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The role of jealousy and infidelity in intimate partner violence against women: a qualitative meta-synthesis of five studies.
Get PDFBACKGROUND: Jealousy and infidelity are frequently identified as key drivers of intimate partner violence (IPV) yet remain underexplored in IPV prevention programming and inadequately conceptualised in measurement frameworks. This study presents the first known meta-synthesis to compare findings across contexts, enhance interpretation, and generate transferable mid-range theories that elucidate the role of jealousy and infidelity in IPV.
METHODS: Using a meta-ethnographic approach, we synthesised findings from five purposively sampled qualitative studies produced by a joint Collaboration of authors, one in Ecuador (n = 100) and four in African countries: Ethiopia (n = 30), Rwanda (n = 224), Tanzania (n = 48) and Uganda (n = 40). Across all studies, women and men in heterosexual intimate relationships, aged 16-70 years were included.
RESULTS: The analysis identified 46 second-order and five third-order constructs linking jealousy and infidelity to physical, sexual, economic and psychological IPV, including controlling behaviours. At the community level findings highlighted traditional gender norms and community gossip that could fuel jealousy as mechanisms of controlling women's behaviour. At the relational level male jealousy was instrumentalised as a socially acceptable means of controlling women, such as feigning jealousy to coerce sex. In contrast, women's expressions of jealousy were typically more constrained, and often expressed through subverting traditional roles (e.g. refusing sex), which could result in violent consequences. At the individual level jealousy and infidelity were perceived as resulting from failure to adhere to hegemonic gender roles, further exacerbating IPV risk.
CONCLUSIONS: To be effective, IPV prevention programmes must support the dismantling of patriarchal hierarchies while simultaneously addressing backlash to shifts in traditional gender norms. Interventions should also target jealousy and suspicions of infidelity to foster safer and more equitable relationships. Addressing these community, relational and individual dimensions is essential for mitigating the complex dynamics of jealousy, infidelity and IPV
The role of cytochrome bc1 inhibitors in future tuberculosis treatment regimens.
Get PDFTuberculosis (TB) remains the foremost cause of death from infectious diseases globally, prompting ongoing efforts to improve treatment options. This includes developing compounds with novel modes of action and identifying optimal treatment regimens that allow for treatment shortening. One promising strategy involves targeting cytochrome bc1 oxidase in Mycobacterium tuberculosis, a key enzyme in the respiratory chain. In this study, we evaluate the potential of cytochrome bc1 inhibitors as partner drugs in TB combination regimens. Using a relapsing mouse model, we demonstrate that these inhibitors enhance regimen sterilisation and significantly reduce the time required for effective treatment. We also propose several novel combination strategies for both multidrug-resistant and drug-sensitive TB, where cytochrome bc1 inhibitors contribute to sterilisation and improved treatment outcomes. Furthermore, M. tuberculosis clinical isolates exhibited heightened susceptibility to cytochrome bc1 inhibitors compared to laboratory-adapted strains, highlighting the importance of using clinical isolates in TB drug discovery to better reflect the diversity of TB populations. These findings emphasise the potential of cytochrome bc1 inhibition in the development of more effective and shorter treatment regimens for TB, supporting the need for further clinical investigation
Adolescent pregnancy in French Guiana: double trouble for young mothers and small vulnerable newborns.
Get PDFObjectives Adolescent pregnancies (AP), defined as pregnancies in girls aged 10-19 years, are associated with adverse maternal and neonatal outcomes. They are frequently reported among those with low economic status. French Guiana (FG) is a French overseas territory with important social inequalities in South America, marked by inequalities. Our study aimed to describe the sociodemographic characteristics and use of the healthcare system for AP in FG. Study design Population based historical cohort. Methods This study included all births in FG between 2013 and 2021. Data from each mother-newborn pair ≥22 weeks of gestation and/or weighing ≥500 g were analysed. AP were compared to non-AP. Results 67,962 newborns were included. AP accounted for 8810 pregnancies (13.0 %), which was 10 times more than in France. Newborns from AP were more frequently transferred to neonatal care units when compared to those from non-AP (10.6 % vs 9.5 %, p -3). St-Laurent-du-Maroni hospital (western part of FG) was the main place of delivery for AP with 50.7 % of all AP delivering there. Two countries of origin of the mothers accounted for the majority of AP: FG (65.9 %) and Suriname (17.3 %) (p-3). AP were more frequently associated with preterm birth (aOR = 1.09 [1.01-1.18]), small for gestational age newborns (aOR = 1.66 [1.55-1.78]) and lack of health insurance coverage at delivery (aOR = 1.34[1.19-1.49]). Conclusions AP in FG is a public health concern. Comprehensive prevention and care approaches are needed given the double burden faced by young mothers and their children
Rates and Risk Factors for On-Treatment Mortality Among a Cohort of Adults Treated for Drug-Sensitive Tuberculosis: Analysis of Data From the Adherence Support Coalition to End Tuberculosis Consortium in Five Countries.
Get PDFBACKGROUND: Tuberculosis remains a leading cause of death globally, particularly in countries with high tuberculosis and HIV burdens. Disruptions caused by the COVID-19 pandemic may have further impacted tuberculosis outcomes. This study examines on-treatment mortality and associated risk factors in five countries.
METHOD: We conducted a secondary analysis of data from ASCENT cluster-randomised trials of digital adherence tools for improved adherence involving 23,799 adults with drug-sensitive tuberculosis in South Africa, Tanzania, Ethiopia, the Philippines, and Ukraine. Analyses were conducted separately by country. Mortality rates were measured from treatment initiation to the earliest of 6 months, death, or loss to follow-up. Cox regression models (with random effects or robust standard errors for clustering) assessed the associations between mortality and HIV status, ART use, tuberculosis diagnosis type, and calendar periods (COVID-19 pandemic and conflict in Ukraine).
RESULTS: Mortality rates ranged from 7.6 (Ethiopia) to 23.2 (Tanzania) and 23.3 (Ukraine) per 100 person-years. Higher mortality was associated with: older age in all countries (age < 30 versus ≥ 60 years, adjusted rate ratio [aRR] ranging from 2.38 to 6.57 by country); HIV status (positive versus negative, aRR ranging from 1.44 to 2.98 by country); tuberculosis diagnosis type (clinical vs. bacteriological, aRR 1.5-1.6 in Ethiopia, Tanzania and South Africa); extrapulmonary tuberculosis (aRR 1.44 to 1.60 in Ukraine and Tanzania). ART versus HIV-positive not on ART was linked to lower mortality in South Africa and Ukraine but not in Tanzania. Analyses suggested possible mortality variations by calendar period.
CONCLUSION: Our findings suggest variability in tuberculosis mortality across settings, influenced by HIV/ART and diagnosis type. The high mortality rates across countries may reflect underlying causes or potential misdiagnoses. Further investigation into these factors may be needed to improve tuberculosis outcomes globally
Building capacity for HIV and implementation science among students in the United States: the stimulating training and access to HIV research experiences (STAR) program.
Get PDFBACKGROUND: Expanding HIV research capacity among the global majority (individuals identifying as Black/African American, American Indian and Alaska Native, Asian, Native Hawaiian and Other Pacific Islander, Multiracial, and Hispanic/Latino) is important. However, achieving national goals to increase the pool of implementation science and HIV early-stage investigators from underrepresented backgrounds remains elusive, largely due to limited investment in training and mentoring these individuals. To address this issue, we launched the Stimulating Training and Access to HIV Research Experiences (STAR) program, a partnership led by Saint Louis University and the University of North Carolina at Chapel Hill in collaboration with Georgia State University and Texas A&M University. The STAR program aims to establish a pathway for Underrepresented minority (UREM) students to engage in HIV and implementation science research.
METHODS: We launched a crowdsourcing open call from November 30, 2022, to January 22, 2023, to identify potential trainees at the four participating institutions (Prompt: "How might we promote HIV prevention among youth aged 13-24 years in your community?"). The finalists from the crowdsourcing call participated in a 2-day designathon, which included didactic introductory lectures on HIV, dissemination and implementation science. The finalists participated in a 6-week innovation bootcamp, including modules on HIV research, implementation science, research ethics, and fieldwork experience with community partners. We assessed the acceptability of the STAR program through participant self-reported surveys on their experience and evaluation of the lectures.
FINDINGS: Twenty-four individuals applied to the STAR program by completing the crowdsourcing open call, 12 were selected for the designathon, and 10 completed the fellowship. The first cohort of STAR trainees (10 students-6 undergraduate and 4 graduate students) successfully completed the STAR innovation bootcamp. The innovation bootcamp culminated in seven proposals that the trainees implemented and evaluated over 12 months, with support from the research team, mentors, and participatory learning community. The implementation strategies proposed by the trainees include the use of peer engagement, storytelling, digital engagement tools, and artificial intelligence to promote awareness of HIV and increase the uptake of HIV testing. All the participants were satisfied with the STAR program (90% very satisfied and 10% satisfied) and indicated enthusiasm for pursuing academic and research careers in HIV and/or implementation science.
CONCLUSION: Building a pathway for UREM investigators is crucial to ending the HIV epidemic. The STAR program may enhance interest, build research capacity, and increase the UREM talent pool retained in this field
Implementing the Molbio Truenat platform and tuberculosis assays versus standard of care at primary care clinics for the detection and treatment of tuberculosis in Mozambique and Tanzania (TB-CAPT CORE): a cluster-randomised trial
Get PDFBackground:
To support access to life-saving tuberculosis testing and treatment, we evaluated whether placing portable, low complexity, WHO-recommended rapid molecular diagnostics at primary care clinics increased diagnoses and accelerated anti-tuberculosis treatment initiation compared to routine off-site testing.
Methods:
We conducted an open cluster-randomised trial of primary care clinics in Mozambique and Tanzania that provided tuberculosis diagnosis and treatment. Clinics were randomly assigned (1:1) to either on-site testing with Molbio Truenat MTB-Plus and RIF-Dx assays (intervention), or standard of care with referral-based testing using Xpert MTB/RIF Ultra (control). Adults (age ≥18 years) presenting to clinics with symptoms of presumptive pulmonary tuberculosis were eligible for inclusion if they could produce sputum and consented to participate. The primary outcome was the absolute number and proportion of participants with microbiologically confirmed tuberculosis who started treatment within 7 days of enrolment (their first visit), assessed among those with outcome data from follow-up calls (analysis population), among all enrolled participants who met eligibility criteria. This study is registered with ClinicalTrials.gov, NCT04568954.
Findings:
Between Nov 19 and Dec 3, 2020, 114 clinics were screened, of which 29 were randomly assigned and allocated to the intervention group (15 clinics) or control group (14 clinics). Between Aug 26, 2022 and June 16, 2023, 4034 participants (median age 42 years [IQR 32–55], 2156 [53·4%] female and 1878 [46·6 %] male, and 1281 [31·8%] living with HIV) were enrolled. 2534 and 2471 individuals were screened for eligibility in the intervention and control groups, respectively, with 2037 (80·4%) and 1997 (80·8%) participants enrolled; 47 participants were lost to follow-up. 302 (7·6%) of 3987 enrolled participants with outcome data had microbiologically confirmed tuberculosis. Among all enrolled participants, 147 (7·3% [95% CI 6·3–8·6]) of 2007 in the intervention group and 95 (4·8% [3·9–5·8]) of 1980 in the control group started treatment within 7 days (odds ratio [OR] 1·62 [95% CI 1·01–2·60]). Among those with microbiologically confirmed tuberculosis who were eligible for treatment, 147 (96·7%) of 152 in the intervention group and 95 (63·3%) of 150 in the control group started treatment within 7 days (OR 17·80 [95% CI 7·16–56·56]). The incidence rate ratios of starting treatment within 7 days were 1·52 (95% CI 1·12–2·07) for all enrolled participants and 1·48 (95% CI 1·35–1·63) for those with microbiologically confirmed tuberculosis who were eligible for treatment.
Interpretation:
This trial provides strong evidence supporting the placement of low complexity molecular tuberculosis diagnostics at primary care level, to enable same-day diagnosis and treatment initiation.
Funding:
The TB-CAPT CORE study is part of the EDCTP2 programme supported by the European Union
Assessing the Impact of SARS-CoV-2 Spike Mutations on Antibody Binding: A Comparative Assessment of the Wuhan and JN.1 Variants' Full-Length Spikes in a Multiplex Luminex Assay.
Get PDFSevere Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) continues to evolve, with mutations leading to the emergence of new variants. JN.1, a subvariant of omicron BA.2.86, has demonstrated marked immune escape and is now included in updated vaccine formulations. While reduced sensitivity has been reported for antibody assays using ancestral spike protein subunits to detect omicron-induced responses, the performance of full-length spike-based assays against omicron sublineages remains unclear. We aimed to compare the sensitivity of ELISA and Luminex assays using full-length spike proteins from the ancestral Wuhan strain and the JN.1 variant. METHODS: Wuhan and JN.1 full-length spike protein constructs were designed and expressed in Expi293F mammalian cells. In-house ELISAs based on previously validated protocols were used to measure anti-spike IgG levels. Additionally, a Luminex-based assay for anti-spike antibody detection was developed and validated. Both assays were applied to the following sample groups: pre-pandemic samples (designated "gold standard negatives"); PCR confirmed 2020 positives ("gold standard wildtype positives"); PCR confirmed 2024 positives ("gold standard omicron positives"); 2022 vaccinated individuals with verbal confirmed infection ("gold standard hybrid positives"); and 2024 household samples ("unknowns"). RESULTS: Wuhan spike protein showed a sensitivity of 100% (95% CI: 0.88-1.0) in detecting omicron-specific antibodies using gold standard omicron positives with JN.1 spike protein as a reference assay. Overall, across all samples, in ELISA, the Wuhan antigen had a sensitivity of 0.93 (95% CI: 0.89-0.95) and a specificity of 0.98 (95% CI: 0.94-0.99). The JN.1 antigen showed a sensitivity of 0.91 (95% CI: 0.87-0.94) and a specificity of 0.97 (95% CI: 0.93-0.99). In Luminex, sensitivity was 0.95 (95% CI: 0.91-0.97) for Wuhan and 0.94 (95% CI: 0.91-0.96) for JN.1. Specificity for both antigens in Luminex was 0.98 (95% CI: 0.94-0.99). CONCLUSIONS: Both ELISA and Luminex assays showed comparable sensitivity and specificity for both Wuhan and JN.1 antigens, indicating that mutations in the JN.1 variant do not significantly impact assay performance. This suggests preserved antigenic recognition across variants
Motivations, Facilitators, and Barriers of Donation-Based Interventions in HIV and Sexually Transmitted Infection Research: A Systematic Review.
Get PDFIMPORTANCE: Donation-based prosocial interventions involve someone receiving a free health service and then distributing or donating to support health services for others; examples within the HIV and sexually transmitted infection (STI) literature include secondary distribution of HIV self-tests, secondary syringe exchange, and pay it forward for STI testing. These interventions answer research and policy recommendations to incorporate prosocial behaviors into HIV/STI services.
OBJECTIVE: To describe motivations, facilitators, and barriers of donation-based interventions in HIV and STI research using data from qualitative studies.
EVIDENCE REVIEW: In this systematic review, 5 databases (PubMed, CINAHL, Embase, PsycInfo, and Scopus) and references were searched up to January 23, 2024, for qualitative studies of donation-based interventions. Thematic synthesis was used to summarize findings, the Critical Appraisal Skills Programme Qualitative Studies Checklist was used to assess risk of bias among studies, and GRADE-CERQual (Confidence in the Evidence From Reviews of Qualitative Research) was used to assess confidence in review findings.
FINDINGS: Of 374 studies screened, 27 were included, which included 1543 participants, assessing secondary distribution of HIV self-tests (15 studies), secondary syringe exchange among people who inject drugs (10 studies), and pay it forward for STI testing (2 studies). Studies were from low-income (5 studies), middle-income (13 studies), and high-income (12 studies) countries. Givers who distributed health services were motivated by a selfless concern to benefit others (20 studies, moderate confidence) and by the cultivation of a prosocial identity (20 studies, moderate confidence). Social proximity between givers and recipients facilitated distribution (22 studies, moderate confidence), allowing for recipient-tailored strategies to introduce the service, strengthen peer relationships, and promote reciprocal giving. However, secondary syringe distribution could subject people who use drugs to legal harms and encourage them to provide unsupervised clinical care (7 studies, low confidence).
CONCLUSIONS AND RELEVANCE: This systematic review identified motivations, facilitators, and barriers of donation-based interventions for HIV/STI services that could enhance implementation. Donation-based interventions may foster prosocial motivation and responsibility among socially marginalized populations to increase access to HIV/STI services
Effectiveness and cost-effectiveness of community perinatal mental health services on access, experience, recovery/relapse and obstetric and neonate outcomes: the ESMI-II mixed-methods study.
Get PDFBACKGROUND: Perinatal mental health disorders affect one in five mothers during pregnancy or within 2 years post childbirth. These disorders can lead to poor pregnancy and childbirth outcomes and maternal deaths. Additionally, they negatively affect a child's cognitive, social and emotional development. Stigma and a lack of specialised services have limited access to mental health care. National Health Service England invested £365M in community perinatal mental health teams, but their impact on women and infants' outcomes are not known. Develop a taxonomy of community perinatal mental health teams (work package 1). Compare and validate two assessments of quality of mother-infant interaction for use by community perinatal mental health teams (work package 2). Evaluate the effectiveness and cost-effectiveness of community perinatal mental health teams (work packages 3 and 4). DESIGN: Mixed-methods study. SETTING: Community perinatal mental health teams in England. PARTICIPANTS: Women who were pregnant or within 2 years postnatal. METHODS AND OUTCOME MEASURES: Work package 1: Typology of community perinatal mental health teams in England. Work package 2: Reliability and validity of two observational assessments of parent-infant interaction. Work package 3: Realist evaluation interviews with women, partners/close others, and staff to determine effective community perinatal mental health team components. Work package 4: Analysis of linked data: Association of community perinatal mental health teams with access to secondary care mental health services. Risk of acute relapse and improved obstetric and neonate outcomes for women with pre-existing severe disorders in areas with community perinatal mental health teams compared to generic services. Economic analysis of cost of community perinatal mental health teams. RESULTS: Objective 1: Community perinatal mental health team typologies revealed in 2020, 84% had basic staffing levels and 63% had more multi-professionals. Objective 2: The 'Parent Infant Interaction Observation Scale' and 'National Institute of Child Health and Human Development' assessments of mother-infant interaction were reliable and valid; the National Institute of Child Health and Human Development is more suitable for community perinatal mental health teams. Objective 3: Work package 3: Interviews with 139 women, 55 partners/close others and 80 health workers highlighted the importance of specialist perinatal knowledge, responding in a warm and non-judgemental way, working closely with other healthcare providers, optimising medication, supporting mothers to reduce conflict and improve social support, helping mother-infant bonding, and teaching emotional management. Work package 4: Analysis of linked health data revealed higher risks for obstetric and neonate problems in women with severe mental health disorders, particularly recent or very serious episodes. Work package 4: Areas with community perinatal mental health teams saw increased mental health access among perinatal women and reduced need for acute care, albeit at a higher cost and with greater neonatal risks. LIMITATIONS: High levels of missing data on diagnosis and mental health outcomes in existing health and service data. Lack of data on child outcomes. Evaluation occurred during community perinatal mental health team changes and the coronavirus disease discovered in 2019 pandemic limiting a full assessment of the impact of community perinatal mental health teams on maternal and child outcomes. CONCLUSIONS: Community perinatal mental health teams can support perinatal women with complex, moderate/severe mental health disorders, but further attention to women's physical needs is essential. The use of observational assessments of parent-infant relationships will enhance the evaluation of community perinatal mental health teams' impact on infant outcomes. FUTURE WORK: Research should focus on prospective studies that gather mental health and child outcomes from community perinatal mental health teams and primary care mental health, to assess broader impacts of perinatal-specific treatment across care pathways. STUDY REGISTRATION: This study is registered on Research Registry as researchregistry5463. FUNDING: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/49/38) and is published in full in Health and Social Care Delivery Research; Vol. 13, No. 38. See the NIHR Funding and Awards website for further award information
Potential of microRNAs as diagnostic markers for distinguishing malaria severity in samples from an Indian cohort.
Get PDFBACKGROUND: Cerebral malaria (CM) is a subcategory of severe malaria (SM) and a major cause of death in Plasmodium falciparum infections, driven by the sequestration of infected red blood cells in the microvasculature of host vital organs. Identifying early biomarkers of CM is crucial for timely intervention. This study assessed the potential of microRNAs, produced upon organ injury, as biomarkers of CM.
METHODS: Plasma levels of six microRNAs were quantified in patients with CM (n = 43), severe non-CM (SNCM; n = 50), uncomplicated malaria (UM; n = 79), asymptomatic malaria (AM; n = 80), and non-malarial febrile illnesses (nMFI; n = 69) using TaqMan-RT-qPCR.
RESULTS: Plasma levels of hsa-miR-21-5p, hsa-miR-150-5p, and hsa-miR-3158-3p correlated with SM (p 80%. A random forest machine learning (ML) model predicted CM patients on admission using a combination of three microRNA levels, achieving 83% sensitivity, 100% specificity, and 92% balanced accuracy.
CONCLUSIONS: The combined use of hsa-miR-21-5p, hsa-miR-150-5p, and hsa-miR-3158-3p microRNAs may offer a powerful, non-invasive approach for early CM diagnosis, potentially improving clinical outcomes and patient survival