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Experiences and perceptions on antiretroviral therapy adherence and non-adherence: a scoping review of young people living with HIV in sub-Saharan Africa.
Get PDFBACKGROUND: Young people in sub-Saharan Africa (SSA) shoulder a disproportionate burden of global HIV. We conducted a scoping review to map the research on the experiences and perceptions of young people living with HIV (YPLHIV) on antiretroviral therapy (ART) in SSA to inform future research. METHODS: Following scoping review guidelines, we searched PubMed, Web of Science, EBSCOhost including Academic Search Complete, APA PsycInfo, Health Source: Nursing/Academic Edition, Medline with Full-text, Scopus and ScienceDirect for papers on YPLHIV adhering and not adhering to ART in SSA. We included literature published between 1 January 2010 and 30 September 2022. Search terms employed were adherence, non-adherence, and related synonyms. Bibliometric data and themes describing factors influencing the experiences and perceptions of ART adherence and non-adherence were extracted. RESULTS: Of the 2671 papers identified, 22 papers from 12 countries were included. Studies employed quantitative (3), mixed (6), and qualitative (13) methods. Most publications concentrated on barriers to adherence rather than enablers. Factors affecting ART adherence and non-adherence were psychosocial, emotional, self-management, support, financial and structural. YPLHIV also faced problems with the responsiveness of health services and access to information. CONCLUSIONS: We identified multiple factors surrounding ART adherence and non-adherence impacting the health and wellbeing of YPLHIV. The review findings showed the importance of research to improve the understanding of the relationships that YPLHIV in SSA develop with ART in adolescence and factors that facilitate adherence. Psychosocial adherence support and patient-centred care approaches are required
Parental involvement in infection prevention and control in low- and middle-income country neonatal units: a scoping review protocol.
Get PDFINTRODUCTION: Neonatal sepsis is a key contributor to neonatal mortality worldwide, and low- and middle-income countries (LMIC) are disproportionately affected. With antimicrobial resistance challenging effective treatment of neonatal sepsis, it is increasingly urgent to improve infection prevention and control (IPC) in LMIC neonatal units (NNU) and reduce transmission of infections. One pathway to improvement which merits further exploration is the collaboration with families to build an IPC intervention.Families are constantly present on neonatal units, and much of the hands-on care for their newborns is given by them. For IPC to be effective, families must adhere to IPC standards within the NNU, but furthermore, any IPC intervention implemented must be feasible and acceptable for families as well as the hospital staff as this will increase uptake and effectiveness of the intervention. This scoping review aims to provide an overview of parental involvement in infection prevention and control in low- and middle-income setting neonatal units. METHODS AND ANALYSIS: This protocol was developed in line with the Joanna Briggs Institute recommendations. Searches will be carried out on six databases (Medline, CINAHL, Global Health, EMBASE, Web of Science and Global Index Medicus), and reference searching will be carried out on included studies. The search will be carried out from 2000 to present (end date 28/02/2024), and included languages will be English, French, Spanish and Portuguese. Screening and data extraction will be performed independently by two reviewers, with a third reviewer to resolve conflicts. Results will be reported by narrative synthesis of each sub-question in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. ETHICS AND DISSEMINATION: This study will be carried out using already published data exclusively and therefore does not require further ethical approval. Results will be disseminated through peer-reviewed publications and conference presentations and through engagement with peers and relevant stakeholders. TRIAL REGISTRATION NUMBER: Registered with Open Science Framework - https://osf.io/snc7a/?view_only=8ffc39d837594b4388c7394a838c3a9e
Polypharmacy's Association With Mortality: Confounding From Underlying Morbidity.
Get PDFBACKGROUND: Studies consistently associate use of multiple medications with increased mortality. However, such studies often lack adequate adjustment for confounding, particularly from underlying diseases. OBJECTIVE: To illustrate challenges in studying the association between polypharmacy and mortality by examining this relationship in two separate populations. METHODS: A register-based nationwide study utilizing a cohort of all Danish citizens admitted to nursing homes 2015-2021 (n = 95,057) and a community dwelling population cohort aged ≥ 65 years (n = 1,005,963). We examined the 1-year mortality using a Kaplan Meier plot from date of nursing home admission or index date and modeled the association between the number of medications used and death using restricted cubic splines with varying levels of adjustment. Further, we modeled the association between the 20 most used drugs and 1-year mortality. RESULTS: In the nursing home cohort, we found an approximately linear increase in mortality with the number of medications used. Adjusting for sex, age, and comorbidities markedly attenuated the association from an odds ratio of 4.70 (95% CI: 4.24-5.21) to 2.23 (95% CI: 1.99-2.49). Paradoxical associations were observed for individual drug classes, such as antidementia drugs showing a strong inverse association with mortality. When examining the stability of the number of drugs used over time, we found considerable fluctuations for individual residents. In the community dwelling population cohort, adjustment for covariates showed an even stronger impact on the association, reducing the odds ratio from 10.39 (95% CI: 9.79-11.03) to 1.34 (95% CI: 1.25-1.43). Further, the individual-level use of medication was found to be stable over time in the general population. CONCLUSION: The association between levels of polypharmacy and mortality is strongly affected by confounding by indication. Basic adjustment for comorbidities attenuates but does not fully eliminate the association, with residual association possibly driven by residual confounding. This emphasizes the need for cautious interpretation of findings associating high use of medication with mortality
Diagnostic accuracy of Computer-Aided Detection for Tuberculosis® and Stool Xpert for detecting TB in prospectively recruited West African children
Get PDFIntroduction
• Tuberculosis (TB) diagnosis in children is challenging due to the difficulty in obtaining sputum and the subjectivity of Chest X-ray interpretation.
• Therefore, most of these cases are clinically diagnosed, resulting in a
wide case detection gap. Non-sputum-based TB diagnostic tests remain a priority.
• We evaluated the diagnostic accuracy of CAD4TB software and Stool
Xpert for diagnosing TB in prospectively recruited children in three West African countrie
Drivers of HPV vaccine hesitancy in New York and Florida.
Get PDFBACKGROUND: This study aimed to identify drivers of HPV vaccine hesitancy and effective public health interventions to increase HPV vaccination rates in two U.S. states (New York and Florida) and 12 counties within each state. The findings provide insights into the impact of demographics, state policies, and vaccine confidence on HPV vaccination. METHODS: We utilized a mixed-method approach, integrating quantitative analysis of county-level surveys, qualitative interviews, and secondary data on HPV vaccine coverage. Surveys, adapted from the Vaccine Confidence Project (VCP) and the World Health Organization (WHO), assessed HPV vaccine confidence, socio-demographics, and behavioral determinants. Interviews explored barriers, interventions, and policies related to HPV vaccination. FINDINGS: Parents and providers have not prioritized HPV vaccination compared to other vaccines, with less concern about HPV than other vaccine-preventable diseases. Socio-demographic factors, such as race, age, gender, religion, employment, and income impacted children's vaccination status. Female parents aged 35-44 and those with a professional degree were more likely to vaccinate their children. Perceptions of the vaccine's importance and safety significantly influenced vaccination. INTERPRETATION: Identifying socio-demographic determinants and behavioral motivators can guide targeted interventions. Our study highlights complex factors influencing HPV vaccination at the state and county level, offering policymakers strategies to tailor interventions addressing barriers and hesitancy in areas with lower vaccination rates
Protocol for the economic evaluation of integrated community-based care compared with integrated facility-based care for HIV, hypertension and diabetes in Tanzania and Uganda (INTE-COMM trial).
Get PDFBACKGROUND: The number of people living with multiple chronic conditions in sub-Saharan Africa is increasing, but health facilities are unable to meet demand. To improve health system capacity and access to care, community models of HIV care have been trialled in countries such as Tanzania and Uganda. However, no evidence exists to inform policymakers on the effectiveness and cost-effectiveness of integrated community-based models of care for HIV and chronic non-communicable conditions. This protocol outlines a within-trial economic evaluation to address this gap. METHODS & ANALYSIS: We will estimate the costs and cost-effectiveness of integrated community-based care for HIV, hypertension and diabetes compared with facility-based care within the INTE-COMM pragmatic cluster-randomised trial in Tanzania and Uganda. Analyses will adopt a 52-week time horizon, the duration of trial follow-up. The full enrolled trial sample will be analysed from a societal perspective, comprising provider and patient perspectives. Economic costs will be estimated, which includes valuing inputs such as donated goods or time foregone by participants because of receiving care. For provider costs, participant case report forms will inform resource use along with data from facilities and community sites. Resources will be valued using project accounts, facility spending, and locally available cost data. Patient costs will be estimated based on a care-seeking and cost questionnaire administered to participants. Estimated costs will be analysed with co-primary trial outcomes on plasma viral load suppression, glycaemia and blood pressure control to calculate incremental cost-effectiveness ratios (ICER). We will also calculate ICERs for secondary trial outcomes related to health-related quality of life and wellbeing. Cost drivers and outcomes will be varied within confidence bounds in a two-way sensitivity analysis. We will investigate equity impact by estimating the mean difference in outcomes between integrated community-based and facility-based care across household socio-economic quintiles and by measuring whether participants incurred catastrophic health expenditures. TRIAL REGISTRATION NUMBER: The ISRCTN Registry: ISRCTN15319595. Registered on 07 June 2022: https://doi.org/10.1186/ISRCTN15319595
School Meals Case Study: Denmark
Get PDFThis school meals case study forms part of a collection led by the Research Consortium for School Health and Nutrition’s "Good Examples" Community of Practice. The School Meals Case Study of Denmark serves to document how the national school meals programme is organized, funded, and monitored throughout the country. The objectives of this case study include presenting an introduction to the country profile, outlining the design and implementation of school feeding programmes, describing their monitoring and evaluation processes, and highlighting lessons learned, best practices, and challenges. This case study is written as a working paper, and can be updated to reflect evolving circumstances. The ‘Good Examples’ Community of Practice supports the evidence generation of the Research Consortium for School Health and Nutrition, the evidence-generating arm of the School Meals Coalition. The Research Consortium’s objective is to carry out independent research across diverse sectors and generate solid, compelling, and actionable evidence regarding the benefits of school food programs to inform evidence-based decision-making on school health and nutrition policies and practices
#TheHealthYouthWant: a qualitative analysis of a global crowdsourcing open call for innovative ideas to promote adolescent health and well-being in countries with a high HIV burden.
Get PDFBackground Improving adolescent health and well-being is a key policy priority in countries with a high HIV burden, because adolescents have lower rates of treatment coverage, viral load suppression and survival compared with others. This study aimed to identify innovative ideas from young people (aged 10-30years) on how adolescent health and well-being can be improved in communities most affected by HIV. Methods We organized a global crowdsourcing open call for ideas from young people on how to improve adolescent HIV outcomes and well-being in countries with a high HIV burden. At least three independent judges assessed each submission based on prespecified criteria. We then conducted a thematic analysis of eligible submissions to identify key themes to inform HIV programming and policy. Results We received 357 submissions from 37 countries. Of 107 eligible submissions, 91 (85%) described new ideas. Seventy-one (66%) participants were aged 20-30years, and 30 (28%) were aged 10-19years. Major themes suggested that edutainment interventions linking entertainment and education could increase adolescent uptake of HIV services. Digital interventions adapted for analog cellphone users (e.g. unstructured supplemental service delivery) could increase the reach of HIV information and engage remote, rural participants. Peer-based interventions could improve feelings of social inclusion among adolescents. Conclusions Adolescents and young people in countries with a high HIV burden can create innovative and feasible ideas for improving health and well-being. Exceptional ideas were presented to senior leadership at UNICEF/WHO/UNAIDS as part of a multi-sectoral HIV strategic planning exercise
Digital-Based Nutrition Interventions Employing the Dietary Approaches to Stop Hypertension (DASH) Diet: A Systematic Scoping Review.
Get PDFBackground: The Dietary Approaches to Stop Hypertension (DASH) diet is an internationally recognized anti-hypertensive dietary model. This systematic scoping review examines the effectiveness of digital-based interventions utilizing the DASH dietary pattern. Methods: A search was conducted using 14 databases to include relevant studies from 1997 to January 2025 using PRISMA guidelines for scoping reviews. Results: The review included 24 studies with almost 7000 participants, including randomized controlled trials and cohort studies conducted in several countries. Interventions using the DASH dietary pattern positively affected blood pressure (BP), nutrition behavior, and weight. Some studies also reported secondary outcomes such as reduced healthcare cost savings. Conclusion: Technology-based DASH diet interventions yielded favorable health outcomes, particularly in reducing BP and dietary salt intake, as well as improved diet quality. This systematic scoping review supports the potential of digital-based interventions utilizing the DASH dietary pattern to improve nutrition and health outcomes, particularly those related to hypertension management. The findings emphasize the importance of using evidence-based approaches, which are grounded in theoretical frameworks and models to develop effective interventions, and thoughtful program design to maximize group effectiveness. Other factors that influenced the effectiveness of the intervention included the type of technology used, as well as participant comfort with using technology. Further research and development are needed to optimize these interventions for widespread impact and long-term sustainability
Knowledge, experience and practices of optometrists in Uganda about keratoconus
Get PDFBackground: Keratoconus has a global prevalence of 0.2 to 4790 per 100 000 persons and there is currently no published report about its incidence, prevalence or the role of optometrists in its management in Uganda. This study looked at the role of optometrists in the diagnosis, management and referral of patients with keratoconus in Uganda.
Aim: To determine the knowledge, experiences and practices of optometrists in the management of keratoconus in Uganda.
Setting: This study was conducted in Uganda.
Methods: Fifteen optometrists who had practiced for at least one year were recruited into the study, which was conducted in accordance with the International Conference on Harmonisation Tripartite Guideline for Good Clinical Practice. The study involved interviews that were conducted over zoom and telephones, which were considered for participants who had internet challenges. The sessions were recorded, transcribed verbatim, coded and themes were derived.
Results: The median number of years of experience was 7 years. The participants’ experiences were reported in terms of diagnosis, management and referral of patients with keratoconus and common themes were explored. Retinoscopy and Munson’s sign were the most common diagnostic methods while spectacles were the most common management option used by the optometrists.
Conclusion: Most optometrists relied on retinoscopy for diagnosis and spectacles for the management of keratoconus because of the lack of diagnostic equipment and challenges associated with contact lens practice in Uganda.
Contribution: This is the first study to explore how keratoconus is managed by optometrists in Uganda and the results can be used to improve patient care in the country