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Understanding the effects of universal test and treat on longitudinal HIV care outcomes among South African youth: A retrospective cohort study
No full textIntroduction: Little is known about the effects of universal test and treat (UTT) policies on HIV care outcomes among youth living with HIV (YLHIV). Moreover, there is a paucity of information regarding when YLHIV are most susceptible to disengagement from care under the newest treatment guidelines. The longitudinal HIV care continuum is an underutilized tool that can provide a holistic understanding of population-level HIV care trajectories and be used to compare treatment outcomes across groups. We aimed to explore effects of the UTT policy on longitudinal outcomes among South African YLHIV and identify temporally precise opportunities for re-engaging this priority population in the UTT era. Methods: Using medical record data, we conducted a retrospective cohort study among youth aged 18–24 diagnosed with HIV from August 2015-December 2018 in nine health care facilities in South Africa. We used Fine and Gray sub-distribution proportional hazards models to characterize longitudinal care continuum outcomes in the population overall and stratified by treatment era of diagnosis. We estimated the proportion of individuals in each stage of the continuum over time and the restricted mean time spent in each stage in the first year following diagnosis. Sub-group estimates were compared using differences. Results: A total of 420 YLHIV were included. By day 365 following diagnosis, just 23% of individuals had no 90-or-more-day lapse in care and were virally suppressed. Those diagnosed in the UTT era spent less time as ART-naïve (mean difference=-19.3 days; 95% CI: -27.7, -10.9) and more time virally suppressed (mean difference = 17.7; 95% CI: 1.0, 34.4) compared to those diagnosed pre-UTT. Most individuals who were diagnosed in the UTT era and experienced a 90-or-more-day lapse in care disengaged between diagnosis and linkage to care or ART initiation and viral suppression. Conclusions: Implementation of UTT yielded modest improvements in time spent on ART and virally suppressed among South African YLHIV— however, meeting UNAIDS’ 95-95-95 targets remains a challenge. Retention in care and re-engagement interventions that can be implemented between diagnosis and linkage to care and between ART initiation and viral suppression (e.g., longitudinal counseling) may be particularly important to improving care outcomes among South African YLHIV in the UTT era
Challenges in obstetric morbidity and mortality, with special reference to India: A literature review
No full textThe purpose of this article was to conduct a review on the determinants of maternal morbidity and mortality, obstetric health scenario, especially after the implementation of the Janani Surksha Yojana (JSY) and recognise the existing gaps in research in obstetric health and healthcare utilisation in India. The articles were retrieved using search engines like Google Scholar and PubMed, using specific combination of terms along with the grey literature available in national and regional health databases. Although the current medical knowledge and interventions are capable to tackle most physical preconditions responsible for maternal deaths, yet the utilisation of healthcare facilities depends on the available health infrastructure, human resources and quality of services that are accessible and acceptable to the beneficiaries. Acceptability especially is impacted by the health-seeking behaviour of a community. The implementation of JSY is believed to contribute to the decline of maternal mortality ratio, yet maternal health outcome reports gross inequity in terms of utilisation of antenatal care and postnatal care at many sub-national levels. Thus, micro-level studies are required to understand critically the level of utilisation of formal healthcare facilities, in order to ensure an unscathed maternal health profile throughout India
The health effects of climate change: Experiences of young people in Bangladesh, Guatemala, and Nigeria
Get PDFClimate change is affecting the health and well-being of adolescents and young people (AYP) worldwide. This happens through direct exposure pathways but mainly indirectly, by influencing economic and food insecurity, access to health services, and harmful gender norms and social inequalities. According to a recent meta-analysis of 130 studies, climate change disproportionately harms the health of women and girls, especially younger generations. There are intergenerational inequities in exposure to climate extremes. A child born in 2020 will face an up to sevenfold increase in extreme climate events compared to one born in 1960. These events will have cascading harms and impacts on the life trajectories of the next generation. This includes impacting their health, economic prospects, and well-being, disproportionately for AYP who face additional gender-related harms. At the same time, young people can and do also contribute to climate action. As noted in this brief, future research is necessary to understand the lived experiences of young people and how climate change is affecting their physical and mental health, especially sexual and reproductive health
The One Who Uses a Pencil Will Go Far
No full textThe Adolescent Girls Initiative–Kenya is a long-term program being implemented by Population Council – Kenya. The initial two-year multi-sectoral, multi-level program for girls 11–14 years old in Wajir County, a marginalized county along the border of Somalia with low rates of girls\u27 school enrollment and high rates of child marriage, showed long term impact on girls schooling and timing of marriage. Since the initial study, Population Council Kenya has been working with the Wajir County Government to scale up the program, implemented by the county government through their existing staff and community structures. This video describes the process and success of scaling up this powerful program
Financing gaps for Pakistan\u27s contraceptive prevalence goals: Analyses using the Guttmacher adding-it-up methodology
No full textObjectives: The objective of the paper is to identify levels of and gaps in family planning financing in Pakistan and to assess whether current funding is sufficient to meet national and FP2030 goals to increase contraceptive use to 60% by 2030. Study Design: We estimate the cost of family planning services nationally and by province based on the Essential Services Package and WHO/UNFPA cost by applying the existing Guttmacher global Adding-It-Up methodology. Additional data are also analyzed to assess trends in expenditures on family planning between 2017 and 2021. Results: The estimated cost of family planning services provided in Pakistan in 2017 was US0.38 per capita. The estimated gap in costs to provide contraceptive services to the additional 8.6 million women with unmet need for modern contraception was US$93 million. While we found evidence of an upward trend in overall government expenditure on family planning services over the period 2017–21, the pace of increase was slow and uneven across regions. Conclusions: The evidence highlights the persistent inadequacy of financing for contraceptive services especially if Pakistan intends to achieve its ambitious national and FP2030 goal of increasing contraceptive prevalence to 60% by 2030. Implications: A doubling of current funding for contraceptive services is required in Pakistan. Additional financing needs to be directed towards the poorest women with unmet need to avoid unintended pregnancies and to improve equity in reproductive health outcomes
Effect of mentorship and a mHealth application in updating provider skills and knowledge in maternal and newborn care in two informal settlements of Nairobi
No full textBackground: Children and women in urban informal settlements have fewer choices to access quality maternal and newborn health care. Many facilities serving these communities are under-resourced and staffed by fewer providers with limited access to skills updates. We sought to increase provider capacity by equipping them with skills to provide general and emergency obstetric and newborn care in 24 facilities serving two informal settlements in Nairobi. We present evidence of the combined effect of mentorship using facility-based mentors who demonstrate skills, support skills drills training, and provide practical feedback to mentees and a self-guided online learning platform with easily accessible EmONC information on providers’ smart phones. Methods: We used mixed methods research with before and after cross-sectional provider surveys conducted at baseline and end line. During end line, 18 in-depth interviews were conducted with mentors and mentees who were exposed, and providers not exposed to the intervention to explore effectiveness and experience of the intervention on quality maternal health services. Results: Results illustrated marked improvement from ability to identify antepartum hemorrhage (APH), postpartum hemorrhage (PPH), manage retained placenta, ability to identify and manage obstructed labour, Pre-Eclampsia and Eclampsia (PE/E), puerperal sepsis, and actions taken to manage conditions when they present. Overall, out of 95 elements examined there were statistically significant improvements of both individual scores and overall scores from 29/95 at baseline (30.5%) to 44.3/95 (46.6%) during end line representing a 16- percentage point increase (p \u3e 0.001). These improvements were evident in public health facilities representing a 17.3% point increase (from 30.9% at baseline to 48.2% at end line, p \u3e 0.001). Similarly, providers working in private facilities exhibited a 15.8% point increase in knowledge from 29.7% at baseline to 45.5% at end line (p = 0.0001). Conclusion: This study adds to the literature on building capacity of providers delivering Maternal and Newborn Health (MNH) services to women in informal settlements. The complex challenges of delivering MNH services in informal urban settings where communities have limited access require a comprehensive approach including ensuring access to supplies and basic equipment. Nevertheless, the combined effects of the self-guided online platform and mentorship reinforces EmONC knowledge and skills. This combined approach is more likely to improve provider competency, and skills as well as improving maternal and newborn health outcomes
Social support and very young adolescent girl’s knowledge on sexual relationships: A comparative qualitative study of Girl Only Clubs’ participants and non-participants in rural Malawi
No full textEarly sexual relationships are associated with an increased risk of acquiring sexually transmitted diseases including HIV/AIDs, teenage pregnancies, and unsafe abortions among other negative health outcomes. Understanding sexual relationships among very young adolescents (VYAs) is important to equip them to protect themselves from negative sexual health (SH) outcomes. DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) is an HIV prevention initiative that provided an evidence-based core package of interventions to VYAs to prevent HIV acquisition in 15 countries in sub-Saharan Africa. The Girl Only Club (GOC) was the primary context for the interventions. Our objective in this study was to explore if there was any difference in social support (SS) received concerning sexual relationships between the VYA girls who attended GOCs and those who did not. In-depth interviews were conducted with 43 VYA girls, aged 10-14 years, in two rural southern districts, Zomba and Machinga, in Malawi. Twenty-three VYA girls were participants in GOCs and 20 VYA girls did not participate. A thematic, descriptive approach that involved a constant comparative analysis guided the data analysis, and Nvivo 12 software was used. In both study sites available SS concerning sexual relationships is informational support including information from parents, older relatives, and friends. However, club participants differed from non-club participants in sexual and reproductive health (SRH) knowledge and use. Club participants reported consulting others on decision-making and information on sexual relationships; receiving detailed SH information from clubs; condom use due to education received from the clubs; quitting sexual relationships; and correcting misinformation with club information. GOC participants received more SS which made them more knowledgeable and better at handling sexual relationship issues than those not in clubs. Interventions that integrate SS including social asset building and safe spaces are critical for VYA SRH programming