6867 research outputs found
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Higher acceptability of the monthly dapivirine ring versus daily oral pre-exposure prophylaxis among adolescent girls and young women in sub-Saharan Africa in the REACH trial
No full textBackground: Oral pre-exposure prophylaxis (PrEP) is effective for HIV prevention, yet use has been inconsistent in adolescent girls and young women (AGYW). We compared PrEP to the dapivirine vaginal ring (ring) among AGYW in MTN-034 (REACH). Methods: We randomized 247 16–21-yr-old AGYW (South Africa, Uganda, Zimbabwe) to the sequence of using the ring and oral PrEP for 6m each (February 2019–September 2021). Participants rated overall product acceptability (1, dislike very much to 5, like very much) after 3m and 6m, and product characteristics/use attributes after 3m. We compared proportions of participants rating each product a “5” (binomial model with generalized estimating equations). We assessed associations between product characteristics/use attribute ratings at 3m and overall acceptability after 6m (Chi-square). Results: 65% and 41% of participants rated the ring versus PrEP a “5” (adjusted risk difference [aRD] 24%, 95% CI: 15%, 32%; p\u3c 0.001). For both products, high overall acceptability was associated with “excellent” self-rated adherence (ring, p\u3c 0.001; PrEP, p = 0.03), product appearance (ring, p = 0.005; PrEP, p \u3c 0.001), and ease of use (ring, p = 0.001; PrEP, p = 0.003). Not worrying about/or experiencing side effects were also associated with high acceptability of oral PREP. Conclusions: The dapivirine ring was highly acceptable to substantially more individuals than oral PrEP, although a significant minority rated oral PrEP highly, even after using the ring. As has been found in the contraceptive field, offering AGYW a choice of PrEP products is likely to increase the use of any HIV prevention method in this vulnerable population
A 3-month pilot crossover study in 24 US couples to compare adherence, preference and acceptability of 3 non-medicated silicone intravaginal rings (IVRs) of different external diameters, each used for 30 days
No full text“Let’s chat!” Piloting a digital chatbot for HIV prevention among cisgender women and transgender men in Nigeria
No full textAwareness and uptake of HIV pre-exposure prophylaxis (PrEP), a highly efficacious medication for HIV prevention, remains low in many sub-Saharan African countries. This study explored the acceptability and feasibility of an HIV prevention chatbot tailored for cisgender women and transgender men in Lagos, Nigeria. The chatbot was developed and implemented in the Nigerian healthcare context using participatory approaches engaging HIV healthcare providers and representatives from the target populations to ensure that the content was appropriate, comprehensible, and non-stigmatizing. The chatbot included information about PrEP, HIV risk/ vulnerabilities, and self-assessment guidelines. The pilot was conducted among 150 participants (132 cisgender women and 18 transgender men) recruited at public health facilities and community health clinics. The chatbot was well-received by clients and healthcare providers and has the potential for rapid scale-up to facilitate PrEP uptake among HIV vulnerable populations. Participants reported the chatbot was easy to understand (97%), a good way to learn health information (99%), and that they would recommend it to others (96%). Participants appreciated the confidentiality of the chatbot, the conversational prompts and offered suggestions to make the chatbot more accessible and user-friendly. Most participants (92%) reported that they learned new information about HIV from the chatbot
A study on the feasibility and acceptability of pericoital Levonorgestrel 1.5mg in Nairobi County and Kiambu County
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Sustaining progress: Investing in adolescent girls amidst global challenges—Slide deck
Full text linkMaking health insurance responsive to citizens: learning from six low-income and middle-income countries
No full textBackground: Many low-income and middle-income countries have introduced public health insurance systems, whereby, thanks to government subsidies, selected groups are entitled to receive insurance coverage even if not paying direct contributions into the system. These efforts towards achieving universal health coverage were often undermined by difficulties in enrolment and registration, barriers to health service utilisation or complicated rules around service packages. Governmental and non-governmental accountability initiatives have been established to overcome these barriers in order to make health insurance programmes responsive and to empower citizens. This paper examines evidence and synthesizes lessons from 20 accountability initiatives in six selected countries to understand how these achieved (or not) these goals. Methods: We systematically analysed six final reports and five published papers which were part of a multicountry research programme from 2019 to end of 2022 studying accountability initiatives. Between June 2023 and September 2024, we systematically extracted data and synthesised findings from the reports and papers based on a conceptual framework, adapted from a framework developed by Molyneux, which had been adopted by the country teams to guide their studies. We coded the extracted data and identified the content, context and process factors that enabled or hindered the accountability initiatives in achieving their intended goals. We present and discuss factors that were present in at least two initiatives. Results: Governmental initiatives were in most instances established in conjunction with the health reforms that introduced the health insurance programmes they address. Whereas some of these initiatives were effective, many were undermined by poor outreach to citizens, inadequacy of resources, conflicts of interest and power imbalances and lack of fidelity to original design. Non-governmental initiatives often emerged to fill existing gaps in government services and programmes. Many of the non-governmental initiatives had several features which helped them in contributing to citizen empowerment, and these included embeddedness in and being trusted by the local communities, flexibility in operating and reaching out to people and the underlying motivation of people working in them. Conclusions: The effective implementation of accountability initiatives requires transparency, trust-building measures, active outreach and community engagement and adequate resources. These elements can ensure that initiatives achieve their intended goal of enhancing citizens\u27 access to their health insurance entitlements. Further research is needed to understand how best collaboration between governmental and non-governmental initiatives can be fostered to build synergies between the two toward the achievement of common goals
Exploring the intersection of young men\u27s mobile-internet use, gender attitudes and intimate relationship dynamics: A mixed-methods study
No full textYoung people’s reliance on telephones and the internet for interpersonal communication is increasingly common, including in Southern Africa. Their role in young people’s sexual health and intimate relationships is poorly understood. This chapter analyses data from surveys with 1,010 men from Eswatini ages 18–34 and 884 men from South Africa ages 20–40, plus 64 in-depth interviews (n = 40 in Eswatini, 24 in South Africa). Three-quarters of respondents owned a smartphone and commonly used WhatsApp and Facebook. A sizable minority of men held inequitable gender attitudes as measured by the GEM Scale (e.g., ‘I want to know where my partner is at all times.’) One quarter of respondents in both countries agreed that ‘I use mobile phones to help me keep control of my partner’s behaviour.’ At the same time, about one-quarter reported mobile-internet use for finding information about a health topic. In multivariate analyses, mobile-internet use to control relationships was associated with more inequitable gender attitudes and poorer couple communication. In qualitative interviews, men mainly described mobile-internet use as leading to distrust and jealousy. Overall, mobile-internet use influenced sexual health and relationship dynamics in both positive and negative ways. This is a critical area for future research
Landscape assessment of renewable energy-powered lift irrigation systems in Bhutan
Full text linkAgriculture is the backbone of Bhutan’s rural communities, sustaining livelihoods and safeguarding food security for generations. Yet, as climate variability intensifies and traditional rainfed systems become increasingly unreliable, our farming communities face unprecedented challenges—declining yields, decreasing crop diversity, and unstable incomes. Renewable energy-powered lift irrigation systems emerge as a transformative solution—one that simultaneously addresses water security, climate resilience, and inclusive development while supporting Bhutan\u27s carbon-neutrality commitments.
This Landscape Assessment of Renewable Energy-Powered Lift Irrigation Systems in Bhutan offers a multidimensional examination of the sector, providing stakeholders with: A comprehensive status assessment of existing systems; Critical analysis of technical, financial, and governance barriers; Identification of market needs and environmental considerations; Gender Equality and Social Inclusion (GESI) perspectives; Policy and institutional framework evaluation; Practical and scalable recommendations for sustainable adoption.
The development of this report was a collaborative effort led by the Department of Energy, Ministry of Energy and Natural Resources, with support from the International Centre for Integrated Mountain Development (ICIMOD)
Revitalisation of intermittent preventive treatment of malaria in pregnancy in Kenya (Revive IPTp)
No full textThis was a repeated cross-sectional survey that aimed to support the Government of Kenya’s National Malaria Control Program goal of closing the gap towards the achievement of the national target of 80% coverage of IPTp-SP by 2025. Specifically, this project sought to: 1. Increase programme implementers and healthcare providers\u27 understanding, capacity and willingness to promote use of SP in IPTp; 2. Increase community engagement on IPTp and promote self-care by pregnant women; and, 3. Strengthen the capacity of county government bodies to deliver and monitor IPTp-SP interventions as part of the country’s decentralised healthcare system