6867 research outputs found
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Dataset: Measuring abortion incidence, severity of complications, and health facilities’ capacity to provide abortion care in refugee settings in Ethiopia, Baobab Study
No full textBackground: Sparse evidence is available to support improved programming and reporting on SRHR in refugee settings in the East and Horn of Africa, where unsafe abortion is one of the major causes of maternal mortality and morbidity. It is important to design studies that explicitly investigate the sexual and reproductive health needs and outcomes of refugee populations, as it is likely that these factors differ among refugee populations as compared to the general population. Understanding the state of abortion in a given context, including abortion incidence, safety, and outcomes, is challenging due to the limitations of currently available methodologies. Objectives: To determine the incidence of induced abortions and the severity of abortion-related complications in refugee settings in Ethiopia. Methods: The study employed a quantitative cross-sectional design. The study components included three separate surveys. Although the study was not nationally representative, efforts were made to ensure representativeness at the refugee settlement/camp level : i) representative Health Facility Survey (HFS) to estimate the number of women who receive post-abortion care (PAC) following abortion complications, ii) a Knowledgeable Informants Survey (KIS) to capture information on the proportion of all women having abortions who receive facility-based treatment for abortion-related complications, and iv) a Prospective Morbidity Survey (PMS) to capture information necessary to describe characteristics of women receiving treatment for abortion complications, the severity of complications, the type of treatment received, and the delays in access to PAC. The PMS also included clinical data abstraction from the medical records. Potential Impact: This will help host governments, humanitarian partners, and donors to seek long-term, innovative, cost-effective SRHR development solutions to bring about change in the health and lives of refugee women and girls
From Tanzania to Washington, DC: Application of the Consolidated Framework for Implementation Research and ADAPT-ITT model to guide the development of a community-based PrEP intervention for Black adults
No full textWhile HIV incidence in Washington, DC has declined overall, significant racial disparities persist. Pre-exposure prophylaxis (PrEP) remains underutilized among Black adults due to multiple barriers including medical mistrust, stigma, and structural barriers to access. Using the Consolidated Framework for Implementation Research (CFIR) and ADAPT-ITT model, we conducted in-depth interviews with opinion leaders (n = 28) including community-based organization leaders, health department representatives, healthcare providers, and current/potential PrEP users to guide the adaptation of a community-based HIV treatment intervention from Tanzania to create a community-based PrEP intervention for Black adults in Washington, DC to address the aforementioned barriers. Data analysis employed thematic content analysis with CFIR construct mapping to identify implementation barriers and facilitators. Key implementation facilitators included: mobile service delivery in high-need areas (Wards 7–8), comprehensive health service integration, culturally matched staffing, flexible evening/weekend hours, and multi-channel outreach via social media and community venues. Major barriers included privacy concerns in mobile settings, social determinants of health challenges, and multilayered stigma. Drawing on these findings, we developed the adapted cbPrEP intervention with the six components featuring: (1) mobile service delivery platform, (2) comprehensive service integration, (3) community-centered staffing model, (4) privacy and confidentiality protocols, (5) multi-channel outreach strategy, and (6) wraparound support services including insurance navigation. This study demonstrates the value of using implementation science frameworks to adapt evidence-based interventions while centering community voices. The resulting cbPrEP intervention model shows promise for increasing PrEP access among Black adults in Washington, DC through culturally responsive, community-based service delivery
The PrEP Ring Quarterly—Edition 4, October 2025
No full textThis is the fourth edition of The PrEP Ring Quarterly newsletter, which provides information, updates, and resources dedicated to the dapivirine vaginal ring (DVR) also known as PrEP ring
Building a rights-based approach to nutrition for women and children: Harnessing the potential of women’s groups and rights-based organizations in South Asia
No full textWomen face numerous gender-based barriers that hinder their access to resources, nutritious foods, nutrition services, and maternity entitlements. Evidence shows that certain types of women’s groups can improve women’s access to resources and social capital and in some approaches also improve health and nutrition outcomes. Women’s rights-based organizations in South Asia have a longstanding tradition of collective action toward gender equality. Women’s rights-based organizations work in areas such as microfinance, livelihoods, women’s rights, health, and combating violence against women. In this perspective article, we explore how women’s groups and rights-based organizations can leverage their collective strength to advance nutrition outcomes for women and children. We identify seven pathways implemented through women’s groups toward improving nutrition outcomes. These pathways include (i) income generation, (ii) agriculture, (iii) health and nutrition behavior change communication and participatory learning and action, (iv) advocating for rights to better health and social services, (v) food access, (vi) cash transfers, and (vii) strengthening service delivery and fostering convergence with health systems. We also note that women’s groups have the potential to implement integrated interventions through combined food-systems-rights pathways. Investing in this area can support transforming nutrition policy from a service delivery model to a rights-based approach
The implementation and costs to deliver a youth-friendly multi-component program addressing stigma, HIV, and linkage to care for adolescent girls and young women in Lusaka, Zambia
No full textCommunity-centered HIV prevention is most effective among adolescent girls and young women (AGYW) when integrated with youth-friendly health care services; yet gaps in the literature remain about the costs and the processes of these services. We describe the implementation and costs of two intervention components: (1) the Support for HIV Integrated Education, Linkages to care, and Destigmatization (SHIELD) program, which includes a monthly group session for AGYW with content on social support, stigma, and self-efficacy in health care seeking–behaviors; and (2) the Integrated Wellness Care (IWC) clinic that provided HIV testing along with other sexual and reproductive health services in a youth-friendly clinical setting. Data (e.g., youth club attendance, daily time reporting) come from a cluster randomized trial (ClinicalTrials.gov NCT03995953) conducted in four communities in Lusaka, Zambia. The economic cost of the SHIELD component per client was approximately twice that of the IWC component per client; the greatest costs for SHIELD included participant follow-up (scheduling and session reminders). Those receiving only the SHIELD component attended an average of 7.4 group sessions and those receiving both SHIELD and IWC components attended an average of 6.6 group sessions. Understanding the processes for implementation and delivery costs of behavioral interventions integrated with existing health care models is needed to inform scale-up and adaptation, particularly for policymakers who require understanding intervention costs to make such decisions. By capturing labor and efforts to navigate clients into care we better understand the full cost of sustaining health programs and long-term health care needs of populations
“It’s everyone’s problem”: Institutionalising multisectoral action for maternal health in Meghalaya, India
No full textBackground: There is widespread agreement on the potential of multisectoral action to address the social determinants of maternal health. We conducted an implementation research study in Meghalaya, a northeastern Indian state with a high burden of maternal mortality where the government initiated Rescue Mission to strengthen the health system and to address underlying determinants to improve maternal health indicators. The initiative was grounded in building state capability and decentralised leadership. Objective: We developed a theory of change and examined implementation barriers and enablers through an implementation research study with government and community actors and institutions. Methods: We conducted multiple rounds of qualitative data collection over a period of eighteen months across six districts. Participants included primary care providers in the public health system and frontline workers in thirty sampled facilities. We also interviewed officials across three government departments, observed meetings and met regularly in a feedback loop with government. Data were analysed thematically and synthesised according to pathways of change. Findings: The state institutionalised multisectoral collaboration across governance levels through building technical and adaptive leadership. Processes included joint meetings at the facility, district and state levels to develop action plans and facilitate collaboration, community engagement through frontline workers and decentralised use of data. Strength of participation by different sectors varied widely; non‑health cadres reported challenges such as being accountable to multiple departments. Political priority and administrative leadership were the key elements of the State\u27s ability to implement a multisectoral approach. Overall, health outcomes improved and the State largely achieved its commitment to building technical skills, but also recognised the need for further investments to develop a sense of purpose amongst government officials. Conclusions: Meghalaya\u27s experience in multisectoral collaboration demonstrates the potential of health systems reform grounded in a state capabilities enhancement approach, with a focus on participation and building decentralised leadership
Communities started the end of the HIV epidemic: Experiences with and recommendations for conducting community-engaged HIV implementation research
No full textCommunities of people living with or impacted by HIV have been at the forefront of HIV research, from identifying the health priorities to advocating for the development and implementation of interventions that benefit affected populations and individuals. Community engagement is considered fundamental for successful implementation of science projects. However, researchers have acknowledged the limited guidance on community engagement for implementation science research. Some recommendations have been made for community engagement in implementation sciences, but conducting HIV implementation research must consider the unique challenges of addressing the stigma and disenfranchisement of the populations affected. Despite the specific difficulties for community-engaged implementation science research, there are successful experiences and lessons learned that could support future fruitful experiences. This publication aims to share recommendations for community-engaged HIV implementation research based on the expertise of community–academic partnerships. These recommendations include the perspectives of academic and community partners. Community engagement in HIV implementation research will be needed beyond ending the epidemic. The future of community engagement in research may lay in embracing the constant change and securing the mechanisms to respond to it
Pathways to prosperity for adolescent girls in Kenya
Full text linkThe World Bank, in partnership with the Population Council, and the Center for Global Development (CGD), launched the Pathways to Prosperity for Adolescent Girls in Africa report in October 2024. The joint report brings urgently needed focus to the challenges faced by adolescent girls across the region and presents targeted policy solutions to address their diverse experiences and needs.
The report findings were discussed in Nairobi, Kenya during a policy and evidence workshop held on March 3, 2025. The workshop shone a spotlight on the status and wellbeing of adolescent girls in Kenya and enabled stakeholders to share insights and priority actions that will set adolescent girls on the path to prosperity, positioning them as key drivers of Kenya and Africa\u27s future. The workshop brought together over 100 participants, including representatives of government ministries and county departments serving adolescents, multi-lateral agencies, youth representatives, and international, national and grassroots organizations focused on adolescents.
Key indicators on adolescent girls in Kenya are included in this country brief and the related presentation