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Jin SL, Kolis J, Parker J, Proctor DA, Prybylski D, Wardle C, Abad N, Brookmeyer KA, Voegeli C, Chiou H. Social histories of public health misinformation and infodemics: case studies of four pandemics. Lancet Infect Dis 2024:S1473-3099(24)00105-1. [PMID: 38648811 DOI: 10.1016/s1473-3099(24)00105-1] [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: 09/28/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 04/25/2024]
Abstract
Recognition of misinformation as a public health threat and interest in infodemics, defined as an inundation of information accompanying an epidemic or acute health event, have increased worldwide. However, scientists have no consensus on how to best define and identify misinformation and other essential characteristics of infodemics. We conducted a narrative review of secondary historical sources to examine previous infodemics in relation to four infectious diseases associated with pandemics (ie, smallpox, cholera, 1918 influenza, and HIV) and challenge the assumption that misinformation is a new phenomenon associated with increased use of social media or with the COVID-19 pandemic. On the contrary, we found that the spread of health misinformation has always been a public health challenge that has necessitated innovative solutions from medical and public health communities. We suggest expanding beyond the narrow scope of addressing misinformation to manage information ecosystems, defined as how people consume, produce, interact with, and behave around information, which include factors such as trust, stigma, and scientific literacy. Although misinformation can spread on a global scale, this holistic approach advocates for community-level interventions that improve relationships and trust between medical or public health entities and local populations.
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Affiliation(s)
- Sabrina L Jin
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessica Kolis
- US Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Jessica Parker
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | - Claire Wardle
- School of Public Health, Brown University, Providence, RI, USA
| | - Neetu Abad
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Howard Chiou
- US Centers for Disease Control and Prevention, Atlanta, GA, USA; Commissioned Corps, US Public Health Service, Rockville, MD, USA
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Ishizumi A, Kolis J, Abad N, Prybylski D, Brookmeyer KA, Voegeli C, Wardle C, Chiou H. Beyond misinformation: developing a public health prevention framework for managing information ecosystems. Lancet Public Health 2024:S2468-2667(24)00031-8. [PMID: 38648815 DOI: 10.1016/s2468-2667(24)00031-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 02/14/2024] [Accepted: 02/14/2024] [Indexed: 04/25/2024]
Abstract
The COVID-19 pandemic has highlighted how infodemics (defined as an overabundance of information, including misinformation and disinformation) pose a threat to public health and could hinder individuals from making informed health decisions. Although public health authorities and other stakeholders have implemented measures for managing infodemics, existing frameworks for infodemic management have been primarily focused on responding to acute health emergencies rather than integrated in routine service delivery. We review the evidence and propose a framework for infodemic management that encompasses upstream strategies and provides guidance on identifying different interventions, informed by the four levels of prevention in public health: primary, secondary, tertiary, and primordial prevention. On the basis of a narrative review of 54 documents (peer-reviewed and grey literature published from 1961 to 2023), we present examples of interventions that belong to each level of prevention. Adopting this framework requires proactive prevention and response through managing information ecosystems, beyond reacting to misinformation or disinformation.
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Affiliation(s)
- Atsuyoshi Ishizumi
- Task Force for Global Health, Decatur, GA, USA; US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessica Kolis
- US Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Neetu Abad
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | - Claire Wardle
- School of Public Health, Brown University, Providence, RI, USA
| | - Howard Chiou
- US Centers for Disease Control and Prevention, Atlanta, GA, USA; Commissioned Corps, US Public Health Service, Rockville, MD, USA
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3
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Perera SM, Garbern SC, Mbong EN, Fleming MK, Muhayangabo RF, Ombeni AB, Kulkarni S, Tchoualeu DD, Kallay R, Song E, Powell J, Gainey M, Glenn B, Mutumwa RM, Mustafa SHB, Earle-Richardson G, Fukunaga R, Abad N, Soke GN, Prybylski D, Fitter DL, Levine AC, Doshi RH. Perceptions toward Ebola vaccination and correlates of vaccine uptake among high-risk community members in North Kivu, Democratic Republic of the Congo. PLOS Glob Public Health 2024; 4:e0002566. [PMID: 38236844 PMCID: PMC10796044 DOI: 10.1371/journal.pgph.0002566] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/22/2023] [Indexed: 01/22/2024]
Abstract
The tenth Ebola Virus Disease (EVD) outbreak (2018-2020, North Kivu, Ituri, South Kivu) in the Democratic Republic of the Congo (DRC) was the second-largest EVD outbreak in history. During this outbreak, Ebola vaccination was an integral part of the EVD response. We evaluated community perceptions toward Ebola vaccination and identified correlates of Ebola vaccine uptake among high-risk community members in North Kivu, DRC. In March 2021, a cross-sectional survey among adults was implemented in three health zones. We employed a sampling approach mimicking ring vaccination, targeting EVD survivors, their household members, and their neighbors. Outbreak experiences and perceptions toward the Ebola vaccine were assessed, and modified Poisson regression was used to identify correlates of Ebola vaccine uptake among those offered vaccination. Among the 631 individuals surveyed, most (90.2%) reported a high perceived risk of EVD and 71.6% believed that the vaccine could reduce EVD severity; however, 63.7% believed the vaccine had serious side effects. Among the 474 individuals who had been offered vaccination, 397 (83.8%) received the vaccine, 180 (45.3%) of those vaccinated received the vaccine after two or more offers. Correlates positively associated with vaccine uptake included having heard positive information about the vaccine (RR 1.30, 95% CI 1.06-1.60), the belief that the vaccine could prevent EVD (RR 1.23, 95% CI 1.09-1.39), and reporting that religion influenced all decisions (RR 1.13, 95% CI 1.02-1.25). Ebola vaccine uptake was high in this population, although mixed attitudes and vaccine delays were common. Communicating positive vaccine information, emphasizing the efficacy of the Ebola vaccine, and engaging religious leaders to promote vaccination may aid in increasing Ebola vaccine uptake during future outbreaks.
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Affiliation(s)
- Shiromi M. Perera
- International Medical Corps, Washington, District of Columbia, United States of America
| | - Stephanie Chow Garbern
- Department of Emergency Medicine, Brown University, Providence, Rhode Island, United States of America
| | - Eta Ngole Mbong
- International Medical Corps, Goma, Democratic Republic of the Congo
| | - Monica K. Fleming
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | - Shibani Kulkarni
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Dieula Delissaint Tchoualeu
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ruth Kallay
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Elizabeth Song
- Brown University, Providence, Rhode Island, United States of America
| | - Jasmine Powell
- Brown University, Providence, Rhode Island, United States of America
| | - Monique Gainey
- Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Bailey Glenn
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- James A. Ferguson Infectious Disease Program, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | - Giulia Earle-Richardson
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rena Fukunaga
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Neetu Abad
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Gnakub Norbert Soke
- Division of Global Health Protection, Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo
| | - Dimitri Prybylski
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - David L. Fitter
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Adam C. Levine
- Department of Emergency Medicine, Brown University, Providence, Rhode Island, United States of America
| | - Reena H. Doshi
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Koyuncu A, Carter RJ, Musaazi J, Namageyo-Funa A, Carter VM, Lamorde M, Prybylski D, Apondi R, Bakyaita T, Boore AL, Homsy J, Brown VR, Kigozi J, Nabaggala MS, Nakate V, Nkurunziza E, Stowell DF, Walwema R, Olowo A, Jalloh MF. Public perceptions of Ebola vaccines and confidence in health services to treat Ebola, malaria, and tuberculosis: Findings from a cross-sectional household survey in Uganda, 2020. PLOS Glob Public Health 2023; 3:e0001884. [PMID: 38113241 PMCID: PMC10729951 DOI: 10.1371/journal.pgph.0001884] [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: 05/31/2023] [Accepted: 10/30/2023] [Indexed: 12/21/2023]
Abstract
Uganda used Ebola vaccines as part of its preparedness and response during the 2018-2020 10th Ebola virus disease (EVD) outbreak in neighboring Democratic Republic of the Congo (DRC). We evaluated the public's perceptions of Ebola vaccines and compared their confidence in health services to treat Ebola versus malaria and tuberculosis as part of a survey on Ebola knowledge, attitudes, and practices (KAP) conducted in March 2020. A cross-sectional household survey was implemented in six districts in Uganda using multi-stage cluster sampling to randomly select participants. The districts were purposively selected from districts classified by the government as at high- or low-risk for an EVD outbreak. We describe perceptions of Ebola vaccines and confidence in health services to treat Ebola, tuberculosis, and malaria. Modified Poisson regression modeling was used to identify the demographic correlates of these outcomes. Among 3,485 respondents, 18% were aware of Ebola vaccines. Of those, 92% agreed that the vaccines were needed to prevent Ebola. Participants aged 15-24 years were 4% more likely to perceive such need compared to those 60 years and older (adjusted prevalence ratio [aPR] 1.04, 95% confidence interval [CI] 1.0-1.08). The perceived need was 5% lower among participants with at least some secondary education compared to uneducated participants (aPR 0.95; 0.92-0.99). Overall, 81% of those aware of the vaccines believed that everyone or most people in their community would get vaccinated if offered, and 94% said they would likely get vaccinated if offered. Confidence in health services to treat Ebola was lower compared to treating malaria or tuberculosis (55% versus 93% and 77%, respectively). However, participants from the EVD high-risk districts were 22% more likely to be confident in health services to treat Ebola compared to those in low-risk districts (aPR: 1.22; 95% CI: 1.08, 1.38). Our findings suggest that intent to take an Ebola vaccine during an outbreak was strong, but more work needs to be done to increase public awareness of these vaccines. The public's high confidence in health services to treat other health threats, such as malaria and tuberculosis, offer building blocks for strengthening their confidence in health services to treat EVD in the event of an outbreak.
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Affiliation(s)
- Aybüke Koyuncu
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rosalind J. Carter
- National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Joseph Musaazi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Apophia Namageyo-Funa
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Victoria M. Carter
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mohammed Lamorde
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Dimitri Prybylski
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rose Apondi
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Amy L. Boore
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jaco Homsy
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Vance R. Brown
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Joanita Kigozi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Maria Sarah Nabaggala
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Vivian Nakate
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Emmanuel Nkurunziza
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Daniel F. Stowell
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Richard Walwema
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Apollo Olowo
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mohamed F. Jalloh
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Doshi RH, Garbern SC, Kulkarni S, Perera SM, Fleming MK, Muhayangabo RF, Ombeni AB, Tchoualeu DD, Kallay R, Song E, Powell J, Gainey M, Glenn B, Mutumwa RM, Hans Bateyi Mustafa S, Earle-Richardson G, Gao H, Abad N, Soke GN, Fitter DL, Hyde TB, Prybylski D, Levine AC, Jalloh MF, Mbong EN. Ebola vaccine uptake and attitudes among healthcare workers in North Kivu, Democratic Republic of the Congo, 2021. Front Public Health 2023; 11:1080700. [PMID: 37559741 PMCID: PMC10408297 DOI: 10.3389/fpubh.2023.1080700] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 10/26/2022] [Accepted: 06/19/2023] [Indexed: 08/11/2023] Open
Abstract
Introduction During the 2018-2020 Ebola virus disease (EVD) outbreak in the eastern part of the Democratic Republic of the Congo (DRC), prevention and control measures, such as Ebola vaccination were challenging by community mistrust. We aimed to understand perceptions regarding Ebola vaccination and identify determinants of Ebola vaccine uptake among HCWs. Methods In March 2021, we conducted a cross-sectional survey among 438 HCWs from 100 randomly selected health facilities in three health zones (Butembo, Beni, Mabalako) affected by the 10th EVD outbreak in North Kivu, DRC. HCWs were eligible if they were ≥ 18 years and were working in a health facility during the outbreak. We used survey logistic regression to assess correlates of first-offer uptake (i.e., having received the vaccine the first time it was offered vs. after subsequent offers). Results Of the 438 HCWs enrolled in the study, 420 (95.8%) reported that they were eligible and offered an Ebola vaccine. Among those offered vaccination, self-reported uptake of the Ebola vaccine was 99.0% (95% confidence interval (CI) [98.5-99.4]), but first-offer uptake was 70.2% (95% CI [67.1, 73.5]). Nearly all HCWs (94.3%; 95% CI [92.7-95.5]) perceived themselves to be at risk of contracting EVD. The most common concern was that the vaccine would cause side effects (65.7%; 95% CI [61.4-69.7]). In the multivariable analysis, mistrust of the vaccine source or how the vaccine was produced decreased the odds of first-time uptake. Discussion Overall uptake of the Ebola vaccine was high among HCWs, but uptake at the first offer was substantially lower, which was associated with mistrust of the vaccine source. Future Ebola vaccination efforts should plan to make repeated vaccination offers to HCWs and address their underlying mistrust in the vaccines, which can, in turn, improve community uptake.
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Affiliation(s)
- Reena H. Doshi
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Stephanie C. Garbern
- Department of Emergency Medicine, Brown University, Providence, RI, United States
| | - Shibani Kulkarni
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Monica K. Fleming
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | | | - Ruth Kallay
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | | | - Bailey Glenn
- James A. Ferguson Infectious Disease Program, Baltimore, MD, United States
| | | | | | - Giulia Earle-Richardson
- National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Hongjiang Gao
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Neetu Abad
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Gnakub Norbert Soke
- Division of Global Health Protection, Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of Congo
| | - David L. Fitter
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Terri B. Hyde
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Dimitri Prybylski
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Adam C. Levine
- International Medical Corps, Washington, DC, United States
- International Medical Corps, Goma, Democratic Republic of Congo
| | - Mohamed F. Jalloh
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Eta Ngole Mbong
- International Medical Corps, Goma, Democratic Republic of Congo
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Garbern SC, Perera SM, Mbong EN, Kulkarni S, Fleming MK, Ombeni AB, Muhayangabo RF, Tchoualeu DD, Kallay R, Song E, Powell J, Gainey M, Glenn B, Gao H, Mutumwa RM, Mustafa SHB, Abad N, Soke GN, Prybylski D, Doshi RH, Fukunaga R, Levine AC. COVID-19 Vaccine Perceptions among Ebola-Affected Communities in North Kivu, Democratic Republic of the Congo, 2021. Vaccines (Basel) 2023; 11:973. [PMID: 37243077 PMCID: PMC10223943 DOI: 10.3390/vaccines11050973] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Populations affected by humanitarian crises and emerging infectious disease outbreaks may have unique concerns and experiences that influence their perceptions toward vaccines. In March 2021, we conducted a survey to examine the perceptions toward COVID-19 vaccines and identify the factors associated with vaccine intention among 631 community members (CMs) and 438 healthcare workers (HCWs) affected by the 2018-2020 Ebola Virus Disease outbreak in North Kivu, Democratic Republic of the Congo. A multivariable logistic regression was used to identify correlates of vaccine intention. Most HCWs (81.7%) and 53.6% of CMs felt at risk of contracting COVID-19; however, vaccine intention was low (27.6% CMs; 39.7% HCWs). In both groups, the perceived risk of contracting COVID-19, general vaccine confidence, and male sex were associated with the intention to get vaccinated, with security concerns preventing vaccine access being negatively associated. Among CMs, getting the Ebola vaccine was associated with the intention to get vaccinated (RR 1.43, 95% CI 1.05-1.94). Among HCWs, concerns about new vaccines' safety and side effects (OR 0.72, 95% CI 0.57-0.91), religion's influence on health decisions (OR 0.45, 95% CI 0.34-0.61), security concerns (OR 0.52, 95% CI 0.37-0.74), and governmental distrust (OR 0.50, 95% CI 0.35-0.70) were negatively associated with vaccine perceptions. Enhanced community engagement and communication that address this population's concerns could help improve vaccine perceptions and vaccination decisions. These findings could facilitate the success of vaccine campaigns in North Kivu and similar settings.
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Affiliation(s)
- Stephanie Chow Garbern
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI 02903, USA
| | | | - Eta Ngole Mbong
- International Medical Corps, Goma, Democratic Republic of the Congo
| | - Shibani Kulkarni
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Monica K. Fleming
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | | | | | | | - Ruth Kallay
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | | | | | | | - Bailey Glenn
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
- James A. Ferguson Infectious Disease Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Hongjiang Gao
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | | | | | - Neetu Abad
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Gnakub Norbert Soke
- Division of Global Health Protection, Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo
| | - Dimitri Prybylski
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Reena H. Doshi
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Rena Fukunaga
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Adam C. Levine
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI 02903, USA
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Koyuncu A, Ishizumi A, Daniels D, Jalloh MF, Wallace AS, Prybylski D. The Use of Adaptive Sampling to Reach Disadvantaged Populations for Immunization Programs and Assessments: A Systematic Review. Vaccines (Basel) 2023; 11:vaccines11020424. [PMID: 36851301 PMCID: PMC9961530 DOI: 10.3390/vaccines11020424] [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: 11/21/2022] [Revised: 01/25/2023] [Accepted: 02/02/2023] [Indexed: 02/16/2023] Open
Abstract
Vaccines prevent 4-5 million deaths every year, but inequities in vaccine coverage persist among key disadvantaged subpopulations. Under-immunized subpopulations (e.g., migrants, slum residents) may be consistently missed with conventional methods for estimating immunization coverage and assessing vaccination barriers. Adaptive sampling, such as respondent-driven sampling, may offer useful strategies for identifying and collecting data from these subpopulations that are often "hidden" or hard-to-reach. However, use of these adaptive sampling approaches in the field of global immunization has not been systematically documented. We searched PubMed, Scopus, and Embase databases to identify eligible studies published through November 2020 that used an adaptive sampling method to collect immunization-related data. From the eligible studies, we extracted relevant data on their objectives, setting and target population, and sampling methods. We categorized sampling methods and assessed their frequencies. Twenty-three studies met the inclusion criteria out of the 3069 articles screened for eligibility. Peer-driven sampling was the most frequently used adaptive sampling method (57%), followed by geospatial sampling (30%), venue-based sampling (17%), ethnographic mapping (9%), and compact segment sampling (9%). Sixty-one percent of studies were conducted in upper-middle-income or high-income countries. Data on immunization uptake were collected in 65% of studies, and data on knowledge and attitudes about immunizations were collected in 57% of studies. We found limited use of adaptive sampling methods in measuring immunization coverage and understanding determinants of vaccination uptake. The current under-utilization of adaptive sampling approaches leaves much room for improvement in how immunization programs calibrate their strategies to reach "hidden" subpopulations.
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Affiliation(s)
- Aybüke Koyuncu
- Global Immunization Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Atsuyoshi Ishizumi
- Global Immunization Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Danni Daniels
- Global Immunization Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Mohamed F Jalloh
- Global Immunization Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Aaron S Wallace
- Global Immunization Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Dimitri Prybylski
- Global Immunization Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
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Jalloh MF, Zeebari Z, Nur SA, Prybylski D, Nur AA, Hakim AJ, Winters M, Steinhardt LC, Gatei W, Omer SB, Brewer NT, Nordenstedt H. Drivers of COVID-19 policy stringency in 175 countries and territories: COVID-19 cases and deaths, gross domestic products per capita, and health expenditures. J Glob Health 2022; 12:05049. [PMID: 36527269 PMCID: PMC9758449 DOI: 10.7189/jogh.12.05049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background New data on COVID-19 may influence the stringency of containment policies, but these potential effect are not understood. We aimed to understand the associations of new COVID-19 cases and deaths with policy stringency globally and regionally. Methods We modelled the marginal effects of new COVID-19 cases and deaths on policy stringency (scored 0-100) in 175 countries and territories, adjusting for gross domestic product (GDP) per capita and health expenditure (% of GDP), and public expenditure on health. The time periods examined were March to August 2020, September 2020 to February 2021, and March to August 2021. Results Policy response to new cases and deaths was faster and more stringent early in the COVID-19 pandemic (March to August 2020) compared to subsequent periods. New deaths were more strongly associated with stringent policies than new cases. In an average week, one new death per 100 000 people was associated with a stringency increase of 2.1 units in the March to August 2020 period, 1.3 units in the September 2020 to February 2021 period, and 0.7 units in the March to August 2021 period. New deaths in Africa and the Western Pacific were associated with more stringency than in other regions. Higher health expenditure as a percentage of GDP was associated with less stringent policies. Similarly, higher public expenditure on health by governments was mostly associated with less stringency across all three periods. GDP per capita did not have consistent patterns of associations with stringency. Conclusions The stringency of COVID-19 policies was more strongly associated with new deaths than new cases. Our findings demonstrate the need for enhanced mortality surveillance to ensure policy alignment during health emergencies. Countries that invest less in health or have a lower public expenditure on health may be inclined to enact more stringent policies. This new empirical understanding of COVID-19 policy drivers can help public health officials anticipate and shape policy responses in future health emergencies.
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Affiliation(s)
- Mohamed F Jalloh
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Zangin Zeebari
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Jönköping International Business School, Jönköping University, Jönköping, Sweden
| | - Sophia A Nur
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Dimitri Prybylski
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aasli A Nur
- Department of Sociology, University of Washington, Seattle, Washington, USA
| | - Avi J Hakim
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maike Winters
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Institute for Global Health, Yale University, New Haven, Connecticut, USA
| | - Laura C Steinhardt
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wangeci Gatei
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Saad B Omer
- Institute for Global Health, Yale University, New Haven, Connecticut, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Helena Nordenstedt
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Department of Internal Medicine and Infectious Diseases, Danderyd University Hospital, Stockholm, Sweden
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9
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Soeters HM, Doshi RH, Fleming M, Adegoke OJ, Ajene U, Aksnes BN, Bennett S, Blau EF, Carlton JG, Clements S, Conklin L, Dahlke M, Duca LM, Feldstein LR, Gidudu JF, Grant G, Hercules M, Igboh LS, Ishizumi A, Jacenko S, Kerr Y, Konne NM, Kulkarni S, Kumar A, Lafond KE, Lam E, Longley AT, McCarron M, Namageyo-Funa A, Ortiz N, Patel JC, Perry RT, Prybylski D, Reddi P, Salman O, Sciarratta CN, Shragai T, Siddula A, Sikare E, Tchoualeu DD, Traicoff D, Tuttle A, Victory KR, Wallace A, Ward K, Wong MKA, Zhou W, Schluter WW, Fitter DL, Mounts A, Bresee JS, Hyde TB. CDC's COVID-19 International Vaccine Implementation and Evaluation Program and Lessons from Earlier Vaccine Introductions. Emerg Infect Dis 2022; 28:S208-S216. [PMID: 36502382 DOI: 10.3201/eid2813.212123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The US Centers for Disease Control and Prevention (CDC) supports international partners in introducing vaccines, including those against SARS-CoV-2 virus. CDC contributes to the development of global technical tools, guidance, and policy for COVID-19 vaccination and has established its COVID-19 International Vaccine Implementation and Evaluation (CIVIE) program. CIVIE supports ministries of health and their partner organizations in developing or strengthening their national capacities for the planning, implementation, and evaluation of COVID-19 vaccination programs. CIVIE's 7 priority areas for country-specific technical assistance are vaccine policy development, program planning, vaccine confidence and demand, data management and use, workforce development, vaccine safety, and evaluation. We discuss CDC's work on global COVID-19 vaccine implementation, including priorities, challenges, opportunities, and applicable lessons learned from prior experiences with Ebola, influenza, and meningococcal serogroup A conjugate vaccine introductions.
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10
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Chiou H, Voegeli C, Wilhelm E, Kolis J, Brookmeyer K, Prybylski D. The Future of Infodemic Surveillance as Public Health Surveillance. Emerg Infect Dis 2022; 28:S121-S128. [PMID: 36502389 DOI: 10.3201/eid2813.220696] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Public health systems need to be able to detect and respond to infodemics (outbreaks of misinformation, disinformation, information overload, or information voids). Drawing from our experience at the US Centers for Disease Control and Prevention, the COVID-19 State of Vaccine Confidence Insight Reporting System has been created as one of the first public health infodemic surveillance systems. Key functions of infodemic surveillance systems include monitoring the information environment by person, place, and time; identifying infodemic events with digital analytics; conducting offline community-based assessments; and generating timely routine reports. Although specific considerations of several system attributes of infodemic surveillance system must be considered, infodemic surveillance systems share several similarities with traditional public health surveillance systems. Because both information and pathogens are spread more readily in an increasingly hyperconnected world, sustainable and routine systems must be created to ensure that timely interventions can be deployed for both epidemic and infodemic response.
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11
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Jalloh MF, Sengeh P, Ibrahim N, Kulkarni S, Sesay T, Eboh V, Jalloh MB, Abu Pratt S, Webber N, Thomas H, Kaiser R, Singh T, Prybylski D, Omer SB, Brewer NT, Wallace AS. Association of community engagement with vaccination confidence and uptake: A cross-sectional survey in Sierra Leone, 2019. J Glob Health 2022; 12:04006. [PMID: 35265325 PMCID: PMC8876869 DOI: 10.7189/jogh.12.04006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 11/27/2022] Open
Abstract
Background The 2014-2016 Ebola epidemic disrupted childhood immunization in Sierra Leone, Liberia, and Guinea. After the epidemic, the Government of Sierra Leone prioritized community engagement to increase vaccination confidence and uptake. To support these efforts, we examined potential drivers of vaccination confidence and uptake in Sierra Leone. Methods We conducted a population-based household survey with primary caregivers of children in a birth cohort of 12 to 23 months in four districts with low vaccination coverage in Sierra Leone in 2019. Modified Poisson regression modeling with robust variance estimation was used to examine if perceived community engagement in planning the immunization program in the community was associated with vaccination confidence and having a fully vaccinated child. Results The sample comprised 621 age-eligible children and their caregivers (91% response rate). Half of the caregivers (52%) reported that it usually takes too long to get to the vaccination site, and 36% perceived that health workers expect money for vaccination services that are supposed to be given at no charge. When mothers were the decision-makers of the children’s vaccination, 80% of the children were fully vaccinated versus 69% when fathers were the decision-makers and 56% when other relatives were the decision-makers. Caregivers with high confidence in vaccination were more likely to have fully vaccinated children compared to caregivers with low confidence (78% versus 53%). For example, caregivers who thought vaccines are ‘very much’ safe were more likely to have fully vaccinated children than those who thought vaccines are ‘somewhat’ safe (76% versus 48%). Overall, 53% of caregivers perceived high level of community engagement, 41% perceived medium level of engagement, and 6% perceived low level of engagement. Perceiving high community engagement was associated with expressing high vaccination confidence (adjusted prevalence ratio (aPR) = 2.60; 95% confidence interval (CI) = 1.67-4.04) and having a fully vaccinated child (aPR = 1.67; 95% CI = 1.18-2.38). Conclusions In these four low coverage districts in Sierra Leone, the perceived level of community engagement was strongly associated with vaccination confidence among caregivers and vaccination uptake among children. We have provided exploratory cross-sectional evidence to inform future longitudinal assessments to further investigate the potential causal effect of community engagement on vaccination confidence and uptake.
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Affiliation(s)
- Mohamed F Jalloh
- Immunization Systems Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Shibani Kulkarni
- Immunization Systems Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tom Sesay
- Expanded Program on Immunization, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Victor Eboh
- Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | - Harold Thomas
- Health Education Division, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Reinhard Kaiser
- Sierra Leone Country Office of U.S. Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | - Tushar Singh
- Sierra Leone Country Office of U.S. Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | - Dimitri Prybylski
- Immunization Systems Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Saad B Omer
- Yale Institute of Global Health, Yale University, New Haven, Connecticut, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Aaron S Wallace
- Immunization Systems Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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12
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Kulkarni S, Sengeh P, Eboh V, Jalloh MB, Conteh L, Sesay T, Ibrahim N, Manneh PO, Kaiser R, Jinnai Y, Wallace AS, Prybylski D, Jalloh MF. Role of Information Sources in Vaccination Uptake: Insights From a Cross-Sectional Household Survey in Sierra Leone, 2019. Glob Health Sci Pract 2022; 10:GHSP-D-21-00237. [PMID: 35294376 PMCID: PMC8885335 DOI: 10.9745/ghsp-d-21-00237] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 01/05/2022] [Indexed: 11/30/2022]
Abstract
Our findings suggest that health workers and faith leaders are important sources of information to deliver vaccination messages, given their strong association with vaccination confidence and uptake. In this context, vaccination promotion efforts that integrate faith leaders and health workers may help increase vaccination uptake. Introduction: There is limited understanding of the potential impact of information sources on vaccination attitudes and behaviors in low-income countries. We examined how exposure to immunization information sources may be associated with vaccination uptake in Sierra Leone. Methods: In 2019, a household survey was conducted using multistage cluster sampling to randomly select 621 caregivers of children aged 12–23 months in 4 districts in Sierra Leone. We measured exposure to various sources of immunization information and 2 outcomes: (1) vaccination confidence using an aggregate score (from 12 Likert items, informed by previously validated scale) that was dichotomized into a binary variable; (2) uptake of the third dose of diphtheria-pertussis-tetanus-hepatitis B-Haemophilus influenzae type-b-pentavalent vaccine (penta-3) based on card record or through caregiver recall when card was unavailable. Associations between information sources and the outcomes were examined using modified Poisson regression with robust variance estimator. Results: Weighted estimate for penta-3 uptake was 81% (75.2%–85.5%). The likelihood of uptake of penta-3 was significantly greater when caregiver received information from health facilities (adjusted prevalence ratio [aPR]=1.26, 95% confidence interval [CI]=1.1, 1.5), faith leaders (aPR=1.16, 95% CI=1.1, 1.3), and community health workers (aPR=1.13, 95% CI=1.003, 1.3). Exposure to greater number of information sources was associated with high penta-3 uptake (aPR=1.05, 95% CI=1.02, 1.1). Discussion: Immunization information received during health facility visits and through engagement with religious leaders may enhance vaccination uptake. Assessments to understand context-specific information dynamics should be prioritized in optimizing immunization outcomes.
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Affiliation(s)
- Shibani Kulkarni
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | | | - Victor Eboh
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Lansana Conteh
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Tom Sesay
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | - Reinhard Kaiser
- U.S. Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | - Yuka Jinnai
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Aaron S Wallace
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dimitri Prybylski
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mohamed F Jalloh
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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13
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Briand SC, Cinelli M, Nguyen T, Lewis R, Prybylski D, Valensise CM, Colizza V, Tozzi AE, Perra N, Baronchelli A, Tizzoni M, Zollo F, Scala A, Purnat T, Czerniak C, Kucharski AJ, Tshangela A, Zhou L, Quattrociocchi W. Infodemics: A new challenge for public health. Cell 2021; 184:6010-6014. [PMID: 34890548 PMCID: PMC8656270 DOI: 10.1016/j.cell.2021.10.031] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/15/2021] [Accepted: 10/27/2021] [Indexed: 11/18/2022]
Abstract
The COVID-19 information epidemic, or "infodemic," demonstrates how unlimited access to information may confuse and influence behaviors during a health emergency. However, the study of infodemics is relatively new, and little is known about their relationship with epidemics management. Here, we discuss unresolved issues and propose research directions to enhance preparedness for future health crises.
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Affiliation(s)
- Sylvie C Briand
- Global Infectious Hazards Preparedness Department, World Health Organization, Geneva, Switzerland
| | - Matteo Cinelli
- Department of Environmental Sciences, Informatics and Statistics, Ca' Foscari University of Venice, 30172 Venice, Italy
| | - Tim Nguyen
- Impact Events Preparedness Unit, Global Infectious Hazards Preparedness Department, World Health Organization, Geneva, Switzerland
| | - Rosamund Lewis
- Infodemic Management Group. Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Dimitri Prybylski
- Global Immunization Division, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30030, USA
| | - Carlo M Valensise
- Enrico Fermi Research Center, Piazza del Viminale, 1 - 00184, Roma, Italy
| | - Vittoria Colizza
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Paris, France
| | - Alberto Eugenio Tozzi
- Multifactorial and Complex Diseases research Area, Bambino Gesù Children's Hospital, Rome, Italy
| | - Nicola Perra
- Networks and Urban Systems Centre, University of Greenwich, London, UK
| | - Andrea Baronchelli
- Department of Mathematics, City University of London & The Alan Turing Institute, London, UK
| | | | - Fabiana Zollo
- Department of Environmental Sciences, Informatics and Statistics, Ca' Foscari University of Venice, 30172 Venice, Italy
| | - Antonio Scala
- Applico Lab, CNR-ISC, Roma, Italy; Big Data in Health Society, Roma, Italy
| | - Tina Purnat
- Impact Events Preparedness Unit, Global Infectious Hazards Preparedness Department, World Health Organization, Geneva, Switzerland
| | - Christine Czerniak
- Global Infectious Hazards Preparedness Department, World Health Organization, Geneva, Switzerland
| | - Adam J Kucharski
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Akhona Tshangela
- Africa Centers for Disease Control and Prevention, African Union Headquarters, Addis Ababa, Ethiopia
| | - Lei Zhou
- Public Health Emergency Center, Chinese Center for Disease Control and Prevention, Beijing, China
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14
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Calleja N, AbdAllah A, Abad N, Ahmed N, Albarracin D, Altieri E, Anoko JN, Arcos R, Azlan AA, Bayer J, Bechmann A, Bezbaruah S, Briand SC, Brooks I, Bucci LM, Burzo S, Czerniak C, De Domenico M, Dunn AG, Ecker UKH, Espinosa L, Francois C, Gradon K, Gruzd A, Gülgün BS, Haydarov R, Hurley C, Astuti SI, Ishizumi A, Johnson N, Johnson Restrepo D, Kajimoto M, Koyuncu A, Kulkarni S, Lamichhane J, Lewis R, Mahajan A, Mandil A, McAweeney E, Messer M, Moy W, Ndumbi Ngamala P, Nguyen T, Nunn M, Omer SB, Pagliari C, Patel P, Phuong L, Prybylski D, Rashidian A, Rempel E, Rubinelli S, Sacco P, Schneider A, Shu K, Smith M, Sufehmi H, Tangcharoensathien V, Terry R, Thacker N, Trewinnard T, Turner S, Tworek H, Uakkas S, Vraga E, Wardle C, Wasserman H, Wilhelm E, Würz A, Yau B, Zhou L, Purnat TD. A Public Health Research Agenda for Managing Infodemics: Methods and Results of the First WHO Infodemiology Conference. ACTA ACUST UNITED AC 2021; 1:e30979. [PMID: 34604708 PMCID: PMC8448461 DOI: 10.2196/30979] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [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: 06/25/2021] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 02/05/2023]
Abstract
Background An infodemic is an overflow of information of varying quality that surges across digital and physical environments during an acute public health event. It leads to confusion, risk-taking, and behaviors that can harm health and lead to erosion of trust in health authorities and public health responses. Owing to the global scale and high stakes of the health emergency, responding to the infodemic related to the pandemic is particularly urgent. Building on diverse research disciplines and expanding the discipline of infodemiology, more evidence-based interventions are needed to design infodemic management interventions and tools and implement them by health emergency responders. Objective The World Health Organization organized the first global infodemiology conference, entirely online, during June and July 2020, with a follow-up process from August to October 2020, to review current multidisciplinary evidence, interventions, and practices that can be applied to the COVID-19 infodemic response. This resulted in the creation of a public health research agenda for managing infodemics. Methods As part of the conference, a structured expert judgment synthesis method was used to formulate a public health research agenda. A total of 110 participants represented diverse scientific disciplines from over 35 countries and global public health implementing partners. The conference used a laddered discussion sprint methodology by rotating participant teams, and a managed follow-up process was used to assemble a research agenda based on the discussion and structured expert feedback. This resulted in a five-workstream frame of the research agenda for infodemic management and 166 suggested research questions. The participants then ranked the questions for feasibility and expected public health impact. The expert consensus was summarized in a public health research agenda that included a list of priority research questions. Results The public health research agenda for infodemic management has five workstreams: (1) measuring and continuously monitoring the impact of infodemics during health emergencies; (2) detecting signals and understanding the spread and risk of infodemics; (3) responding and deploying interventions that mitigate and protect against infodemics and their harmful effects; (4) evaluating infodemic interventions and strengthening the resilience of individuals and communities to infodemics; and (5) promoting the development, adaptation, and application of interventions and toolkits for infodemic management. Each workstream identifies research questions and highlights 49 high priority research questions. Conclusions Public health authorities need to develop, validate, implement, and adapt tools and interventions for managing infodemics in acute public health events in ways that are appropriate for their countries and contexts. Infodemiology provides a scientific foundation to make this possible. This research agenda proposes a structured framework for targeted investment for the scientific community, policy makers, implementing organizations, and other stakeholders to consider.
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Affiliation(s)
- Neville Calleja
- Directorate for Health Information & Research Ministry for Health Valetta Malta
| | | | - Neetu Abad
- US Centers for Disease Control and Prevention Atlanta, GA United States
| | - Naglaa Ahmed
- WHO Regional Office for Eastern Mediterranean Cairo Egypt
| | - Dolores Albarracin
- Department of Psychology College of Liberal Arts & Sciences University of Illinois Urbana-Champaign Champaign, IL United States
| | - Elena Altieri
- Department of Communications World Health Organization Geneva Switzerland
| | | | - Ruben Arcos
- Department of Communication Sciences and Sociology Communication Sciences Faculty University Rey Juan Carlos Madrid Spain
| | - Arina Anis Azlan
- Faculty of Social Sciences and Humanities Universiti Kebangsaan Malaysia Bangi Malaysia
| | - Judit Bayer
- Department of Communication Budapest Economics University (BGE) Budapest Hungary.,Institute for Information, Telecommunications and Media Law University of Münster (WWU) Münster Germany
| | - Anja Bechmann
- DATALAB - Center for Digital Social Research School of Communication and Culture Aarhus University Aarhus Denmark
| | | | - Sylvie C Briand
- Department of Infectious Hazards Management Emergency Preparedness Division World Health Organization Geneva Switzerland
| | - Ian Brooks
- Center for Health Informatics School of Information Sciences University of Illinois at Urbana-Champaign Champaign, IL United States
| | - Lucie M Bucci
- Immunize Canada Canadian Public Health Association Ottawa, ON Canada
| | - Stefano Burzo
- Department of Political Science University of British Columbia Vancouver, BC Canada
| | - Christine Czerniak
- Department of Infectious Hazards Management Emergency Preparedness Division World Health Organization Geneva Switzerland
| | | | - Adam G Dunn
- Biomedical Informatics and Digital Health School of Medical Sciences The University of Sydney Sydney Australia
| | - Ullrich K H Ecker
- School of Psychological Science The University of Western Australia Perth Australia
| | - Laura Espinosa
- European Centre for Disease Prevention and Control Stockholm Sweden
| | | | - Kacper Gradon
- Department of Security and Crime Science University College London London United Kingdom
| | - Anatoliy Gruzd
- Ted Rogers School of Management Ryerson University Toronto, ON Canada
| | | | | | - Cherstyn Hurley
- Immunisation and Countermeasures Department Public Health England London United Kingdom
| | - Santi Indra Astuti
- The Faculty of Communication Science Bandung Islamic University (UNISBA) Bandung Indonesia
| | - Atsuyoshi Ishizumi
- US Centers for Disease Control and Prevention Atlanta, GA United States.,Oak Ridge Institute for Science and Education Oak Ridge, TN United States
| | - Neil Johnson
- Department of Physics George Washington University Washington, DC United States
| | | | - Masato Kajimoto
- Journalism and Media Studies Centre The University of Hong Kong Hong Kong China
| | - Aybüke Koyuncu
- US Centers for Disease Control and Prevention Atlanta, GA United States
| | - Shibani Kulkarni
- US Centers for Disease Control and Prevention Atlanta, GA United States.,Oak Ridge Institute for Science and Education Oak Ridge, TN United States
| | - Jaya Lamichhane
- Department of Infectious Hazards Management Emergency Preparedness Division World Health Organization Geneva Switzerland
| | - Rosamund Lewis
- Emergency Preaparedness Division World Health Organization Geneva Switzerland
| | - Avichal Mahajan
- Department of Infectious Hazards Management Emergency Preparedness Division World Health Organization Geneva Switzerland
| | - Ahmed Mandil
- WHO Regional Office for Eastern Mediterranean Cairo Egypt
| | | | - Melanie Messer
- Faculty I Department of Nursing Science II Trier University Trier Germany
| | - Wesley Moy
- Advanced Academic Programs Johns Hopkins University Washington, DC United States
| | - Patricia Ndumbi Ngamala
- Department of Digital Health and Innovation Science Division World Health Organization Geneva Switzerland
| | - Tim Nguyen
- Department of Infectious Hazards Management Emergency Preparedness Division World Health Organization Geneva Switzerland
| | - Mark Nunn
- Directorate for Health Information & Research Ministry for Health Valetta Malta.,WHO Regional Office for Africa Brazzaville Congo.,US Centers for Disease Control and Prevention Atlanta, GA United States.,WHO Regional Office for Eastern Mediterranean Cairo Egypt.,Department of Psychology College of Liberal Arts & Sciences University of Illinois Urbana-Champaign Champaign, IL United States.,Department of Communications World Health Organization Geneva Switzerland.,WHO Regional Office for Africa Dakar Senegal.,Department of Communication Sciences and Sociology Communication Sciences Faculty University Rey Juan Carlos Madrid Spain.,Faculty of Social Sciences and Humanities Universiti Kebangsaan Malaysia Bangi Malaysia.,Department of Communication Budapest Economics University (BGE) Budapest Hungary.,Institute for Information, Telecommunications and Media Law University of Münster (WWU) Münster Germany.,DATALAB - Center for Digital Social Research School of Communication and Culture Aarhus University Aarhus Denmark.,WHO Regional Office for South East Asia New Delhi India.,Department of Infectious Hazards Management Emergency Preparedness Division World Health Organization Geneva Switzerland.,Center for Health Informatics School of Information Sciences University of Illinois at Urbana-Champaign Champaign, IL United States.,Immunize Canada Canadian Public Health Association Ottawa, ON Canada.,Department of Political Science University of British Columbia Vancouver, BC Canada.,CoMuNe Lab Fondazione Bruno Kessler Povo Italy.,Biomedical Informatics and Digital Health School of Medical Sciences The University of Sydney Sydney Australia.,School of Psychological Science The University of Western Australia Perth Australia.,European Centre for Disease Prevention and Control Stockholm Sweden.,Graphika New York, NY United States.,Department of Security and Crime Science University College London London United Kingdom.,Ted Rogers School of Management Ryerson University Toronto, ON Canada.,Ministry of Health Ankara Turkey.,UNICEF Headquarters New York, NY United States.,Immunisation and Countermeasures Department Public Health England London United Kingdom.,The Faculty of Communication Science Bandung Islamic University (UNISBA) Bandung Indonesia.,Oak Ridge Institute for Science and Education Oak Ridge, TN United States.,Department of Physics George Washington University Washington, DC United States.,Journalism and Media Studies Centre The University of Hong Kong Hong Kong China.,Emergency Preaparedness Division World Health Organization Geneva Switzerland.,Faculty I Department of Nursing Science II Trier University Trier Germany.,Advanced Academic Programs Johns Hopkins University Washington, DC United States.,Department of Digital Health and Innovation Science Division World Health Organization Geneva Switzerland.,Yale Institute for Global Health Yale University New Haven, CT United States.,Usher Institute Edinburgh Medical School University of Edinburgh Edinburgh United Kingdom.,British Columbia Centre for Disease Control Vancouver, BC Canada.,Department of Health Sciences and Medicine University of Lucerne Lucerne Switzerland.,Swiss Paraplegic Research Lucerne Switzerland.,Department of Humanities Studies Free University of Languages and Communication IULM Milan Italy.,metaLAB (at) Harvard Harvard University Cambridge, MA United States.,Office of Infectious Disease Global Health Bureau United States Agency for International Development (USAID) Washington, DC United States.,Computer Science Department Illinois Institute of Technology Chicago, IL United States.,Masyarakat Anti Fitnah Indonesia (MAFINDO) Jakarta Indonesia.,International Health Policy Programme Ministry of Public Health Bangkok Thailand.,Science Division World Health Organization Geneva Switzerland.,Deep Children Hospital and Research Centre Gandhidham India.,Fathm London United Kingdom.,Public Health Association of British Columbia Victoria, BC Canada.,Vaccine Safety Net (VSN) Geneva Switzerland.,Department of History University of British Columbia Vancouver, BC Canada.,Faculty of Medicine Mohamed V University in Rabat Rabat Morocco.,Hubbard School of Journalism and Mass Communication University of Minnesota Minneapolis, MN United States.,First Draft News New York, NY United States.,Centre for Film and Media Studies University of Cape Town Cape Town South Africa.,Department of Regulation and Prequalification Access to Medicines and Health Products Division World Health Organization Geneva Switzerland.,Public Health Emergency Center Chinese Center for Disease Control and Prevention Beijing China
| | - Saad B Omer
- Yale Institute for Global Health Yale University New Haven, CT United States
| | - Claudia Pagliari
- Usher Institute Edinburgh Medical School University of Edinburgh Edinburgh United Kingdom
| | - Palak Patel
- US Centers for Disease Control and Prevention Atlanta, GA United States.,Oak Ridge Institute for Science and Education Oak Ridge, TN United States
| | - Lynette Phuong
- Department of Infectious Hazards Management Emergency Preparedness Division World Health Organization Geneva Switzerland
| | - Dimitri Prybylski
- US Centers for Disease Control and Prevention Atlanta, GA United States
| | | | - Emily Rempel
- British Columbia Centre for Disease Control Vancouver, BC Canada
| | - Sara Rubinelli
- Department of Health Sciences and Medicine University of Lucerne Lucerne Switzerland.,Swiss Paraplegic Research Lucerne Switzerland
| | - PierLuigi Sacco
- Department of Humanities Studies Free University of Languages and Communication IULM Milan Italy.,metaLAB (at) Harvard Harvard University Cambridge, MA United States
| | - Anton Schneider
- Office of Infectious Disease Global Health Bureau United States Agency for International Development (USAID) Washington, DC United States
| | - Kai Shu
- Computer Science Department Illinois Institute of Technology Chicago, IL United States
| | | | - Harry Sufehmi
- Masyarakat Anti Fitnah Indonesia (MAFINDO) Jakarta Indonesia
| | | | - Robert Terry
- Science Division World Health Organization Geneva Switzerland
| | - Naveen Thacker
- Deep Children Hospital and Research Centre Gandhidham India
| | | | - Shannon Turner
- Public Health Association of British Columbia Victoria, BC Canada.,Vaccine Safety Net (VSN) Geneva Switzerland
| | - Heidi Tworek
- Department of History University of British Columbia Vancouver, BC Canada
| | - Saad Uakkas
- Faculty of Medicine Mohamed V University in Rabat Rabat Morocco
| | - Emily Vraga
- Hubbard School of Journalism and Mass Communication University of Minnesota Minneapolis, MN United States
| | | | - Herman Wasserman
- Centre for Film and Media Studies University of Cape Town Cape Town South Africa
| | - Elisabeth Wilhelm
- US Centers for Disease Control and Prevention Atlanta, GA United States
| | - Andrea Würz
- European Centre for Disease Prevention and Control Stockholm Sweden
| | - Brian Yau
- Department of Regulation and Prequalification Access to Medicines and Health Products Division World Health Organization Geneva Switzerland
| | - Lei Zhou
- Public Health Emergency Center Chinese Center for Disease Control and Prevention Beijing China
| | - Tina D Purnat
- Department of Digital Health and Innovation Science Division World Health Organization Geneva Switzerland
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15
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Jalloh MF, Hickler B, Parmley LE, Sutton R, Kulkarni S, Mansaray A, Eleeza O, Patel P, Wilhelm E, Conklin L, Akinjeji A, Toure M, Wolff B, Prybylski D, Wallace AS, Lahuerta M. Using immunisation caregiver journey interviews to understand and optimise vaccination uptake: lessons from Sierra Leone. BMJ Glob Health 2021; 6:bmjgh-2021-005525. [PMID: 34045184 PMCID: PMC8162096 DOI: 10.1136/bmjgh-2021-005525] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/10/2021] [Indexed: 11/10/2022] Open
Abstract
Quantitative and qualitative assessments have revealed diverse factors that influence the uptake of childhood immunisation services and shed light on reasons for vaccination delays and refusals. UNICEF and partner organisations developed the Immunisation Caregiver Journey Framework as a novel way to understand caregiver experiences in accessing and receiving immunisation services for children. This framework aims to help immunisation programmes identify vaccination barriers and opportunities to improve vaccination uptake by enhancing the overall caregiver journey in a systems-focused manner, using human-centred design principles. In this paper, we adapt the framework into a flexible qualitative inquiry approach with theoretical guidance from interpretative phenomenology. We draw from the implementation experiences in Sierra Leone to inform methodological guidance on how to design and implement the Immunisation Caregiver Journey Interviews (ICJI) to understand the lived experiences of caregivers as they navigate immunisation services for their children. Practical guidance is provided on sampling techniques, conducting interviews, data management, data analysis and the use of data to inform programmatic actions. When properly implemented, the ICJI approach generates a rich qualitative understanding of how caregivers navigate household and community dynamics, as well as primary healthcare delivery systems. We argue that understanding and improving the caregiver journey will enhance essential immunisation outcomes, such as the completion of the recommended vaccination schedule, timeliness of vaccination visits and reduction in dropouts between vaccine doses.
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Affiliation(s)
- Mohamed F Jalloh
- Immunization Systems Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Lauren E Parmley
- ICAP at Columbia University, Mailman School of Public Health, New York, New York, USA
| | - Roberta Sutton
- ICAP at Columbia University, Mailman School of Public Health, New York, New York, USA
| | - Shibani Kulkarni
- Immunization Systems Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Anthony Mansaray
- Sierra Leone Country Office, ICAP at Columbia University, Freetown, Sierra Leone
| | - Oliver Eleeza
- Sierra Leone Country Office, ICAP at Columbia University, Freetown, Sierra Leone
| | - Palak Patel
- Immunization Systems Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Elisabeth Wilhelm
- Immunization Systems Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura Conklin
- Immunization Systems Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Adewale Akinjeji
- Sierra Leone Country Office, ICAP at Columbia University, Freetown, Sierra Leone
| | - Mame Toure
- Sierra Leone Country Office, ICAP at Columbia University, Freetown, Sierra Leone
| | - Brent Wolff
- Immunization Systems Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Dimitri Prybylski
- Immunization Systems Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aaron S Wallace
- Immunization Systems Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maria Lahuerta
- ICAP at Columbia University, Mailman School of Public Health, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, New York, New York, USA
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16
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Nyarko KM, Miller LA, Baughman AL, Katjiuanjo P, Evering-Watley M, Antara S, Angula P, Mitonga HK, Prybylski D, Dziuban EJ, Ndevaetela EE. The role of Namibia Field Epidemiology and Laboratory Training Programme in strengthening the public health workforce in Namibia, 2012-2019. BMJ Glob Health 2021; 6:e005597. [PMID: 33849899 PMCID: PMC8051409 DOI: 10.1136/bmjgh-2021-005597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/04/2021] [Accepted: 03/28/2021] [Indexed: 11/16/2022] Open
Abstract
Namibia faces a critical shortage of skilled public health workers to perform emergency response operations, preparedness activities and real-time surveillance. The Namibia Field Epidemiology and Laboratory Training Programme (NamFELTP) increases the number of skilled public health professionals and strengthens the public health system in Namibia. We describe the NamFELTP during its first 7 years, assess its impact on the public health workforce and provide recommendations to further strengthen the workforce. We reviewed disease outbreak investigations and response reports, field projects and epidemiological investigations conducted during 2012-2019. The data were analysed using descriptive methods such as frequencies and rates. Maps representing the geographical distribution of NamFELTP workforce were produced using QGIS software V.3.2. There were no formally trained field epidemiologists working in Namibia before the NamFELTP. In its 7 years of operation, the programme graduated 189 field epidemiologists, of which 28 have completed the Advanced FELTP. The graduates increased epidemiological capacity for surveillance and response in Namibia at the national and provincial levels, and enhanced epidemiologist-led outbreak responses on 35 occasions, including responses to outbreaks of human and zoonotic diseases. Trainees analysed data from 51 surveillance systems and completed 31 epidemiological studies. The NamFELTP improved outcomes in the Namibia's public health systems; including functional and robust public health surveillance systems that timely and effectively respond to public health emergencies. However, the current epidemiological capacity is insufficient and there is a need to continue training and mentorship to fill key leadership and strategic roles in the public health system.
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Affiliation(s)
- Kofi Mensah Nyarko
- Namibia Ministry of Health and Social Services, Windhoek, Khomas, Namibia
- School of Public Health, University of Namibia, Windhoek, Namibia
| | - Leigh Ann Miller
- US Centers for Disease Control and Prevention, Windhoek, Namibia
| | | | - Puumue Katjiuanjo
- Namibia Ministry of Health and Social Services, Windhoek, Khomas, Namibia
| | | | - Simon Antara
- Namibia Ministry of Health and Social Services, Windhoek, Khomas, Namibia
| | - Penehafo Angula
- School of Public Health, University of Namibia, Windhoek, Namibia
| | - Honore K Mitonga
- School of Public Health, University of Namibia, Windhoek, Namibia
| | | | - Eric J Dziuban
- US Centers for Disease Control and Prevention, Windhoek, Namibia
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17
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Kulkarni S, Harvey B, Prybylski D, Jalloh MF. Trends in classifying vaccine hesitancy reasons reported in the WHO/UNICEF Joint Reporting Form, 2014-2017: Use and comparability of the Vaccine Hesitancy Matrix. Hum Vaccin Immunother 2021; 17:2001-2007. [PMID: 33534626 PMCID: PMC8189077 DOI: 10.1080/21645515.2020.1859319] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Since 2014, the World Health Organization (WHO) member states have been annually reporting vaccine hesitancy reasons, using the WHO/UNICEF Joint Reporting Form (JRF). The Vaccine Hesitancy Matrix (VHM), developed by a WHO strategic advisory group of experts, can serve as an important tool to categorize vaccine hesitancy reasons reported in the JRF. We aimed to describe the reasons for vaccine hesitancy reported globally from 2014 to 2017 to ascertain trends over time and understand the comparability of using the VHM to classify hesitancy reasons from 2014 to 2016 based on previously published literature. We conducted a quantitative content analysis to code and categorize vaccine hesitancy reasons reported in the JRF from 2014 to 2017. Vaccine hesitancy trends were consistent from 2014 to 2017, where vaccine hesitancy reasons were mainly related to “individual and group level influences” (59%) followed by “contextual influences” (25%), and “vaccine- or vaccination-specific issues” (16%). Comparability of our approach to categorize vaccine hesitancy to the previously published JRF data showed that results were mostly but not entirely consistent. Major differences in categorizing vaccine hesitancy were noted between two specific reasons – “experience with past vaccination” (under “individual and group influences”) and “risk/benefit- scientific evidence” (under “vaccine and vaccination-specific issues”); this was usually due to lack of clear definitions in some sub-categories and generic responses reported in the JRF. The JRF hesitancy module may benefit from modifications to improve the data quality. Understanding global vaccine hesitancy is crucial and JRF can serve as an important tool, especially with the potential introduction of a COVID-19 vaccine.
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Affiliation(s)
- Shibani Kulkarni
- Immunization Systems Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Oak Ridge Institute for Science and Education, Oak ridge, TN, USA
| | - Bonnie Harvey
- Oak Ridge Institute for Science and Education, Oak ridge, TN, USA.,Strategic Information and Workforce Development Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dimitri Prybylski
- Immunization Systems Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mohamed F Jalloh
- Immunization Systems Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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18
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Jalloh MF, Nur AA, Nur SA, Winters M, Bedson J, Pedi D, Prybylski D, Namageyo-Funa A, Hageman KM, Baker BJ, Jalloh MB, Eng E, Nordenstedt H, Hakim AJ. Behaviour adoption approaches during public health emergencies: implications for the COVID-19 pandemic and beyond. BMJ Glob Health 2021; 6:e004450. [PMID: 33514594 PMCID: PMC7849902 DOI: 10.1136/bmjgh-2020-004450] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 11/12/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 12/29/2022] Open
Abstract
Human behaviour will continue to play an important role as the world grapples with public health threats. In this paper, we draw from the emerging evidence on behaviour adoption during diverse public health emergencies to develop a framework that contextualises behaviour adoption vis-à-vis a combination of top-down, intermediary and bottom-up approaches. Using the COVID-19 pandemic as a case study, we operationalise the contextual framework to demonstrate how these three approaches differ in terms of their implementation, underlying drivers of action, enforcement, reach and uptake. We illustrate how blended strategies that include all three approaches can help accelerate and sustain protective behaviours that will remain important even when safe and effective vaccines become more widely available. As the world grapples with the COVID-19 pandemic and prepares to respond to (re)emerging public health threats, our contextual framework can inform the design, implementation, tracking and evaluation of comprehensive public health and social measures during health emergencies.
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Affiliation(s)
- Mohamed F Jalloh
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aasli A Nur
- Department of Sociology, University of Washington, Seattle, Washington, USA
| | - Sophia A Nur
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maike Winters
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Jamie Bedson
- Independent Consultant, Seattle, Washington, USA
| | - Danielle Pedi
- Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | - Dimitri Prybylski
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Apophia Namageyo-Funa
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathy M Hageman
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brian J Baker
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Eugenia Eng
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Helena Nordenstedt
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Avi J Hakim
- CDC COVID-19 Response Team, Atlanta, Georgia, USA
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19
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Neal JJ, Prybylski D, Sanchez T, Hladik W. Population Size Estimation Methods: Searching for the Holy Grail. JMIR Public Health Surveill 2020; 6:e25076. [PMID: 33270035 PMCID: PMC7746490 DOI: 10.2196/25076] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/30/2020] [Indexed: 11/24/2022] Open
Abstract
Accurate size estimates of key populations (eg, sex workers, people who inject drugs, transgender people, and men who have sex with men) can help to ensure adequate availability of services to prevent or treat HIV infection; inform HIV response planning, target setting, and resource allocation; and provide data for monitoring and evaluating program outcomes and impact. A gold standard method for population size estimation does not exist, but quality of estimates could be improved by using empirical methods, multiple data sources, and sound statistical concepts. To highlight such methods, a special collection of papers in JMIR Public Health and Surveillance has been released under the title “Key Population Size Estimations.” We provide a summary of these papers to highlight advances in the use of empirical methods and call attention to persistent gaps in information.
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Affiliation(s)
- Joyce J Neal
- Epidemiology and Surveillance Branch, Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Dimitri Prybylski
- Epidemiology and Surveillance Branch, Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Travis Sanchez
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Wolfgang Hladik
- Epidemiology and Surveillance Branch, Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
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20
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Jonas A, Patel SV, Katuta F, Maher AD, Banda KM, Gerndt K, Pietersen I, Menezes de Prata N, Mutenda N, Nakanyala T, Kisting E, Kawana B, Nietschke AM, Prybylski D, McFarland W, Lowrance DW. HIV Prevalence, Risk Factors for Infection, and Uptake of Prevention, Testing, and Treatment among Female Sex Workers in Namibia. J Epidemiol Glob Health 2020; 10:351-358. [PMID: 32959617 PMCID: PMC7758860 DOI: 10.2991/jegh.k.200603.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/22/2020] [Accepted: 05/21/2020] [Indexed: 11/26/2022] Open
Abstract
Background: In most settings, Female Sex Workers (FSW) bear a disproportionate burden of Human Immunodeficiency Virus (HIV) disease worldwide. Representative data to inform the development of behavioral and biomedical interventions for FSW in Namibia have not been published. Objectives: Our objectives were to measure HIV prevalence, identify risk factors for infection, and describe uptake of prevention, testing, and treatment among FSW in Namibia. Methods: We conducted cross-sectional surveys using Respondent-driven Sampling (RDS) in the Namibian cities of Katima Mulilo, Oshikango, Swakopmund/Walvis Bay, and Windhoek. Participating FSW completed behavioral questionnaires and rapid HIV testing. Results: City-specific ranges of key indicators were: HIV prevalence (31.0–52.3%), reached by prevention programs in the past 12 months (46.9–73.6%), condom use at last sex with commercial (82.1–91.1%) and non-commercial (87.0–94.2%) partners, and tested for HIV within past 12 months or already aware of HIV-positive serostatus (56.9–82.1%). Factors associated with HIV infection varied by site and included: older age, having multiple commercial or non-commercial sex partners, unemployment, being currently out of school, and lower education level. Among HIV-positive FSW, 57.1% were aware of their HIV-positive serostatus and 33.7% were on antiretroviral treatment. Discussion: Our results indicate extremely high HIV prevalence and low levels of case identification and treatment among FSW in Namibia. Our results, which are the first representative community-based estimates among FSW in Namibia, can inform the scale-up of interventions to reduce the risk for HIV acquisition and onward transmission, including treatment as prevention and pre-exposure prophylaxis.
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Affiliation(s)
- Anna Jonas
- Ministry of Health and Social Services, Windhoek, Namibia
| | - Sadhna V Patel
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Windhoek, Namibia.,Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | - Frieda Katuta
- Ministry of Health and Social Services, Windhoek, Namibia
| | - Andrew D Maher
- University of California San Francisco, Institute for Global Health Sciences, San Francisco, USA
| | - Karen M Banda
- Ministry of Health and Social Services, Windhoek, Namibia
| | - Krysta Gerndt
- University of California San Francisco, Institute for Global Health Sciences, San Francisco, USA
| | | | - Neia Menezes de Prata
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Windhoek, Namibia.,Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | | | - Tuli Nakanyala
- Ministry of Health and Social Services, Windhoek, Namibia
| | - Esme Kisting
- Ministry of Health and Social Services, Windhoek, Namibia
| | - Brown Kawana
- University of California San Francisco, Institute for Global Health Sciences, San Francisco, USA
| | | | - Dimitri Prybylski
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Windhoek, Namibia.,Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | - Willi McFarland
- University of California San Francisco, Institute for Global Health Sciences, San Francisco, USA
| | - David W Lowrance
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Windhoek, Namibia.,Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, USA
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21
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Maher AD, Nakanyala T, Mutenda N, Banda KM, Prybylski D, Wolkon A, Jonas A, Sawadogo S, Ntema C, Chipadze MR, Sinvula G, Tizora A, Mwandemele A, Chaturvedi S, Agovi AMA, Agolory S, Hamunime N, Lowrance DW, Mcfarland W, Patel SV. Rates and Correlates of HIV Incidence in Namibia's Zambezi Region From 2014 to 2016: Sentinel, Community-Based Cohort Study. JMIR Public Health Surveill 2020; 6:e17107. [PMID: 32348290 PMCID: PMC7381049 DOI: 10.2196/17107] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/06/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Direct measures of HIV incidence are needed to assess the population-level impact of prevention programs but are scarcely available in the subnational epidemic hotspots of sub-Saharan Africa. We created a sentinel HIV incidence cohort within a community-based program that provided home-based HIV testing to all residents of Namibia's Zambezi region, where approximately 24% of the adult population was estimated to be living with HIV. OBJECTIVE The aim of this study was to estimate HIV incidence, detect correlates of HIV acquisition, and assess the feasibility of the sentinel, community-based approach to HIV incidence surveillance in a subnational epidemic hotspot. METHODS Following the program's initial home-based testing (December 2014-July 2015), we purposefully selected 10 clusters of 60 to 70 households each and invited residents who were HIV negative and aged ≥15 years to participate in the cohort. Consenting participants completed behavioral interviews and a second HIV test approximately 1 year later (March-September 2016). We used Poisson models to calculate HIV incidence rates between baseline and follow-up and multivariable Cox proportional hazard models to assess the correlates of seroconversion. RESULTS Among 1742 HIV-negative participants, 1624 (93.23%) completed follow-up. We observed 26 seroconversions in 1954 person-years (PY) of follow-up, equating to an overall incidence rate of 1.33 per 100 PY (95% CI 0.91-1.95). Among women, the incidence was 1.55 per 100 PY (95% CI 1.12-2.17) and significantly higher among those aged 15 to 24 years and residing in rural areas (adjusted hazard ratio [aHR] 4.26, 95% CI 1.39-13.13; P=.01), residing in the Ngweze suburb of Katima Mulilo city (aHR 2.34, 95% CI 1.25-4.40; P=.01), who had no prior HIV testing in the year before cohort enrollment (aHR 3.38, 95% CI 1.04-10.95; P=.05), and who had engaged in transactional sex (aHR 17.64, 95% CI 2.88-108.14; P=.02). Among men, HIV incidence was 1.05 per 100 PY (95% CI 0.54-2.31) and significantly higher among those aged 40 to 44 years (aHR 13.04, 95% CI 5.98-28.41; P<.001) and had sought HIV testing outside the study between baseline and follow-up (aHR 8.28, 95% CI 1.39-49.38; P=.02). No seroconversions occurred among persons with HIV-positive partners on antiretroviral treatment. CONCLUSIONS Nearly three decades into Namibia's generalized HIV epidemic, these are the first estimates of HIV incidence for its highest prevalence region. By creating a sentinel incidence cohort from the infrastructure of an existing community-based testing program, we were able to characterize current transmission patterns, corroborate known risk factors for HIV acquisition, and provide insight into the efficacy of prevention interventions in a subnational epidemic hotspot. This study demonstrates an efficient and scalable framework for longitudinal HIV incidence surveillance that can be implemented in diverse sentinel sites and populations.
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Affiliation(s)
- Andrew D Maher
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, United States
- South African Centre for Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
| | - Tuli Nakanyala
- Directorate for Special Programs, Ministry of Health and Social Services, Windhoek, Namibia
| | - Nicholus Mutenda
- Directorate for Special Programs, Ministry of Health and Social Services, Windhoek, Namibia
| | - Karen M Banda
- Directorate for Special Programs, Ministry of Health and Social Services, Windhoek, Namibia
| | - Dimitri Prybylski
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Adam Wolkon
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Anna Jonas
- Directorate for Special Programs, Ministry of Health and Social Services, Windhoek, Namibia
| | - Souleymane Sawadogo
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Charity Ntema
- Total Control of the Epidemic, Development Aid from People to People, Windhoek, Namibia
| | | | - Grace Sinvula
- Total Control of the Epidemic, Development Aid from People to People, Windhoek, Namibia
| | - Annastasia Tizora
- Total Control of the Epidemic, Development Aid from People to People, Windhoek, Namibia
| | - Asen Mwandemele
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Shaan Chaturvedi
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Afiba Manza-A Agovi
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Simon Agolory
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Ndapewa Hamunime
- Directorate for Special Programs, Ministry of Health and Social Services, Windhoek, Namibia
| | - David W Lowrance
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Willi Mcfarland
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Sadhna V Patel
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, United States
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22
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Ropa B, Flint J, O'Reilly M, Pavlin BI, Dagina R, Peni B, Bauri M, Pukienei A, Merritt T, Terrell-Perica S, Yamba A, Prybylski D, Collins J, Durrheim DN, Henderson A, Bieb S. Lessons from the first 6 years of an intervention-based field epidemiology training programme in Papua New Guinea, 2013-2018. BMJ Glob Health 2019; 4:e001969. [PMID: 31908873 PMCID: PMC6936504 DOI: 10.1136/bmjgh-2019-001969] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 09/07/2019] [Revised: 11/18/2019] [Accepted: 11/22/2019] [Indexed: 11/12/2022] Open
Abstract
Papua New Guinea (PNG) faces a critical shortage of human resources to address pressing public health challenges arising from an increasing burden of communicable and non-communicable diseases. PNG is an independent State in the Pacific and home to 8.2 million people. Resource and infrastructure constraints due to the country’s challenging geography have made it difficult and expensive to deliver health services and implement health programmes. The National Department of Health and its partners developed a field epidemiology training programme of Papua New Guinea (FETPNG) to strengthen the country’s public health workforce. The training programme covers field epidemiology competencies and includes the design, implementation and evaluation of evidence-based interventions by Fellows. From 2013 to 2018, FETPNG graduated 81 field epidemiologists. Most FETPNG graduates (84%) were from provincial or district health departments or organisations. Many of their intervention projects resulted in successful public health outcomes with tangible local impacts. Health challenges addressed included reducing the burden of multi-drug resistant-tuberculosis (TB), increasing immunisation coverage, screening and treating HIV/TB patients, and improving reproductive health outcomes. FETPNG Fellows and graduates have also evaluated disease surveillance systems and investigated disease outbreaks. Early and unwavering national ownership of FETPNG created a sustainable programme fitting the needs of this low-resource country. A focus on designing and implementing effective public health interventions not only provides useful skills to Fellows but also contributes to real-time, tangible and meaningful improvements in the health of the population. The graduates of FETPNG now provide a critical mass of public health practitioners across the country. Their skills in responding to outbreaks and public health emergencies, in collecting, analysing and interpreting data, and in designing, implementing and evaluating public health interventions continues to advance public health in PNG.
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Affiliation(s)
- Barry Ropa
- Government of Papua New Guinea National Department of Health, Port Moresby, National Capital District, Papua New Guinea
| | - James Flint
- Health Protection, Hunter New England Health, Wallsend, New South Wales, Australia
| | - Michael O'Reilly
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Boris Igor Pavlin
- World Health Organization Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Rosheila Dagina
- Government of Papua New Guinea National Department of Health, Port Moresby, National Capital District, Papua New Guinea
| | - Bethseba Peni
- Public Health Department, West New Britain Provincial Health Authority, Kimbe, Papua New Guinea
| | - Mathias Bauri
- Government of Papua New Guinea National Department of Health, Port Moresby, National Capital District, Papua New Guinea
| | - Alois Pukienei
- Department of Health, Autonomous Bougainville Government, Buka Town, Papua New Guinea
| | - Tony Merritt
- Health Protection, Hunter New England Health, Wallsend, New South Wales, Australia
| | - Steven Terrell-Perica
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Abel Yamba
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Dimitri Prybylski
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Julie Collins
- Health Protection, Hunter New England Health, Wallsend, New South Wales, Australia
| | - David N Durrheim
- Health Protection, Hunter New England Health, Wallsend, New South Wales, Australia
| | - Alden Henderson
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sibauk Bieb
- Government of Papua New Guinea National Department of Health, Port Moresby, National Capital District, Papua New Guinea
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23
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Tang AM, Hamunime N, Adams RA, Kanyinga G, Fischer-Walker C, Agolory S, Prybylski D, Mutenda N, Sughrue S, Walker DD, Rennie T, Zahralban-Steele M, Kerrigan A, Hong SY. Introduction of an Alcohol-Related Electronic Screening and Brief Intervention (eSBI) Program to Reduce Hazardous Alcohol Consumption in Namibia's Antiretroviral Treatment (ART) Program. AIDS Behav 2019; 23:3078-3092. [PMID: 31444711 PMCID: PMC6801208 DOI: 10.1007/s10461-019-02648-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Alcohol is the most widely abused substance in Namibia and is associated with poor adherence and retention in care among people on antiretroviral therapy (ART). Electronic screening and brief interventions (eSBI) are effective in reducing alcohol consumption in various contexts. We used a mixed methods approach to develop, implement, and evaluate the introduction of an eSBI in two ART clinics in Namibia. Of the 787 participants, 45% reported some alcohol use in the past 12 months and 25% reported hazardous drinking levels. Hazardous drinkers were more likely to be male, separated/widowed/divorced, have a monthly household income > $1000 NAD, and report less than excellent ART adherence. Based on qualitative feedback from participants and providers, ART patients using the eSBI for the first time found it to be a positive and beneficial experience. However, we identified several programmatic considerations that could improve the experience and yield in future implementation studies.
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Affiliation(s)
- A M Tang
- School of Medicine, Tufts University, Boston, MA, USA.
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, MV248, Boston, MA, 02111, USA.
| | - N Hamunime
- Government of Namibia, Ministry of Health and Social Services, Windhoek, Namibia
| | - R A Adams
- Government of Namibia, Ministry of Health and Social Services, Windhoek, Namibia
| | - G Kanyinga
- Government of Namibia, Ministry of Health and Social Services, Windhoek, Namibia
| | | | - S Agolory
- U.S. Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - D Prybylski
- U.S. Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - N Mutenda
- Government of Namibia, Ministry of Health and Social Services, Windhoek, Namibia
| | - S Sughrue
- School of Medicine, Tufts University, Boston, MA, USA
| | - D D Walker
- School of Social Work, University of Washington, Seattle, WA, USA
| | - T Rennie
- School of Pharmacy, University of Namibia, Windhoek, Namibia
| | | | - A Kerrigan
- School of Medicine, Tufts University, Boston, MA, USA
| | - S Y Hong
- U.S. Centers for Disease Control & Prevention, Atlanta, GA, USA
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Jalloh MF, Wilhelm E, Abad N, Prybylski D. Mobilize to vaccinate: lessons learned from social mobilization for immunization in low and middle-income countries. Hum Vaccin Immunother 2019; 16:1208-1214. [PMID: 31464551 PMCID: PMC7227704 DOI: 10.1080/21645515.2019.1661206] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Creating and sustaining demand for immunization services is a global priority to ensure that vaccine-eligible populations are fully protected from vaccine-preventable diseases. Social mobilization remains a key health promotion strategy used by low- and middle-income countries (LMICs) to promote vaccination demand. In this commentary, we synthesize illustrative evidence on successful social mobilization efforts promoting the uptake of immunization services in select LMICs. The first example focuses on Sierra Leone’s routine immunization program during the Universal Child Immunization initiative in the late 1980s. We then give an example of India’s establishment of a social mobilization network in the early- to mid-2000s to support polio elimination in high-risk communities. Thirdly, we highlight the complexities of social mobilization in a humanitarian emergency during the 2017–2018 diphtheria outbreak among displaced Rohingyas in camps and settlements in Bangladesh. Lastly, we draw upon examples from the introduction of the human papillomavirus vaccine in several countries. We then critically examine recurring challenges faced when implementing social mobilization for immunization in LMICs and offer practical recommendations for improvement.
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Affiliation(s)
- Mohamed F Jalloh
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, USA
| | - Elisabeth Wilhelm
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, USA
| | - Neetu Abad
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, USA
| | - Dimitri Prybylski
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, USA
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Taffa N, Roscoe C, Sawadogo S, De Klerk M, Baughman AL, Wolkon A, Mutenda N, DeVos J, Zheng DP, Wagar N, Prybylski D, Yang C, Hamunime N, Agolory S, Raizes E. Pretreatment HIV drug resistance among adults initiating ART in Namibia. J Antimicrob Chemother 2019; 73:3137-3142. [PMID: 30137412 DOI: 10.1093/jac/dky278] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/19/2018] [Indexed: 11/12/2022] Open
Abstract
Background Continued use of standardized, first-line ART containing NNRTIs and NRTIs may contribute to ongoing emergence of HIV drug resistance (HIVDR) in Namibia. Methods A nationally representative cross-sectional survey was conducted during 2015-16 to estimate the prevalence of significant pretreatment HIV drug resistance (PDR) and viral load (VL) suppression rates 6-12 months after initiating standardized first-line ART. Consenting adult patients (≥18 years) initiating ART were interviewed about prior antiretroviral drug (ARV) exposure and underwent resistance testing using dried blood spot samples. PDR was defined as mutations causing low-, intermediate- and high-level resistance to ARVs according to the 2014 WHO Surveillance of HIV Drug Resistance in Adults Initiating ART. The prevalence of PDR was described by patient characteristics, ARV exposure and VL results. Results were weighted to be nationally representative. Results Successful genotyping was performed for 381 specimens; 144 (36.6%) specimens demonstrated HIVDR, of which 54 (12.7%) demonstrated PDR. Resistance to NNRTIs was most prevalent (11.9%). PDR was higher in patients with previous ARV exposure compared with no exposure (30.5% versus 9.6%) (prevalence ratio = 3.17; P < 0.01). Conclusions This survey demonstrated overall PDR at >10% among adults initiating ART in Namibia. Patients with prior ARV exposure had higher rates of PDR. Introducing a non-NNRTI-based regimen for first-line ART should be considered to maximize benefit of ART and minimize the emergence of HIVDR.
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Affiliation(s)
- Negussie Taffa
- Centers for Disease Control and Prevention (CDC), Windhoek, Namibia
| | - Clay Roscoe
- Centers for Disease Control and Prevention (CDC), Windhoek, Namibia
| | | | - Michael De Klerk
- Centers for Disease Control and Prevention (CDC), Windhoek, Namibia
| | | | - Adam Wolkon
- Centers for Disease Control and Prevention (CDC), Windhoek, Namibia
| | - Nicholus Mutenda
- Directorate of Special Programs (DSP) for HIV, TB and Malaria, Ministry of Health and Social Services (MoHSS), Windhoek, Namibia
| | - Josh DeVos
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Du-Ping Zheng
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Nick Wagar
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - Chunfu Yang
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Ndapewa Hamunime
- Directorate of Special Programs (DSP) for HIV, TB and Malaria, Ministry of Health and Social Services (MoHSS), Windhoek, Namibia
| | - Simon Agolory
- Centers for Disease Control and Prevention (CDC), Windhoek, Namibia
| | - Elliot Raizes
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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Rudd KE, Puttkammer N, Antilla J, Richards J, Heffron M, Tolentino H, Jacobs DJ, KatjiuanJo P, Prybylski D, Shepard M, Kumalija JC, Katuma HL, Leon BK, Mgonja NG, Santas XM. Building workforce capacity for effective use of health information systems: Evaluation of a blended eLearning course in Namibia and Tanzania. Int J Med Inform 2019; 131:103945. [PMID: 31561193 DOI: 10.1016/j.ijmedinf.2019.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/23/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Electronic health information systems (HIS) are critical components of national health systems, and have been identified as a key element in the development and strengthening of health systems globally. Novel approaches are needed to effectively and efficiently train health care workers on the use of HIS. One such approach is the use of digital eLearning programs, either alone or blended with face-to-face learning activities. METHODS We developed a novel blended eLearning course based on an in-person HIS training package previously developed by the United States Centers for Disease Control and Prevention. We then conducted a pilot implementation of the eLearning course in Namibia and Tanzania. RESULTS The blended eLearning pilot program enrolled 131 people, 72 (55%) from Namibia and 59 (45%) from Tanzania. The majority of enrollees were female (n = 88, 67%) and were nurses (n = 66, 50%). Of the 131 people who participated in the in-person orientation, 95 (73%) completed some or all of the eLearning modules. Across all three modules, the mean score on the post-test was significantly greater than on the pre-test (p < 0.001). When comparing results from previous in-person workshops and the blended eLearning course, we found that participants experienced strong learning gains in both, although learning gains were somewhat greater in the in-person course. Blended eLearning course participants reported good to very good satisfaction with the overall content of the course and with the eLearning modules (3.5 and 3.6 out of 5-point Likert scale). We estimate that the total cost per participant is 2.2-3.4 times greater for the in-person course (estimated cost USD $980) than for the blended eLearning course (estimated cost USD $287-$437). CONCLUSION A blended eLearning course is an effective method with which to train healthcare workers in the basic features of HIS, and the cost is up to 3.4 times less expensive than for an in-person course with similar content.
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Affiliation(s)
- Kristina E Rudd
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nancy Puttkammer
- International Training and Education Center for Health, University of Washington, Seattle, WA, USA.
| | - Jennifer Antilla
- International Training and Education Center for Health, University of Washington, Seattle, WA, USA
| | - Janise Richards
- United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthew Heffron
- International Training and Education Center for Health, University of Washington, Seattle, WA, USA
| | - Herman Tolentino
- United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Daniel J Jacobs
- United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Dimitri Prybylski
- United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark Shepard
- International Training and Education Center for Health - Namibia, Windhoek, Namibia
| | - John Claud Kumalija
- Ministry of Health and Social Welfare, Dar es Salaam, United Republic of Tanzania
| | | | - Beatus K Leon
- International Training and Education Center for Health - Tanzania, Dar es Salam, United Republic of Tanzania
| | - Neema Gabriel Mgonja
- International Training and Education Center for Health - Tanzania, Dar es Salam, United Republic of Tanzania
| | - Xenophon M Santas
- United States Centers for Disease Control and Prevention, Atlanta, GA, USA
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27
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Wesson PD, Adhikary R, Jonas A, Gerndt K, Mirzazadeh A, Katuta F, Maher A, Banda K, Mutenda N, McFarland W, Lowrance D, Prybylski D, Patel S. Estimating the Population Size of Female Sex Workers in Namibia Using a Respondent-Driven Sampling Adjustment to the Reverse Tracking Method: A Novel Approach. JMIR Public Health Surveill 2019; 5:e11737. [PMID: 30869646 PMCID: PMC6437614 DOI: 10.2196/11737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/03/2018] [Revised: 12/27/2018] [Accepted: 01/27/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Key populations, including female sex workers (FSWs), are at a disproportionately high risk for HIV infection. Estimates of the size of these populations serve as denominator data to inform HIV prevention and treatment programming and are necessary for the equitable allocation of limited public health resources. OBJECTIVE This study aimed to present the respondent-driven sampling (RDS) adjusted reverse tracking method (RTM; RadR), a novel population size estimation approach that combines venue mapping data with RDS data to estimate the population size, adjusted for double counting and nonattendance biases. METHODS We used data from a 2014 RDS survey of FSWs in Windhoek and Katima Mulilo, Namibia, to demonstrate the RadR method. Information from venue mapping and enumeration from the survey formative assessment phase were combined with survey-based venue-inquiry questions to estimate population size, adjusting for double counting, and FSWs who do not attend venues. RadR estimates were compared with the official population size estimates, published by the Namibian Ministry of Health and Social Services (MoHSS), and with the unadjusted RTM. RESULTS Using the RadR method, we estimated 1552 (95% simulation interval, SI, 1101-2387) FSWs in Windhoek and 453 (95% SI: 336-656) FSWs in Katima Mulilo. These estimates were slightly more conservative than the MoHSS estimates-Windhoek: 3000 (1800-3400); Katima Mulilo: 800 (380-2000)-though not statistically different. We also found 75 additional venues in Windhoek and 59 additional venues in Katima Mulilo identified by RDS participants' responses that were not detected during the initial mapping exercise. CONCLUSIONS The RadR estimates were comparable with official estimates from the MoHSS. The RadR method is easily integrated into RDS studies, producing plausible population size estimates, and can also validate and update key population maps for outreach and venue-based sampling.
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Affiliation(s)
- Paul Douglas Wesson
- Center for AIDS Prevention Studies, Division of Prevention Science, University of California, San Francisco, San Francisco, CA, United States
| | - Rajatashuvra Adhikary
- Strategic Information/Monitoring and Evaluation, WHO India Country Office, Gurugaon, Haryana, India
| | - Anna Jonas
- Directorate of Special Programmes, Response Monitoring & Evaluation Subdivision, Ministry of Health and Social Services, Windhoek, Namibia.,Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Krysta Gerndt
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Ali Mirzazadeh
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Frieda Katuta
- Directorate of Special Programmes, Response Monitoring & Evaluation Subdivision, Ministry of Health and Social Services, Windhoek, Namibia
| | - Andrew Maher
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Karen Banda
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Nicholus Mutenda
- Directorate of Special Programmes, Response Monitoring & Evaluation Subdivision, Ministry of Health and Social Services, Windhoek, Namibia
| | - Willi McFarland
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - David Lowrance
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Dimitri Prybylski
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sadhna Patel
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, Atlanta, GA, United States
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28
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Agolory S, de Klerk M, Baughman AL, Sawadogo S, Mutenda N, Pentikainen N, Shoopala N, Wolkon A, Taffa N, Mutandi G, Jonas A, Mengistu AT, Dzinotyiweyi E, Prybylski D, Hamunime N, Medley A. Low Case Finding Among Men and Poor Viral Load Suppression Among Adolescents Are Impeding Namibia's Ability to Achieve UNAIDS 90-90-90 Targets. Open Forum Infect Dis 2018; 5:ofy200. [PMID: 30211248 DOI: 10.1093/ofid/ofy200] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 06/27/2018] [Accepted: 08/09/2018] [Indexed: 02/04/2023] Open
Abstract
Background In 2015, Namibia implemented an Acceleration Plan to address the high burden of HIV (13.0% adult prevalence and 216 311 people living with HIV [PLHIV]) and achieve the UNAIDS 90-90-90 targets by 2020. We provide an update on Namibia's overall progress toward achieving these targets and estimate the percent reduction in HIV incidence since 2010. Methods Data sources include the 2013 Namibia Demographic and Health Survey (2013 NDHS), the national electronic patient monitoring system, and laboratory data from the Namibian Institute of Pathology. These sources were used to estimate (1) the percentage of PLHIV who know their HIV status, (2) the percentage of PLHIV on antiretroviral therapy (ART), (3) the percentage of patients on ART with suppressed viral loads, and (4) the percent reduction in HIV incidence. Results In the 2013 NDHS, knowledge of HIV status was higher among HIV-positive women 91.8% (95% confidence interval [CI], 89.4%-93.7%) than HIV-positive men 82.5% (95% CI, 78.1%-86.1%). At the end of 2016, an estimated 88.3% (95% CI, 86.3%-90.1%) of PLHIV knew their status, and 165 939 (76.7%) PLHIV were active on ART. The viral load suppression rate among those on ART was 87%, and it was highest among ≥20-year-olds (90%) and lowest among 15-19-year-olds (68%). HIV incidence has declined by 21% since 2010. Conclusions With 76.7% of PLHIV on ART and 87% of those on ART virally suppressed, Namibia is on track to achieve UNAIDS 90-90-90 targets by 2020. Innovative strategies are needed to improve HIV case identification among men and adherence to ART among youth.
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Affiliation(s)
- Simon Agolory
- US Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Michael de Klerk
- US Centers for Disease Control and Prevention, Windhoek, Namibia
| | | | | | - Nicholus Mutenda
- Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | | | - Naemi Shoopala
- US Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Adam Wolkon
- US Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Negussie Taffa
- US Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Gram Mutandi
- US Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Anna Jonas
- US Centers for Disease Control and Prevention, Windhoek, Namibia
| | | | | | | | - Ndapewa Hamunime
- Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - Amy Medley
- US Centers for Disease Control and Prevention, Atlanta, Georgia
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Ongwandee S, Lertpiriyasuwat C, Khawcharoenporn T, Chetchotisak P, Thiansukhon E, Leerattanapetch N, Leungwaranan B, Manopaiboon C, Phoorisri T, Visavakum P, Jetsawang B, Poolsawat M, Nookhai S, Vasanti-Uppapokakorn M, Karuchit S, Kittinunvorakoon C, Mock P, Prybylski D, Sukkul AC, Roels T, Martin M. Implementation of a Test, Treat, and Prevent HIV program among men who have sex with men and transgender women in Thailand, 2015-2016. PLoS One 2018; 13:e0201171. [PMID: 30044867 PMCID: PMC6059477 DOI: 10.1371/journal.pone.0201171] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 02/28/2018] [Accepted: 07/10/2018] [Indexed: 12/02/2022] Open
Abstract
Introduction Antiretroviral therapy reduces the risk of serious illness among people living with HIV and can prevent HIV transmission. We implemented a Test, Treat, and Prevent HIV Program among men who have sex with men (MSM) and transgender women at five hospitals in four provinces of Thailand to increase HIV testing, help those who test positive start antiretroviral therapy, and increase access to pre-exposure prophylaxis (PrEP). Methods We implemented rapid HIV testing and trained staff on immediate antiretroviral initiation at the five hospitals and offered PrEP at two hospitals. We recruited MSM and transgender women who walked-in to clinics and used a peer-driven intervention to expand recruitment. We used logistic regression to determine factors associated with prevalent HIV infection and the decision to start antiretroviral therapy and PrEP. Results During 2015 and 2016, 1880 people enrolled. Participants recruited by peers were younger (p<0.0001), less likely to be HIV-infected (p<0.0001), and those infected had higher CD4 counts (p = 0.04) than participants who walked-in to the clinics. Overall, 16% were HIV-positive: 18% of MSM and 9% of transgender women; 86% started antiretroviral therapy and 46% of eligible participants started PrEP. A higher proportion of participants at hospitals with one-stop HIV services started antiretroviral therapy than other hospitals. Participants who started PrEP were more likely to report sex with an HIV-infected partner (p = 0.002), receptive anal intercourse (p = 0.02), and receiving PrEP information from a hospital (p<0.0001). Conclusions We implemented a Test, Treat, and Prevent HIV Program offering rapid HIV testing and immediate access to antiretroviral therapy and PrEP. Peer-driven recruitment reached people at high risk of HIV and people early in HIV illness, providing an opportunity to promote HIV prevention services including PrEP and early antiretroviral therapy. Sites with one-stop HIV services had a higher uptake of antiretroviral therapy and PrEP.
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Affiliation(s)
| | | | | | | | | | | | | | - Chomnad Manopaiboon
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
- * E-mail:
| | | | - Prin Visavakum
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
| | - Bongkoch Jetsawang
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
| | - Monsicha Poolsawat
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
| | - Somboon Nookhai
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
| | | | - Samart Karuchit
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
| | - Chonticha Kittinunvorakoon
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
| | - Philip Mock
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
| | - Dimitri Prybylski
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
| | - Ake-Chittra Sukkul
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
| | - Thierry Roels
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
| | - Michael Martin
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
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30
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Hakim AJ, MacDonald V, Hladik W, Zhao J, Burnett J, Sabin K, Prybylski D, Garcia Calleja JM. Gaps and opportunities: measuring the key population cascade through surveys and services to guide the HIV response. J Int AIDS Soc 2018; 21 Suppl 5:e25119. [PMID: 30033654 PMCID: PMC6055128 DOI: 10.1002/jia2.25119] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 05/12/2018] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The UNAIDS 90-90-90 targets to diagnose 90% of people living with HIV, put 90% of them on treatment, and for 90% of them to have suppressed viral load have focused the international HIV response on the goal of eliminating HIV by 2030. They are also a constructive tool for measuring progress toward reaching this goal but their utility is dependent upon data availability. Though more than 25% of new infections are among key populations (KP)- sex workers, men who have sex with men, transgender people, people who inject drugs, and prisoners- and their sex partners, there is a dearth of treatment cascade data for KP. We assess the availability of cascade data and review the opportunities offered by biobehavioral and programme data to inform the HIV response. DISCUSSION The emphasis on the collection of treatment cascade data among the general population in higher prevalence countries has not led to a similar increase in the availability of cascade data for KP. The limited data available for KP highlight large gaps in service uptake across the cascade, particularly in the first 90, awareness of HIV status. Biobehavioral surveys (BBS), with linked population size estimation, provide population-based data on the treatment cascade and should be conducted every two to three years in locations with services for KP. With the inclusion of viral load testing, these surveys are able to monitor the entire treatment cascade among KP regardless of whether these populations access HIV services targeting the general population or KP. BBS also reach people accessing services and those who do not, thereby providing a unique opportunity to learn about barriers to service uptake including stigma and discrimination. At the same time high-quality programme data can play a complementary role in identifying missed opportunities that can be addressed in real-time. CONCLUSIONS Data are more important than ever for guiding the HIV response toward reaching 90-90-90 targets and eliminating HIV, particularly in the face of decreased funding for HIV and specifically for KP. Timely high-quality BBS data can be triangulated with high-quality programme data to provide a comprehensive picture of the epidemic response for KP.
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Affiliation(s)
- Avi Joseph Hakim
- Division of Global HIV and TuberculosisUS Centers for Disease Control and PreventionAtlantaGAUSA
| | | | - Wolfgang Hladik
- Division of Global HIV and TuberculosisUS Centers for Disease Control and PreventionAtlantaGAUSA
| | - Jinkou Zhao
- The Global Fund to Fight AIDS, Tuberculosis and MalariaGenevaSwitzerland
| | - Janet Burnett
- Division of HIV/AIDS PreventionUS Centers for Disease Control and PreventionAtlantaGAUSA
| | - Keith Sabin
- United Nations Joint Programme for HIV/AIDSGenevaSwitzerland
| | - Dimitri Prybylski
- Division of Global HIV and TuberculosisUS Centers for Disease Control and PreventionAtlantaGAUSA
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31
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Hakim AJ, Johnston LG, Dittrich S, Prybylski D, Burnett J, Kim E. Defining and surveying key populations at risk of HIV infection: Towards a unified approach to eligibility criteria for respondent-driven sampling HIV biobehavioral surveys. Int J STD AIDS 2018; 29:895-903. [PMID: 29629653 DOI: 10.1177/0956462418763882] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Substantial resources are invested in human immunodeficiency virus biobehavioral surveys using respondent-driven sampling for measuring progress towards the UNAIDS 90-90-90 goals and to obtain other essential data on key populations. Survey data are used to meet country needs as well those of development partners, whose data needs may sometimes diverge. Surveys using differing eligibility criteria impede comparisons across surveys. With scant literature and guidelines on how to approach eligibility criteria, diverse criteria are used within and across countries. We conducted a review of peer-reviewed human immunodeficiency virus respondent-driven sampling biobehavioral survey literature published through December 2013. We describe eligibility criteria of 137 articles representing 214 surveys. Reporting on age, risk behavior, and reference period of risk behavior was nearly universal; however, reporting on gender, geography, and language was less common. Multiple definitions were used for each criterion, making comparisons challenging. We provide a framework for how to approach defining eligibility to improve consistency and comparability across surveys.
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Affiliation(s)
- Avi J Hakim
- 1 Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lisa G Johnston
- 2 Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA.,3 School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Samantha Dittrich
- 4 Association of Public Health Laboratories, Global Health, Silver Spring, MD, USA
| | - Dimitri Prybylski
- 1 Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Janet Burnett
- 1 Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Evelyn Kim
- 1 Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, USA
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Johnston LG, McFarland W, Sabin ML, Prybylski D, Sabin K, Baral S, Kim AA, Raymond HF. Measuring self-reported HIV status in bio-behavioural surveys. Bull World Health Organ 2017; 93:287-287A. [PMID: 26229196 PMCID: PMC4431523 DOI: 10.2471/blt.15.153064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Lisa G Johnston
- Global Health Sciences, University of California-San Francisco, 550 - 16th Street (3rd floor), San Francisco, CA 94158, United States of America (USA)
| | - Willi McFarland
- San Francisco Department of Public Health, San Francisco, USA
| | - Miriam Lewis Sabin
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Dimitri Prybylski
- US Centers for Disease Control and Prevention, Global AIDS Program Asia Regional Office, Nonthaburi, Thailand
| | - Keith Sabin
- Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland
| | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, USA
| | - Andrea A Kim
- US Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Atlanta, USA
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Johnston LG, Sabin ML, Prybylski D, Sabin K, McFarland W, Baral S, Kim AA, Raymond HF. The importance of assessing self-reported HIV status in bio-behavioural surveys. Bull World Health Organ 2016; 94:605-12. [PMID: 27516638 PMCID: PMC4969987 DOI: 10.2471/blt.15.162933] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 01/18/2016] [Accepted: 02/04/2016] [Indexed: 11/27/2022] Open
Abstract
In bio-behavioural surveys measuring prevalence of infection with human immunodeficiency virus (HIV), respondents should be asked the results of their last HIV test. However, many government authorities, nongovernmental organizations, researchers and other civil society stakeholders have stated that respondents involved in such surveys should not be asked to self-report their HIV status. The reasons offered for not asking respondents to report their status are that responses may be inaccurate and that asking about HIV status may violate the respondents’ human rights and exacerbate stigma and discrimination. Nevertheless, we contend that, in the antiretroviral therapy era, asking respondents in bio-behavioural surveys to self-report their HIV status is essential for measuring and improving access to – and coverage of – services for the care, treatment and prevention of HIV infection. It is also important for estimating the true size of the unmet needs in addressing the HIV epidemic and for interpreting the behaviours associated with the acquisition and transmission of HIV infection correctly. The data available indicate that most participants in health-related surveys are willing to respond to a question about HIV status – as one of possibly several sensitive questions about sexual and drug use behaviours. Ultimately, normalizing the self-reporting of HIV status could help the global community move from an era of so-called exceptionalism to one of destigmatization – and so improve the epidemic response worldwide.
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Affiliation(s)
- Lisa G Johnston
- Global Health Sciences, University of California - San Francisco, San Francisco, United States of America (USA)
| | - Miriam Lewis Sabin
- Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Dimitri Prybylski
- Global AIDS Program Asia Regional Office, Centers for Disease Control and Prevention, Nonthaburi, Thailand
| | - Keith Sabin
- Joint United Nations Programme on HIV/AIDS, 20 avenue Appia, CH-1211 Geneva 27, Switzerland
| | - Willi McFarland
- Global Health Sciences, University of California - San Francisco, San Francisco, United States of America (USA)
| | - Stefan Baral
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Andrea A Kim
- Division of Global HIV/AIDS, United States Centers for Disease Control and Prevention, Atlanta, USA
| | - H Fisher Raymond
- Global Health Sciences, University of California - San Francisco, San Francisco, United States of America (USA)
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Visavakum P, Punsuwan N, Manopaiboon C, Pattanasin S, Thiengtham P, Tanpradech S, Sukwicha W, Wolfe M, Prybylski D. HIV prevalence and risk behaviors among people who inject drugs in Songkhla, Thailand: A respondent-driven sampling survey. Int J Drug Policy 2016; 31:163-7. [PMID: 26916088 DOI: 10.1016/j.drugpo.2016.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 01/12/2016] [Accepted: 01/22/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Prin Visavakum
- Thailand MOPH - U.S. CDC Collaboration, Nonthaburi 11000, Thailand.
| | - Niramon Punsuwan
- Bureau of Epidemiology, Disease Control Department, Ministry of Public Health, Nonthaburi 11000, Thailand
| | | | | | - Panupit Thiengtham
- Bureau of Epidemiology, Disease Control Department, Ministry of Public Health, Nonthaburi 11000, Thailand
| | | | - Wichuda Sukwicha
- Thailand MOPH - U.S. CDC Collaboration, Nonthaburi 11000, Thailand
| | - Mitchell Wolfe
- Thailand MOPH - U.S. CDC Collaboration, Nonthaburi 11000, Thailand; Division of Global HIV/AIDS, Center for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Dimitri Prybylski
- Thailand MOPH - U.S. CDC Collaboration, Nonthaburi 11000, Thailand; Division of Global HIV/AIDS, Center for Disease Control and Prevention, Atlanta, GA 30333, USA
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Gleason B, Redd J, Kilmarx P, Sesay T, Bayor F, Mozalevskis A, Connolly A, Akpablie J, Prybylski D, Moffett D, King M, Bass M, Joseph K, Jones J, Ocen F. Establishment of an Ebola Treatment Unit and Laboratory - Bombali District, Sierra Leone, July 2014-January 2015. MMWR Morb Mortal Wkly Rep 2015; 64:1108-11. [PMID: 26447483 DOI: 10.15585/mmwr.mm6439a4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The first confirmed case of Ebola virus disease (Ebola) in Sierra Leone related to the ongoing epidemic in West Africa occurred in May 2014, and the outbreak quickly spread. To date, 8,704 Ebola cases and 3,955 Ebola deaths have been confirmed in Sierra Leone. The first Ebola treatment units (ETUs) in Sierra Leone were established in the eastern districts of Kenema and Kailahun, where the first Ebola cases were detected, and these districts were also the first to control the epidemic. By September and October 2014, districts in the western and northern provinces, including Bombali, had the highest case counts, but additional ETUs outside of the eastern province were not operational for weeks to months. Bombali became one of the most heavily affected districts in Sierra Leone, with 873 confirmed patients with Ebola during July-November 2014. The first ETU and laboratory in Bombali District were established in late November and early December 2014, respectively. T- evaluate the impact of the first ETU and laboratory becoming operational in Bombali on outbreak control, the Bombali Ebola surveillance team assessed epidemiologic indicators before and after the establishment of the first ETU and laboratory in Bombali. After the establishment of the ETU and laboratory, the interval from symptom onset to laboratory result and from specimen collection to laboratory result decreased. By providing treatment to Ebola patients and isolating contagious persons to halt ongoing community transmission, ETUs play a critical role in breaking chains of transmission and preventing uncontrolled spread of Ebola (4). Prioritizing and expediting the establishment of an ETU and laboratory by pre-positioning resources needed to provide capacity for isolation, testing, and treatment of Ebola are essential aspects of pre-outbreak planning.
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Prybylski D, Manopaiboon C, Visavakum P, Yongvanitjit K, Aramrattana A, Manomaipiboon P, Tanpradech S, Suksripanich O, Pattanasin S, Wolfe M, Whitehead SJ. Diverse HIV epidemics among people who inject drugs in Thailand: evidence from respondent-driven sampling surveys in Bangkok and Chiang Mai. Drug Alcohol Depend 2015; 148:126-35. [PMID: 25640153 PMCID: PMC4749571 DOI: 10.1016/j.drugalcdep.2014.12.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 11/04/2014] [Revised: 12/20/2014] [Accepted: 12/23/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Thailand's long-standing HIV sero-sentinel surveillance system for people who inject drugs (PWID) is confined to those in methadone-based drug treatment clinics and representative data are scarce, especially outside of Bangkok. METHODS We conducted probability-based respondent-driven sampling (RDS) surveys in Bangkok (n=738) and Chiang Mai (n=309) to increase understanding of local HIV epidemics and to better inform the planning of evidence-based interventions. RESULTS PWID had different epidemiological profiles in these two cities. Overall HIV prevalence was higher in Bangkok (23.6% vs. 10.9%, p<0.001) but PWID in Bangkok are older and appear to have long-standing HIV infections. In Chiang Mai, HIV infections appear to be more recently acquired and PWID were younger and had higher levels of recent injecting and sexual risk behaviors with lower levels of intervention exposure. Methamphetamine was the predominant drug injected in both sites and polydrug use was common although levels and patterns of the specific drugs injected varied significantly between the sites. In multivariate analysis, recent midazolam injection was significantly associated with HIV infection in Chiang Mai (adjusted odds ratio=8.1; 95% confidence interval: 1.2-54.5) whereas in Bangkok HIV status was not associated with recent risk behaviors as infections had likely been acquired in the past. CONCLUSION PWID epidemics in Thailand are heterogeneous and driven by local factors. There is a need to customize intervention strategies for PWID in different settings and to integrate population-based survey methods such as RDS into routine surveillance to monitor the national response.
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Affiliation(s)
- Dimitri Prybylski
- Thailand MOPH - U.S. CDC Collaboration, Nonthaburi 11000, Thailand; Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, 30333, USA.
| | | | - Prin Visavakum
- Thailand MOPH – U.S. CDC Collaboration, Nonthaburi 11000, Thailand
| | | | | | | | | | | | | | - Mitchell Wolfe
- Thailand MOPH – U.S. CDC Collaboration, Nonthaburi 11000, Thailand,Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, 30333, USA
| | - Sara J. Whitehead
- Thailand MOPH – U.S. CDC Collaboration, Nonthaburi 11000, Thailand,Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, 30333, USA
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Ming Z, Prybylski D, Cheng F, Airawanwat R, Zhu Q, Liu W, Huang S. Two-year prospective cohort study on quality of life outcomes among people living with HIV after initiation of antiretroviral therapy in Guangxi, China. J Assoc Nurses AIDS Care 2014; 25:603-13. [PMID: 24950656 DOI: 10.1016/j.jana.2014.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 04/14/2014] [Indexed: 10/25/2022]
Abstract
The long-term impact of antiretroviral therapy (ART) on quality of life (QOL) is not well understood in China. From 2007-2008, 332 treatment-naïve, HIV-infected adults from five hospitals in Guangxi were enrolled in a 2-year prospective cohort study. Information was collected at the time of ART initiation and during 6-, 12-, and 24-month follow-up visits. Significant improvements were observed across all QOL domains during the first 6 months on ART as measured using the WHOQOL-HIV BREF instrument. These were closely tracked by increases in CD4+ T cell counts, total lymphocyte counts, and the Karnofsky performance scores (p < .05). After 6 months, improvements were smaller and uneven across QOL domains; social relationships was the only domain to not significantly improve at 24 months compared to baseline. Poorer and socially isolated participants had lower QOL outcomes. Strengthening ART program interventions to increase social support for patients may increase QOL outcomes.
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Cassell MM, Holtz TH, Wolfe MI, Hahn M, Prybylski D. 'Getting to zero' in Asia and the Pacific through more strategic use of antiretrovirals for HIV prevention. Sex Health 2014; 11:107-18. [DOI: 10.1071/sh13116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 04/30/2014] [Indexed: 12/15/2022]
Abstract
Encouraged by experimental trials demonstrating the efficacy of antiretrovirals (ARVs) in preventing HIV infection, countries across the Asia-Pacific region have committed to the achievement of ambitious targets tantamount to ending AIDS. The available data suggest that some countries still can make progress through targeted condom promotion and the expansion of harm-reduction interventions, but that none may realise its vision of ‘zero new HIV infections’ without more strategic use of ARVs as part of a combination of HIV prevention efforts targeting key populations. Low rates of HIV testing among men who have sex with men, people who inject drugs, sex workers and other key populations evidence low treatment coverage where treatment could have the greatest impact on curbing local epidemics. Studies have demonstrated the promise of adding ARV treatment and pre-exposure prophylaxis to the existing HIV prevention toolkit, but achieving population-level impact will require service-delivery approaches that overcome traditional prevention, care and treatment program distinctions. Priorities include: (1) innovative strategies to reach, test, treat and retain in services the individuals most likely to acquire or transmit HIV; (2) task shifting and enhanced partnerships between the public sector and civil society; (3) improved ‘cascade’ data systems to assess and promote service uptake and retention; and (4) policy and financing reform to enhance HIV testing and treatment access among key populations.
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Manopaiboon C, Prybylski D, Subhachaturas W, Tanpradech S, Suksripanich O, Siangphoe U, Johnston LG, Akarasewi P, Anand A, Fox KK, Whitehead SJ. Unexpectedly high HIV prevalence among female sex workers in Bangkok, Thailand in a respondent-driven sampling survey. Int J STD AIDS 2013; 24:34-8. [PMID: 23512512 DOI: 10.1177/0956462412472300] [Citation(s) in RCA: 24] [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] [Indexed: 11/16/2022]
Abstract
The pattern of sex work in Thailand has shifted substantially over the last two decades from direct commercial establishments to indirect venues and non-venue-based settings. This respondent-driven sampling survey was conducted in Bangkok in 2007 among female sex workers (FSW) in non-venue-based settings to pilot a new approach to surveillance among this hidden population. Fifteen initial participants recruited 707 consenting participants who completed a behavioural questionnaire, and provided oral fluid for HIV testing, and urine for sexually transmitted infection (STI) testing. Overall HIV prevalence was 20.2% (95% confidence interval [CI] 16.3-24.7). Three-quarters of women were street-based (75.8%, 95% CI 69.9-81.1) who had an especially high HIV prevalence (22.7%, 95% CI 18.2-28.4); about 10 times higher than that found in routine sentinel surveillance among venue-based FSW (2.5%). STI prevalence (Chlamydia trachomatis and Neisseria gonorrhoeae) was 8.7% (95% CI 6.4-10.8) and 1.0% (95% CI 0.2-1.9), respectively. Lower price per sex act and a current STI infection were independently associated with HIV infection (P < 0.05). High HIV prevalence found among FSW participating in the survey, particularly non-venue-based FSW, identifies need for further prevention efforts. In addition, it identifies a higher-risk segment of FSW not reached through routine sentinel surveillance but accessible through this survey method.
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Affiliation(s)
- C Manopaiboon
- Global AIDS Program, Thailand/Asia Regional Office, Thailand MOPH-U.S. CDC Collaboration, Ministry of Public Health, Nonthabhuri
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Dokubo EK, Kim AA, Le LV, Nadol PJ, Prybylski D, Wolfe MI. HIV incidence in Asia: a review of available data and assessment of the epidemic. AIDS Rev 2013; 15:67-76. [PMID: 23681434] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Rates of new HIV infections in Asia are poorly characterized, likely resulting in knowledge gaps about infection trends and the most important areas to target for interventions. We conducted a systematic review of peer-reviewed English language publications and conference abstracts on HIV incidence in thirteen countries - Bangladesh, Cambodia, China, India, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Taiwan, Thailand, and Vietnam. We obtained data on HIV incidence rate, incidence estimation method, population, and risk factors for incident infection. Our search yielded 338 unique incidence estimates from 70 published articles and 41 conference abstracts for eight countries. A total of 138 (41%) were obtained from prospective cohort studies and 106 (31%) were from antibody-based tests for recent infection. High HIV incidence rates were observed among commercial sex workers (0.4-27.8 per 100 person-years), people who inject drugs (0.0-43.6 per 100 person-years) and men who have sex with men (0.7-15.0 per 100 person-years). Risk factors for incident HIV infection include brothel-based sex work and cervicitis among commercial sex workers; young age, frequent injection use and sharing needles or syringes among people who inject drugs; multiple male sexual partners, receptive anal intercourse and syphilis infection among men who have sex with men. In the countries with available data, incidence rates were highest in key populations and varied widely by incidence estimation method. Established surveillance systems that routinely monitor trends in HIV incidence are needed to inform prevention planning, prioritize resources, measure impact, and improve the HIV response in Asia.
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Affiliation(s)
- E Kainne Dokubo
- University of California San Francisco, Center for AIDS Prevention Studies, San Francisco, CA, USA.
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Horyniak D, Guy R, Prybylski D, Hellard M, Kaldor J. The utility of voluntary counselling and testing data as a source of information on HIV prevalence: a systematic review. Int J STD AIDS 2010; 21:305-11. [DOI: 10.1258/ijsa.2009.009427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We explored the utility of routine HIV testing data from clinical services for estimating HIV prevalence. A systematic review identified 28 eligible publications, covering concentrated epidemics (16 of 28) and generalized epidemics (12). Of the 16 papers from concentrated epidemics, five presented estimates by risk group and four by testing history with a median HIV prevalence of 1.8% in first-time testers compared with 3% in repeat testers. Two reports from generalized epidemics restricted estimates to asymptomatic clients and three included breakdowns by reason-for-test, with the median HIV prevalence higher in symptomatic clients (62%) than others (24%). Two papers from generalized epidemics showed prevalence estimates based on routine HIV testing data were slightly higher than estimates derived from other surveillance methods, but did not restrict estimates to asymptomatic patients. We conclude that routine HIV testing data may be a supplementary data source for HIV surveillance provided careful analyses are conducted.
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Affiliation(s)
- D Horyniak
- Centre for Population Health, Macfarlane Burnet Institute for Medical Research and Public Health, 85 Commercial Rd, Melbourne VIC 3004
| | - R Guy
- Centre for Population Health, Macfarlane Burnet Institute for Medical Research and Public Health, 85 Commercial Rd, Melbourne VIC 3004
- National Centre in HIV Epidemiology and Clinical Research (NCHECR), University of New South Wales, 45 Beach St, Coogee, NSW, Australia
| | - D Prybylski
- Family Health International, Asia-Pacific Regional Office, 130-132 Sindhorn Bldg, 19th Floor, Bangkok, Thailand
| | - M Hellard
- Centre for Population Health, Macfarlane Burnet Institute for Medical Research and Public Health, 85 Commercial Rd, Melbourne VIC 3004
| | - J Kaldor
- National Centre in HIV Epidemiology and Clinical Research (NCHECR), University of New South Wales, 45 Beach St, Coogee, NSW, Australia
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Guy RJ, Prybylski D, Fairley CK, Hellard ME, Kaldor JM. Can data from HIV voluntary counselling and testing be used to assess the impact of public health interventions? A literature review. Int J STD AIDS 2009; 20:378-83. [PMID: 19451320 DOI: 10.1258/ijsa.2009.009005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Routinely collected data from clinical sites offering voluntary counselling and testing (VCT) for HIV diagnosis have been used to evaluate the impact of public health interventions; however, there has been considerable diversity in strategies. To gain an understanding of the outcome of these evaluations and provide the basis for considering methodological issues, we reviewed published studies. Search criteria were met by 20 papers that described 38 interventions, of which 29 were media-related and nine were policy changes. Most (25 of 38) were based on comparisons between two time periods, before and during the intervention, while 13 used multiple time points, including nine that adopted regression methods. About a third (13 out of 38) of the evaluations monitored HIV positivity rates and a small number investigated impact according to sex (six), age (five) and whether clients were new or repeat (three). For the 29 media-related interventions, there was an average 53% increase in the number of HIV tests performed during the intervention compared with beforehand. For policy change interventions, a 35% increase was found. Routinely collected data from VCT sites can be used to evaluate the impact of public health interventions, but attention to methodological issues will maximize their value for evaluation purposes.
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Affiliation(s)
- R J Guy
- National Centre in HIV Epidemiology and Clinical Research, Level 2, Darlinghurst, 2010, Sydney, New South Wales, Australia.
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Morineau G, Vun MC, Barennes H, Wolf RC, Song N, Prybylski D, Chawalit N. Survival and quality of life among HIV-positive people on antiretroviral therapy in Cambodia. AIDS Patient Care STDS 2009; 23:669-77. [PMID: 19591600 DOI: 10.1089/apc.2008.0241] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In 2004, Cambodia, a low-income country, undertook a rapid scale-up of free antiretroviral therapy (ART) through the public sector in order to respond to the need for treatment for those living with HIV/AIDS. A cohort of patients initiating ART in a provincial national hospital was set up at the beginning of the program to monitor the impact of treatment on patients. Patients provided information on behaviors through face-to-face interviews. Medical data were obtained from clinical files. Health-related quality of life (HRQOL) was assessed using the Medical Outcomes Study 21-Items Short Form (MOS SF-21). Patients were interviewed when initiating ART and followed up at 3 months, 6 months, and each consecutive 6 months thereafter. From March 2005 through January 2008, the cohort included 549 patients followed for a total of 645 person-years. The 4.0% of patients lost to follow-up were considered dead in the analysis. Incidence of mortality was 9.1 per 100 person-years, which is comparable to international standards. HRQOL subscale scores increased dramatically in the first year after initiating ART. The mean of overall HRQOL score rose from 63.0 at baseline to 81.1 at 1 year and 89.9 at 30 months of follow-up (chi(2) for trends p < 0.001). Simultaneously, the proportion of patients with full-time employment increased from 48.8% to 95.7%.We conclude that the rapid scaling-up of ART delivery in a resource poor Asian setting dramatically improved the survival and well-being of its beneficiaries, who in turn resumed productive lives within their communities.
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Affiliation(s)
| | - Mean Chhi Vun
- National Center for HIV/AIDS, STI and Dermatology, Phnom Penh, Cambodia
| | | | | | - Ngak Song
- Family Health International, Phnom Penh, Cambodia
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Morineau G, Prybylski D, Song N, Natpratan C, Neilsen G. Simultaneous Use of Multiple Condoms Among Male Cambodian Military Personnel Visiting Female Sex Workers. Sex Transm Dis 2007; 34:808-12. [PMID: 17891032 DOI: 10.1097/olq.0b013e31805d01f8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To estimate the prevalence of simultaneous use of multiple condoms (SUMC) and identify the characteristics of the multiple condoms users. STUDY DESIGN Cross-sectional survey among military men from a purposively selected Cambodian military region. Military men were interviewed face to face. RESULTS From the 1638 respondents, 40% never had sex with female sex workers (FSWs), 55% had used condom(s), and 5% had unprotected sex at their last encounter with a FSW. Among those reporting sex with FSWs, 21% had used multiple condoms simultaneously at their last sex with a FSW. CONCLUSION Compared with single condom users, multiple condom users were younger, had lower rank, had first sex more recently, had lower knowledge of HIV transmission, had received less HIV peer-education sessions, were more likely to have visited multiple FSWs, and were more likely to have sought their HIV serostatus. As it is unknown if SUMC increases or decreases condom effectiveness, more research is needed to investigate the effect of SUMC on condom failure rates.
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Affiliation(s)
- Guy Morineau
- Family Health International, Phnom Penh, Cambodia.
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Yeka W, Maibani-Michie G, Prybylski D, Colby D. Application of respondent driven sampling to collect baseline data on FSWs and MSM for HIV risk reduction interventions in two urban centres in Papua New Guinea. J Urban Health 2006; 83:i60-72. [PMID: 17066328 PMCID: PMC1705546 DOI: 10.1007/s11524-006-9103-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The need to obtain unbiased information among hard-to-reach and hidden populations for behavioural and biological surveillance, epidemiological studies, and intervention program evaluations has led researchers to search for a suitable sampling method. One method that has been tested among IDU and MSM recently is respondent-driven sampling (RDS). We used RDS to conduct a behavioural survey among FSWs and MSM in two urban centres in Papua New Guinea (PNG). In this paper we present the lessons learned implementing RDS in a developing country setting. We also present comparisons of RDSAT-adjusted versus unadjusted crude estimates of some key socio-demographic indicators as well as comparisons between the estimates from RDS and a hypothetical time-location sample (TLS). Overall, the use of RDS among the MSM and FSWs in PNG had numerous advantages in terms of collecting a required sample size in a short time period, minimizing costs and maximising security for staff and respondents. Although there were a few problems these were easily remedied and we would recommend RDS for other similar studies in PNG and other developing countries.
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Affiliation(s)
- William Yeka
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
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Abstract
The relationship between quantitative Plasmodiumfalciparum or P. vivax parasitemia and clinical illness has not been defined in Pakistan or in other areas where malaria transmission is not highly endemic. Standardized questionnaires were given to and physical examinations and parasitologic tests were performed in 8,941 subjects seen in outpatient clinics in 4 villages for 13 consecutive months in the Punjab region of Pakistan. The results, based on multivariable analysis, showed that a clinical diagnosis of malaria, a history of fever, rigors, headache, myalgia, elevated temperature, and a palpable spleen among children were all strongly associated with the presence and density of P. falciparum or P. vivax malaria in a monotonic dose-response fashion. The malaria attributable fraction of a clinical diagnosis of malaria, and the same symptoms and signs also increased with increasing P. falciparum and, to a lesser extent, P. vivax, parasitemia. Unlike in sub-Saharan Africa, clinical illness due to malaria often occurs in the Punjab among adolescents and adults and in patients with parasite densities less than 1,000/microl. Clinical guidelines based upon parasitemia and symptomatology must be adjusted according to the intensity of transmission and be specific for each geographic area.
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Affiliation(s)
- D Prybylski
- International Health Program and Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland-Baltimore, 21201-1596, USA
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48
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Abstract
The human immunodeficiency virus (HIV)/AIDS epidemic is currently spreading faster in Cambodia than anywhere else in Asia. Heterosexual transmission of HIV through prostitution is believed to be catalyzing the epidemic, and sex workers (SWs) are at a very high risk for becoming infected with HIV and subsequently developing AIDS. In order to gain a better understanding of the knowledge, attitudes and practices of this highly vulnerable population, face-to-face interviews were conducted with SWs (N = 502) in the capital city, Phnom Penh. The SWs surveyed were predominantly young, uneducated, poor women from rural areas, many of whom remain isolated in brothels. Brothel-based SWs are probably at greatest risk for acquiring HIV. They reported twice as many sexual contacts per day and used condoms less frequently than community-based SWs. The majority of SWs surveyed knew that condoms offered protection against HIV/AIDS, although one-quarter of SWs did not always use condoms. Despite their high level of baseline HIV/AIDS knowledge, nearly all SWs requested that additional health education materials be made available to them and their customers.
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Affiliation(s)
- D Prybylski
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore 21201-1596, USA.
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49
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Abstract
Contrary to what would be expected, smoking habits of asthmatics do not differ from those of the general population: approximately 30% of asthmatic patients smoke cigarettes. Although the relationship between smoking and the incidence of asthma has been well explored, little attention has been paid to documenting the relationship between smoking and asthma symptoms among adults with asthma. The objective of this study was to assess the association of cigarette smoking with asthma symptom severity. The present report is of a cross-sectional study of 225 asthmatics, aged 20-54 years, from six general practice clinics in East Anglia, U.K. The outcome measures are overall asthma symptom score (range 6.3-28) and three asthma symptom domains: respiratory (range 1.3-8), daily activity interference (range 2-8), and physical activity interference (range 3-12), generated from the sum of ordinal responses to questions on asthma symptom severity. Of the sample, 27.0% were current and 22.1% were former smokers. Current smokers more frequently had bothersome asthma symptoms than nonsmokers in both unadjusted analyses and analyses controlling for age, gender, recent visits to the general practitioner for asthma, and asthma medication use (p = 0.06). Respiratory symptoms (p = 0.03) and symptoms that affect daily activities (p = 0.03) were more strongly associated with smoking than symptoms that affect physical activities (p = 0.62). Our data suggest that smoking hastens asthma progression or affects disease control. Increased frequency of symptoms may be an indicator for potential morbidity among asthmatics, especially those who smoke cigarettes. The hazards associated with smoking among asthmatics need to be more clearly emphasized by physicians and public health officials in order to convince people with asthma who smoke to stop.
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Affiliation(s)
- M D Althuis
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore 21201, USA.
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50
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