1
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Shaw SY, Leung S, Isac S, Musyoki H, Mugambi M, Kioko J, Musimbi J, Olango K, Kuria S, Ongaro MK, Walimbwa J, Melon M, Emmanuel F, Moses S, Blanchard JF, Pickles M, Lazarus L, Lorway RR, Becker ML, Mishra S, Bhattacharjee P. Assessing awareness and use of HIV self-testing kits after the introduction of a community-based HIV self-testing programme among men who have sex with men in Kenya. PLOS Glob Public Health 2023; 3:e0001547. [PMID: 37594918 PMCID: PMC10437899 DOI: 10.1371/journal.pgph.0001547] [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: 11/14/2022] [Accepted: 07/18/2023] [Indexed: 08/20/2023]
Abstract
Men who have sex with men (MSM) bear a disproportionate burden of new HIV infections in Kenya, while experiencing discrimination, leading to suboptimal levels of HIV care. HIV self-testing (HIVST) is a tool to increase HIV screening and earlier diagnosis; however, questions remain regarding how best to scale-up HIVST to MSM in Kenya. The main objective of this study was to examine changes in knowledge and use of HIVST after implementation of a community-led HIVST project. Participants were MSM recruited from Kisumu, Mombasa, and Kiambu counties. Data were collected from two rounds (Round 1: 2019; Round 2: 2020) of serial cross-sectional integrated biological and behavioural assessments (IBBA), pre-, and post-project implementation. Two main outcomes were measured: 1) whether the respondent had ever heard of HIVST; and 2) whether they had ever used HIVST kits. Changes in outcomes between IBBA rounds were examined using modified multivariable Poisson regression models; adjusted prevalence ratios (aPR) and 95% confidence intervals (95% CI) are reported. A total of 2,328 respondents were included in main analyses. The proportion of respondents who had heard of HIVST increased from 75% in Round 1 to 94% in Round 2 (aPR: 1.2, 95% CI: 1.2-1.3), while those reporting using an HIVST kit increased from 20% to 53% (aPR: 2.3, 95% CI: 2.0-2.6). Higher levels of education and HIV programme awareness were associated with both outcomes. Awareness and use of HIVST kits increased after implementation of a community-led HIVST implementation project, demonstrating the importance of integration with existing community groups.
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Affiliation(s)
- Souradet Y. Shaw
- Institute for Global Public Health, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stella Leung
- Institute for Global Public Health, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Helgar Musyoki
- National Syndemic Disease Control Council, Nairobi, Kenya
| | - Mary Mugambi
- National Syndemic Disease Control Council, Nairobi, Kenya
| | - Japheth Kioko
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Janet Musimbi
- Partners for Health and Development in Africa, Nairobi, Kenya
| | | | | | | | | | - Memory Melon
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Faran Emmanuel
- Institute for Global Public Health, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stephen Moses
- Institute for Global Public Health, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James F. Blanchard
- Institute for Global Public Health, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael Pickles
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, England
| | - Lisa Lazarus
- Institute for Global Public Health, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert R. Lorway
- Institute for Global Public Health, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marissa L. Becker
- Institute for Global Public Health, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sharmistha Mishra
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Parinita Bhattacharjee
- Institute for Global Public Health, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Closson K, Prakash R, Javalkar P, Beattie T, Thalinja R, Collumbien M, Ramanaik S, Isac S, Watts C, Moses S, Gafos M, Heise L, Becker M, Bhattacharjee P. Adolescent Girls and Their Family Members' Attitudes Around Gendered Power Inequity and Associations with Future Aspirations in Karnataka, India. Violence Against Women 2023; 29:836-859. [PMID: 35959552 PMCID: PMC9950596 DOI: 10.1177/10778012221097142] [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] [Indexed: 11/15/2022]
Abstract
Intergenerational differences in inequitable gender attitudes may influence developmental outcomes, including education. In rural Karnataka, India, we examined the extent of intergenerational (adolescent girls [AGs] vs. older generation family members) dis/agreement to attitudes around gendered power inequities, including gender roles and violence against women (VAW). Unadjusted and adjusted logistic regression examined associations between intergenerational dis/agreement to attitude statements and AGs' future educational and career aspirations. Of 2,457 AGs, 90.9% had a matched family member (55% mothers). While traditional gender roles were promoted intergenerationally, more AGs supported VAW than family members. In adjusted models, discordant promotion of traditional gender roles and concordant disapproval of VAW were associated with greater aspirations. Results highlight the need for family-level programming promoting positive modeling of gender-equitable attitudes.
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Affiliation(s)
| | - Ravi Prakash
- India Health Action Trust, Lucknow, India,University of Manitoba, Winnipeg, Canada,Ravi Prakash, India Health Action Trust,
405A, Ratan Square, VS Marg, Lucknow 226001, India.
| | | | - Tara Beattie
- London School of Hygiene and Tropical
Medicine (LSHTM), London, UK
| | | | | | | | - Shajy Isac
- India Health Action Trust, Lucknow, India,University of Manitoba, Winnipeg, Canada
| | - Charlotte Watts
- London School of Hygiene and Tropical
Medicine (LSHTM), London, UK
| | | | - Mitzy Gafos
- London School of Hygiene and Tropical
Medicine (LSHTM), London, UK
| | - Lori Heise
- Johns Hopkins Bloomberg School of Public
Health & Johns Hopkins University School of Nursing, Boston, MA, USA
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Lorway RR, Macharia P, Maina J, Mathenge J, Gorigo SA, McKinnon LR, Bhattacharjee P, Arimi P, Shaw S, Keynan Y, Moses S, Kimani J, Becker ML, Mishra S, Lazarus L, Thomann M. An urgent call to include men who have sex with men in the HPV immunisation programme in Kenya. BMJ Glob Health 2022; 7:bmjgh-2022-009831. [PMID: 36171018 PMCID: PMC9528582 DOI: 10.1136/bmjgh-2022-009831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/13/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Robert R Lorway
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Pascal Macharia
- Health Options for Young Men on HIV/AIDS/STI (HOYMAS), Nairobi, Kenya
| | - John Maina
- Health Options for Young Men on HIV/AIDS/STI (HOYMAS), Nairobi, Kenya
| | - John Mathenge
- Health Options for Young Men on HIV/AIDS/STI (HOYMAS), Nairobi, Kenya
| | | | - Lyle R McKinnon
- Department of Medical Microbiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Parinita Bhattacharjee
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Partners for Health and Development in Africa, Nairobi, Kenya
| | - Peter Arimi
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Souradet Shaw
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Yoav Keynan
- Department of Medical Microbiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stephen Moses
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joshua Kimani
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Marissa L Becker
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Medical Microbiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sharmistha Mishra
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Lazarus
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Matthew Thomann
- Department of Anthropology, University of Maryland at College Park, College Park, Maryland, USA
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Haddadi N, Mande P, Brodeur T, Hao K, Ryan G, Moses S, Subramanian S, Picari X, Afshari K, Marshak-Rothstein A, Richmond J. LB868 Th2 skewing promotes the expression of skin-homing molecules on T cells and is required for the induction of skin lesions in lupus-prone mice. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Shaw SY, Ireland L, McClarty LM, Loeppky C, Bullard J, Van Caeseele P, Keynan Y, Kasper K, Moses S, Blanchard JF, Becker ML. Healthcare utilization among persons living with HIV in Manitoba, Canada, prior to HIV diagnosis: A case-control analysis. Int J STD AIDS 2021; 33:265-274. [PMID: 34894866 DOI: 10.1177/09564624211051615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Understanding care patterns of persons living with HIV prior to diagnosis can inform prevention opportunities, earlier diagnosis, and engagement strategies. We examined healthcare utilization among HIV-positive individuals and compared them to HIV-negative controls. METHODS Data were from a retrospective cohort from Manitoba, Canada. Participants included individuals living with HIV presenting to care between 2007 and 2011, and HIV-negative controls, matched (1:5) by age, sex, and region. Data from population-based administrative databases included physician visits, hospitalizations, drug dispensation, and chlamydia and gonorrhea testing. Diagnoses associated with physician visits were classified according to International Classification of Diseases chapters. Conditional logistic regression models were used to compare cases/controls, with adjusted odds ratios (AORs) and their 95% confidence intervals (95% CI) reported. RESULTS A total of 193 cases and 965 controls were included. Physician visits and hospitalizations were higher for cases, compared to controls. In the 2 years prior to case date, cases were more likely to be diagnosed with "blood disorders" (AOR: 4.2, 95% CI: 2.0-9.0), be treated for mood disorders (AOR: 2.4, 95% CI: 1.6-3.4), and to have 1+ visits to a hospital (AOR: 2.2, 95% CI: 1.4-3.6). CONCLUSION Opportunities exist for prevention, screening, and earlier diagnosis. There is a need for better integration of healthcare services with public health.
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Affiliation(s)
- Souradet Y Shaw
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Population Health Surveillance, Population and Public Health Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Laurie Ireland
- Nine Circles Community Health Centre, Winnipeg, MB, Canada
| | - Leigh M McClarty
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Carla Loeppky
- Manitoba Health, Seniors, and Active Living, Winnipeg, MB, Canada.,Department of Medical Microbiology, College of Medicine, Faculty of Health Sciences, 423134University of Manitoba, Winnipeg, MB, Canada
| | - Jared Bullard
- Department of Medical Microbiology, College of Medicine, Faculty of Health Sciences, 423134University of Manitoba, Winnipeg, MB, Canada.,Cadham Provincial Laboratory, Winnipeg, MB, Canada
| | - Paul Van Caeseele
- Department of Medical Microbiology, College of Medicine, Faculty of Health Sciences, 423134University of Manitoba, Winnipeg, MB, Canada.,Cadham Provincial Laboratory, Winnipeg, MB, Canada
| | - Yoav Keynan
- Department of Medical Microbiology, College of Medicine, Faculty of Health Sciences, 423134University of Manitoba, Winnipeg, MB, Canada.,Manitoba HIV Program, Winnipeg, MB, Canada
| | - Ken Kasper
- Manitoba HIV Program, Winnipeg, MB, Canada.,Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Stephen Moses
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - James F Blanchard
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Marissa L Becker
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Manitoba HIV Program, Winnipeg, MB, Canada
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Lazarus L, Reza-Paul S, Rahman SHU, Ramaiah M, Venugopal MS, Venukumar KT, Moses S, Becker M, Lorway R. Beyond remedicalisation: a community-led PrEP demonstration project among sex workers in India. Cult Health Sex 2021; 23:1255-1269. [PMID: 32672518 DOI: 10.1080/13691058.2020.1774656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 05/22/2020] [Indexed: 06/11/2023]
Abstract
Global health policy-makers have called for demonstration projects to better understand pre-exposure prophylaxis' (PrEP) effectiveness across geographies and populations. Ashodaya, a sex worker collective, initiated a PrEP project in Mysore, India. We conducted a project ethnography to explore the role that community participation played within the project. Although the project proved immensely successful in terms of retention and adherence, to explain these findings we point towards Ashodaya's history of collectivisation around sexual health-a history of community action that has given rise to new spaces of belonging and accumulated knowledges that became instrumental in the formulation of strategies to confront anticipated challenges during the project. These strategies included: (1) the participation of community leaders as the first participants to take PrEP, followed by the sharing of their experiences through testimonials to their peers; (2) the endorsement of PrEP among community leaders living with HIV, to avoid social divisions around HIV status; and (3) ongoing community-level support from outreach workers that went beyond administering PrEP to address the various needs of the community. These community-led approaches demonstrate that communities hold key insights into the delivery of clinically-oriented interventions, suggesting the vital role they continue to play in planning and implementing new prevention technologies.
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Affiliation(s)
- Lisa Lazarus
- Rady Faculty of Health Sciences, Department of Community Health Sciences, The Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sushena Reza-Paul
- Rady Faculty of Health Sciences, Department of Community Health Sciences, The Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Ashodaya Samithi, Mysuru, Karnataka, India
| | | | | | | | | | - Stephen Moses
- Rady Faculty of Health Sciences, Department of Community Health Sciences, The Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marissa Becker
- Rady Faculty of Health Sciences, Department of Community Health Sciences, The Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert Lorway
- Rady Faculty of Health Sciences, Department of Community Health Sciences, The Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
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Smith JS, Backes DM, Hudgens MG, Mei W, Chakraborty H, Rohner E, Moses S, Agot K, Meijer CJLM, Bailey RC. Male Circumcision Reduces Penile HPV Incidence and Persistence: A Randomized Controlled Trial in Kenya. Cancer Epidemiol Biomarkers Prev 2021; 30:1139-1148. [PMID: 33972367 PMCID: PMC8172477 DOI: 10.1158/1055-9965.epi-20-1272] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/24/2021] [Accepted: 03/22/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Male circumcision reduces the risk of human immunodeficiency virus infection in men. We assessed the effect of male circumcision on the incidence and natural history of human papillomavirus (HPV) in a randomized clinical trial in Kisumu, Kenya. METHODS Sexually active, 18- to 24-year-old men provided penile exfoliated cells for HPV DNA testing every 6 months for 2 years. HPV DNA was detected via GP5+/6+ PCR in glans/coronal sulcus and in shaft samples. HPV incidence and persistence were assessed by intent-to-treat analyses. RESULTS A total of 2,193 men participated (1,096 randomized to circumcision; 1,097 controls). HPV prevalence was 50% at baseline for both groups and dropped to 23.7% at 24 months in the circumcision group, and 41.0% in control group. Incident infection of any HPV type over 24 months was lower among men in the circumcision group than in the control group [HR = 0.61; 95% confidence interval (CI), 0.52-0.72]. Clearance rate of any HPV infection over 24 months was higher in the circumcision group than in the control group (HR = 1.87; 95% CI, 1.49-2.34). Lower HPV point-prevalence, lower HPV incidence, and higher HPV clearance in the circumcision group were observed in glans but not in shaft samples. CONCLUSION Male circumcision reduced the risk of HPV acquisition and reinfection, and increased HPV clearance in the glans. IMPACT Providing voluntary, safe, and affordable male circumcision should help reduce HPV infections in men, and consequently, HPV-associated disease in their partners.
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Affiliation(s)
- Jennifer S Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.
- Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Danielle M Backes
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Michael G Hudgens
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Wenwen Mei
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | | | - Eliane Rohner
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Stephen Moses
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | - Chris J L M Meijer
- Department of Pathology, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Robert C Bailey
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Illinois
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Raef H, Wong L, Garelli C, Kim E, Ahmed M, Pike K, Moses S, Harris J, Marshak-Rothstein A, Rashighi M, Richmond J. 041 CXCR3 blockade reduces skin germinal center B cells and autoantibody titers in murine cutaneous lupus erythematosus. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Wilson A, Musyoki H, Avery L, Cheuk E, Gichangi P, Bhattacharjee P, Musimbe J, Leung S, Blanchard J, Moses S, Mishra S, Becker M. Sexual and reproductive health among adolescent girls and young women in Mombasa, Kenya. Sex Reprod Health Matters 2021; 28:1749341. [PMID: 32425108 PMCID: PMC7888015 DOI: 10.1080/26410397.2020.1749341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/17/2022] Open
Abstract
This secondary data analysis of a cross-sectional survey conducted in Mombasa, Kenya characterises sexual and reproductive health (SRH) indicators among adolescent girls and young women (AGYW) engaged in casual and transactional sexual relationships as well as sex work. It describes the association between awareness of local HIV programmes and SRH services uptake for AGYW engaged in sex work. Thirty-eight percent of the participants reported a history of pregnancy. Among participants not trying to get pregnant, 27% stated that they were not currently using any form of contraception. Of the participants who had an abortion, 59% were completed under unsafe conditions. For AGYW engaged in sex work, awareness of local HIV prevention programmes was associated with increased STI testing within the last year (29%) as well as at least one HIV test (99%) compared to those who were not aware of local programming (18% and 92%, respectively); however, only 26% of participants engaged in sex work had heard of local HIV prevention programmes. There were no associations between awareness of local HIV programming and rates of dual contraception use, safe abortion, most recent birth attended by a skilled health professional or testing for HIV during pregnancy. Our study found high need for SRH services, particularly, access to contraception and safe abortion. Continued efforts are required to improve access to the full spectrum of SRH interventions, including family planning services and access to safe abortion in addition to HIV prevention to promote health equity.
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Affiliation(s)
- Andrea Wilson
- Research Associate, Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Helgar Musyoki
- Program Manager, Key Populations Programme, National AIDS and STI Control Programme, Nairobi, Kenya
| | - Lisa Avery
- Associate Professor, Centre for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | - Eve Cheuk
- Research Associate, Centre for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | - Peter Gichangi
- Senior Adviser, International Centre for Reproductive Health, Mombasa, Kenya
| | - Parinita Bhattacharjee
- Senior Technical Advisor, Africa Programs, Centre for Global Public Health, University of Manitoba, Nairobi, Kenya
| | - Janet Musimbe
- Technical Manager, Partnership for Health and Development in Africa, Nairobi, Kenya
| | - Stella Leung
- Senior Technical Advisor, Centre for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | - James Blanchard
- Professor, Centre for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | - Stephen Moses
- Professor, Centre for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | - Sharmistha Mishra
- Assistant Professor, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Marissa Becker
- Associate Professor, Centre for Global Public Health, University of Manitoba, Winnipeg, MB, Canada. Correspondence:
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Jana S, Ray P, Roy S, Kadam A, Gangakhedkar RR, Rewari BB, Moses S, Becker ML. Successful integration of HIV pre-exposure prophylaxis into a community-based HIV prevention program for female sex workers in Kolkata, India. Int J STD AIDS 2021; 32:638-647. [PMID: 33596735 PMCID: PMC8091404 DOI: 10.1177/0956462420983992] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We assessed the impact of pre-exposure prophylaxis (PrEP) in the context of a community-based HIV program among female sex workers (FSWs) in Kolkata, India. This was an open-label, uncontrolled demonstration trial. HIV seronegative FSWs over 18 years were eligible. Participants were administered daily tenofovir/emtricitabine (TDF-FTC) with follow-up visits at months 1, 3, 6, 9, 12, and 15. Drug adherence was monitored by self-report, and a random subset of participants underwent plasma TDF testing. 843 women were screened and 678 enrolled and started on PrEP. Seventy-nine women (11%) did not complete all scheduled visits: four women died of reasons unrelated to PrEP and 75 withdrew, for a 15-month retention rate of 89%. Self-reported daily adherence was over 70%. Among those tested for TDF, the percentage of women whose level reached ≥40 ng/mL was 65% by their final visit. There were no HIV seroconversions, and no evidence of significant changes in sexual behavior. This study demonstrated the feasibility and effectiveness of PrEP for FSWs in Kolkata, with very high levels of adherence to PrEP and no HIV seroconversions. The integration of PrEP into an existing community-based HIV prevention program ensured community support and facilitated adherence.
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Affiliation(s)
| | - Protim Ray
- Durbar Mahila Samanwaya Committee, Kolkata, India
| | - Soma Roy
- Durbar Mahila Samanwaya Committee, Kolkata, India
| | | | | | | | - Stephen Moses
- Department of Community Health Sciences, Institute for Global Public Health, 8664University of Manitoba, Winnipeg, Canada
| | - Marissa L Becker
- Department of Community Health Sciences, Institute for Global Public Health, 8664University of Manitoba, Winnipeg, Canada
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11
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Backes DM, Bosire C, Hudgens MG, Fokar A, Agot K, Opiyo F, Moses S, Meijer CJ, Bailey RC, Snijders PJ, Smith JS. Incidence and clearance of penile human papillomavirus infection among circumcised Kenyan men. Int J STD AIDS 2020; 31:1202-1211. [PMID: 32928051 DOI: 10.1177/0956462420948370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Prospective data are limited on human papillomavirus (HPV) acquisition and clearance among circumcised men from resource-limited geographical regions, particularly Africa. The goal of this study was to estimate incidence and clearance of type-specific genital HPV infection in men. Penile exfoliated cell specimens were collected from the glans/coronal sulcus and shaft of 1,037 circumcised Kenyan men at baseline and 6-, 12- and 18-month follow-up visits between 2003-2007. Specimens were tested with GP5+/6+ PCR to detect 44 HPV types. The median age of participants at baseline was 21 years (range 18-28). The 12- and 18-month incidence rates (IRs) for any HPV were 34.9/100 person-years (95% confidence interval [CI]: 31.2-39.0) and 36.4/100 person-years (95% CI: 32.9-40.2), respectively. The 18-month cumulative risk for high-risk HPV was 30% compared to 16% for low-risk HPV. Cumulative risk was not associated with age or anatomical site. The estimated probability of any HPV infection clearing by 12 months was 0.92. Time until HPV clearance was not associated with age, anatomical site, or whether HPV infection type was high-risk or low-risk. HPV IRs among circumcised men in this study were comparable to other circumcised populations.
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Affiliation(s)
- Danielle M Backes
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Claire Bosire
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Michael G Hudgens
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Ali Fokar
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | - Felix Opiyo
- Nyanza Reproductive Health Society, Kisumu, Kenya
| | - Stephen Moses
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Chris Jlm Meijer
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Robert C Bailey
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, IL, USA
| | - Peter Jf Snijders
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Jennifer S Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Linberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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12
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Foss AM, Prudden HJ, Mitchell KM, Pickles M, Washington R, Phillips AE, Alary M, Boily MC, Moses S, Watts CH, Vickerman PT. Using data from 'visible' populations to estimate the size and importance of 'hidden' populations in an epidemic: A modelling technique. Infect Dis Model 2020; 5:798-813. [PMID: 33102985 PMCID: PMC7566088 DOI: 10.1016/j.idm.2020.09.007] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 09/24/2020] [Indexed: 11/23/2022] Open
Abstract
We used reported behavioural data from cisgender men who have sex with men and transgender women (MSM/TGW) in Bangalore, mainly collected from 'hot-spot' locations that attract MSM/TGW, to illustrate a technique to deal with potential issues with the representativeness of this sample. A deterministic dynamic model of HIV transmission was developed, incorporating three subgroups of MSM/TGW, grouped according to their reported predominant sexual role (insertive, receptive or versatile). Using mathematical modelling and data triangulation for 'balancing' numbers of partners and role preferences, we compared three different approaches to determine if our technique could be useful for inferring characteristics of a more 'hidden' insertive MSM subpopulation, and explored their potential importance for the HIV epidemic. Projections for 2009 across all three approaches suggest that HIV prevalence among insertive MSM was likely to be less than half that recorded in the surveys (4.5-6.5% versus 13.1%), but that the relative size of this subgroup was over four times larger (61-69% of all MSM/TGW versus 15%). We infer that the insertive MSM accounted for 10-20% of all prevalent HIV infections among urban males aged 15-49. Mathematical modelling can be used with data on 'visible' MSM/TGW to provide insights into the characteristics of 'hidden' MSM. A greater understanding of the sexual behaviour of all MSM/TGW is important for effective HIV programming. More broadly, a hidden subgroup with a lower infectious disease prevalence than more visible subgroups, has the potential to contain more infections, if the hidden subgroup is considerably larger in size.
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Affiliation(s)
- Anna M. Foss
- Department of Global Health and Development and Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Holly J. Prudden
- Department of Global Health and Development and Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Kate M. Mitchell
- Department of Global Health and Development and Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Michael Pickles
- Department of Global Health and Development and Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Medical School Building, St Mary’s Campus, Norfolk Place, London, W2 1PG, UK
| | - Reynold Washington
- St John’s Research Institute, 100 Feet Road, John Nagar, Koramangala, Bangalore, 560 034, Karnataka, India
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, S113-750 Bannatyne Avenue, Winnipeg, Manitoba, R3E 0W3, Canada
| | - Anna E. Phillips
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Medical School Building, St Mary’s Campus, Norfolk Place, London, W2 1PG, UK
| | - Michel Alary
- Centre de recherche du CHU de Québec – Université Laval, 1050 Chemin Ste-Foy, Québec (Qc), G1S 4L8, Canada
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, 1050, avenue de la Médecine, Québec (Qc), G1V 0A6, Canada
| | - Marie-Claude Boily
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Medical School Building, St Mary’s Campus, Norfolk Place, London, W2 1PG, UK
| | - Stephen Moses
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, S113-750 Bannatyne Avenue, Winnipeg, Manitoba, R3E 0W3, Canada
| | - Charlotte H. Watts
- Department of Global Health and Development and Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Peter T. Vickerman
- Department of Global Health and Development and Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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13
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Ramanaik S, Collumbien M, Pujar A, Howard-Merrill L, Cislaghi B, Prakash R, Javalkar P, Thalinja R, Beattie T, Moses S, Isac S, Gafos M, Bhattacharjee P, Heise L. 'I have the confidence to ask': thickening agency among adolescent girls in Karnataka, South India. Cult Health Sex 2020; 24:1-15. [PMID: 32969330 DOI: 10.1080/13691058.2020.1812118] [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] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/16/2020] [Indexed: 06/11/2023]
Abstract
Gender norms serve to normalise gender inequalities and constrain girls' agency. This paper examines how girls' agency, along a continuum, is influenced by the interplay between constraining and enabling influences in the girls' environments. We analyse data from a qualitative study nested within a cluster randomised evaluation of Samata, a multi-layered programme supporting adolescent girls to stay in school and delay marriage in Karnataka, South India. Specifically, we compare agency among 22 girls from intervention communities and 9 girls in control communities using data from the final round of interviews in a qualitative cohort. Using the concept of 'thin' and 'thick' agency on a continuum, we identified shocks like mothers' death or illness, poverty stress, gender norms and poor school performance as thinning influences. Good school examination results; norms in support of education; established educational aspirations; supportive parents, siblings and teachers; and strategic government and Samata resources enabled thicker agency. The intervention programme's effect increased in parallel to the gradient from thin to thicker agency among girls in progressively supportive family contexts. Engagement with the programme was however selective; families adhering to harmful gender norms were not receptive to outreach. In line with diffusion theory, late adopters required additional peer encouragement to change norms.
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Affiliation(s)
| | - Martine Collumbien
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Ashwini Pujar
- Karnataka Health Promotion Trust (KHPT), IT Park, Bangalore, India
| | - Lottie Howard-Merrill
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Ravi Prakash
- Karnataka Health Promotion Trust (KHPT), IT Park, Bangalore, India
- Center for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Prakash Javalkar
- Karnataka Health Promotion Trust (KHPT), IT Park, Bangalore, India
| | | | - Tara Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Stephen Moses
- Center for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Shajy Isac
- Karnataka Health Promotion Trust (KHPT), IT Park, Bangalore, India
- Center for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Mitzy Gafos
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | | | - Lori Heise
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health and Johns Hopkins University School of Nursing, Baltimore, MD, USA
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14
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Cheuk E, Mishra S, Balakireva O, Musyoki H, Isac S, Pavlova D, Bhattacharjee P, Lorway R, Pickles M, Ma H, Gichangi P, Sandstrom P, McKinnon LR, Lazarus L, Moses S, Blanchard J, Becker M. Transitions: Novel Study Methods to Understand Early HIV Risk Among Adolescent Girls and Young Women in Mombasa, Kenya, and Dnipro, Ukraine. Front Reprod Health 2020; 2:7. [PMID: 36304700 PMCID: PMC9580775 DOI: 10.3389/frph.2020.00007] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/30/2020] [Indexed: 11/13/2022] Open
Abstract
Transitions aims to understand the human immunodeficiency virus (HIV) risk at critical transition points in the sexual life course of adolescent girls and young women (AGYW) who engage in casual sex, transactional sex, and sex work. In this article, we present the Transitions study methods. The Transitions study has the following objectives: (1) to describe how the characteristics and length of the transition period and access gap vary across two epidemiological contexts (Mombasa, Kenya, and Dnipro, Ukraine); (2) to understand how the risk of HIV varies by length and characteristics of the transition period and access gap across epidemiologic contexts; and (3) to assess the extent to which HIV infections acquired during the transition period and access gap could mitigate the population-level impact of focused interventions for female sex workers and explore the potential marginal benefit of expanding programs to reach AGYW during the transition period and access gap. Cross-sectional biobehavioral data were collected from young women aged 14 to 24 years who were recruited from locations in Mombasa County, Kenya, and Dnipro, Ukraine, where sex work took place. Data are available for 1,299 Kenyan and 1,818 Ukrainian participants. The survey addressed the following areas: timing of transition events (first sex, first exchange of sex for money or other resources, self-identification as sex workers, entry into formal sex work, access to prevention program services); sexual behaviors (condom use, anal sex, sex under the influence of drugs or alcohol); partnerships (regular and first-time clients, regular and first-time transactional sex partners, and husbands and boyfriends); alcohol use; injection and non-injection illicit drug use; experience of violence; access to HIV prevention and treatment program; testing for sexually transmitted and blood-borne infections and HIV; and reproductive health (pregnancies, abortions, contraceptives). HIV and hepatitis C virus prevalence data were based on rapid test results. Mathematical modeling will be used to generate projections of onward HIV transmission at specific transition points in the sexual life course of AGYW. Taken together, these data form a novel data resource providing comprehensive behavioral, structural, and biological data on a high-risk group of AGYW in two distinct sociocultural and epidemiologic contexts.
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Affiliation(s)
- Eve Cheuk
- Centre for Global Public Health, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Sharmistha Mishra
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Olga Balakireva
- Institute for Economics and Forecasting, Ukrainian National Academy of Sciences, Kyiv, Ukraine
- Ukrainian Institute for Social Research After Oleksandr Yaremenko, Kyiv, Ukraine
| | - Helgar Musyoki
- National AIDS and STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Shajy Isac
- India Health Action Trust, New Delhi, India
| | - Daria Pavlova
- Ukrainian Institute for Social Research After Oleksandr Yaremenko, Kyiv, Ukraine
| | - Parinita Bhattacharjee
- Centre for Global Public Health, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Robert Lorway
- Centre for Global Public Health, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Michael Pickles
- Centre for Global Public Health, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Imperial College London, London, United Kingdom
| | - Huiting Ma
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Peter Gichangi
- International Centre for Reproductive Health Kenya, Mombasa, Kenya
- Technical University of Mombasa, Mombasa, Kenya
| | - Paul Sandstrom
- National HIV and Retrovirology Laboratories, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Lyle R. McKinnon
- Department of Medical Microbiology and Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lisa Lazarus
- Centre for Global Public Health, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Stephen Moses
- Centre for Global Public Health, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - James Blanchard
- Centre for Global Public Health, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Marissa Becker
- Centre for Global Public Health, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- *Correspondence: Marissa Becker
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15
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Prakash R, Beattie TS, Cislaghi B, Bhattacharjee P, Javalkar P, Ramanaik S, Thalinja R, Davey C, Gafos M, Watts C, Collumbien M, Moses S, Isac S, Heise L. Changes in Family-Level Attitudes and Norms and Association with Secondary School Completion and Child Marriage Among Adolescent Girls: Results from an Exploratory Study Nested Within a Cluster-Randomised Controlled Trial in India. Prev Sci 2020; 21:1065-1080. [PMID: 32720188 DOI: 10.1007/s11121-020-01143-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We evaluated the impact of Samata, a 3-year multilayered intervention among scheduled caste/scheduled tribe (SC/ST) adolescent girls in rural northern Karnataka, on family-level (parents or guardian) attitudes and direct and indirect norms related to child marriage and girl's education. Endline data from 1840 family members were used to assess the effect of Samata on attitudes and norms related to schooling and child marriage, while data from 4097 family members (including 2257 family members at baseline) were used to understand the shifts in attitudes and norms over the period 2014-2017. Overall, we found that the programme had little impact on family-level attitudes and norms. However, there were shifts in some attitudes, norms and perceived sanctions between baseline (when girls were aged 13-14 years) and endline (when girls were aged 15-16 years), with some becoming more progressive (e.g. direct norms related to child marriage) and others more restrictive (e.g. norms around girls completing secondary education and norms related to child marriage and educational drop-out, blaming girls for eve teasing and limiting girls' mobility so as to protect family honour). Moreover, non-progressive norms related to marriage and education were strongly associated with child marriage and secondary school non-completion among adolescent girls in this rural setting. Norms hypothesised to be important for marriage and schooling outcomes were indeed associated with these outcomes, but the intervention was not able to significantly shift these norms. In part, this may have been due to the intervention focusing much of its initial efforts on working with girls alone rather than family members, the relevant reference group. Future interventions that seek to affect norms should conduct formative research to clarify the specific norms affecting the outcome(s) of interest; likewise, programme planners should ensure that all activities engage those most influential in enforcing the norm(s) from the beginning. ClinicalTrials.gov registration number: NCT01996241.
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Affiliation(s)
- Ravi Prakash
- Department of Community Health Sciences, Institute for Global Public Health, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada.
- India Health Action Trust (IHAT), Bangalore, India.
| | - Tara S Beattie
- Departments of Global Health and Development and Public Health, Environments and Society, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, UK
| | - Beniamino Cislaghi
- Departments of Global Health and Development and Public Health, Environments and Society, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, UK
| | - Parinita Bhattacharjee
- Department of Community Health Sciences, Institute for Global Public Health, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | | | | | | | - Calum Davey
- Departments of Global Health and Development and Public Health, Environments and Society, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, UK
| | - Mitzy Gafos
- Departments of Global Health and Development and Public Health, Environments and Society, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, UK
| | - Charlotte Watts
- Departments of Global Health and Development and Public Health, Environments and Society, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, UK
| | - Martine Collumbien
- Departments of Global Health and Development and Public Health, Environments and Society, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, UK
| | - Stephen Moses
- Department of Community Health Sciences, Institute for Global Public Health, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Shajy Isac
- Department of Community Health Sciences, Institute for Global Public Health, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
- India Health Action Trust (IHAT), Bangalore, India
| | - Lori Heise
- Departments of Global Health and Development and Public Health, Environments and Society, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, UK
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg Institute for Global Public Health and JHU School of Nursing, 615 N. Wolfe Street, Baltimore, MD, USA
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16
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Sankaran D, Sharma P, Lazarus L, Swain T, Pilli B, Kumar PM, Namasivayam V, Blanchard J, Moses S. Visualizing participant experiences in maternal and child nutrition studies using timeline mapping. Gates Open Res 2020; 3:1535. [PMID: 32695962 PMCID: PMC7343969 DOI: 10.12688/gatesopenres.13055.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2020] [Indexed: 11/26/2022] Open
Abstract
Iron and folic acid (IFA) supplementation is one of the most cost-effective interventions to prevent and treat anemia during pregnancy. Despite having the highest global burden of anemia among pregnant women, rates of IFA uptake in pregnancy in India are still very low, particularly in the state of Uttar Pradesh. While there have been several studies that explored challenges around IFA consumption and adherence, there is a paucity of studies that have synthesized this information into a single visual tool that can help program implementers understand the challenges and identify potential areas of intervention. Timeline maps were developed as a visual qualitative tool to explore the nuances of health behaviors among pregnant women with respect to antenatal care (ANC) services, including IFA consumption. Timeline maps were used to visually document critical events pertaining to ANC services chronologically, including details on contact points with the health system and events specific to IFA distribution, consumption and counselling. Six research assistants (RAs) were trained on how to use timeline maps and record participant narratives. The RAs later participated in a focus group discussion to gain insight about their experiences using the tool. RAs reported that the timeline maps were easy-to-use and facilitated in-depth conversations with participants. RAs shared that they were able to actively engage the participants in co-creating the maps. The visual nature of the tool prompted participants’ recall of key pregnancy events and reflexivity. Challenges reported with the tool/process included recollection of past events and potential misrepresentation of information. These highlight a need to restructure training processes. Our findings indicate that timeline maps have the potential to be used in a variety of other program contexts, and merit further exploration.
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Affiliation(s)
- Deepa Sankaran
- Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, R3E0T6, Canada
| | - Priyanshu Sharma
- India Health Action Trust, Lucknow, Uttar Pradesh, 226001, India
| | - Lisa Lazarus
- Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, R3E0T6, Canada
| | - Tapaswini Swain
- India Health Action Trust, Lucknow, Uttar Pradesh, 226001, India
| | - Bhanu Pilli
- Department of Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, R3T2N2, Canada
| | - P Manish Kumar
- India Health Action Trust, Lucknow, Uttar Pradesh, 226001, India
| | | | - James Blanchard
- Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, R3E0T6, Canada
| | - Stephen Moses
- Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, R3E0T6, Canada
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Sankaran D, Sharma P, Lazarus L, Swain T, Pilli B, Kumar PM, Namasivayam V, Blanchard J, Moses S. Visualizing participant experiences in maternal and child nutrition studies using timeline mapping. Gates Open Res 2020; 3:1535. [PMID: 32695962 PMCID: PMC7343969 DOI: 10.12688/gatesopenres.13055.1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2020] [Indexed: 02/02/2024] Open
Abstract
Iron and folic acid (IFA) supplementation is one of the most cost-effective interventions to prevent and treat anemia during pregnancy. Despite having the highest global burden of anemia among pregnant women, rates of IFA uptake in pregnancy in India are still very low, particularly in the state of Uttar Pradesh. While there have been several studies that explored challenges around IFA consumption and adherence, there is a paucity of studies that have synthesized this information into a single visual tool that can help program implementers understand the challenges and identify potential areas of intervention. Timeline maps were developed as a visual qualitative tool to explore the nuances of health behaviors among pregnant women with respect to antenatal care (ANC) services, including IFA consumption. Timeline maps were used to visually document critical events pertaining to ANC services chronologically, including details on contact points with the health system and events specific to IFA distribution, consumption and counselling. Six research assistants (RAs) were trained on how to use timeline maps and record participant narratives. The RAs later participated in a focus group discussion to gain insight about their experiences using the tool. RAs reported that the timeline maps were easy-to-use and facilitated in-depth conversations with participants. RAs shared that they were able to actively engage the participants in co-creating the maps. The visual nature of the tool prompted participants' recall of key pregnancy events and reflexivity. Challenges reported with the tool/process included recollection of past events and potential misrepresentation of information. These highlight a need to restructure training processes. Our findings indicate that timeline maps have the potential to be used in a variety of other program contexts, and merit further exploration.
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Affiliation(s)
- Deepa Sankaran
- Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, R3E0T6, Canada
| | - Priyanshu Sharma
- India Health Action Trust, Lucknow, Uttar Pradesh, 226001, India
| | - Lisa Lazarus
- Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, R3E0T6, Canada
| | - Tapaswini Swain
- India Health Action Trust, Lucknow, Uttar Pradesh, 226001, India
| | - Bhanu Pilli
- Department of Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, R3T2N2, Canada
| | - P. Manish Kumar
- India Health Action Trust, Lucknow, Uttar Pradesh, 226001, India
| | | | - James Blanchard
- Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, R3E0T6, Canada
| | - Stephen Moses
- Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, R3E0T6, Canada
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18
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Sankaran D, Sharma P, Isac S, Kumar M, Blanchard J, Moses S. Complementary Feeding Practices and Associated Factors in Children 6–23 months in Uttar Pradesh, India: Program Implications. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa053_107] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Optimal complementary feeding (CF) practices among children 6–23 months can prevent childhood malnutrition and can improve long term development and health. Our study aimed to understand CF practices in children 6–23 months, as part of an ongoing nutrition program (with a focus on improving dietary diversity) in UP, India.
Methods
Mothers of children 6–23 months old were interviewed in 125 blocks across 25 districts of UP (N = 34,290). We assessed dietary intake using 24-hour dietary recalls and calculated minimum dietary diversity (MDD, 4 + food groups) and age-appropriate minimum meal frequency (MMF). We used multivariate logistic regression to test for associations between MDD and program exposure variables, such as frontline worker (FLW) CF knowledge, home visits by FLWs, and FLW counseling on age-appropriate CF practices, controlling for age, caste, religion, mother's education level, birth order and sex of the child.
Results
Merely 22% of children 6–8 months old received any semisolid/solid food the previous day, and even at 1 year of age, only 60% children received any CF. Fourteen % of all children and 5% of children 9–11 months received age-appropriate MMF. Children 6–23 months old had poor diets with only 11% reaching MDD. Only 3% of younger children (6–11 months) and 18% of children 12–23 months reached MDD. In children 12–23 months, starchy staples, pulses, other fruits and vegetables (F&V) and dairy products were consumed in higher proportions (65%, 52%, 36% and 36% respectively) while Vitamin-A rich F&V, eggs and flesh foods were rarely consumed (11%, 2% and 3.1% respectively). Higher odds of achieving MDD were associated with FLWs CF knowledge (OR: 3.2; 95% CI: 2.2–4.5), home visit by FLWs in the past month (OR: 1.2; 95% CI: 1.1–1.4) and counselling by FLWs on age-appropriate CF practices (OR: 1.4; 95% CI: 1.2–1.7) were positively associated with MDD.
Conclusions
CF practices in children 6–23 months old in these 25 districts in UP are suboptimal. Dietary diversity in this age group can be improved by improving FLW knowledge and quantity and quality of FLW interactions with families. Results suggest a need for targeted age-specific counselling to increase meal frequency and to introduce a greater variety of foods to younger children.
Funding Sources
Bill and Melinda Gates Foundation.
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Affiliation(s)
| | | | | | | | | | - Stephen Moses
- Centre for Global Public Health, University of Manitoba
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19
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Bhattacharjee P, Isac S, Musyoki H, Emmanuel F, Olango K, Kuria S, Ongaro MK, Walimbwa J, Musimbi J, Mugambi M, Kaosa S, Kioko J, Njraini M, Melon M, Onyoni J, Bartilol K, Becker M, Lorway R, Pickles M, Moses S, Blanchard J, Mishra S. HIV prevalence, testing and treatment among men who have sex with men through engagement in virtual sexual networks in Kenya: a cross-sectional bio-behavioural study. J Int AIDS Soc 2020; 23 Suppl 2:e25516. [PMID: 32589341 PMCID: PMC7319161 DOI: 10.1002/jia2.25516] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 09/19/2019] [Revised: 04/06/2020] [Accepted: 04/23/2020] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION In Kenya, men who have sex with men (MSM) are increasingly using virtual sites, including web-based apps, to meet sex partners. We examined HIV testing, HIV prevalence, awareness of HIV-positive status and linkage to antiretroviral therapy (ART), for HIV-positive MSM who solely met partners via physical sites (PMSM), compared with those who did so in virtual sites (either solely via virtual sites (VMSM), or via both virtual and physical sites (DMSM)). METHODS We conducted a cross-sectional bio-behavioural survey of 1200 MSM, 15 years and above, in three counties in Kenya between May and July 2019, using random sampling of physical and virtual sites. We classified participants as PMSM, DMSM and VMSM, based on where they met sex partners, and compared the following between groups using chi-square tests: (i) proportion tested; (ii) HIV prevalence and (iii) HIV care continuum among MSM living with HIV. We then performed multivariable logistic regression to measure independent associations between network engagement and HIV status. RESULTS 177 (14.7%), 768 (64.0%) and 255 (21.2%), of participants were classified as PMSM, DMSM and VMSM respectively. 68.4%, 70.4% and 78.5% of PMSM, DMSM and VMSM, respectively, reported an HIV test in the previous six months. HIV prevalence was 8.5% (PMSM), 15.4% (DMSM) and 26.7% (VMSM), p < 0.001. Among those living with HIV, 46.7% (PMSM), 41.5% (DMSM) and 29.4% (VMSM) were diagnosed and aware of their status; and 40.0%, 35.6% and 26.5% were on antiretroviral treatment. After adjustment for other predictors, MSM engaged in virtual networks remained at a two to threefold higher risk of prevalent HIV: VMSM versus PMSM (adjusted odds ratio 3.88 (95% confidence interval (CI) 1.84 to 8.17) p < 0.001); DMSM versus PMSM (2.00 (95% CI 1.03 to 3.87), p = 0.040). CONCLUSIONS Engagement in virtual networks is associated with elevated HIV risk, irrespective of individual-level risk factors. Understanding the difference in characteristics among MSM-seeking partners in different sites will help HIV programmes to develop subpopulation-specific interventions.
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Affiliation(s)
- Parinita Bhattacharjee
- Centre for Global Public HealthUniversity of ManitobaWinnipegCanada
- Technical Support UnitPartners for Health and Development in AfricaNairobiKenya
| | - Shajy Isac
- Centre for Global Public HealthUniversity of ManitobaWinnipegCanada
- India Health Action TrustNew DelhiIndia
| | - Helgar Musyoki
- National AIDS and STI Control ProgrammeMinistry of HealthNairobiKenya
| | - Faran Emmanuel
- Centre for Global Public HealthUniversity of ManitobaWinnipegCanada
| | | | | | | | | | - Janet Musimbi
- Technical Support UnitPartners for Health and Development in AfricaNairobiKenya
| | - Mary Mugambi
- National AIDS and STI Control ProgrammeMinistry of HealthNairobiKenya
| | - Shem Kaosa
- Technical Support UnitPartners for Health and Development in AfricaNairobiKenya
| | - Japheth Kioko
- Technical Support UnitPartners for Health and Development in AfricaNairobiKenya
| | - Margret Njraini
- Technical Support UnitPartners for Health and Development in AfricaNairobiKenya
| | - Memory Melon
- Technical Support UnitPartners for Health and Development in AfricaNairobiKenya
| | - Juddie Onyoni
- Technical Support UnitPartners for Health and Development in AfricaNairobiKenya
| | - Kigen Bartilol
- National AIDS and STI Control ProgrammeMinistry of HealthNairobiKenya
| | - Marissa Becker
- Centre for Global Public HealthUniversity of ManitobaWinnipegCanada
| | - Robert Lorway
- Centre for Global Public HealthUniversity of ManitobaWinnipegCanada
| | | | - Stephen Moses
- Centre for Global Public HealthUniversity of ManitobaWinnipegCanada
| | - James Blanchard
- Centre for Global Public HealthUniversity of ManitobaWinnipegCanada
| | - Sharmistha Mishra
- St. Michael’s HospitalDepartment of MedicineUniversity of TorontoTorontoCanada
- Institute of Medical SciencesUniversity of TorontoTorontoCanada
- Institute of Health Policy Management and EvaluationDalla Lana School of Public HealthUniversity of TorontoTorontoCanada
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Kimani J, Adhiambo J, Kasiba R, Mwangi P, Were V, Mathenge J, Macharia P, Cholette F, Moore S, Shaw S, Becker M, Musyoki H, Bhattacharjee P, Moses S, Fowke KR, McKinnon LR, Lorway R. The effects of COVID-19 on the health and socio-economic security of sex workers in Nairobi, Kenya: Emerging intersections with HIV. Glob Public Health 2020; 15:1073-1082. [DOI: 10.1080/17441692.2020.1770831] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Joshua Kimani
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- Sex Worker Outreach Program (SWOP), Nairobi, Kenya
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | | | | | - Peninah Mwangi
- Bar Hostess Empowerment and Support Programme (BHESP), Nairobi, Kenya
| | | | - John Mathenge
- Health Options for Young Men on HIV/AIDS/STI (HOYMAS), Nairobi, Kenya
| | - Pascal Macharia
- Health Options for Young Men on HIV/AIDS/STI (HOYMAS), Nairobi, Kenya
| | - Francois Cholette
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Samantha Moore
- Institute for Global Public Health (IGPH), University of Manitoba, Winnipeg, Canada
| | - Souradet Shaw
- Institute for Global Public Health (IGPH), University of Manitoba, Winnipeg, Canada
| | - Marissa Becker
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Institute for Global Public Health (IGPH), University of Manitoba, Winnipeg, Canada
- National AIDS and STI Control Programme (NASCOP), Ministry of Health, Nairobi, Kenya
| | - Helgar Musyoki
- National AIDS and STI Control Programme (NASCOP), Ministry of Health, Nairobi, Kenya
| | - Parinita Bhattacharjee
- Institute for Global Public Health (IGPH), University of Manitoba, Winnipeg, Canada
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Stephen Moses
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Institute for Global Public Health (IGPH), University of Manitoba, Winnipeg, Canada
| | - Keith R. Fowke
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Lyle R. McKinnon
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- Centre for the AIDS Programme of Research in South Africa (CAPRISA)
| | - Robert Lorway
- Institute for Global Public Health (IGPH), University of Manitoba, Winnipeg, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
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Banadakoppa Manjappa R, Kar A, Jayanna K, Hallad JS, Cunningham T, Potty R, Mohan HL, Crockett M, Bradley J, Fischer E, Sudarshan H, Blanchard JF, Moses S, Avery L. Potential contributions of an on-site nurse mentoring program on neonatal mortality reductions in rural Karnataka state, South India: evidence from repeat community cross-sectional surveys. BMC Pregnancy Childbirth 2020; 20:242. [PMID: 32326902 PMCID: PMC7181530 DOI: 10.1186/s12884-020-02942-8] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 04/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We assessed the effects of a nurse mentoring program on neonatal mortality in eight districts in India. METHODS From 2012 to 2015, nurse mentors supported improvements in critical MNCH-related practices among health providers at primary health centres (PHCs) in northern Karnataka, South India. Baseline (n = 5240) and endline (n = 5154) surveys of randomly selected ever-married women were conducted. Neonatal mortality rates (NMR) among the last live-born children in the three years prior to each survey delivered in NM and non-NM-supported facilities were calculated and compared using survival analysis and cumulative hazard function. Mortality rates on days 1, 2-7 and 8-28 post-partum were compared. Cox survival regression analysis measured the adjusted effect on neonatal mortality of delivering in a nurse mentor supported facility. RESULTS Overall, neonatal mortality rate in the three years preceding the baseline and endline surveys was 30.5 (95% CI 24.3-38.4) and 21.6 (95% CI 16.3-28.7) respectively. There was a substantial decline in neonatal mortality between the survey rounds among children delivered in PHCs supported by NM: 29.4 (95% CI 18.1-47.5) vs. 9.3 (95% CI 3.9-22.3) (p = 0.09). No significant declines in neonatal mortality rate were observed among children delivered in other facilities or at home. In regression analysis, among children born in nurse mentor supported facilities, the estimated hazard ratio at endline was significantly lower compared with baseline (HR: 0.23, 95% CI: 0.06-0.82, p = 0.02). CONCLUSION The nurse mentoring program was associated with a substantial reduction in neonatal mortality. Further research is warranted to delineate whether this may be an effective strategy for reducing NMR in resource-poor settings.
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Affiliation(s)
- Ramesh Banadakoppa Manjappa
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada.
| | - Arin Kar
- Karnataka Health Promotion Trust, Bangalore, India
| | - Krishnamurthy Jayanna
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | | | | | | | - H L Mohan
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Maryanne Crockett
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Janet Bradley
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | | | | | - James F Blanchard
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Stephen Moses
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Lisa Avery
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
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Beattie TS, Prakash R, Javalkar P, Collumbien M, Ramanaik S, Thalinja R, Murthy S, Davey C, Moses S, Heise L, Watts C, Isac S, Gafos M, Bhattacharjee P. Assessing the effect of the Samata intervention on factors hypothesised to be on the pathway to child marriage and school drop-out: results from a cluster-randomised trial in rural north Karnataka, India. Journal of Global Health Reports 2020. [DOI: 10.29392/001c.12345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Tara S Beattie
- London School of Hygiene & Tropical Medicine, Departments of Global Health and Development and Public Health, Environments and Society, London, UK
| | - Ravi Prakash
- University of Manitoba, Department of Community Health Sciences, Manitoba, Canada
| | | | - Martine Collumbien
- London School of Hygiene & Tropical Medicine, Departments of Global Health and Development and Public Health, Environments and Society, London, UK
| | | | | | | | - Calum Davey
- London School of Hygiene & Tropical Medicine, Departments of Global Health and Development and Public Health, Environments and Society, London, UK
| | - Stephen Moses
- University of Manitoba, Department of Community Health Sciences, Manitoba, Canada
| | - Lori Heise
- Johns Hopkins Bloomberg School of Public Health and JHU School of Nursing, Department of Population, Family and Reproductive Health, Baltimore, MD, USA
| | - Charlotte Watts
- London School of Hygiene & Tropical Medicine, Departments of Global Health and Development and Public Health, Environments and Society, London, UK
| | - Shajy Isac
- University of Manitoba, Department of Community Health Sciences, Manitoba, Canada
| | - Mitzy Gafos
- London School of Hygiene & Tropical Medicine, Departments of Global Health and Development and Public Health, Environments and Society, London, UK
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Beattie TS, Javalkar P, Gafos M, Heise L, Moses S, Prakash R. Secular changes in child marriage and secondary school completion among rural adolescent girls in India. Journal of Global Health Reports 2019. [DOI: 10.29392/joghr.3.e2019041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Prakash R, Beattie TS, Javalkar P, Bhattacharjee P, Ramanaik S, Thalinja R, Murthy S, Davey C, Gafos M, Blanchard J, Watts C, Collumbien M, Moses S, Heise L, Isac S. The Samata intervention to increase secondary school completion and reduce child marriage among adolescent girls: results from a cluster-randomised control trial in India. J Glob Health 2019; 9:010430. [PMID: 31448111 PMCID: PMC6684866 DOI: 10.7189/jogh.09.010430] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Secondary education and delayed marriage provide long-term socio-economic and health benefits to adolescent girls. We tested whether a structural and norms-based intervention, which worked with adolescent girls, their families, communities, and secondary schools to address poverty, schooling quality and gender norms, could reduce secondary school drop-out and child marriage among scheduled-caste/scheduled-tribe (SC/ST) adolescent girls in rural settings of southern India. Methods 80 of 121 villages in Vijayapura and Bagalkote districts, Karnataka State, were randomly selected (control = 40; intervention = 40). All 12-13 year-old SC/ST girls in final year of primary school (standard 7th) were enrolled and followed for 3 years (2014-2017) until the end of secondary school (standard 10th). Primary trial outcomes were proportion of girls who completed secondary school and were married, by trial end-line (15-16 years). Analyses were intention-to-treat and used individual-level girl data. Results 92.6% (2275/2457) girls at baseline and 72.8% (1788/2457) at end-line were interviewed. At end-line, one-fourth had not completed secondary school (control = 24.9%; intervention = 25.4%), and one in ten reported being married (control = 9.6%; intervention = 10.1%). These were lower than expected based on district-level data available before the trial, with no difference between these, or other schooling or sexual and reproductive outcomes, by trial arm. There was a small but significant increase in secondary school entry (adjusted odds ratio AOR = 3.58, 95% confidence interval CI = 1.36-9.44) and completion (AOR=1.54, 95%CI = 1.02-2.34) in Vijayapura district. The sensitivity and attrition analyses did not impact the overall result indicating that attrition of girls at end-line was random without much bearing on overall result. Conclusions Samata intervention had no overall impact, however, it added value in one of the two implementation districts- increasing secondary school entry and completion. Lower than expected school drop-out and child marriage rates at end-line reflect strong secular changes, likely due to large-scale government initiatives to keep girls in school and delay marriage. Although government programmes may be sufficient to reach most girls in these settings, a substantial proportion of SC/ST girls remain at-risk of early marriage and school drop-out, and require targeted programming. Addressing multiple forms of clustered disadvantage among hardest to reach will be key to ensuring India "leaves no-one behind" and achieves its gender, health and education Sustainable Development Goal aspirations. Trial registration ClinicalTrials.gov registration number NCT01996241.
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Affiliation(s)
- Ravi Prakash
- Karnataka Health Promotion Trust (KHPT), Rajajinagar, Bangalore, India.,Joint first authorship
| | - Tara S Beattie
- London School of Hygiene & Tropical Medicine (LSHTM), Departments of Global Health and Development and Public Health, Environments and Society, London, UK.,Joint first authorship
| | - Prakash Javalkar
- Karnataka Health Promotion Trust (KHPT), Rajajinagar, Bangalore, India
| | - Parinita Bhattacharjee
- University of Manitoba, Departments of Community Medicine and Medical Microbiology, Winnipeg, Canada
| | | | | | - Srikanta Murthy
- Karnataka Health Promotion Trust (KHPT), Rajajinagar, Bangalore, India
| | - Calum Davey
- London School of Hygiene & Tropical Medicine (LSHTM), Departments of Global Health and Development and Public Health, Environments and Society, London, UK
| | - Mitzy Gafos
- London School of Hygiene & Tropical Medicine (LSHTM), Departments of Global Health and Development and Public Health, Environments and Society, London, UK
| | - James Blanchard
- University of Manitoba, Departments of Community Medicine and Medical Microbiology, Winnipeg, Canada
| | - Charlotte Watts
- London School of Hygiene & Tropical Medicine (LSHTM), Departments of Global Health and Development and Public Health, Environments and Society, London, UK
| | - Martine Collumbien
- London School of Hygiene & Tropical Medicine (LSHTM), Departments of Global Health and Development and Public Health, Environments and Society, London, UK
| | - Stephen Moses
- University of Manitoba, Departments of Community Medicine and Medical Microbiology, Winnipeg, Canada
| | - Lori Heise
- London School of Hygiene & Tropical Medicine (LSHTM), Departments of Global Health and Development and Public Health, Environments and Society, London, UK.,Johns Hopkins Bloomberg School of Public Health and JHU School of Nursing, Department of Population, Family and Reproductive Health, Baltimore, Maryland, USA.,Joint last authorship
| | - Shajy Isac
- Karnataka Health Promotion Trust (KHPT), Rajajinagar, Bangalore, India.,University of Manitoba, Departments of Community Medicine and Medical Microbiology, Winnipeg, Canada.,Joint last authorship
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Bhattacharjee P, Rego D, Musyoki H, Becker M, Pickles M, Isac S, Lorway R, Musimbi J, Walimbwa J, Olango K, Kuria S, Ongaro MK, Sahai A, Mugambi M, Emmanuel F, Mishra S, Bartilol K, Moses S, Blanchard J. Evaluation of community-based HIV self-testing delivery strategies on reducing undiagnosed HIV infection, and improving linkage to prevention and treatment services, among men who have sex with men in Kenya: a programme science study protocol. BMC Public Health 2019; 19:986. [PMID: 31337368 PMCID: PMC6652006 DOI: 10.1186/s12889-019-7291-2] [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: 06/29/2019] [Accepted: 07/09/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND HIV prevalence among men having sex with men (MSM) in Kenya is 18.2%. Despite scale-up of HIV testing services, many MSM remain unaware of their HIV status and thus do not benefit from accessing HIV treatment or prevention services. HIV self-testing (HIVST) may help address this gap. However, evidence is limited on how, when, and in what contexts the delivery of HIVST to MSM could increase awareness of HIV status and lead to early linkage to HIV treatment and prevention. METHODS The study will be embedded within existing MSM-focused community-based HIV prevention and treatment programmes in 3 counties in Kenya (Kisumu, Mombasa, Kiambu). The study is designed to assess three HIV testing outcomes among MSM, namely a) coverage b) frequency of testing and c) early uptake of testing. The study will adopt a mixed methods programme science approach to the implementation and evaluation of HIVST strategies via: (i) a baseline and endline bio-behavioural survey with 1400 MSM; (ii) a socio-sexual network study with 351 MSM; (iii) a longitudinal qualitative cohort study with 72 MSM; (iv) routine programme monitoring in three sites; (v) a programme-specific costing exercise; and (vi) mathematical modelling. This protocol evaluates the impact of community-based implementation of HIV self-testing delivery strategies among MSM in Kenya on reducing the undiagnosed MSM population, and time for linkage to prevention, treatment and care following HIV self-testing. Baseline data collection started in April 2019 and the endline data collection will start in July 2020. DISCUSSION This study is one of the first programme science studies in Sub-Saharan Africa exploring the effectiveness of integrating HIVST interventions within already existing HIV prevention and treatment programmes for MSM in Kenya at scale. Findings from this study will inform national best approaches to scale up HIVST among MSM in Kenya.
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Affiliation(s)
- Parinita Bhattacharjee
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada. .,Partners for Health and Development in Africa, University of Manitoba, Geomaps Building, Upper Hill, Nairobi, Kenya.
| | | | - Helgar Musyoki
- National AIDS and STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Marissa Becker
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | | | - Shajy Isac
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada.,India Health Action Trust, New Delhi, India
| | - Robert Lorway
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Janet Musimbi
- Partners for Health and Development in Africa, University of Manitoba, Geomaps Building, Upper Hill, Nairobi, Kenya
| | | | | | | | | | - Amy Sahai
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Mary Mugambi
- National AIDS and STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Faran Emmanuel
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Sharmistha Mishra
- Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Canada.,Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Kigen Bartilol
- National AIDS and STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Stephen Moses
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - James Blanchard
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
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Bhattacharjee P, Musyoki HK, Becker M, Musimbi J, Kaosa S, Kioko J, Mishra S, Isac SK, Moses S, Blanchard JF. HIV prevention programme cascades: insights from HIV programme monitoring for female sex workers in Kenya. J Int AIDS Soc 2019; 22 Suppl 4:e25311. [PMID: 31328436 PMCID: PMC6643069 DOI: 10.1002/jia2.25311] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 05/10/2019] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION HIV prevention cascades have emerged as a programme management and monitoring tool that outlines the sequential steps of an HIV prevention programme. We describe the application of an HIV combination prevention programme cascade framework to monitor and improve HIV prevention interventions for female sex workers (FSWs) in Kenya. METHODS Two data sources were analysed: (1) annual programme outcome surveys conducted using a polling booth survey methodology in 2017 among 4393 FSWs, and (2) routine programme monitoring data collected by (a) 92 implementing partners between July 2017 and June 2018, and (b) Learning Site in Mombasa (2014 to 2015) and Nairobi (2013). We present national, sub-national and implementing partner level cascades. RESULTS At the national level, the population size estimates for FSW were 133,675 while the programme coverage targets were 174,073. Programme targets as denominator, during the period 2017 to 2018, 156,220 (90%) FSWs received peer education and contact, 148,713 (85%) received condoms and 83,053 (48%) received condoms as per their estimated need. At the outcome level, 92% of FSWs used condoms at the last sex with their client but 73% reported consistent condom use. Although 96% of FSWs had ever tested for HIV, 85% had tested in the last three months. Seventy-nine per cent of the HIV-positive FSWs were enrolled in HIV care, 73% were currently enrolled on antiretroviral therapy (ART) and 52% had attended an ART clinic in the last month. In the last six months, 48% of the FSWs had experienced police violence but 24% received violence support. National and sub-national level cascades showed proportions of FSWs lost at each step of programme implementation and variability in programme achievement. Hotspot and sub-population level cascades, presented as examples, demonstrate development and use of these cascades at the implementation level. CONCLUSIONS HIV prevention programme cascades, drawing on multiple data sources to provide an understanding of gaps in programme outputs and outcomes, can provide powerful information for monitoring and improving HIV prevention programmes for FSWs at all levels of implementation and decision-making. Complexity of prevention programmes and the paucity of consistent data can pose a challenge to development of these cascades.
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Affiliation(s)
- Parinita Bhattacharjee
- Centre for Global Public HealthUniversity of ManitobaWinnipegManitobaCanada
- Partners for Health and Development in AfricaNairobiKenya
| | - Helgar K Musyoki
- National AIDS and STI Control ProgrammeMinistry of HealthNairobiKenya
| | - Marissa Becker
- Centre for Global Public HealthUniversity of ManitobaWinnipegManitobaCanada
| | - Janet Musimbi
- Partners for Health and Development in AfricaNairobiKenya
| | - Shem Kaosa
- Partners for Health and Development in AfricaNairobiKenya
| | - Japheth Kioko
- Partners for Health and Development in AfricaNairobiKenya
| | - Sharmistha Mishra
- Department of MedicineSt. Michael's HospitalUniversity of TorontoTorontoOntarioCanada
- Institute of Medical SciencesUniversity of TorontoTorontoOntarioCanada
- Institute of Health Policy Management and EvaluationDalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Shajy K Isac
- Centre for Global Public HealthUniversity of ManitobaWinnipegManitobaCanada
- Karnataka Health Promotion TrustBangaloreKarnatakaIndia
| | - Stephen Moses
- Centre for Global Public HealthUniversity of ManitobaWinnipegManitobaCanada
| | - James F Blanchard
- Centre for Global Public HealthUniversity of ManitobaWinnipegManitobaCanada
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Patel D, Mande P, Moses S, Harris J, Rothstein A, Richmond J. 095 Targeting CXCR3 in a mouse model of cutaneous lupus Eeythematosus. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Javalkar P, Platt L, Prakash R, Beattie T, Bhattacharjee P, Thalinja R, L KD, Sangha CATM, Ramanaik S, Collumbien M, Davey C, Moses S, Jewkes R, Isac S, Heise L. What determines violence among female sex workers in an intimate partner relationship? Findings from North Karnataka, south India. BMC Public Health 2019; 19:350. [PMID: 30922283 PMCID: PMC6440026 DOI: 10.1186/s12889-019-6673-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 03/18/2019] [Indexed: 11/16/2022] Open
Abstract
Background Like other women in India, female sex workers (FSWs) frequently experience violence from their intimate partners (IPs)-a reality that increases their risk of acquiring HIV or other sexually transmitted infections. Less is known about the nature of these intimate relationships or what aspect of the relationship increases the risk of IP violence (IPV). We measured the prevalence and determinants of IPV on FSWs in the context of north Karnataka, India, characterized by high HIV-prevalence and extreme poverty. Methods Overall 620 FSWs with an IP participated in a baseline survey conducted for an on-going cluster-randomised controlled trial aiming to evaluate the impact of a multi-level intervention on IPV reduction. We characterize the nature of intimate relationships and explored determinants of severe physical and/or sexual IP violence using univariable and multivariable analyses. Results The median age of participants was 35 years with 10 years of duration in an intimate relationship. Though most relationships originated from a sex work encounter, 84% stated that IPs did not know they were currently practicing sex work. In past 6 months, the experience of emotional violence was 49% (95%CI:45.2–53.2), physical 33% (95%CI:29.5–37.1) and sexual violence 7% (95%CI:4.8–8.9), while 24% (95%CI:21.0–27.9) FSWs experienced recent severe physical and/or sexual violence from IPs. Factors associated with recent IPV included experience of physical and/or sexual violence from their clients in last 6 months (AOR 2.20; 95%CI: 1.29–3.75), sexual intercourse in the past 1 month when their IP was under the influence of alcohol (AOR 2.30; 95%CI: 1.47–3.59) and providing financial support to their IP (AOR 2.07; 95%CI: 1.28–3.34). Conclusions The association between increased risk of violence and provision of financial support to an IP is indicative of gendered power dynamics as men remain dominant irrespective of their financial dependency on FSWs. Interventions are needed that address inequitable gender norms which makes FSWs tolerate violence even though she is not financially dependent on IP. Higher likelihood of violence in presence of alcohol use and FSWs’ previous experience of workplace violence linked to IPV call for strengthening the crisis management systems within community-based organisations that can address all forms of violence and associated risk factors. Trial registration Clinical Trials NCT02807259
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Affiliation(s)
- Prakash Javalkar
- Karnataka Health Promotion Trust (KHPT), IT Park, 5th Floor, #1-4, Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka, 560044, India.
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SN, UK
| | - Ravi Prakash
- Karnataka Health Promotion Trust (KHPT), IT Park, 5th Floor, #1-4, Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka, 560044, India
| | - Tara Beattie
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SN, UK
| | - Parinita Bhattacharjee
- Karnataka Health Promotion Trust (KHPT), IT Park, 5th Floor, #1-4, Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka, 560044, India.,Center for Global Public Health, University of Manitoba, Winnipeg, Manitoba, R3T 2N2, Canada
| | - Raghavendra Thalinja
- Karnataka Health Promotion Trust (KHPT), IT Park, 5th Floor, #1-4, Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka, 560044, India
| | - Kavitha D L
- Karnataka Health Promotion Trust (KHPT), IT Park, 5th Floor, #1-4, Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka, 560044, India
| | | | - Satyanarayana Ramanaik
- Karnataka Health Promotion Trust (KHPT), IT Park, 5th Floor, #1-4, Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka, 560044, India
| | - Martine Collumbien
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SN, UK
| | - Calum Davey
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SN, UK
| | - Stephen Moses
- Center for Global Public Health, University of Manitoba, Winnipeg, Manitoba, R3T 2N2, Canada
| | - Rachel Jewkes
- South African Medical Research Council, 1 Soutpansberg Road, Pretoria, South Africa
| | - Shajy Isac
- Karnataka Health Promotion Trust (KHPT), IT Park, 5th Floor, #1-4, Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka, 560044, India.,Center for Global Public Health, University of Manitoba, Winnipeg, Manitoba, R3T 2N2, Canada
| | - Lori Heise
- Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD, USA
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Beattie TS, Prakash R, Mazzuca A, Kelly L, Javalkar P, Raghavendra T, Ramanaik S, Collumbien M, Moses S, Heise L, Isac S, Watts C. Prevalence and correlates of psychological distress among 13-14 year old adolescent girls in North Karnataka, South India: a cross-sectional study. BMC Public Health 2019; 19:48. [PMID: 30630455 PMCID: PMC6327490 DOI: 10.1186/s12889-018-6355-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 12/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental health disorders among adolescents have emerged as a major public health issue in many low and middle-income countries, including India. There is a paucity of research on the determinants of psychological distress, particularly among the poorest girls in the poorest communities. The purpose of this study was to assess the prevalence and correlates of different indicators of psychological distress among 13-14 year old low caste girls in rural, south India. METHODS Cross-sectional survey of 1191 low caste girls in two districts in north Karnataka, conducted as part of a cluster randomised-control trial. Bivariate and multivariate logistic regression analysis assessed correlates of different indicators of psychological distress. RESULTS More than one third of girls (35.1%) reported having no hope for the future. 6.9% reported feeling down, depressed or hopeless in the past 2 weeks. 2.1% reported thinking they would be better off dead or of hurting themselves in some way in the past 2 weeks. 1.6% reported sexual abuse, 8.0% rrecent eve teasing and 6.3% having no parental emotional support. Suicidal ideation was independently associated with sexual abuse (AOR 11.9 (3.0-47.0)) and a lack of parental emotional support (AOR 0.2 (0.1-0.5)). Feeling down, depressed or hopeless was independently associated with recent eve-teasing (AOR 2.9 (1.6-5.4)), a harassing or abusive school environment (AOR 3.9 (1.8-8.2)), being frequently absent (AOR 2.8 (1.5-5.5)) or having dropped out of school (AOR 2.1 (1.0-4.3)), and living in Vijayapura district (AOR 2.5 (1.6-4.1)). Having no hope for the future was independently associated with a range of factors, including recent "eve-teasing" (AOR 1.5 (1.0-2.4)), being engaged (AOR 2.9 (0.9-9.7)), not participating in groups (AOR 0.5 (0.4-0.6)) and a lack of emotional support (AOR 0.6 (0.4-0.7)). CONCLUSIONS Rather than being a time of optimism, a third of low caste girls in rural north, Karnataka have limited hope for the future, with some contemplating suicide. As well as having important development benefits, interventions that address the upstream structural and gender-norms based determinants of poor mental health, and provide adolescent services for girls who require treatment and support, should have important benefits for girls' psychological wellbeing. TRIAL REGISTRATION Prospectively registered at ClinicalTrials.GovNCT01996241 . November 27, 2013.
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Affiliation(s)
- Tara S Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
| | - Ravi Prakash
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India
| | - April Mazzuca
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Leslie Kelly
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - T Raghavendra
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India
| | | | - Martine Collumbien
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Stephen Moses
- Departments of Community Health Sciences and Medicine and Medical Microbiology, University of Manitoba, Winnipeg, Canada
| | - Lori Heise
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Shajy Isac
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India.,Departments of Community Health Sciences and Medicine and Medical Microbiology, University of Manitoba, Winnipeg, Canada
| | - Charlotte Watts
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Bhattacharjee P, Musyoki H, Prakash R, Malaba S, Dallabetta G, Wheeler T, Moses S, Isac S, Steen R. Micro-planning at scale with key populations in Kenya: Optimising peer educator ratios for programme outreach and HIV/STI service utilisation. PLoS One 2018; 13:e0205056. [PMID: 30383786 PMCID: PMC6211676 DOI: 10.1371/journal.pone.0205056] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 05/20/2018] [Accepted: 09/19/2018] [Indexed: 11/19/2022] Open
Abstract
Peer education with micro-planning has been integral to scaling up key population (KP) HIV/STI programmes in Kenya since 2013. Micro-planning reinforces community cohesion within peer networks and standardizes programme inputs, processes and targets for outreach, including peer educator (PE) workloads. We assessed programme performance for outreach-in relation to the mean number of KPs for which one PE is responsible (KP:PE ratio)-and effects on HIV/STI service utilisation. Quarterly programmatic monitoring data were analysed from October 2013 to September 2016 from implementing partners working with female sex workers (FSWs) and men who have sex with men (MSM) across the country. All implementing partners are expected to follow national guidelines and receive micro-planning training for PEs with support from a Technical Support Unit for KP programmes. We examined correlations between KP:PE ratios and regular outreach contacts, condom distribution, risk reduction counselling, STI screening, HIV testing and violence reporting by KPs. Kenya conducted population size estimates (PSEs) of KPs in 2012. From 2013 to 2016, KP programmes were scaled up to reach 85% of FSWs (PSE 133,675) and 90% of MSM (PSE 18,460). Overall, mean KP:PE ratios decreased from 147 to 91 for FSWs, and from 79 to 58 for MSM. Lower KP:PE ratios, up to 90:1 for FSW and 60:1 for MSM, were significantly associated with more regular outreach contacts (p<0.001), as well as more frequent risk reduction counselling (p<0.001), STI screening (p<0.001) and HIV testing (p<0.001). Condom distribution and reporting of violence by KPs did not differ significantly between the two groups over all time periods. Micro-planning with adequate KP:PE ratios is an effective approach to scaling up HIV prevention programmes among KPs, resulting in high levels of programme uptake and service utilisation.
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Affiliation(s)
| | - Helgar Musyoki
- National AIDS and STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Ravi Prakash
- Karnataka Health Promotion Trust, Bangalore, India
| | - Serah Malaba
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Gina Dallabetta
- Bill & Melinda Gates Foundation, Washington DC, United States of America
| | - Tisha Wheeler
- Office of HIV/AIDS, Bureau for Global Health, U.S. Agency for International Development, Washington DC, United States of America
| | - Stephen Moses
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Shajy Isac
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Richard Steen
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Musyoki H, Bhattacharjee P, Blanchard AK, Kioko J, Kaosa S, Anthony J, Javalkar P, Musimbi J, Malaba SJ, Olwande C, Blanchard JF, Sirengo M, Isac S, Moses S. Changes in HIV prevention programme outcomes among key populations in Kenya: Data from periodic surveys. PLoS One 2018; 13:e0203784. [PMID: 30231072 PMCID: PMC6145580 DOI: 10.1371/journal.pone.0203784] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/27/2018] [Indexed: 11/28/2022] Open
Abstract
The Kenya National AIDS and STI Control Programme (NASCOP) conducted annual polling booth surveys (PBS) in 2014 and 2015 to measure outcomes from the national HIV prevention programme for key populations (KPs), comprising behavioural, biomedical and structural interventions. KPs included female sex workers (FSWs), men who have sex with men (MSM) and people who inject drugs (PWID). We compared survey results from the first and second rounds. Comparing the second to the first round, significantly more FSWs (93% vs. 88%, p<0.001) and MSM (77% vs. 58%, p<0.001) reported condom use at last sex with a paying client, and at last anal sex among MSM (80% vs. 77%, p<0.05) and PWID (48% vs. 27%, p<0.01). However, condom use with regular partners remained low, at less than 53% for FSWs and 69% for MSM. Among PWID, there was a significant increase in use of new needles and syringes at last injection (93% vs. 88%, p<0.001), and a significant decrease in reported non-availability of clean needles (23% vs. 36%, p<0.001). The number of overdoses in the past six months reduced significantly but remained high (40% vs. 51%, p<0.001). FSWs and MSM reported significantly higher HIV testing, and in all KP groups, over 93% reported ever having been tested for HIV. Among the respondents self-reporting to have tested HIV positive (24% of FSW, 22% of MSM and 19% of PWID), 80% of FSWs, 70% of MSM, and 73% of PWID reported currently taking antiretroviral therapy (ART). While the experience of forced intercourse by partners declined among FSWs (18% vs. 22%, p<0.01) and MSM (13% vs. 17%, p<0.01), more FSWs reported violence by law enforcement personnel (49% vs. 44%, p<0.001). These findings provide valuable information on the programme's progress, and a signpost for the integrated behavioural, biomedical and structural interventions to achieve their HIV prevention targets.
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Affiliation(s)
- Helgar Musyoki
- National AIDS and STI Control Programme, Ministry of Health, Government of Kenya, Nairobi, Kenya
| | - Parinita Bhattacharjee
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Andrea K. Blanchard
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Japheth Kioko
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Shem Kaosa
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - John Anthony
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Janet Musimbi
- Partners for Health and Development in Africa, Nairobi, Kenya
| | | | - Carol Olwande
- National AIDS and STI Control Programme, Ministry of Health, Government of Kenya, Nairobi, Kenya
| | - James F. Blanchard
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Martin Sirengo
- National AIDS and STI Control Programme, Ministry of Health, Government of Kenya, Nairobi, Kenya
| | - Shajy Isac
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Stephen Moses
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
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Beksinska A, Prakash R, Isac S, Mohan HL, Platt L, Blanchard J, Moses S, Beattie TS. Violence experience by perpetrator and associations with HIV/STI risk and infection: a cross-sectional study among female sex workers in Karnataka, south India. BMJ Open 2018; 8:e021389. [PMID: 30206080 PMCID: PMC6144389 DOI: 10.1136/bmjopen-2017-021389] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Female sex workers (FSWs) experience violence from a range of perpetrators, but little is known about how violence experience across multiple settings (workplace, community, domestic) impacts on HIV/sexually transmitted infection (STI) risk. We examined whether HIV/STI risk differs by the perpetrator of violence. METHODS An Integrated Biological and Behavioural Assessment survey was conducted among random samples of FSWs in two districts (Bangalore and Shimoga) in Karnataka state, south India, in 2011. Physical and sexual violence in the past six months, by workplace (client, police, coworker, pimp) or community (stranger, rowdy, neighbour, auto-driver) perpetrators was assessed, as was physical and sexual intimate partner violence in the past 12 months. Weighted, bivariate and multivariate analyses were used to examine associations between violence by perpetrator and HIV/STI risk. RESULTS 1111 FSWs were included (Bangalore=718, Shimoga=393). Overall, 34.9% reported recent physical and/or sexual violence. Violence was experienced from domestic (27.1%), workplace (11.1%) and community (4.2%) perpetrators, with 6.2% of participants reporting recent violence from both domestic and non-domestic (workplace/community) perpetrators. Adjusted analysis suggests that experience of violence by workplace/community perpetrators is more important in increasing HIV/STI risk during sex work (lower condom use with clients; client or FSW under the influence of alcohol at last sex) than domestic violence. However, women who reported recent violence by domestic and workplace/community perpetrators had the highest odds of high-titre syphilis infection, recent STI symptoms and condom breakage at last sex, and the lowest odds of condom use at last sex with regular clients compared with women who reported violence by domestic or workplace/community perpetrators only. CONCLUSION HIV/STI risk differs by the perpetrator of violence and is highest among FSWs experiencing violence in the workplace/community and at home. Effective HIV/STI prevention programmes with FSWs need to include violence interventions that address violence across both their personal and working lives.
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Affiliation(s)
- Alicja Beksinska
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Ravi Prakash
- Karnataka Health Promotion Trust, Bengaluru, Karnataka, India
| | - Shajy Isac
- Karnataka Health Promotion Trust, Bengaluru, Karnataka, India
| | - H L Mohan
- Karnataka Health Promotion Trust, Bengaluru, Karnataka, India
| | - Lucy Platt
- Department of Social and Environmental Health, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - James Blanchard
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stephen Moses
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tara S Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Ramanaik S, Collumbien M, Prakash R, Howard-Merrill L, Thalinja R, Javalkar P, Murthy S, Cislaghi B, Beattie T, Isac S, Moses S, Heise L, Bhattacharjee P. Education, poverty and "purity" in the context of adolescent girls' secondary school retention and dropout: A qualitative study from Karnataka, southern India. PLoS One 2018; 13:e0202470. [PMID: 30183747 PMCID: PMC6124724 DOI: 10.1371/journal.pone.0202470] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 08/03/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Gender-related norms and poverty remain important structural barriers to secondary school attendance among adolescent girls in southern India. We analyse how gender norms interact with family deprivation and dynamics to result in girls dropping out of school; we identify the main facilitators of school retention and changes to gender socialisation. METHODS Longitudinal qualitative case studies with 36 girls were nested within a cluster randomized trial to evaluate the Samata intervention targeting adolescent girls in Bagalkote and Vijayapura districts in northern Karnataka. We used two rounds of in-depth interviews, conducted in 2014 at a time when respondents were in 8th standard at the age of 13 to 14 and sixteen months later. We combined thematic and narrative analyses. RESULTS Our study found that poverty and socioeconomic realities at the household level strongly affect conformity with discriminatory gender practices such as restricting girls' mobility. The value placed on education by parents clearly differentiates the regular school goers from those frequently absent and others who dropped out. With active encouragement of the girls' educational and career aspirations, parents engendered the girl's agency to communicate openly both at home and at school, allowing subtle changes to gender performance while resisting the pressure of social sanctions. In contrast, where educational aspirations were weak, parents invested more intensely in enforcing correct performance of gender, prioritising her well-being by aiming to secure her future in a good marriage. Among poorer families, girls' domestic duties came at the cost of schooling with concerns about protecting her sexual purity predominating. CONCLUSIONS In contexts where a strong gender ideology of virginity before marriage rules, subtle shifts in harmful gender practices are possible. Interventions aiming to improve education need to target the most deprived families, focussing on trust building through open communication.
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Affiliation(s)
- Satyanarayana Ramanaik
- Karnataka Health Promotion Trust (KHPT), IT Park, Rajajinagar, Bangalore, India
- * E-mail:
| | - Martine Collumbien
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine (LSHTM), London, London, United Kingdom
| | - Ravi Prakash
- Karnataka Health Promotion Trust (KHPT), IT Park, Rajajinagar, Bangalore, India
| | - Lottie Howard-Merrill
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine (LSHTM), London, London, United Kingdom
| | | | - Prakash Javalkar
- Karnataka Health Promotion Trust (KHPT), IT Park, Rajajinagar, Bangalore, India
| | - Srikanta Murthy
- Karnataka Health Promotion Trust (KHPT), IT Park, Rajajinagar, Bangalore, India
| | - Ben Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine (LSHTM), London, London, United Kingdom
| | - Tara Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine (LSHTM), London, London, United Kingdom
| | - Shajy Isac
- Karnataka Health Promotion Trust (KHPT), IT Park, Rajajinagar, Bangalore, India
- Center for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stephen Moses
- Center for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lori Heise
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - Parinita Bhattacharjee
- Karnataka Health Promotion Trust (KHPT), IT Park, Rajajinagar, Bangalore, India
- Center for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
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Bhattacharjee P, Morales GJ, Kilonzo TM, Dayton RL, Musundi RT, Mbole JM, Malaba SJ, Ogwang BE, Isac SK, Moses S, Musyoki HK. Can a national government implement a violence prevention and response strategy for key populations in a criminalized setting? A case study from Kenya. J Int AIDS Soc 2018; 21 Suppl 5:e25122. [PMID: 30033535 PMCID: PMC6055121 DOI: 10.1002/jia2.25122] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 05/04/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Key population (KP) members frequently experience violence that violates their human rights, increases their risk of HIV, and acts as a barrier to access and uptake of HIV services. To be effective, HIV programmes for members of KPs need to prevent and respond to violence against them. We describe a violence prevention and response strategy led by the national KP programme in Kenya and examine trends in reports of and responses to violence (provision of support to an individual who reports violence within 24 hours of receiving the report). METHODS Quarterly programme monitoring data on the number of reports of violence and the number of responses to violence from 81 implementing partners between October 2013 and September 2017 were aggregated annually and analysed using simple trend analysis. Reports of violence relative to KP members reached, expressed as a percentage, and the percentage of reports of violence that received a response were also examined. RESULTS AND DISCUSSION Between 2013 and 2017, annual reports of violence increased from 4171 to 13,496 cases among female sex workers (FSWs), 910 to 1122 cases among men who have sex with men (MSM) and 121 to 873 cases among people who inject drugs (PWID). Reports of violence relative to KP members reached increased among FSWs (6.2% to 9.7%; p < 0.001) and PWID (2.1% to 6.0%; p < 0.001) and decreased among MSM (10.0% to 4.2%; p < 0.001). During the same period, timely responses to reports of violence increased from 53% to 84% (p < 0.001) among FSWs, 44% to 80% (p < 0.001) among MSM and 37% to 97% (p < 0.001) among PWID. CONCLUSIONS Over the past four years in Kenya, there has been an increase in violence reporting among FSWs and PWID and an increase in violence response among all KPs. This case study demonstrates that violence against KP members can be effectively addressed under the leadership of the national government, even in an environment where KP members' behaviours are criminalized. Creating an enabling environment to promote wellbeing and safety for KP members is a critical enabler for HIV prevention programmes to achieve 95-95-95 goals.
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Affiliation(s)
| | | | | | | | | | - Janet M Mbole
- Partners for Health and Development in AfricaNairobiKenya
| | - Serah J Malaba
- Partners for Health and Development in AfricaNairobiKenya
| | | | - Shajy K Isac
- Centre for Global Public HealthUniversity of ManitobaWinnipegCanada
| | - Stephen Moses
- Centre for Global Public HealthUniversity of ManitobaWinnipegCanada
| | - Helgar K Musyoki
- National AIDS and STI Control ProgrammeMinistry of HealthNairobiKenya
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Prakash R, Bhattacharjee P, Blanchard A, Musyoki H, Anthony J, Kimani J, Gakii G, Sirengo M, Muraguri N, Mziray E, Kasonde L, Blanchard J, Isac S, Moses S. Effects of exposure to an intensive HIV-prevention programme on behavioural changes among female sex workers in Nairobi, Kenya. Afr J AIDS Res 2018. [PMID: 29514590 DOI: 10.2989/16085906.2017.1377268] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
While Kenya has had a long-standing national HIV-prevention programme, evidence on the level of exposure to its interventions and related effects on behavioural changes among female sex workers (FSWs) is limited. Using cross-sectional behavioural data collected in 2013 from 1 357 FSWs aged 18 years and above in Nairobi, Kenya, this study explores the relationship between FSW programme exposure levels and behavioural outcomes including condom use, sexually transmitted infection (STI)-treatment, and empowerment measures like disclosure of self-identity and violence reporting. We categorised programme exposure levels as none, moderate and intensive. Multivariate logistic regression was used for analysis. Overall, 35% of the FSWs were not exposed to any HIV prevention programme, whereas about 24% had moderate and 41% had intensive exposure. FSWs having intensive programme exposure had a higher likelihood of using condoms consistently with occasional clients (AOR: 1.57; 95% CI: 1.08-2.31) and seeking treatment for STIs (AOR: 3.37; 95% CI: 1.63-7.02) compared to FSWs with no or moderate exposure. Intensive programme exposure was also associated with higher self-disclosure of sex-work identity (AOR: 1.63; 95% CI: 1.19-2.24), reporting of violence to police (AOR: 2.45; 95% CI: 1.03-5.84), and negotiation of condom use at last sex when the client was under the influence of alcohol (AOR: 1.63; 95% CI: 0.94-2.82). Although HIV prevention programmes in Kenya have been underway for over a decade, programme efforts were largely focused on saturating the coverage (intervention breadth). Strategies should now focus on ensuring improved quality of contacts through intensified programme exposure (intervention depth) to enhance gains in behavioural change among FSWs and preventing the burden of HIV infection among them.
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Affiliation(s)
- Ravi Prakash
- a Karnataka Health Promotion Trust (KHPT) , Bangalore , India
| | - Parinita Bhattacharjee
- b Department of Community Health Sciences , University of Manitoba (UoM) , Winnipeg , Canada
| | - Andrea Blanchard
- b Department of Community Health Sciences , University of Manitoba (UoM) , Winnipeg , Canada
| | - Helgar Musyoki
- c National AIDS and STI Control Programme (NASCOP), Ministry of Health , Nairobi , Kenya
| | - John Anthony
- b Department of Community Health Sciences , University of Manitoba (UoM) , Winnipeg , Canada
| | - Joshua Kimani
- b Department of Community Health Sciences , University of Manitoba (UoM) , Winnipeg , Canada
| | - Gloria Gakii
- d Partners for Health and Development in Africa (PHDA) , Nairobi , Kenya
| | - Martin Sirengo
- c National AIDS and STI Control Programme (NASCOP), Ministry of Health , Nairobi , Kenya
| | | | | | | | - James Blanchard
- b Department of Community Health Sciences , University of Manitoba (UoM) , Winnipeg , Canada
| | - Shajy Isac
- b Department of Community Health Sciences , University of Manitoba (UoM) , Winnipeg , Canada
| | - Stephen Moses
- b Department of Community Health Sciences , University of Manitoba (UoM) , Winnipeg , Canada
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Lorway R, Lazarus L, Chevrier C, Khan S, Musyoki HK, Mathenge J, Mwangi P, Macharia P, Bhattacharjee P, Isac S, Kimani J, Gaaki G, Becker M, Moses S, Blanchard J. Ecologies of security: On the everyday security tactics of female sex workers in Nairobi, Kenya. Glob Public Health 2018; 13:1767-1780. [PMID: 29506439 DOI: 10.1080/17441692.2018.1442487] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This paper highlights important environmental dimensions of HIV vulnerability by describing how the sex trade operates in Nairobi, Kenya. Although sex workers there encounter various forms of violence and harassment, as do sex workers globally, we highlight how they do not merely fall victim to a set of environmental risks but also act upon their social environment, thereby remaking it, as they strive to protect their health and financial interests. In so doing, we illustrate the mutual constitution of 'agency' and 'structure' in social network formations that take shape in everyday lived spaces. Our findings point to the need to expand the focus of interventions to consider local ecologies of security in order to place the local knowledges, tactics, and capacities that communities might already possess on centre stage in interventions. Planning, implementing, and monitoring interventions with a consideration of these ecologies would tie interventions not only to the risk reduction goals of global public health policy, but also to the very real and grounded financial priorities of what it means to try to safely earn a living through sex work.
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Affiliation(s)
- Robert Lorway
- a Centre for Global Public Health, Department of Community Health Sciences , University of Manitoba , Winnipeg , Manitoba , Canada
| | - Lisa Lazarus
- a Centre for Global Public Health, Department of Community Health Sciences , University of Manitoba , Winnipeg , Manitoba , Canada
| | - Claudyne Chevrier
- a Centre for Global Public Health, Department of Community Health Sciences , University of Manitoba , Winnipeg , Manitoba , Canada
| | - Shamshad Khan
- b Department of Communication , University of Texas at San Antonio , San Antonio , TX , USA
| | - Helgar K Musyoki
- c Kenya National AIDS & STI Control Programme (NASCOP) , Ministry of Health, Kenya , Nairobi , Kenya
| | - John Mathenge
- d Health Options for Young Men on HIV/AIDS & STIs (HOYMAS) , Nairobi , Kenya.,e Kenya Sex Workers Alliance (KESWA) , Nairobi , Kenya
| | - Peninah Mwangi
- f Bar Hostess Empowerment & Support Programme (BHESP) , Nairobi , Kenya
| | - Pascal Macharia
- a Centre for Global Public Health, Department of Community Health Sciences , University of Manitoba , Winnipeg , Manitoba , Canada
| | - Parinita Bhattacharjee
- a Centre for Global Public Health, Department of Community Health Sciences , University of Manitoba , Winnipeg , Manitoba , Canada.,g Key Population Technical Support Unit (TSU), Kenya , University of Manitoba , Nairobi , Kenya
| | - Shajy Isac
- a Centre for Global Public Health, Department of Community Health Sciences , University of Manitoba , Winnipeg , Manitoba , Canada.,h Karnataka Health Promotion Trust , Bengaluru , Karnataka , India
| | - Joshua Kimani
- a Centre for Global Public Health, Department of Community Health Sciences , University of Manitoba , Winnipeg , Manitoba , Canada.,i Department of Medical Microbiology , University of Nairobi , Nairobi , Kenya.,j Sex Workers Outreach Programme (SWOP), Nairobi , Partners in Health and Development , Nairobi , Kenya
| | - Gloria Gaaki
- j Sex Workers Outreach Programme (SWOP), Nairobi , Partners in Health and Development , Nairobi , Kenya
| | - Marissa Becker
- a Centre for Global Public Health, Department of Community Health Sciences , University of Manitoba , Winnipeg , Manitoba , Canada
| | - Stephen Moses
- a Centre for Global Public Health, Department of Community Health Sciences , University of Manitoba , Winnipeg , Manitoba , Canada
| | - James Blanchard
- a Centre for Global Public Health, Department of Community Health Sciences , University of Manitoba , Winnipeg , Manitoba , Canada
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McClarty LM, Bhattacharjee P, Isac S, Emmanuel F, Kioko J, Njiraini M, Gichangi P, Okoth CD, Musimbi-Mbole J, Blanchard JF, Moses S, Muysyoki H, Becker ML. Key Programme Science lessons from an HIV prevention 'Learning Site' for sex workers in Mombasa, Kenya. Sex Transm Infect 2017; 94:346-352. [PMID: 29242195 PMCID: PMC6204943 DOI: 10.1136/sextrans-2017-053228] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 04/12/2017] [Revised: 11/17/2017] [Accepted: 11/25/2017] [Indexed: 11/08/2022] Open
Abstract
Objectives In 2013, Kenya’s National AIDS and STI Control Programme established a Learning Site (LS) in Mombasa County to support and strengthen capacity for HIV prevention programming within organisations working with sex workers. A defining feature of LS was the use of a Programme Science approach throughout its development and implementation. We provide an overview of the key components of LS, present findings from 23 months of programme monitoring data, and highlight key Programme Science lessons from its implementation and monitoring. Methods Routine monitoring data collected from September 2013 through July 2015 are presented. Individual-level service utilisation data were collected monthly and indicators of interest were analysed over time to illustrate trends in enrolment, programme coverage and service utilisation among sex workers in Mombasa County. Results Over the monitoring period, outreach programme enrolment occurred rapidly; condom distribution targets were met consistently; rates of STI screening remained high and diagnoses declined; and reporting of and response to violent incidents increased. At the same time, enrolment in LS clinics was relatively low among female sex workers, and HIV testing at LS was low among both female and male sex workers. Conclusion Lessons learnt from operationalising the Programme Science framework through the Mombasa LS can inform the development and implementation of similar LS in different geographical and epidemiological contexts. Importantly, meaningful involvement of sex workers in the design, implementation and monitoring processes ensures that overall programme performance is optimised in the context of local, ‘on-the-ground’ realities. Additionally, learnings from LS highlight the importance of introducing enhanced monitoring and evaluations systems into complex programmes to better understand and explain programme dynamics over time.
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Affiliation(s)
- Leigh M McClarty
- Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Parinita Bhattacharjee
- Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shajy Isac
- Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Faran Emmanuel
- Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Japheth Kioko
- National AIDS and STI Control Programme, Ministry of Health, Government of Kenya, Nairobi, Kenya.,Partners for Health and Development in Africa, Nairobi, Kenya
| | | | - Peter Gichangi
- International Centre for Reproductive Health Kenya, Mombasa, Kenya
| | | | | | - James F Blanchard
- Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stephen Moses
- Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Helgar Muysyoki
- National AIDS and STI Control Programme, Ministry of Health, Government of Kenya, Nairobi, Kenya
| | - Marissa L Becker
- Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
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Khan S, Lorway R, Chevrier C, Dutta S, Ramanaik S, Roy A, Bhattacharjee P, Mishra S, Moses S, Blanchard J, Becker M. Dutiful daughters: HIV/AIDS, moral pragmatics, female citizenship and structural violence among Devadasis in northern Karnataka, India. Glob Public Health 2017; 13:1065-1080. [PMID: 28102112 DOI: 10.1080/17441692.2017.1280070] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Decades of research have documented how sex workers worldwide, particularly female sex workers (FSWs), shoulder a disproportionate burden of the HIV epidemic. In India, although a substantial progress has been made in controlling the epidemic, its prevalence among FSWs and the Devadasis (also called traditional sex workers) in northern Karnataka is still significantly high. On the other hand, much of the HIV prevention research has focused on their mapping and size estimation, typologies, bio-behavioural surveillance, condom use and other prevention technologies. In this article, drawing on critical theoretical perspectives, secondary historical sources and in-depth interviews, we unravel wider social, cultural and political economic complexities surrounding the lives of Devadasis, and specifically illuminate the moral pragmatics that shed light on their entry into sex trade and vulnerability to HIV. Findings from this research are extremely important since while much is known about Devadasis in social sciences and humanities, relatively little is known about the complexities of their lives within public health discourses related to HIV. Our work has direct implications for ongoing HIV prevention and health promotion efforts in the region and beyond.
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Affiliation(s)
- Shamshad Khan
- a Department of Communication , University of Texas at San Antonio , San Antonio , TX , USA
| | - Robert Lorway
- b Center for Global Public Health, Department of Community Health Sciences , University of Manitoba , Winnipeg , Canada
| | - Claudyne Chevrier
- b Center for Global Public Health, Department of Community Health Sciences , University of Manitoba , Winnipeg , Canada
| | - Sumit Dutta
- c Department of Sociology , Dr. K. N. Modi University , Niwai , Rajasthan , India
| | - Satyanarayana Ramanaik
- d Centre for Multi-Disciplinary Development Research , Dharwad , India.,f Karnataka Health Promotion Trust , Bengaluru , India
| | - Anu Roy
- e Independent Consultant , Stanford , CA , USA
| | | | - Sharmistha Mishra
- g Department of Medicine , St. Michael's Hospital, University of Toronto , Toronto , Canada
| | - Stephen Moses
- b Center for Global Public Health, Department of Community Health Sciences , University of Manitoba , Winnipeg , Canada
| | - James Blanchard
- b Center for Global Public Health, Department of Community Health Sciences , University of Manitoba , Winnipeg , Canada
| | - Marissa Becker
- b Center for Global Public Health, Department of Community Health Sciences , University of Manitoba , Winnipeg , Canada
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Bradley J, Jayanna K, Shaw S, Cunningham T, Fischer E, Mony P, Ramesh BM, Moses S, Avery L, Crockett M, Blanchard JF. Improving the knowledge of labour and delivery nurses in India: a randomized controlled trial of mentoring and case sheets in primary care centres. BMC Health Serv Res 2017; 17:14. [PMID: 28061783 PMCID: PMC5219705 DOI: 10.1186/s12913-016-1933-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 09/04/2015] [Accepted: 12/06/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Birthing in health facilities in India has increased over the last few years, yet maternal and neonatal mortality rates remain high. Clinical mentoring with case sheets or checklists for nurses is viewed as essential for on-going knowledge transfer, particularly where basic training is inadequate. This paper summarizes a study of the effect of such a programme on staff knowledge and skills in a randomized trial of 295 nurses working in 108 Primary Health Centres (PHCs) in Karnataka, India. METHODS Stratifying by district, half of the PHCs were randomly assigned to be intervention sites and provided with regular mentoring visits where case sheet/checklists were a central job and teaching aid, and half to be control sites, where no support was provided except provision of case sheets. Nurses' knowledge and skills around normal labour, labour complications and neonate issues were tested before the intervention began and again one year later. Univariate and multivariate analyses were conducted to examine the effect of mentoring and case sheets. RESULTS Overall, on none of the 3 measures, did case sheet use without mentoring add anything to the basic nursing training when controlling for other factors. Only individuals who used both case-sheets and received mentoring scored significantly higher on the normal labour and neonate indices, scoring almost twice as high as those who only used case-sheets. This group was also associated with significantly higher scores on the complications of labour index, with their scores 2.3 times higher on average than the case sheet only control group. Individuals from facilities with 21 or more deliveries in a month tended to fare worse on all 3 indices. There were no differences in outcomes according to district or years of experience. CONCLUSIONS This study demonstrates that provision of case sheets or checklists alone is insufficient to improve knowledge and practices. However, on-site mentoring in combination with case sheets can have a demonstrable effect on improving nurse knowledge and skills around essential obstetric and neonatal care in remote rural areas of India. We recommend scaling up of this mentoring model in order to improve staff knowledge and skills and reduce maternal and neonatal mortality in India. TRIAL REGISTRATION This study is registered at clinicaltrials.gov, Identifier No. NCT02004912 , November 27, 2013.
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Affiliation(s)
- Janet Bradley
- Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB R3E 0T6 Canada
| | - Krishnamurthy Jayanna
- Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB R3E 0T6 Canada
- Karnataka Health Promotion Trust, IT Park 5th floor, #1-4 Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, 560 044 India
| | - Souradet Shaw
- Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB R3E 0T6 Canada
| | - Troy Cunningham
- Karnataka Health Promotion Trust, IT Park 5th floor, #1-4 Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, 560 044 India
| | - Elizabeth Fischer
- IntraHealth, 6340 Quadrangle Drive, Suite 200, Chapel Hill, NC 27517 USA
| | - Prem Mony
- St. John’s National Academy of Health Sciences, Sarjapur Road, Bangalore, Karnataka State 560 034 India
| | - B. M. Ramesh
- Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB R3E 0T6 Canada
| | - Stephen Moses
- Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB R3E 0T6 Canada
| | - Lisa Avery
- Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB R3E 0T6 Canada
| | - Maryanne Crockett
- Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB R3E 0T6 Canada
| | - James F. Blanchard
- Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB R3E 0T6 Canada
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Jayanna K, Bradley J, Mony P, Cunningham T, Washington M, Bhat S, Rao S, Thomas A, S R, Kar A, N S, B M R, H L M, Fischer E, Crockett M, Blanchard J, Moses S, Avery L. Effectiveness of Onsite Nurse Mentoring in Improving Quality of Institutional Births in the Primary Health Centres of High Priority Districts of Karnataka, South India: A Cluster Randomized Trial. PLoS One 2016; 11:e0161957. [PMID: 27658215 PMCID: PMC5033379 DOI: 10.1371/journal.pone.0161957] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 08/12/2016] [Indexed: 01/24/2023] Open
Abstract
Background In India, although the proportion of institutional births is increasing, there are concerns regarding quality of care. We assessed the effectiveness of a nurse-led onsite mentoring program in improving quality of care of institutional births in 24/7 primary health centres (PHCs that are open 24 hours a day, 7 days a week) of two high priority districts in Karnataka state, South India. Primary outcomes were improved facility readiness and provider preparedness in managing institutional births and associated complications during child birth. Methods All functional 24/7 PHCs in the two districts were included in the study. We used a parallel, cluster randomized trial design in which 54 of 108 facilities received six onsite mentoring visits, along with an initial training update and specially designed case sheets for providers; the control arm received just the initial training update and the case sheets. Pre- and post-intervention surveys were administered in April-2012 and August-2013 using facility audits, provider interviews and case sheet audits. The provider interviews were administered to all staff nurses available at the PHCs and audits were done of all the filled case sheets during the month prior to data collection. In addition, a cost analysis of the intervention was undertaken. Results Between the surveys, we achieved coverage of 100% of facilities and 91.2% of staff nurse interviews. Since the case sheets were newly designed, case-sheet audit data were available only from the end line survey for about 80.2% of all women in the intervention facilities and 57.3% in the control facilities. A higher number of facilities in the intervention arm had all appropriate drugs, equipment and supplies to deal with gestational hypertension (19 vs.3, OR (odds ratio) 9.2, 95% C.I 2.5 to33.6), postpartum haemorrhage (29 vs. 12, OR 3.7, 95% C.I 1.6 to8.3); and obstructed labour (25 vs.9, OR 3.4, 95% CI 1.6 to8.3). The providers in the intervention arm had better knowledge of active management of the third stage of labour (82.4% vs.35.8%, AOR (adjusted odds ratio) 10, 95% C.I 5.5 to 18.2); management of maternal sepsis (73.5% vs. 10.9%, AOR 36.1, 95% C.I 13.6 to 95.9); neonatal resuscitation (48.5% vs.11.7%, AOR 10.7, 95% C.I 4.6 to 25.0) and low birth weight newborn care (58.1% vs. 40.9%, AOR 2.4, 95% C.I 1.2 to 4.7). The case sheet audits revealed that providers in the intervention arm showed greater compliance with the protocols during labour monitoring (77.3% vs. 32.1%, AOR 25.8, 95% C.I 9.6 to 69.4); delivery and immediate post-partum care for mothers (78.6% vs. 31.8%, AOR 22.1, 95% C.I 8.0 to 61.4) and for newborns (73.9% vs. 32.8%, AOR 24.1, 95% C.I 8.1 to 72.0). The cost analysis showed that the intervention cost an additional $5.60 overall per delivery. Conclusions The mentoring program successfully improved provider preparedness and facility readiness to deal with institutional births and associated complications. It is feasible to improve the quality of institutional births at a large operational scale, without substantial incremental costs. Trial Registration ClinicalTrials.gov NCT02004912
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Affiliation(s)
- Krishnamurthy Jayanna
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India
- * E-mail:
| | - Janet Bradley
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Prem Mony
- St John’s National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Troy Cunningham
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India
| | - Maryann Washington
- St John’s National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Swarnarekha Bhat
- St John’s National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Suman Rao
- St John’s National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Annamma Thomas
- St John’s National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Rajaram S
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India
| | - Arin Kar
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India
| | - Swaroop N
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India
| | - Ramesh B M
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India
| | - Mohan H L
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India
| | - Elizabeth Fischer
- IntraHealth International, Chapel Hill, North Carolina, United States of America
| | - Maryanne Crockett
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Blanchard
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stephen Moses
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa Avery
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Senkomago V, Backes DM, Hudgens MG, Poole C, Meshnick SR, Agot K, Moses S, Snijders PJ, Meijer CJ, Hesselink AT, Schlecht NF, Bailey RC, Smith JS. Higher HPV16 and HPV18 Penile Viral Loads Are Associated With Decreased Human Papillomavirus Clearance in Uncircumcised Kenyan Men. Sex Transm Dis 2016; 43:572-8. [PMID: 27513384 PMCID: PMC4985051 DOI: 10.1097/olq.0000000000000500] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Whether higher penile human papillomavirus (HPV) viral load is associated with a lower rate of HPV clearance remains unknown. OBJECTIVES We examined the association between penile HPV16 and HPV18 viral load and subsequent HPV clearance in uncircumcised Kenyan men. STUDY DESIGN Participants were human immunodeficiency virus (HIV)-seronegative, sexually active, 18- to 24-year-old men randomized to the control arm of a male circumcision trial in Kisumu, Kenya. Men provided exfoliated penile cells from two anatomical sites (glans/coronal sulcus and shaft) every 6 months for 2 years. GP5+/6+ polymerase chain reaction was used to identify 44 HPV-DNA types. Human papillomavirus viral load testing was conducted using a LightCyler real-time polymerase chain reaction assay; viral load was classified as high (>250 copies/scrape) or low (≤250 copies/scrape), for nonquantifiable values. The Kaplan-Meier method and Cox regression modeling were used to examine the association between HPV viral load and HPV clearance. RESULTS A total of 1097 men, with 291 HPV16 and 131 HPV18 cumulative infections over 24 months were analyzed. Human papillomavirus clearance at 6 months after first HPV detection was lower for high versus low viral load HPV16 infections in the glans (adjusted hazard ratio [aHR], 0.65; 95% confidence interval [CI], 0.46-0.92)] and shaft (aHR, 0.44; 95% CI, 0.16-0.90), and HPV18 infections in the glans (aHR, 0.05; 95% CI, 0.01-0.17). DISCUSSION High versus low HPV viral load was associated with a reduced HPV clearance for HPV16 infections in the glans and shaft, and for HPV18 infections in the glans, among young uncircumcised men. Reduced clearance of high viral load HPV16 and HPV18 infections in men may increase HPV transmission to their female partners as well as enhance the development of penile lesions in comparison to men with low viral load HPV infections.
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Affiliation(s)
- Virginia Senkomago
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Danielle M. Backes
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Michael G. Hudgens
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Charles Poole
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Steven R. Meshnick
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | - Stephen Moses
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Peter J.F. Snijders
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - Chris J.L.M. Meijer
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | | | - Nicolas F. Schlecht
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, USA
| | - Robert C. Bailey
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Illinois, USA
| | - Jennifer S. Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
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Beattie TS, Isac S, Bhattacharjee P, Javalkar P, Davey C, Raghavendra T, Nair S, Ramanaik S, Kavitha DL, Blanchard JF, Watts C, Collumbien M, Moses S, Heise L. Reducing violence and increasing condom use in the intimate partnerships of female sex workers: study protocol for Samvedana Plus, a cluster randomised controlled trial in Karnataka state, south India. BMC Public Health 2016; 16:660. [PMID: 27473180 PMCID: PMC4966746 DOI: 10.1186/s12889-016-3356-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/22/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Female sex workers (FSWs) are at increased risk of HIV and STIs compared to women in the general population, and frequently experience violence in their working and domestic lives from a variety of perpetrators, which can enhance this risk. While progress has been made in addressing violence by police and clients, little work has been done to understand and prevent violence by intimate partners (IPs) among FSW populations. METHODS Samvedana Plus is a multi-level intervention programme that works with FSWs, their IPs, the sex worker community, and the general population, and aims to reduce violence and increase consistent condom use within these 'intimate' relationships. The programme involves shifting norms around the acceptability of beating as a form of discipline, challenging gender roles that give men authority over women, and working with men and women to encourage new relationship models based on gender equity and respect. The programme will aim to cover 800 FSWs and their IPs living in 47 villages in Bagalkot district, northern Karnataka. The study is designed to assess two primary outcomes: the proportion of FSWs who report: (i) physical or sexual partner violence; and (ii) consistent condom use in their intimate relationship, within the past 6 months. The evaluation will employ a cluster-randomised controlled trial design, with 50 % of the village clusters (n = 24) randomly selected to receive the intervention for the first 24 months and the remaining 50 % (n = 23) receiving the intervention thereafter. Statisticians will be blinded to treatment arm allocation. The evaluation will use an adjusted, cluster-level intention to treat analysis, comparing outcomes in intervention and control villages at midline (12 months) and endline (24 months). The evaluation design will involve quantitative and qualitative assessments with (i) all FSWs who report an IP (ii) IPs; and process/ implementation monitoring. Baseline data collection was completed in April 2015, and endline data collection is anticipated in May 2017. CONCLUSIONS This is an innovative intervention programme that aims to address violence by IPs as part of HIV prevention programming with FSWs. Reducing violence is expected to reduce vulnerability to HIV acquisition, and help women to work and live without fear of violence. TRIAL REGISTRATION Clinical Trials NCT02807259 Jun 24 2016 (retrospectively registered).
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Affiliation(s)
- Tara S. Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SN UK
| | - Shajy Isac
- Karnataka Health Promotion Trust, Bangalore, India
- University of Manitoba, Winnipeg, Canada
| | - Parinita Bhattacharjee
- Karnataka Health Promotion Trust, Bangalore, India
- University of Manitoba, Winnipeg, Canada
| | | | - Calum Davey
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SN UK
| | | | - Sapna Nair
- Karnataka Health Promotion Trust, Bangalore, India
| | - Satyanarayana Ramanaik
- Karnataka Health Promotion Trust, Bangalore, India
- University of Manitoba, Winnipeg, Canada
| | | | | | - Charlotte Watts
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SN UK
| | - Martine Collumbien
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SN UK
| | | | - Lori Heise
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SN UK
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Mishra S, Boily MC, Schwartz S, Beyrer C, Blanchard JF, Moses S, Castor D, Phaswana-Mafuya N, Vickerman P, Drame F, Alary M, Baral SD. Data and methods to characterize the role of sex work and to inform sex work programs in generalized HIV epidemics: evidence to challenge assumptions. Ann Epidemiol 2016; 26:557-569. [PMID: 27421700 DOI: 10.1016/j.annepidem.2016.06.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 05/06/2016] [Accepted: 06/03/2016] [Indexed: 01/15/2023]
Abstract
In the context of generalized human immunodeficiency virus (HIV) epidemics, there has been limited recent investment in HIV surveillance and prevention programming for key populations including female sex workers. Often implicit in the decision to limit investment in these epidemic settings are assumptions including that commercial sex is not significant to the sustained transmission of HIV, and HIV interventions designed to reach "all segments of society" will reach female sex workers and clients. Emerging empiric and model-based evidence is challenging these assumptions. This article highlights the frameworks and estimates used to characterize the role of sex work in HIV epidemics as well as the relevant empiric data landscape on sex work in generalized HIV epidemics and their strengths and limitations. Traditional approaches to estimate the contribution of sex work to HIV epidemics do not capture the potential for upstream and downstream sexual and vertical HIV transmission. Emerging approaches such as the transmission population attributable fraction from dynamic mathematical models can address this gap. To move forward, the HIV scientific community must begin by replacing assumptions about the epidemiology of generalized HIV epidemics with data and more appropriate methods of estimating the contribution of unprotected sex in the context of sex work.
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Affiliation(s)
- Sharmistha Mishra
- Division of Infectious Diseases, Department of Medicine, St. Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada; Department of Infectious Disease Epidemiology, Imperial College, London, UK
| | - Marie-Claude Boily
- Department of Infectious Disease Epidemiology, Imperial College, London, UK
| | - Sheree Schwartz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Chris Beyrer
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - James F Blanchard
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Stephen Moses
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Delivette Castor
- Office of HIV/AIDS, United States Agency for International Development, Washington, DC
| | - Nancy Phaswana-Mafuya
- HIV/AIDS, STI, and Tuberculosis Department, Human Sciences Research Council, Port Elizabeth, South Africa
| | - Peter Vickerman
- School of Social and Community Medicine, Bristol University, Bristol, UK
| | - Fatou Drame
- Department of Geography, Université Gaston-Berger, St. Louis, Senegal
| | - Michel Alary
- Département de médecine sociale et préventive, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | - Stefan D Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.
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Legendre-Dugal M, Bradley J, Rajaram SP, Lowndes CM, Ramesh BM, Washington R, Moses S, Blanchard J, Alary M. Association between treatment for gonorrhoea and chlamydia and lower condom use in a cross-sectional study of female sex workers in southern India. BMJ Open 2016; 6:e009774. [PMID: 27194314 PMCID: PMC4874098 DOI: 10.1136/bmjopen-2015-009774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To assess whether having received grey packets containing treatment for gonorrhoea and chlamydia was associated with condom use among female sex workers (FSWs) in 5 districts of southern India covered by the Avahan programme where both periodic presumptive treatment (PPT) and syndromic management were used to control these sexually transmitted infections (STIs) among FSWs. SETTING Cross-sectional study of FSWs recruited in the field in 5 districts of southern India (Bangalore, Belgaum, Bellary, Guntur and Mumbai) in 2006-2007. PARTICIPANTS 1378 self-identified FSWs out of 1442 were approached to participate in the study (participation rate: 95.6%). The only exclusion criterion was to be aged <18 years. PRIMARY AND SECONDARY OUTCOME MEASURES Consistent condom use (CCU) with new or occasional clients, and with the most recent repeat client as assessed using a questionnaire administered through face-to-face interviews. RESULTS Using the Poisson regression to model the association between the number of grey packets received in the past 3-12 months and reported CCU, adjusting for factors associated with condom use and other potential confounders in our data, CCU was lowest among FSWs who had received ≥3 grey packets in the past 3-12 months with their new or occasional clients (adjusted prevalence ratio (APR): 0.70, 95% CI 0.57 to 0.84, p<0.001) and with the most recent repeat client (APR 0.63, 95% CI 0.51 to 0.78, p<0.001). Tests for trends showed that CCU with both types of clients decreased with the number of grey packets received (p<0.001). CONCLUSIONS Since we could not distinguish grey packets used for PPT from those given for syndromic management, these results could be either due to a perception of protection conferred by PPT or by the fact that inconsistent condom users are more at risk for STIs. Further research on the potential disinhibiting effect of PPT is warranted.
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Affiliation(s)
- Marianne Legendre-Dugal
- Centre de recherche du CHU de Québec, Québec, Canada
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
| | - Janet Bradley
- Centre de recherche du CHU de Québec, Québec, Canada
- CHARME-Project, Bangalore, Karnataka, India
| | - Subramanian Potty Rajaram
- CHARME-Project, Bangalore, Karnataka, India
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India
| | | | | | - Reynold Washington
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India
- St. John's Research Institute, Bangalore, Karnataka, India
| | - Stephen Moses
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Blanchard
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michel Alary
- Centre de recherche du CHU de Québec, Québec, Canada
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
- Institut national de santé publique du Québec, Québec, Canada
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Bradley J, Rajaram SP, Isac S, Gurav K, Ramesh BM, Gowda C, Moses S, Alary M. Pornography, Sexual Enhancement Products, and Sexual Risk of Female Sex Workers and their Clients in Southern India. Arch Sex Behav 2016; 45:945-954. [PMID: 25905909 DOI: 10.1007/s10508-015-0486-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 01/13/2015] [Accepted: 01/16/2015] [Indexed: 06/04/2023]
Abstract
Despite their large numbers, and important role in the HIV epidemic in India, male clients of female sex workers (FSWs) are a difficult to reach population and little is known about their sexual behaviors. Using data from an integrated behavioral and biological assessment of 684 clients in Bangalore in 2012, we examined factors associated with their reports of having sex with three or more different female sex workers in the last month, and anal sex with sex workers. We included sociodemographic and sexual behavior factors and, for the first time in client studies in India, included data on the use of pornography and sexual enhancement products (SEPs) such as pills, oils, and sprays, in our multivariable analyses of client risk. Seventy-eight percent of clients had seen pornographic material and 8% reported ever having used SEPs. The profiles of men practicing the two risk behaviors examined were quite different. Travel in the past year, drunkenness in the past month, young age at first commercial sex, non-use of condoms at last sex, and finding sex workers in public places (but not use of pornography and SEPs) were independently associated with multiple partnering. Sex with a man or transsexual, being a white collar worker, seeking out FSWs at home, pornography and SEP use, and condom use at last FSW sex, were all independently associated with anal sex with an FSW. More research is needed to better understand the links between pornography and SEPs, and HIV risk behaviors, and HIV prevention programs need to be cognizant of the importance of ensuring that condom use is adequately promoted and supported in the context of anal sex in female sex worker-client interactions.
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Affiliation(s)
- Janet Bradley
- Population Health and Optimal Health Practices Research Unit, Centre de recherche du CHU de Québec, Hôpital du Saint-Sacrement, Quebec City, PQ, Canada.
- Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 McDermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB, R3E 0T6, Canada.
| | - Subramanian Potty Rajaram
- Population Health and Optimal Health Practices Research Unit, Centre de recherche du CHU de Québec, Hôpital du Saint-Sacrement, Quebec City, PQ, Canada
- CHARME-India Project, Bangalore, India
- India KHPT Office, Bangalore, India
| | | | | | | | | | - Stephen Moses
- Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 McDermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB, R3E 0T6, Canada
| | - Michel Alary
- Population Health and Optimal Health Practices Research Unit, Centre de recherche du CHU de Québec, Hôpital du Saint-Sacrement, Quebec City, PQ, Canada
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Mahapatra B, Lowndes CM, Gurav K, Ramesh BM, Moses S, Washington R, Alary M. Degree and correlates of sexual mixing in female sex workers in Karnataka, India. Sex Health 2016; 10:305-10. [PMID: 23651667 DOI: 10.1071/sh12215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 03/06/2013] [Indexed: 11/23/2022]
Abstract
UNLABELLED Background The degree of sexual mixing plays an important role in understanding disparities in sexually transmissible infections and HIV across social groups. This study examines the degree of sexual age mixing, and explores its individual and partnership level correlates among female sex workers (FSWs) in Karnataka, India. METHODS Data were drawn from special behavioural surveys conducted in 2006-07 among 577 FSWs in two districts of Karnataka: Belgaum and Bangalore. Sexual mixing in age was assessed as the difference in age between FSWs and their sexual partners, and the degree of assortativeness in sexual mixing was assessed using Newman's assortativity coefficient. RESULTS A total of 577 FSWs were interviewed; 418 of whom reported two or more partnerships, resulting in 942 partnerships. In about half (52%) of these partnerships, the age difference between the FSW and her sexual partner was 5 years or more. The degree of assortativity in age mixing was 0.098, indicating minimally assortative mixing. The disassortativeness in age mixing was positively associated with young age and no formal education, and negatively with duration in sex work. Partnerships which were of a commercial nature were more likely to be disassortative than noncommercial partnerships. CONCLUSION The minimally assortative age mixing indicates sexually transmissible infections can transfer from members of one age group to another. Efforts are required to limit the transmission of infection from one group to other by promoting safer sexual behaviour.
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Shaw SY, Lorway R, Bhattacharjee P, Reza-Paul S, du Plessis E, McKinnon L, Thompson LH, Isac S, Ramesh BM, Washington R, Moses S, Blanchard JF. Descriptive Epidemiology of Factors Associated with HIV Infections Among Men and Transgender Women Who Have Sex with Men in South India. LGBT Health 2016; 3:292-9. [PMID: 27058882 PMCID: PMC4976224 DOI: 10.1089/lgbt.2015.0023] [Citation(s) in RCA: 5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose: Men and transgender women who have sex with men (MTWSM) continue to be an at-risk population for human immunodeficiency virus (HIV) infection in India. Identification of risk factors and determinants of HIV infection is urgently needed to inform prevention and intervention programming. Methods: Data were collected from cross-sectional biological and behavioral surveys from four districts in Karnataka, India. Multivariable logistic regression models were constructed to examine factors related to HIV infection. Sociodemographic, sexual history, sex work history, condom practices, and substance use covariates were included in regression models. Results: A total of 456 participants were included; HIV prevalence was 12.4%, with the highest prevalence (26%) among MTWSM from Bellary District. In bivariate analyses, district (P = 0.002), lack of a current regular female partner (P = 0.022), and reported consumption of an alcoholic drink in the last month (P = 0.004) were associated with HIV infection. In multivariable models, only alcohol use remained statistically significant (adjusted odds ratios: 2.6, 95% confidence intervals: 1.2–5.8; P = 0.02). Conclusion: The prevalence of HIV continues to be high among MTWSM, with the highest prevalence found in Bellary district.
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Affiliation(s)
- Souradet Y Shaw
- 1 Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba , Winnipeg, Manitoba, Canada
| | - Robert Lorway
- 1 Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba , Winnipeg, Manitoba, Canada
| | | | - Sushena Reza-Paul
- 1 Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba , Winnipeg, Manitoba, Canada
| | - Elsabé du Plessis
- 1 Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba , Winnipeg, Manitoba, Canada
| | - Lyle McKinnon
- 3 Department of Medicine, University of Toronto , Toronto, Ontario, Canada .,4 Department of Medical Microbiology, University of Nairobi , Nairobi, Kenya
| | - Laura H Thompson
- 1 Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba , Winnipeg, Manitoba, Canada
| | - Shajy Isac
- 2 Karnataka Health Promotion Trust , Bangalore, India
| | | | - Reynold Washington
- 2 Karnataka Health Promotion Trust , Bangalore, India .,5 St. John's Research Institute , Bangalore, India
| | - Stephen Moses
- 1 Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba , Winnipeg, Manitoba, Canada .,6 Department of Medical Microbiology, University of Manitoba , Winnipeg, Manitoba, Canada
| | - James F Blanchard
- 1 Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba , Winnipeg, Manitoba, Canada
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Moses S, Jambulingam M, Madhavan HN. A pilot study on expression of toll like receptors (TLRs) in response to herpes simplex virus (HSV) infection in acute retinal pigment epithelial cells (ARPE) cells. J Postgrad Med 2016; 60:243-7. [PMID: 25121361 DOI: 10.4103/0022-3859.138720] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Toll like receptors (TLRs) have been proven to play an important role in mounting the innate immune response in an infected host. The expression of TLRs against herpes simplex virus (HSV) have not been studied in retinitis. Therefore, the current study was undertaken to determine the same using the retinal pigment epithelial (ARPE-19) cell line. MATERIALS AND METHODS APRE cells cultured in vitro were challenged with HSV 1 and 2 standard strains and 20 other clinical isolates. The cells were observed for cytopathic changes. The cell culture harvest was subjected to RNA extraction using a Total RNA mini kit. The RNA was subjected to reverse transcriptase polymerase chain reaction (PCR) for the amplification of TLRs 3, 4 and 9 and GAPDH housekeeping gene. The amplified products were subjected to electrophoresis on a 2% agarose gel and viewed under a transilluminator. RESULTS TLR 3 and 4 were expressed by ARPE treated with all the 22 isolates. TLR 9 expression was seen in 16 of the 22 isolates. Bacterial contamination was ruled out by subjecting the harvests to PCR amplification of 16sRNA gene amplification of the eubacterial genome. CONCLUSIONS The expression of TLR 4 has been reported for the first time in HSV infection. TLR 4 along with TLR 3 and 9 is responsible for the antiviral response in HSV infections.
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Affiliation(s)
| | - M Jambulingam
- L and T Microbiology Research Center, Kamal Nayan Bajaj Research Centre, Vision Research Foundation, Chennai, Tamil Nadu, India
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Lépine A, Chandrashekar S, Shetty G, Vickerman P, Bradley J, Alary M, Moses S, Vassall A. What Determines HIV Prevention Costs at Scale? Evidence from the Avahan Programme in India. Health Econ 2016; 25 Suppl 1:67-82. [PMID: 26763652 PMCID: PMC5019264 DOI: 10.1002/hec.3296] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/02/2015] [Accepted: 09/24/2015] [Indexed: 05/24/2023]
Abstract
Expanding essential health services through non-government organisations (NGOs) is a central strategy for achieving universal health coverage in many low-income and middle-income countries. Human immunodeficiency virus (HIV) prevention services for key populations are commonly delivered through NGOs and have been demonstrated to be cost-effective and of substantial global public health importance. However, funding for HIV prevention remains scarce, and there are growing calls internationally to improve the efficiency of HIV prevention programmes as a key strategy to reach global HIV targets. To date, there is limited evidence on the determinants of costs of HIV prevention delivered through NGOs; and thus, policymakers have little guidance in how best to design programmes that are both effective and efficient. We collected economic costs from the Indian Avahan initiative, the largest HIV prevention project conducted globally, during the first 4 years of its implementation. We use a fixed-effect panel estimator and a random-intercept model to investigate the determinants of average cost. We find that programme design choices such as NGO scale, the extent of community involvement, the way in which support is offered to NGOs and how clinical services are organised substantially impact average cost in a grant-based payment setting.
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Affiliation(s)
- Aurélia Lépine
- London School of Hygiene and Tropical Medicine, London, UK
| | - Sudhashree Chandrashekar
- London School of Hygiene and Tropical Medicine, London, UK
- St John's Research Institute, Bangalore, India
| | | | | | - Janet Bradley
- URESP, Centre de recherche du CHU de Québec, Québec, Canada
| | - Michel Alary
- URESP, Centre de recherche du CHU de Québec, Québec, Canada
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
| | - Stephen Moses
- Karnataka Health Promotion Trust, Bangalore, India
- University of Manitoba, Winnipeg, Canada
| | - Anna Vassall
- London School of Hygiene and Tropical Medicine, London, UK
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Fischer EA, Jayana K, Cunningham T, Washington M, Mony P, Bradley J, Moses S. Nurse Mentors to Advance Quality Improvement in Primary Health Centers: Lessons From a Pilot Program in Northern Karnataka, India. Glob Health Sci Pract 2015; 3:660-75. [PMID: 26681711 PMCID: PMC4682589 DOI: 10.9745/ghsp-d-15-00142] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/27/2015] [Indexed: 11/15/2022]
Abstract
Trained nurse mentors catalyzed quality improvements in facility-based maternal and newborn care by: (1) encouraging use of self-assessment checklists and team-based problem solving, (2) introducing case sheets to ensure adherence to clinical guidelines, and (3) strengthening clinical skills through on-site demonstrations and bedside teaching. Inadequate leadership and staffing were challenges in some facilities. Some social norms, such as client resistance to referral and to staying 48 hours after delivery, also impact quality and mandate community mobilization efforts. High-quality care during labor, delivery, and the postpartum period is critically important since maternal and child morbidity and mortality are linked to complications that arise during these stages. A nurse mentoring program was implemented in northern Karnataka, India, to improve quality of services at primary health centers (PHCs), the lowest level in the public health system that offers basic obstetric care. The intervention, conducted between August 2012 and July 2014, employed 53 full-time nurse mentors and was scaled-up in 385 PHCs in 8 poor rural districts. Each mentor was responsible for 6 to 8 PHCs and conducted roughly 6 mentoring visits per PHC in the first year. This paper reports the results of a qualitative inquiry, conducted between September 2012 and April 2014, assessing the program's successes and challenges from the perspective of mentors and PHC teams. Data were gathered through 13 observations, 9 focus group discussions with mentors, and 25 individual and group interviews with PHC nurses, medical officers, and district health officers. Mentors and PHC staff and leaders reported a number of successes, including development of rapport and trust between mentors and PHC staff, introduction of team-based quality improvement processes, correct and consistent use of a new case sheet to ensure adherence to clinical guidelines, and increases in staff nurses’ knowledge and skills. Overall, nurses in many PHCs reported an increased ability to provide care according to guidelines and to handle maternal and newborn complications, along with improvements in equipment and supplies and referral management. Challenges included high service delivery volumes and/or understaffing at some PHCs, unsupportive or absent PHC leadership, and cultural practices that impacted quality. Comprehensive mentoring can build competence and improve performance by combining on-the-job clinical and technical support, applying quality improvement principles, and promoting team-based problem solving.
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Affiliation(s)
| | - Krishnamurthy Jayana
- Karnataka Health Promotion Trust, Bangalore, India University of Manitoba, Department of Community Health Services, Winnipeg, Canada
| | | | - Maryann Washington
- St. John's National Academy of Health Sciences, St. John's Research Institute, Bangalore, India
| | - Prem Mony
- St. John's National Academy of Health Sciences, St. John's Research Institute, Bangalore, India
| | - Janet Bradley
- University of Manitoba, Department of Community Health Services, Winnipeg, Canada
| | - Stephen Moses
- University of Manitoba, Department of Community Health Services, Winnipeg, Canada
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