriage, while data from 4097 family members (including 2257 family members at baseline) were used to understand the shifts in attitudes and norms over the period 2014-2017. Overall, we found that the programme had little impact on family-level attitudes and norms. However, there were shifts in some attitudes, norms and perceived sanctions between baseline (when girls were aged 13-14 years) and endline (when girls were aged 15-16 years), with some becoming more progressive (e.g. direct norms related to child marriage) and others more restrictive (e.g. norms around girls completing secondary education and norms related to child marriage and educational drop-out, blaming girls for eve teasing and limiting girls' mobility so as to protect family honour). Moreover, non-progressive norms related to marriage and education were strongly associated with child marriage and secondary school non-completion among adolescent girls in this rural setting. Norms hypothesised to be important for marriage and schooling outcomes were indeed associated with these outcomes, but the intervention was not able to significantly shift these norms. In part, this may have been due to the intervention focusing much of its initial efforts on working with girls alone rather than family members, the relevant reference group. Future interventions that seek to affect norms should conduct formative research to clarify the specific norms affecting the outcome(s) of interest; likewise, programme planners should ensure that all activities engage those most influential in enforcing the norm(s) from the beginning. ClinicalTrials.gov registration number: NCT01996241.
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Affiliation(s)
- Ravi Prakash
- Department of Community Health Sciences, Institute for Global Public Health, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada.
- India Health Action Trust (IHAT), Bangalore, India.
| | - Tara S Beattie
- Departments of Global Health and Development and Public Health, Environments and Society, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, UK
| | - Beniamino Cislaghi
- Departments of Global Health and Development and Public Health, Environments and Society, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, UK
| | - Parinita Bhattacharjee
- Department of Community Health Sciences, Institute for Global Public Health, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | | | | | | | - Calum Davey
- Departments of Global Health and Development and Public Health, Environments and Society, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, UK
| | - Mitzy Gafos
- Departments of Global Health and Development and Public Health, Environments and Society, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, UK
| | - Charlotte Watts
- Departments of Global Health and Development and Public Health, Environments and Society, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, UK
| | - Martine Collumbien
- Departments of Global Health and Development and Public Health, Environments and Society, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, UK
| | - Stephen Moses
- Department of Community Health Sciences, Institute for Global Public Health, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Shajy Isac
- Department of Community Health Sciences, Institute for Global Public Health, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
- India Health Action Trust (IHAT), Bangalore, India
| | - Lori Heise
- Departments of Global Health and Development and Public Health, Environments and Society, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, UK
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg Institute for Global Public Health and JHU School of Nursing, 615 N. Wolfe Street, Baltimore, MD, USA
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Cowan FM, Chabata ST, Musemburi S, Fearon E, Davey C, Ndori-Mharadze T, Bansi-Matharu L, Cambiano V, Steen R, Busza J, Yekeye R, Mugurungi O, Hargreaves JR, Phillips AN. Strengthening the scale-up and uptake of effective interventions for sex workers for population impact in Zimbabwe. J Int AIDS Soc 2020; 22 Suppl 4:e25320. [PMID: 31328445 PMCID: PMC6643097 DOI: 10.1002/jia2.25320] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 05/13/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction UNAIDS’ goal of ending AIDS by 2030 is unreachable without better targeting of testing, prevention and care. Female sex workers (FSW) in Zimbabwe are at high risk of HIV acquisition and transmission. Here, we report on collated programme and research data from Zimbabwe's national sex work programme. We also assess the potential for wider population impact of FSW programmes by modelling the impact on HIV incidence of eliminating transmission through FSW (i.e. calculate the population attributable fraction of incidence attributable to sex work). Methods Descriptive analyses of individual‐level programme data collected from FSW between 2009 and June 2018 are triangulated with data collected through 37 respondent driven sampling surveys from 19 sites in Zimbabwe 2011 to 2017. We describe programme coverage, uptake, retention and patterns of sex work behaviour and gaps in service provision. An individual‐level stochastic simulation model is used to reconstruct the epidemic and then the incidence compared with the counter‐factual trend in incidence from 2010 had transmission through sex work been eliminated from that date. Results Sisters has reached >67,000 FSW since 2009, increasing attendance as number of sites, programme staff and peer educators were increased. Over 57% of all FSW estimated to be working in Zimbabwe in 2017 (n = 40,000) attended the programme at least once. The proportion of young FSW reached has increased with introduction of the “Young Sisters programme.” There are no clear differences in pattern of sex work across settings. Almost all women report condom use with clients at last sex (95%); however, consistent condom use with clients in the last month varies from 52% to 95% by site. Knowledge of HIV‐positive status has increased from 48 to 78% between 2011 and 2016, as has prevalence of ART use among diagnosed women (29 to 67%). Although subject to uncertainty, modelling suggests that 70% (90% range: 32%, 93%) of all new infections in Zimbabwe from 2010 are directly or indirectly attributable to transmission via sex work. Conclusions It is feasible to increase coverage and impact of sex work programming through community‐led scale‐up of evidence‐based interventions. Eliminating transmission through commercial sex would likely have a substantial impact on new infections occurring more widely across Zimbabwe.
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Affiliation(s)
- Frances M Cowan
- Department of International Public Health, Liverpool School of Medicine, Liverpool, United Kingdom.,Centre for Sexual Health and HIV AIDS Research (CSHHAR) Zimbabwe, Harare, Zimbabwe
| | - Sungai T Chabata
- Centre for Sexual Health and HIV AIDS Research (CSHHAR) Zimbabwe, Harare, Zimbabwe
| | - Sithembile Musemburi
- Centre for Sexual Health and HIV AIDS Research (CSHHAR) Zimbabwe, Harare, Zimbabwe
| | - Elizabeth Fearon
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Calum Davey
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Valentina Cambiano
- Institute for Global Health, University College London, London, United Kingdom
| | - Richard Steen
- Department of Public Health, Erasmus University, Rotterdam, The Netherlands
| | - Joanna Busza
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Owen Mugurungi
- AIDS and TB Directorate, Ministry of Health and Child Care, Harare, Zimbabwe
| | - James R Hargreaves
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Andrew N Phillips
- Institute for Global Health, University College London, London, United Kingdom
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Kuper H, Banks LM, Bright T, Davey C, Shakespeare T. Disability-inclusive COVID-19 response: What it is, why it is important and what we can learn from the United Kingdom's response. Wellcome Open Res 2020; 5:79. [PMID: 32500099 PMCID: PMC7236579 DOI: 10.12688/wellcomeopenres.15833.1] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 01/13/2023] Open
Abstract
All too often, disabled people are left behind in emergencies, and this is a risk in the ongoing COVID-19 pandemic. This is an important issue, as globally there are approximately one billion people with disabilities. This number includes one in three people aged over 60, who are the group at greatest risk from COVID-19. The COVID-19 pandemic in the UK has highlighted additional difficulties that disabled people may face. Complying with preventative measures, like social distancing, can be challenging, particular for people who rely on carers. Disabled people may also be at greater risk of morbidity and mortality if they contract the virus, yet in danger of being de-prioritised for care. Many people with disabilities have ongoing healthcare needs, and these need to still be supported during the pandemic. Furthermore, people may become newly disabled as a result of the pandemic, and therefore require appropriate care. Good practice examples have emerged for meeting these challenges, such as guidance for healthcare professionals on treating people with dementia, but these need to be scaled up further and adapted for other settings. In conclusion, it is clear that a disability-inclusive COVID-19 response is needed, both in the UK and as the pandemic unfolds globally. This response will require inclusion of disability measures within data collection, consulting with disabled people, and tailoring responses to be appropriate for this group.
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Affiliation(s)
- Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Lena Morgon Banks
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Tess Bright
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Calum Davey
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Tom Shakespeare
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
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22
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Busza J, Chiyaka T, Musemburi S, Fearon E, Davey C, Chabata S, Mushati P, Dirawo J, Napierala S, Phillips AN, Cowan FM, Hargreaves JR. Enhancing national prevention and treatment services for sex workers in Zimbabwe: a process evaluation of the SAPPH-IRe trial. Health Policy Plan 2020; 34:337-345. [PMID: 31157368 DOI: 10.1093/heapol/czz037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2019] [Indexed: 11/13/2022] Open
Abstract
Targeted HIV interventions for female sex workers (FSW) combine biomedical technologies, behavioural change and community mobilization with the aim of empowering FSW and improving prevention and treatment. Understanding how to deliver combined interventions most effectively in sub-Saharan Africa is critical to the HIV response. The Sisters' Antiretroviral Programme for Prevention of HIV: an Integrated Response (SAPPH-Ire) randomized controlled trial in Zimbabwe tested an intervention to improve FSW engagement with HIV services. After 2 years, results of the trial showed no significant difference between study arms in proportion of FSW with HIV viral load ≥1000 copies/ml as steep declines occurred in both. We present the results of a process evaluation aiming to track the intervention's implementation, assess its feasibility and accessibility, and situate trial results within the national HIV policy context. We conducted a mixed methods study using data from routine programme statistics, qualitative interviews with participants and respondent driven surveys. The intervention proved feasible to deliver and was acceptable to FSW and providers. Intervention clinics saw more new FSW (4082 vs 2754), performed over twice as many HIV tests (2606 vs 1151) and nearly double the number of women were diagnosed with HIV (1042 vs 546). Community mobilization meetings in intervention sites also attracted higher numbers. We identified some gaps in programme fidelity: offering pre-exposure prophylaxis took time to engage FSW, viral load monitoring was not performed, and ratio of peer educators to FSW was lower than intended. During the trial, reaching FSW with HIV testing and treatment became a national priority, leading to increasing attendance at both intervention and control clinics. Throughout Zimbabwe, antiretroviral therapy coverage improved and HIV-stigma declined. Zimbabwe's changing HIV policy context appeared to contribute to positive improvements across the HIV care continuum for all FSW over the course of the trial. More intense community-based interventions for FSW may be needed to make further gains.
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Affiliation(s)
- Joanna Busza
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Tarisai Chiyaka
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Harare, Zimbabwe
| | - Sithembile Musemburi
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Harare, Zimbabwe
| | - Elizabeth Fearon
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Calum Davey
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Sungai Chabata
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Harare, Zimbabwe
| | - Phillis Mushati
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Harare, Zimbabwe
| | - Jeffrey Dirawo
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Harare, Zimbabwe
| | - Sue Napierala
- RTI International, 351 California Street, Suite 500, San Francisco, CA, USA
| | - Andrew N Phillips
- Institute for Global Health, UCL, Royal Free Hospital, Rowland Hill Street, London, UK and
| | - Frances M Cowan
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Harare, Zimbabwe.,Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool, UK
| | - James R Hargreaves
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
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Beattie TS, Prakash R, Javalkar P, Collumbien M, Ramanaik S, Thalinja R, Murthy S, Davey C, Moses S, Heise L, Watts C, Isac S, Gafos M, Bhattacharjee P. Assessing the effect of the Samata intervention on factors hypothesised to be on the pathway to child marriage and school drop-out: results from a cluster-randomised trial in rural north Karnataka, India. Journal of Global Health Reports 2020. [DOI: 10.29392/001c.12345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Tara S Beattie
- London School of Hygiene & Tropical Medicine, Departments of Global Health and Development and Public Health, Environments and Society, London, UK
| | - Ravi Prakash
- University of Manitoba, Department of Community Health Sciences, Manitoba, Canada
| | | | - Martine Collumbien
- London School of Hygiene & Tropical Medicine, Departments of Global Health and Development and Public Health, Environments and Society, London, UK
| | | | | | | | - Calum Davey
- London School of Hygiene & Tropical Medicine, Departments of Global Health and Development and Public Health, Environments and Society, London, UK
| | - Stephen Moses
- University of Manitoba, Department of Community Health Sciences, Manitoba, Canada
| | - Lori Heise
- Johns Hopkins Bloomberg School of Public Health and JHU School of Nursing, Department of Population, Family and Reproductive Health, Baltimore, MD, USA
| | - Charlotte Watts
- London School of Hygiene & Tropical Medicine, Departments of Global Health and Development and Public Health, Environments and Society, London, UK
| | - Shajy Isac
- University of Manitoba, Department of Community Health Sciences, Manitoba, Canada
| | - Mitzy Gafos
- London School of Hygiene & Tropical Medicine, Departments of Global Health and Development and Public Health, Environments and Society, London, UK
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24
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Affiliation(s)
- James Hargreaves
- London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK.
| | - Calum Davey
- London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
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Abstract
Female sex workers (FSW) face structural barriers to HIV-service access, however the effect of their mobility is uncertain. Using cross-sectional data from 2839 FSW in 14 sites in Zimbabwe, we explored the association between mobility (number of trips, distance, duration) in the past 12 months and five HIV-service-access outcomes: exposure to community mobilisation, clinic attendance, HIV testing, antiretroviral treatment initiation, and viral suppression (< 1000 copies per mL). We used modified-Poisson regression, and natural-effects models to estimate how the effect of trip frequency was mediated by distance and duration away. Each additional trip in 12 months was associated with increased community-mobilisation-event attendance (adjusted RR 1.08, 95% CI 1.04-1.12) and attending clinic two-or-more times (adjusted RR 1.02, 95% CI 1.00-1.05). There was little evidence of any other associations, or of mediation. Our findings are consistent with literature that found the effects of mobility to vary by context and outcome. This is the first study to consider many FSW-mobility and HIV-service-access measures together. Future research on mobility and health-related behaviour should use a spectrum of measures.
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Affiliation(s)
- Calum Davey
- London School of Hygiene and Tropical Medicine, 15 Tavistock Place, London, WC1H 9SH, UK.
| | - Jeffrey Dirawo
- Centre for Sexual Health and HIV/AIDS Research, 9 Monmouth Rd, 5 Avondale West, Harare, Zimbabwe
| | - James R Hargreaves
- London School of Hygiene and Tropical Medicine, 15 Tavistock Place, London, WC1H 9SH, UK
| | - Frances M Cowan
- Centre for Sexual Health and HIV/AIDS Research, 9 Monmouth Rd, 5 Avondale West, Harare, Zimbabwe
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
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26
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Javalkar P, Platt L, Prakash R, Beattie TS, Collumbien M, Gafos M, Ramanaik S, Davey C, Jewkes R, Watts C, Bhattacharjee P, Thalinja R, Dl K, Isac S, Heise L. Effectiveness of a multilevel intervention to reduce violence and increase condom use in intimate partnerships among female sex workers: cluster randomised controlled trial in Karnataka, India. BMJ Glob Health 2019; 4:e001546. [PMID: 31798984 PMCID: PMC6861099 DOI: 10.1136/bmjgh-2019-001546] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 09/05/2019] [Accepted: 09/12/2019] [Indexed: 11/03/2022] Open
Abstract
Introduction Samvedana Plus is a multilevel intervention working with sex workers, their intimate partners (IPs) and communities to reduce intimate partner violence (IPV) and to increase condom use within intimate relationships of sex workers in Northern Karnataka, India. Methods A cluster randomised controlled trial in 47 villages. Female sex workers with IPs in the last 6 months were eligible for baseline (2014), midline (2016) and endline (2017) surveys. 24 villages were randomised to Samvedana Plus and 23 to a wait-list control. Primary outcomes among sex workers included experience of physical and/or sexual IPV or severe physical/sexual IPV in the last 6 months and consistent condom use with their IP in past 30 days. Analyses adjusted for clustering and baseline cluster-level means of outcomes. Result Baseline (n=620) imbalance was observed with respect to age (33.9 vs 35.2) and IPV (31.4% vs 45.0%). No differences in physical/sexual IPV (8.1% vs 9.0%), severe physical/sexual IPV (6.9% vs 8.7%) or consistent condom use with IPs (62.5% vs 57.3%) were observed by trial arm at end line (n=547). Samvedana Plus was associated with decreased acceptance of IPV (adjusted OR (AOR)=0.62, 95% CI 0.40 to 0.94, p=0.025), increased awareness of self-protection strategies (AOR=1.73, 95% CI=1.04-2.89, p=0.035) and solidarity of sex workers around issues of IPV (AOR=1.69, 95% CI=1.02-2.82, p=0.042). We observed an increase in IPV between baseline (25.9%) and midline (63.5%) among women in Samvedana Plus villages but lower in comparison villages (41.8%-44.3%) and a sharp decrease at end line in both arms (~8%). Conclusion We found no evidence that Samvedana Plus reduced IPV or increased condom use, but it may impact acceptance of IPV, increase knowledge of self-protection strategies and increase sex worker solidarity. Inconsistencies in reported IPV undermined the ability of the trial to assess effectiveness. Trial registration number NCT02807259.
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Affiliation(s)
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ravi Prakash
- Karnataka Health Promotion Trust, Bengalaru, India
| | - Tara S Beattie
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Martine Collumbien
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Mitzy Gafos
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Calum Davey
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rachel Jewkes
- Gender and Health Division, South African Medical Research Council, Pretoria, South Africa
| | - Charlotte Watts
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Kavitha Dl
- Karnataka Health Promotion Trust, Bengalaru, India
| | - Shajy Isac
- Karnataka Health Promotion Trust, Bengalaru, India
| | - Lori Heise
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Lye J, Shaw M, Alves A, Supple J, Davey C, Brown R, Cole A, Kadeer F, Kenny J, Lehmann J. OC-016: Results from ACDS end-to-end dosimetry audit of spine and lung SBRT. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(20)30422-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Thompson J, Davey C, Hayes R, Hargreaves J, Fielding K. swpermute: Permutation tests for Stepped-Wedge Cluster-Randomised Trials. Stata J 2019; 19:803-819. [PMID: 32565746 PMCID: PMC7305031 DOI: 10.1177/1536867x19893624] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Permutation tests are useful in stepped-wedge trials to provide robust statistical tests of intervention-effect estimates. However, the Stata command permute does not produce valid tests in this setting because individual observations are not exchangeable. We introduce the swpermute command that permutes clusters to sequences to maintain exchangeability. The command provides additional functionality to aid users in performing analyses of stepped-wedge trials. In particular, we include the option "withinperiod" that performs the specified analysis separately in each period of the study with the resulting period-specific intervention-effect estimates combined as a weighted average. We also include functionality to test non-zero null hypotheses to aid the construction of confidence intervals. Examples of the application of swpermute are given using data from a trial testing the impact of a new tuberculosis diagnostic test on bacterial confirmation of a tuberculosis diagnosis.
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Bansi-Matharu L, Cambiano V, Apollo T, Yekeye R, Dirawo J, Musemburi S, Davey C, Napierala S, Fearon E, Mpofu A, Mugurungi O, Hargreaves JR, Cowan FM, Phillips AN. 90-90-90 by 2020? Estimation and projection of the adult HIV epidemic and ART programme in Zimbabwe - 2017 to 2020. J Int AIDS Soc 2019; 21:e25205. [PMID: 30465689 PMCID: PMC6250855 DOI: 10.1002/jia2.25205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/16/2018] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The 90-90-90 targets set by the United Nations aspire to 73% of people living with HIV (PLHIV) being virally suppressed by 2020. Using the HIV Synthesis Model, we aim to mimic the epidemic in Zimbabwe and make projections to assess whether Zimbabwe is on track to meet the 90-90-90 targets and assess whether recently proposed UNAIDS HIV transition metrics are likely to be met. METHODS We used an approximate Bayesian computation approach to identify model parameter values which result in model outputs consistent with observed data, evaluated using a calibration score. These parameter values were then used to make projections to 2020 to compare with the 90-90-90 targets and other key indicators. We also calculated HIV transition metrics proposed by UNAIDS (percentage reduction in new HIV infections and AIDS-related mortality from 2010 to 2020, absolute rate of new infections and AIDS-related mortality, incidence-mortality ratio and incidence-prevalence ratios). RESULTS After calibration, there was general agreement between modelled and observed data. The median predicted outcomes in 2020 were: proportion of PLHIV (aged 15 to 65) diagnosed 0.91 (90% uncertainty range 0.87, 0.94) (0.84 men, 0.95 women); of those diagnosed, proportion on treatment 0.92 (0.90, 0.93); of those receiving treatment, proportion with viral suppression 0.86 (0.81, 0.91). This results in 72% of PLHIV having viral suppression in 2020. We estimated a percentage reduction of 36.5% (13.7% increase to 67.4% reduction) in new infections from 2010 to 2020, and of 30.4% (9.7% increase to 56.6% reduction) in AIDS-related mortality (UNAIDS target 75%). The modelled absolute rates of HIV incidence and AIDS-related mortality in 2020 were 5.48 (2.26, 9.24) and 1.93 (1.31, 2.71) per 1000 person-years respectively. The modelled incidence-mortality ratio and incidence-prevalence ratios in 2020 were 1.05 (0.46, 1.66) and 0.009 (0.004, 0.013) respectively. CONCLUSIONS Our model was able to produce outputs that are simultaneously consistent with an array of observed data and predicted that while the 90-90-90 targets are within reach in Zimbabwe, increased efforts are required in diagnosing men in particular. Calculation of the HIV transition metrics suggest increased efforts are needed to bring the HIV epidemic under control.
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Affiliation(s)
| | | | - Tsitsi Apollo
- Department of HIV/AIDS and STIs, Ministry of Health and Childcare, Harare, Zimbabwe
| | | | - Jeffrey Dirawo
- Centre for Sexual Health, HIV/AIDS Research Zimbabwe, Harare, Zimbabwe
| | | | - Calum Davey
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | | | - Elizabeth Fearon
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Amon Mpofu
- Zimbabwe National AIDS Council, Harare, Zimbabwe
| | - Owen Mugurungi
- TB and AIDS Unit, Zimbabwe Ministry of Health, Harare, Zimbabwe
| | - James R Hargreaves
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Frances M Cowan
- Centre for Sexual Health, HIV/AIDS Research Zimbabwe, Harare, Zimbabwe.,Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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30
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Prakash R, Beattie TS, Javalkar P, Bhattacharjee P, Ramanaik S, Thalinja R, Murthy S, Davey C, Gafos M, Blanchard J, Watts C, Collumbien M, Moses S, Heise L, Isac S. The Samata intervention to increase secondary school completion and reduce child marriage among adolescent girls: results from a cluster-randomised control trial in India. J Glob Health 2019; 9:010430. [PMID: 31448111 PMCID: PMC6684866 DOI: 10.7189/jogh.09.010430] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Secondary education and delayed marriage provide long-term socio-economic and health benefits to adolescent girls. We tested whether a structural and norms-based intervention, which worked with adolescent girls, their families, communities, and secondary schools to address poverty, schooling quality and gender norms, could reduce secondary school drop-out and child marriage among scheduled-caste/scheduled-tribe (SC/ST) adolescent girls in rural settings of southern India. Methods 80 of 121 villages in Vijayapura and Bagalkote districts, Karnataka State, were randomly selected (control = 40; intervention = 40). All 12-13 year-old SC/ST girls in final year of primary school (standard 7th) were enrolled and followed for 3 years (2014-2017) until the end of secondary school (standard 10th). Primary trial outcomes were proportion of girls who completed secondary school and were married, by trial end-line (15-16 years). Analyses were intention-to-treat and used individual-level girl data. Results 92.6% (2275/2457) girls at baseline and 72.8% (1788/2457) at end-line were interviewed. At end-line, one-fourth had not completed secondary school (control = 24.9%; intervention = 25.4%), and one in ten reported being married (control = 9.6%; intervention = 10.1%). These were lower than expected based on district-level data available before the trial, with no difference between these, or other schooling or sexual and reproductive outcomes, by trial arm. There was a small but significant increase in secondary school entry (adjusted odds ratio AOR = 3.58, 95% confidence interval CI = 1.36-9.44) and completion (AOR=1.54, 95%CI = 1.02-2.34) in Vijayapura district. The sensitivity and attrition analyses did not impact the overall result indicating that attrition of girls at end-line was random without much bearing on overall result. Conclusions Samata intervention had no overall impact, however, it added value in one of the two implementation districts- increasing secondary school entry and completion. Lower than expected school drop-out and child marriage rates at end-line reflect strong secular changes, likely due to large-scale government initiatives to keep girls in school and delay marriage. Although government programmes may be sufficient to reach most girls in these settings, a substantial proportion of SC/ST girls remain at-risk of early marriage and school drop-out, and require targeted programming. Addressing multiple forms of clustered disadvantage among hardest to reach will be key to ensuring India "leaves no-one behind" and achieves its gender, health and education Sustainable Development Goal aspirations. Trial registration ClinicalTrials.gov registration number NCT01996241.
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Affiliation(s)
- Ravi Prakash
- Karnataka Health Promotion Trust (KHPT), Rajajinagar, Bangalore, India.,Joint first authorship
| | - Tara S Beattie
- London School of Hygiene & Tropical Medicine (LSHTM), Departments of Global Health and Development and Public Health, Environments and Society, London, UK.,Joint first authorship
| | - Prakash Javalkar
- Karnataka Health Promotion Trust (KHPT), Rajajinagar, Bangalore, India
| | - Parinita Bhattacharjee
- University of Manitoba, Departments of Community Medicine and Medical Microbiology, Winnipeg, Canada
| | | | | | - Srikanta Murthy
- Karnataka Health Promotion Trust (KHPT), Rajajinagar, Bangalore, India
| | - Calum Davey
- London School of Hygiene & Tropical Medicine (LSHTM), Departments of Global Health and Development and Public Health, Environments and Society, London, UK
| | - Mitzy Gafos
- London School of Hygiene & Tropical Medicine (LSHTM), Departments of Global Health and Development and Public Health, Environments and Society, London, UK
| | - James Blanchard
- University of Manitoba, Departments of Community Medicine and Medical Microbiology, Winnipeg, Canada
| | - Charlotte Watts
- London School of Hygiene & Tropical Medicine (LSHTM), Departments of Global Health and Development and Public Health, Environments and Society, London, UK
| | - Martine Collumbien
- London School of Hygiene & Tropical Medicine (LSHTM), Departments of Global Health and Development and Public Health, Environments and Society, London, UK
| | - Stephen Moses
- University of Manitoba, Departments of Community Medicine and Medical Microbiology, Winnipeg, Canada
| | - Lori Heise
- London School of Hygiene & Tropical Medicine (LSHTM), Departments of Global Health and Development and Public Health, Environments and Society, London, UK.,Johns Hopkins Bloomberg School of Public Health and JHU School of Nursing, Department of Population, Family and Reproductive Health, Baltimore, Maryland, USA.,Joint last authorship
| | - Shajy Isac
- Karnataka Health Promotion Trust (KHPT), Rajajinagar, Bangalore, India.,University of Manitoba, Departments of Community Medicine and Medical Microbiology, Winnipeg, Canada.,Joint last authorship
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Lye J, Shaw M, Lehmann J, Alves A, Brown R, Davey C, Kadeer F, Kenny J, Supple J. PO-0902 The ACDS approach to measuring dose to bone and comparing to TPS reported dose to water and medium. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31322-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shaw M, Alves A, Davey C, Geso M, Kadeer F, Lehmann J, Supple J, Lye J. EP-2116 End-to-end dosimetry audits of Stereotactic Ablative Radiotherapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32536-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Javalkar P, Platt L, Prakash R, Beattie T, Bhattacharjee P, Thalinja R, L KD, Sangha CATM, Ramanaik S, Collumbien M, Davey C, Moses S, Jewkes R, Isac S, Heise L. What determines violence among female sex workers in an intimate partner relationship? Findings from North Karnataka, south India. BMC Public Health 2019; 19:350. [PMID: 30922283 PMCID: PMC6440026 DOI: 10.1186/s12889-019-6673-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 03/18/2019] [Indexed: 11/16/2022] Open
Abstract
Background Like other women in India, female sex workers (FSWs) frequently experience violence from their intimate partners (IPs)-a reality that increases their risk of acquiring HIV or other sexually transmitted infections. Less is known about the nature of these intimate relationships or what aspect of the relationship increases the risk of IP violence (IPV). We measured the prevalence and determinants of IPV on FSWs in the context of north Karnataka, India, characterized by high HIV-prevalence and extreme poverty. Methods Overall 620 FSWs with an IP participated in a baseline survey conducted for an on-going cluster-randomised controlled trial aiming to evaluate the impact of a multi-level intervention on IPV reduction. We characterize the nature of intimate relationships and explored determinants of severe physical and/or sexual IP violence using univariable and multivariable analyses. Results The median age of participants was 35 years with 10 years of duration in an intimate relationship. Though most relationships originated from a sex work encounter, 84% stated that IPs did not know they were currently practicing sex work. In past 6 months, the experience of emotional violence was 49% (95%CI:45.2–53.2), physical 33% (95%CI:29.5–37.1) and sexual violence 7% (95%CI:4.8–8.9), while 24% (95%CI:21.0–27.9) FSWs experienced recent severe physical and/or sexual violence from IPs. Factors associated with recent IPV included experience of physical and/or sexual violence from their clients in last 6 months (AOR 2.20; 95%CI: 1.29–3.75), sexual intercourse in the past 1 month when their IP was under the influence of alcohol (AOR 2.30; 95%CI: 1.47–3.59) and providing financial support to their IP (AOR 2.07; 95%CI: 1.28–3.34). Conclusions The association between increased risk of violence and provision of financial support to an IP is indicative of gendered power dynamics as men remain dominant irrespective of their financial dependency on FSWs. Interventions are needed that address inequitable gender norms which makes FSWs tolerate violence even though she is not financially dependent on IP. Higher likelihood of violence in presence of alcohol use and FSWs’ previous experience of workplace violence linked to IPV call for strengthening the crisis management systems within community-based organisations that can address all forms of violence and associated risk factors. Trial registration Clinical Trials NCT02807259
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Affiliation(s)
- Prakash Javalkar
- Karnataka Health Promotion Trust (KHPT), IT Park, 5th Floor, #1-4, Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka, 560044, India.
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SN, UK
| | - Ravi Prakash
- Karnataka Health Promotion Trust (KHPT), IT Park, 5th Floor, #1-4, Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka, 560044, India
| | - Tara Beattie
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SN, UK
| | - Parinita Bhattacharjee
- Karnataka Health Promotion Trust (KHPT), IT Park, 5th Floor, #1-4, Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka, 560044, India.,Center for Global Public Health, University of Manitoba, Winnipeg, Manitoba, R3T 2N2, Canada
| | - Raghavendra Thalinja
- Karnataka Health Promotion Trust (KHPT), IT Park, 5th Floor, #1-4, Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka, 560044, India
| | - Kavitha D L
- Karnataka Health Promotion Trust (KHPT), IT Park, 5th Floor, #1-4, Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka, 560044, India
| | | | - Satyanarayana Ramanaik
- Karnataka Health Promotion Trust (KHPT), IT Park, 5th Floor, #1-4, Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka, 560044, India
| | - Martine Collumbien
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SN, UK
| | - Calum Davey
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SN, UK
| | - Stephen Moses
- Center for Global Public Health, University of Manitoba, Winnipeg, Manitoba, R3T 2N2, Canada
| | - Rachel Jewkes
- South African Medical Research Council, 1 Soutpansberg Road, Pretoria, South Africa
| | - Shajy Isac
- Karnataka Health Promotion Trust (KHPT), IT Park, 5th Floor, #1-4, Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka, 560044, India.,Center for Global Public Health, University of Manitoba, Winnipeg, Manitoba, R3T 2N2, Canada
| | - Lori Heise
- Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD, USA
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Davey C, Dirawo J, Mushati P, Magutshwa S, Hargreaves JR, Cowan FM. Mobility and sex work: why, where, when? A typology of female-sex-worker mobility in Zimbabwe. Soc Sci Med 2018; 220:322-330. [PMID: 30500610 DOI: 10.1016/j.socscimed.2018.11.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 11/15/2018] [Indexed: 11/17/2022]
Abstract
Sex-worker mobility may have implications for health and access to care but has not been described in sub-Saharan Africa. We described sex-worker mobility in Zimbabwe and a mobility typology using data from 2591 and 2839 female sex workers in 14 sites from 2013 and 2016. We used latent class analysis to identify a typology of mobile sex workers. More women travelled for work in 2016 (59%) than in 2013 (27%), usually to find clients with more money (57% of the journeys), spending a median of 21 (2013) and 24 (2016) days away. A five-class mixture model best fitted the data, with 39% women in an infrequent work-mobility class, 21% in a domestic-high-mobility class, 16% in an international-high-mobility class, 16% in an infrequent opportunistic-non-work-mobility class, and 7% who travel with clients. More-mobile classes were better educated; risk behaviours differed by class. Mobility is increasing among sex worker in Zimbabwe, multi-faceted, and not explained by other vulnerabilities.
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Affiliation(s)
- Calum Davey
- London School of Hygiene and Tropical Medicine, 15 Tavistock Place, London, WC1H 9SH, UK.
| | - Jeffrey Dirawo
- Centre for Sexual Health and HIV/AIDS Research, 9 Monmouth Rd, Avondale West, Harare, Zimbabwe
| | - Phillis Mushati
- Centre for Sexual Health and HIV/AIDS Research, 9 Monmouth Rd, Avondale West, Harare, Zimbabwe
| | - Sitholubuhle Magutshwa
- Centre for Sexual Health and HIV/AIDS Research, 9 Monmouth Rd, Avondale West, Harare, Zimbabwe
| | - James R Hargreaves
- London School of Hygiene and Tropical Medicine, 15 Tavistock Place, London, WC1H 9SH, UK
| | - Frances M Cowan
- Centre for Sexual Health and HIV/AIDS Research, 9 Monmouth Rd, Avondale West, Harare, Zimbabwe; Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
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Powell-Jackson T, Davey C, Masset E, Krishnaratne S, Hayes R, Hanson K, Hargreaves JR. Trials and tribulations: cross-learning from the practices of epidemiologists and economists in the evaluation of public health interventions. Health Policy Plan 2018; 33:702-706. [PMID: 29596614 PMCID: PMC5950929 DOI: 10.1093/heapol/czy028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2018] [Indexed: 11/15/2022] Open
Abstract
The randomized controlled trial is commonly used by both epidemiologists and economists to test the effectiveness of public health interventions. Yet we have noticed differences in practice between the two disciplines. In this article, we propose that there are some underlying differences between the disciplines in the way trials are used, how they are conducted and how results from trials are reported and disseminated. We hypothesize that evidence-based public health could be strengthened by understanding these differences, harvesting best-practice across the disciplines and breaking down communication barriers between economists and epidemiologists who conduct trials of public health interventions.
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Affiliation(s)
- Timothy Powell-Jackson
- London School of Hygiene and Tropical Medicine (LSHTM), Faculty of Public Health and Policy, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Calum Davey
- London School of Hygiene and Tropical Medicine (LSHTM), Faculty of Public Health and Policy, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Edoardo Masset
- London International Development Centre (LIDC), 36 Gordon Square, London, WC1E 0PD, UK
| | - Shari Krishnaratne
- London School of Hygiene and Tropical Medicine (LSHTM), Faculty of Public Health and Policy, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Richard Hayes
- London School of Hygiene and Tropical Medicine (LSHTM), MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, Keppel Street, London WC1E 7HT, UK
| | - Kara Hanson
- London School of Hygiene and Tropical Medicine (LSHTM), Faculty of Public Health and Policy, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - James R Hargreaves
- London School of Hygiene and Tropical Medicine (LSHTM), Faculty of Public Health and Policy, 15-17 Tavistock Place, London WC1H 9SH, UK
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Cowan FM, Davey C, Fearon E, Mushati P, Dirawo J, Chabata S, Cambiano V, Napierala S, Hanisch D, Wong-Gruenwald R, Masuka N, Mabugo T, Hatzold K, Mugurungi O, Busza J, Phillips A, Hargreaves JR. Targeted combination prevention to support female sex workers in Zimbabwe accessing and adhering to antiretrovirals for treatment and prevention of HIV (SAPPH-IRe): a cluster-randomised trial. Lancet HIV 2018; 5:e417-e426. [PMID: 30030134 DOI: 10.1016/s2352-3018(18)30111-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 05/14/2018] [Accepted: 05/24/2018] [Indexed: 05/26/2023]
Abstract
BACKGROUND Strengthening engagement of female sex workers with health services is needed to eliminate HIV. We assessed the efficacy of a targeted combination intervention for female sex workers in Zimbabwe. METHODS We did a cluster-randomised trial from 2014 to 2016. Clusters were areas surrounding female sex worker clinics and were enrolled in matched pairs. Sites were randomly assigned (1:1) to receive usual care (free sexual-health services supported by peer educators, including HIV testing on demand, referral for antiretroviral therapy [ART], and health education) or an intervention that supported additional regular HIV testing, on-site initiation of ART, pre-exposure prophylaxis, adherence, and intensified community mobilisation. The primary outcome was the proportion of all female sex workers with HIV viral load 1000 copies per mL or greater, assessed through respondent-driven sampling surveys. We used an adapted cluster-summary approach to estimate risk differences. This trial is registered with Pan African Clinical Trials Registry, number PACTR201312000722390. RESULTS We randomly assigned 14 clusters to usual care or the intervention (seven in each group). 3612 female sex workers attended clinics in the usual-care clusters and 4619 in the intervention clusters during the study. Half as many were tested (1151 vs 2606) and diagnosed as being HIV positive (546 vs 1052) in the usual-care clusters. The proportion of all female sex workers with viral loads of 1000 copies per mL or greater fell in both study groups (from 421 [30%] of 1363 to 279 [19%] of 1443 in the usual-care group and from 399 [30%] of 1303 to 240 [16%] of 1439 in the intervention group), but with a risk difference at the end of the assessment period of only -2·8% (95% CI -8·1 to 2·5, p=0·23). Among HIV-positive women, the proportions with viral loads less than 1000 copies per mL were 590 (68%) of 869 in the usual-care group and 588 (72%) of 828 in the intervention group at the end of the assessment period, adjusted risk difference of 5·3% (95% CI -4·0 to 14·6, p=0·20). There were no adverse events. INTERPRETATION Our intervention of a dedicated programme for female sex workers led to high levels of HIV diagnosis and treatment. Further research is needed to optimise programme content and intensity for the broader population. FUNDING UN Population Fund (through Zimbabwe's Integrated Support Fund funded by UK Department for International Development, Irish Aid, and Swedish International Development Cooperation Agency).
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Affiliation(s)
- Frances M Cowan
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK; Centre for Sexual Health and HIV AIDS Research (CeSHHAR), Harare, Zimbabwe.
| | - Calum Davey
- Department of Social and Environmental Health Research, Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth Fearon
- Department of Social and Environmental Health Research, Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Phillis Mushati
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR), Harare, Zimbabwe
| | - Jeffrey Dirawo
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR), Harare, Zimbabwe
| | - Sungai Chabata
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR), Harare, Zimbabwe
| | | | - Sue Napierala
- Women's Global Health Imperative, RTI International, San Francisco, CA, USA
| | | | | | | | - Travor Mabugo
- Health Economics and Policy Research Initiative, Zimbabwe
| | | | | | - Joanna Busza
- Department of Social and Environmental Health Research, Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew Phillips
- Institute for Global Health, University College London, London, UK
| | - James R Hargreaves
- Department of Social and Environmental Health Research, Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Metrebian N, Weaver T, Pilling S, Hellier J, Byford S, Shearer J, Mitcheson L, Astbury M, Bijral P, Bogdan N, Bowden-Jones O, Day E, Dunn J, Finch E, Forshall S, Glasper A, Morse G, Akhtar S, Bajaria J, Bennett C, Bishop E, Charles V, Davey C, Desai R, Goodfellow C, Haque F, Little N, McKechnie H, Morris J, Mosler F, Mutz J, Pauli R, Poovendran D, Slater E, Strang J. Positive reinforcement targeting abstinence in substance misuse (PRAISe): Study protocol for a Cluster RCT & process evaluation of contingency management. Contemp Clin Trials 2018; 71:124-132. [PMID: 29908336 DOI: 10.1016/j.cct.2018.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 10/14/2022]
Abstract
There are approximately 256,000 heroin and other opiate users in England of whom 155,000 are in treatment for heroin (or opiate) addiction. The majority of people in treatment receive opiate substitution treatment (OST) (methadone and buprenorphine). However, OST suffers from high attrition and persistent heroin use even whilst in treatment. Contingency management (CM) is a psychological intervention based on the principles of operant conditioning. It is delivered as an adjunct to existing evidence based treatments to amplify patient benefit and involves the systematic application of positive reinforcement (financial or material incentives) to promote behaviours consistent with treatment goals. With an international evidence base for CM, NICE recommended that CM be implemented in UK drug treatment settings alongside OST to target attendance and the reduction of illicit drug use. While there was a growing evidence base for CM, there had been no examination of its delivery in UK NHS addiction services. The PRAISe trial evaluates the feasibility, acceptability, clinical and cost effectiveness of CM in UK addiction services. It is a cluster randomised controlled effectiveness trial of CM (praise and financial incentives) targeted at either abstinence from opiates or attendance at treatment sessions versus no CM among individuals receiving OST. The trial includes an economic evaluation which explores the relative costs and cost effectiveness of the two CM intervention strategies compared to TAU and an embedded process evaluation to identify contextual factors and causal mechanisms associated with variations in outcome. This study will inform UK drug treatment policy and practice. Trial registration ISRCTN 01591254.
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Affiliation(s)
- N Metrebian
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
| | - T Weaver
- Imperial College London, London, UK; Middlesex University, London, UK
| | - S Pilling
- University College London, London, UK
| | - J Hellier
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - S Byford
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - J Shearer
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - L Mitcheson
- South London and Maudsley NHS Foundation Trust, London, UK
| | - M Astbury
- Dudley & Walsall Mental Health Partnership Trust, Dudley, UK
| | - P Bijral
- Change, Grow, Live Charity, Management Offices, London, UK
| | - N Bogdan
- South Essex Partnership NHS Foundation Trust, Essex, UK
| | - O Bowden-Jones
- Central and North West London NHS Foundation Trust, London, UK
| | - E Day
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK; Birmingham & Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - J Dunn
- Camden & Islington NHS Foundation Trust, London, UK
| | - E Finch
- South London and Maudsley NHS Foundation Trust, London, UK
| | - S Forshall
- Avon & Wiltshire Mental Health Partnership NHS Trust, Bristol, UK
| | - A Glasper
- Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - G Morse
- Turning Point Charity, London, UK
| | - S Akhtar
- Birmingham & Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - J Bajaria
- South Essex Partnership NHS Foundation Trust, Essex, UK
| | - C Bennett
- Birmingham & Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - E Bishop
- University College London, London, UK
| | - V Charles
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - C Davey
- Avon & Wiltshire Mental Health Partnership NHS Trust, Bristol, UK
| | - R Desai
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | | | - F Haque
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - N Little
- University College London, London, UK
| | | | - J Morris
- Avon & Wiltshire Mental Health Partnership NHS Trust, Bristol, UK
| | - F Mosler
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - J Mutz
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - R Pauli
- Birmingham & Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | | | - E Slater
- South Essex Partnership NHS Foundation Trust, Essex, UK
| | - J Strang
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
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Ndori‐Mharadze T, Fearon E, Busza J, Dirawo J, Musemburi S, Davey C, Acharya X, Mtetwa S, Hargreaves JR, Cowan F. Changes in engagement in HIV prevention and care services among female sex workers during intensified community mobilization in 3 sites in Zimbabwe, 2011 to 2015. J Int AIDS Soc 2018; 21 Suppl 5:e25138. [PMID: 30033558 PMCID: PMC6055130 DOI: 10.1002/jia2.25138] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 05/22/2018] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION 'Sisters with a Voice', Zimbabwe's nationally scaled comprehensive programme for female sex workers (FSWs), intensified community mobilization activities in three sites to increase protective behaviours and utilization of clinical services. We compare indicators among FSWs at the beginning and after implementation. METHODS We used mixed methods to collect data at three sites: in-depth interviews (n = 22) in 2015, routine clinical data from 2010 to 2015, and two respondent driven sampling surveys in 2011 and 2015, in which participants completed an interviewer-administered questionnaire and provided a finger prick blood sample for HIV antibody testing. Estimates were weighted using RDS-1 and estimate convergence assessed in both years. We assessed differences in six indicators between 2011 and 2015 using logistic regression adjusted for age, duration in sex work and education. RESULTS 870 FSWs were recruited from the three sites in 2011 and 915 in 2015. Using logistic regression to adjust for socio-demographic differences, we found higher estimates of the proportion of HIV-positive FSWs and HIV-positive FSWs who knew their status and reported being on ART in Mutare and Victoria Falls in 2015 compared to 2011. Reported condom use with clients did not differ by year; however, condom use with regular partners was higher in 2015 in Mutare and Hwange. Reported HIV testing in the last six months among HIV-negative FSWs was higher in 2015 across sites: for instance, in Victoria Falls it was 13.4% (95% CI 8.7% to 19.9%) in 2011 and 80.8% (95% CI 74.0 to 87.7) in 2015. FSWs described positive perceptions of the Sisters programme, ease of engaging with health services, and improved solidarity among peers. Programme data showed increases in service use by 2015 across all sites. CONCLUSIONS Improvements in key HIV care engagement indicators were observed among FSWs in two sites and in testing and prevention indicators across the three sites after implementation of an intensified community mobilization intervention. Engagement with services for FSWs is critical for countries to reach 90-90-90 targets.
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Affiliation(s)
| | - Elizabeth Fearon
- Department of Public Health, Environments and SocietyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Joanna Busza
- Department of Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Jeffrey Dirawo
- Centre for Sexual Health HIV and AIDS Research (CeSHHAR Zimbabwe)HarareZimbabwe
| | | | - Calum Davey
- Department of Public Health, Environments and SocietyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Xeno Acharya
- Epidemiology and Public HealthHarvard TH Chan School of Public HealthBostonMA
| | - Sibongile Mtetwa
- Centre for Sexual Health HIV and AIDS Research (CeSHHAR Zimbabwe)HarareZimbabwe
| | - James R Hargreaves
- Department of Public Health, Environments and SocietyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Frances Cowan
- Centre for Sexual Health HIV and AIDS Research (CeSHHAR Zimbabwe)HarareZimbabwe
- Department of International Public HealthLiverpool School of Tropical MedicineLiverpoolUK
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Davey C, Cowan F, Hargreaves J. The effect of mobility on HIV-related healthcare access and use for female sex workers: A systematic review. Soc Sci Med 2018; 211:261-273. [PMID: 29966821 DOI: 10.1016/j.socscimed.2018.06.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 05/09/2018] [Accepted: 06/19/2018] [Indexed: 11/28/2022]
Abstract
Female sex workers (FSW) experience a high HIV burden and are often mobile. FSW access to HIV-related healthcare is essential for equitable welfare and to reduce new HIV infections. We systematically reviewed the literature on mobility and HIV-related healthcare access and use among FSW. Outcome measures included: HIV/STI testing, STI treatment, PrEP (initiation or adherence), and ART (initiation or adherence). We summarised the results with a narrative synthesis. From 7417 non-duplicated citations, nine studies from Canada (3), Guatamala, Honduras (2), India, South Africa, and Vietnam were included. Only one of the studies was designed to address mobility and healthcare access, and only six reported adjusted effect estimates. Mobility was measured over four time-frames (from 'current' to 'ever'), as having lived or worked elsewhere or in another town/province/country. Three studies from Canada, Guatemala, and India found mobility associated with increased odds of poor initial access to healthcare (adjusted odds ratios (AOR) from 1.33, 95% CI 1.02, 1.75, to 2.27, 95% CI 1.09, 4.76), and one from Vietnam found no association (odds ratio (OR): 0.92, 95% CI 0.65, 1.28). The study from South Africa found no association with initiating ART (risk ratio: 0.86, 95% CI 0.65, 1.14). Two studies from Canada and Honduras found increased odds of ART interruption (AOR 2.74, 95% CI 0.89, 8.42; 5.19, 95% CI 1.38, 19.56), while two other studies from Canada and Honduras found no association with detectable viral load (OR 0.84, 95% CI 0.08, 8.33; AOR 0.79, 95% CI 0.41, 1.69). We found that mobility is associated with reduced initial healthcare access and interruption of ART, consistent with literature from the general population. Discordance between effects on adherence and viral load may be due to measurement of mobility. Future research should carefully construct measures of mobility and consider a range of HIV-related healthcare outcomes.
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Affiliation(s)
- Calum Davey
- London School of Hygiene and Tropical Medicine, London, UK.
| | - Frances Cowan
- Liverpool School of Tropical Medicine, Liverpool, UK.
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Hickson F, Davey C, Reid D, Weatherburn P, Bourne A. Mental health inequalities among gay and bisexual men in England, Scotland and Wales: a large community-based cross-sectional survey. J Public Health (Oxf) 2018; 39:266-273. [PMID: 27118380 DOI: 10.1093/pubmed/fdw021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Sexual minorities suffer worse mental health than the sexual majority but little is known about differences in mental health within sexual minorities. We aimed to describe inequality in mental health indicators among gay and bisexual men. Methods Using multi-channel community-based opportunistic sampling we recruited 5799 eligible men aged 16 years and over, living in England, Scotland and Wales and who were sexually attracted to other men, to a self-completion Internet health survey. Mental health indicators (depression (PHQ-9), anxiety (GAD-7), suicide attempt and self-harm) were examined for independent associations across common axes of inequality (age, ethnicity, migrancy, education, income, cohabitation and living in London). Results Mental ill-health was common: 21.3% were depressed and 17.1% anxious, while 3.0% had experienced attempted suicide and 6.5% had self-harmed within the last 12 months. All four indicators were associated with younger age, lower education and lower income. Depression was also associated with being a member of visible ethnic minorities and sexual attraction to women as well as men. Cohabiting with a male partner and living in London were protective of mental health. Conclusion Community interventions to increase mental health among gay and bisexual men should be designed to disproportionately benefit younger men and those living on lower incomes.
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Affiliation(s)
- Ford Hickson
- Sigma Research, Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Calum Davey
- Sigma Research, Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - David Reid
- Sigma Research, Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Peter Weatherburn
- Sigma Research, Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Adam Bourne
- Sigma Research, Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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Thompson JA, Davey C, Fielding K, Hargreaves JR, Hayes RJ. Robust analysis of stepped wedge trials using cluster-level summaries within periods. Stat Med 2018; 37:2487-2500. [PMID: 29635789 PMCID: PMC6032886 DOI: 10.1002/sim.7668] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 02/22/2018] [Accepted: 03/02/2018] [Indexed: 12/29/2022]
Abstract
In stepped‐wedge trials (SWTs), the intervention is rolled out in a random order over more than 1 time‐period. SWTs are often analysed using mixed‐effects models that require strong assumptions and may be inappropriate when the number of clusters is small. We propose a non‐parametric within‐period method to analyse SWTs. This method estimates the intervention effect by comparing intervention and control conditions in a given period using cluster‐level data corresponding to exposure. The within‐period intervention effects are combined with an inverse‐variance‐weighted average, and permutation tests are used. We present an example and, using simulated data, compared the method to (1) a parametric cluster‐level within‐period method, (2) the most commonly used mixed‐effects model, and (3) a more flexible mixed‐effects model. We simulated scenarios where period effects were common to all clusters, and when they varied according to a distribution informed by routinely collected health data. The non‐parametric within‐period method provided unbiased intervention effect estimates with correct confidence‐interval coverage for all scenarios. The parametric within‐period method produced confidence intervals with low coverage for most scenarios. The mixed‐effects models' confidence intervals had low coverage when period effects varied between clusters but had greater power than the non‐parametric within‐period method when period effects were common to all clusters. The non‐parametric within‐period method is a robust method for analysing SWT. The method could be used by trial statisticians who want to emphasise that the SWT is a randomised trial, in the common position of being uncertain about whether data will meet the assumptions necessary for mixed‐effect models.
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Affiliation(s)
- J A Thompson
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,MRC London Hub for Trials Methodology Research, London, UK
| | - C Davey
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - K Fielding
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - J R Hargreaves
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - R J Hayes
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Hickson F, Davey C, Reid D, Weatherburn P, Bourne A. Mental health inequalities among gay and bisexual men in England, Scotland and Wales: a large community-based cross-sectional survey. J Public Health (Oxf) 2017; 39:645. [PMID: 27613766 DOI: 10.1093/pubmed/fdw079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 07/07/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ford Hickson
- Sigma Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Calum Davey
- Sigma Research, London School of Hygiene & Tropical Medicine, London, UK
| | - David Reid
- Sigma Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter Weatherburn
- Sigma Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Adam Bourne
- Sigma Research, London School of Hygiene & Tropical Medicine, London, UK
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43
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Thompson JA, Fielding KL, Davey C, Aiken AM, Hargreaves JR, Hayes RJ. Bias and inference from misspecified mixed-effect models in stepped wedge trial analysis. Stat Med 2017; 36:3670-3682. [PMID: 28556355 PMCID: PMC5600088 DOI: 10.1002/sim.7348] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 05/02/2017] [Indexed: 11/09/2022]
Abstract
Many stepped wedge trials (SWTs) are analysed by using a mixed‐effect model with a random intercept and fixed effects for the intervention and time periods (referred to here as the standard model). However, it is not known whether this model is robust to misspecification. We simulated SWTs with three groups of clusters and two time periods; one group received the intervention during the first period and two groups in the second period. We simulated period and intervention effects that were either common‐to‐all or varied‐between clusters. Data were analysed with the standard model or with additional random effects for period effect or intervention effect. In a second simulation study, we explored the weight given to within‐cluster comparisons by simulating a larger intervention effect in the group of the trial that experienced both the control and intervention conditions and applying the three analysis models described previously. Across 500 simulations, we computed bias and confidence interval coverage of the estimated intervention effect. We found up to 50% bias in intervention effect estimates when period or intervention effects varied between clusters and were treated as fixed effects in the analysis. All misspecified models showed undercoverage of 95% confidence intervals, particularly the standard model. A large weight was given to within‐cluster comparisons in the standard model. In the SWTs simulated here, mixed‐effect models were highly sensitive to departures from the model assumptions, which can be explained by the high dependence on within‐cluster comparisons. Trialists should consider including a random effect for time period in their SWT analysis model. © 2017 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd.
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Affiliation(s)
- Jennifer A Thompson
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, U.K.,MRC London Hub for Trials Methodology Research, London, U.K
| | - Katherine L Fielding
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, U.K
| | - Calum Davey
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, U.K
| | - Alexander M Aiken
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, U.K
| | - James R Hargreaves
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, U.K
| | - Richard J Hayes
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, U.K
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Ratheesh A, Davey C, Hetrick S, Alvarez-Jimenez M, Voutier C, Bechdolf A, McGorry PD, Scott J, Berk M, Cotton SM. A systematic review and meta-analysis of prospective transition from major depression to bipolar disorder. Acta Psychiatr Scand 2017; 135:273-284. [PMID: 28097648 DOI: 10.1111/acps.12686] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Some people with major depressive disorder (MDD) may be at a pre-onset stage for bipolar disorder (BD), where early identification or prevention efforts may be feasible. We aimed to identify rates and characteristics predictive of transition to BD in prospective follow-up studies of people with MDD. METHODS Using a systematic search strategy, we identified studies with a diagnostic ascertainment of MDD and BD of an adequate standard, and where the minimum length of follow-up was 6 months. We examined the incidence and point prevalence of BD and the pooled odds ratios (OR) for baseline predictors. RESULTS From 5554 unique publications, 56 were included. Nearly a quarter of adults (22.5%) and adolescents with MDD followed up for a mean length of 12-18 years developed BD, with the greatest risk of transition being in the first 5 years. The meta-analysis identified that transition from MDD to BD was predicted by family history of BD (OR = 2.89, 95% CI: 2.01-4.14, N = 7), earlier age of onset of depression (g = -0.33, SE = 0.05, N = 6) and presence of psychotic symptoms (OR = 4.76, 95% CI: 1.79-12.66, N = 5). CONCLUSIONS Participants with the identified risk factors merit closer observation and may benefit from prevention efforts, especially if outcomes broader than BD are considered.
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Affiliation(s)
- A Ratheesh
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Vic
| | - C Davey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Vic
| | - S Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Vic
| | - M Alvarez-Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Vic
| | - C Voutier
- Royal Melbourne Hospital Library, Melbourne, Vic., Australia
| | - A Bechdolf
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne.,Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Hospital am Urban and Vivantes Hospital im Friedrichshain, Charite Universitätsmedizin, Berlin, Germany
| | - P D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Vic
| | - J Scott
- University of Newcastle, Newcastle upon Tyne, UK
| | - M Berk
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Vic.,Florey Institute of Neuroscience and Mental Health, Parkville, Vic.,Impact Strategic Research Centre, Deakin University, Geelong, Vic, Australia
| | - S M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Vic
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Davey C, Desai AB, Shajahan PM. Are we giving General Practitioners what they want from Psychiatric out-patient review letters? Scott Med J 2016. [DOI: 10.1258/rsmsmj.51.4.49c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We aimed to assess the quality of out-patient clinic letters in relation to GPs expectations. A questionnaire was devised and sent to 65 GPs to ascertain what they felt to be important in a psychiatric out-patient clinic letter. We examined 250 out-patient clinic letters comprising both a formatted and unformatted pattern. We compared whether one particular type of letter was more successful at providing the information specifically requested by GPs. Fifty seven per cent of GPs responded to the questionnaire. Letters following a pre-determined formatted template, although slightly longer, consistently conveyed more relevant information. Conclusion: The use of formatted letters is a means of enhancing communication between psychiatrists and GPs and within secondary psychiatry services.
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Glen AS, Pech RP, Davey C, Molsher RL. Raptors vs aliens: can indigenous birds of prey help control invasive predators? New Zealand Journal of Zoology 2016. [DOI: 10.1080/03014223.2016.1261910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A. S. Glen
- Landcare Research, Private Bag 92170, Auckland 1142, New Zealand
| | - R. P. Pech
- Landcare Research, PO Box 69040, Lincoln 7640, New Zealand
| | - C. Davey
- 24 Bardsley Place, Holt, Canberra, ACT 2615, Australia
| | - R. L. Molsher
- Department of Environment, Water and Natural Resources, PO Box 39, Kingscote, Kangaroo Island SA 5223, Australia
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Beattie TS, Isac S, Bhattacharjee P, Javalkar P, Davey C, Raghavendra T, Nair S, Ramanaik S, Kavitha DL, Blanchard JF, Watts C, Collumbien M, Moses S, Heise L. Reducing violence and increasing condom use in the intimate partnerships of female sex workers: study protocol for Samvedana Plus, a cluster randomised controlled trial in Karnataka state, south India. BMC Public Health 2016; 16:660. [PMID: 27473180 PMCID: PMC4966746 DOI: 10.1186/s12889-016-3356-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/22/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Female sex workers (FSWs) are at increased risk of HIV and STIs compared to women in the general population, and frequently experience violence in their working and domestic lives from a variety of perpetrators, which can enhance this risk. While progress has been made in addressing violence by police and clients, little work has been done to understand and prevent violence by intimate partners (IPs) among FSW populations. METHODS Samvedana Plus is a multi-level intervention programme that works with FSWs, their IPs, the sex worker community, and the general population, and aims to reduce violence and increase consistent condom use within these 'intimate' relationships. The programme involves shifting norms around the acceptability of beating as a form of discipline, challenging gender roles that give men authority over women, and working with men and women to encourage new relationship models based on gender equity and respect. The programme will aim to cover 800 FSWs and their IPs living in 47 villages in Bagalkot district, northern Karnataka. The study is designed to assess two primary outcomes: the proportion of FSWs who report: (i) physical or sexual partner violence; and (ii) consistent condom use in their intimate relationship, within the past 6 months. The evaluation will employ a cluster-randomised controlled trial design, with 50 % of the village clusters (n = 24) randomly selected to receive the intervention for the first 24 months and the remaining 50 % (n = 23) receiving the intervention thereafter. Statisticians will be blinded to treatment arm allocation. The evaluation will use an adjusted, cluster-level intention to treat analysis, comparing outcomes in intervention and control villages at midline (12 months) and endline (24 months). The evaluation design will involve quantitative and qualitative assessments with (i) all FSWs who report an IP (ii) IPs; and process/ implementation monitoring. Baseline data collection was completed in April 2015, and endline data collection is anticipated in May 2017. CONCLUSIONS This is an innovative intervention programme that aims to address violence by IPs as part of HIV prevention programming with FSWs. Reducing violence is expected to reduce vulnerability to HIV acquisition, and help women to work and live without fear of violence. TRIAL REGISTRATION Clinical Trials NCT02807259 Jun 24 2016 (retrospectively registered).
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Affiliation(s)
- Tara S. Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SN UK
| | - Shajy Isac
- Karnataka Health Promotion Trust, Bangalore, India
- University of Manitoba, Winnipeg, Canada
| | - Parinita Bhattacharjee
- Karnataka Health Promotion Trust, Bangalore, India
- University of Manitoba, Winnipeg, Canada
| | | | - Calum Davey
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SN UK
| | | | - Sapna Nair
- Karnataka Health Promotion Trust, Bangalore, India
| | - Satyanarayana Ramanaik
- Karnataka Health Promotion Trust, Bangalore, India
- University of Manitoba, Winnipeg, Canada
| | | | | | - Charlotte Watts
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SN UK
| | - Martine Collumbien
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SN UK
| | | | - Lori Heise
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SN UK
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Kanaan M, Mdege ND, Keding A, Parker RA, Mills N, Shah A, Strachan F, Keerie C, Weir CJ, Forbes A, Hemming K, Lawton SA, Healey E, Lewis M, Nicholls E, Jinks C, Tan V, Finney A, Mallen CD, Lenguerrand E, MacLennan G, Norrie J, Bhattacharya S, Draycott T, Hooper R, Teerenstra S, de Hoop E, Eldridge S, Girling A, Taljaard M, Di Tanna GL, Gasparrini A, Casula A, Caskey F, Lenguerrand E, Methven S, MacNeill S, May M, Selby N, Danon L, Christensen H, Finn A, May M, Takanashi F, Keding A, Crouch S, Kanaan M, Kristunas CA, Smith KL, Gray LJ, Matthews JN, Salman RAS, Parker RA, Maxwell A, Dennis M, Rudd A, Weir CJ, Thompson JA, Fielding KL, Davey C, Aiken AM, Hargreaves JR, Hayes RJ, Lyons VH, Li L, Hughes J, Rowhani-Rahbar A, Hemming K, Taljaard M, Forbes A. Proceedings of the First International Conference on Stepped Wedge Trial Design. Trials 2016; 17 Suppl 1:311. [PMID: 27454562 PMCID: PMC4959349 DOI: 10.1186/s13063-016-1436-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
I1 Introduction Mona Kanaan, Noreen Dadirai Mdege, Ada Keding O1 The HiSTORIC trial: a hybrid before-and-after and stepped wedge design RA Parker, N Mills, A Shah, F Strachan, C Keerie, CJ Weir O2 Stepped wedge trials with non-uniform correlation structure Andrew Forbes, Karla Hemming O3 Challenges and solutions for the operationalisation of the ENHANCE study: a pilot stepped wedge trial within a general practice setting Sarah A Lawton, Emma Healey, Martyn Lewis, Elaine Nicholls, Clare Jinks, Valerie Tan, Andrew Finney, Christian D Mallen, on behalf of the ENHANCE Study Team O4 Early lessons from the implementation of a stepped wedge trial design investigating the effectiveness of a training intervention in busy health care settings: the Thistle study Erik Lenguerrand, Graeme MacLennan, John Norrie, Siladitya Bhattacharya, Tim Draycott, on behalf of the Thistle group O5 Sample size calculation for longitudinal cluster randomised trials: a unified framework for closed cohort and repeated cross-section designs Richard Hooper, Steven Teerenstra, Esther de Hoop, Sandra Eldridge O6 Restricted randomisation schemes for stepped-wedge studies with a cluster-level covariate Alan Girling, Monica Taljaard O7 A flexible modelling of the time trend for the analysis of stepped wedge trials: results of a simulation study Gian Luca Di Tanna, Antonio Gasparrini P1 Tackling acute kidney injury – a UK stepped wedge clinical trial of hospital-level quality improvement interventions Anna Casula, Fergus Caskey, Erik Lenguerrand, Shona Methven, Stephanie MacNeill, Margaret May, Nicholas Selby P2 Sample size considerations for quantifying secondary bacterial transmission in a stepped wedge trial of influenza vaccine Leon Danon, Hannah Christensen, Adam Finn, Margaret May P3 Sample size calculation for time-to-event data in stepped wedge cluster randomised trials Fumihito Takanashi, Ada Keding, Simon Crouch, Mona Kanaan P4 Sample size calculations for stepped-wedge cluster randomised trials with unequal cluster sizes Caroline A. Kristunas, Karen L. Smith, Laura J. Gray P5 The design of stepped wedge trials with unequal cluster sizes John N.S. Matthews P6 Promoting Recruitment using Information Management Efficiently (PRIME): a stepped wedge SWAT (study-within-a-trial) R Al-Shahi Salman, RA Parker, A Maxwell, M Dennis, A Rudd, CJ Weir P7 Implications of misspecified mixed effect models in stepped wedge trial analysis: how wrong can it be? Jennifer A Thompson, Katherine L Fielding, Calum Davey, Alexander M Aiken, James R Hargreaves, Richard J Hayes S1 Stepped Wedge Designs with Multiple Interventions Vivian H Lyons, Lingyu Li, James Hughes, Ali Rowhani-Rahbar S2 Analysis of the cross-sectional stepped wedge cluster randomised trial Karla Hemming, Monica Taljaard, Andrew Forbes
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Bourne A, Davey C, Hickson F, Reid D, Weatherburn P. Physical health inequalities among gay and bisexual men in England: a large community-based cross-sectional survey. J Public Health (Oxf) 2016; 39:290-296. [DOI: 10.1093/pubmed/fdw029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hargreaves JRM, Goodman C, Davey C, Willey BA, Avan BI, Schellenberg JRA. Measuring implementation strength: lessons from the evaluation of public health strategies in low- and middle-income settings. Health Policy Plan 2016; 31:860-7. [PMID: 26965038 PMCID: PMC4977426 DOI: 10.1093/heapol/czw001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 11/28/2022] Open
Abstract
Evaluation of strategies to ensure evidence-based, low-cost interventions reach those in need is critical. One approach is to measure the strength, or intensity, with which packages of interventions are delivered, in order to explore the association between implementation strength and public health gains. A recent systematic review suggested methodological guidance was needed. We described the approaches used in three examples of measures of implementation strength in evaluation. These addressed important public health topics with a substantial disease burden in low-and middle-income countries; they involved large-scale implementation; and featured evaluation designs without comparison areas. Strengths and weaknesses of the approaches were discussed. In the evaluation of Ethiopia’s Health Extension Programme, implementation strength scoring for each kebele (ward) was based on aggregated data from interviews with mothers of children aged 12–23 months, reflecting their reports of contact with four elements of the programme. An evaluation of the Avahan HIV prevention programme in India used the cumulative amount of Avahan funding per HIV-infected person spent each year in each district. In these cases, a single measure was developed and the association with hypothesised programme outcomes presented. In the evaluation of the Affordable Medicines Facility—malaria, several implementation strength measures were developed based on the duration of activity of the programme and the level of implementation of supporting interventions. Measuring the strength of programme implementation and assessing its association with outcomes is a promising approach to strengthen pragmatic impact evaluation. Five key aspects of developing an implementation strength measure are to: (a) develop a logic model; (b) identify aspects of implementation to be assessed; (c) design and implement data collection from a range of data sources; (d) decide whether and how to combine data into a single measure; and, (e) plan whether and how to use the measure(s) in outcome analysis.
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Affiliation(s)
| | | | | | | | - Bilal Iqbal Avan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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