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Qualitative evaluation of two London Faith and Health Networks: lessons learnt from a model of an interface between health systems and minority communities.
Get PDFBACKGROUND: Ethnic and religious minorities in the UK had a higher risk of severe illness and mortality from COVID-19 in 2020-2021, yet were less likely to receive vaccinations. Two Faith Health Networks (FHNs) were established in London in 2022-2024 as a partnership approach to mitigate health inequalities among Muslim and Jewish Londoners through a health system-community collaboration. By evaluating the FHNs, this study aimed to examine: the organisational processes required for FHNs to serve as a model of interface between health systems and minority communities; the role these networks play in addressing public health inequalities; and implications for their future development and sustainability. METHODS: A qualitative evaluation of the two FHNs was conducted using semi-structured interviews (n=19) with members of the 'London Jewish Health Partnership' and the 'London Muslim Health Network'. Participant clusters included public health professionals, healthcare workers, community representatives and local government workers. RESULTS: The FHNs shared similar structures of leadership, but differed in core membership, which influenced their access to expertise and the activities developed. They were found to perform a key conduit role by integrating expertise from within the health system and faith communities to address the needs and expectations of underserved communities, with the ultimate goal of addressing health inequalities through the design of tailored campaigns and services. Emerging themes for developing an FHN model included enhancing their sustainability by determining funding allocation, strategic integration into health systems and identifying the appropriate geographical scope to sustain their impact. Further implications included recognition of intersectionality, addressing diverse needs within faith communities and trust-building approaches. CONCLUSION: This evaluation offers insights into developing partnership models between faith-based organisations and health sectors to foster relationships with underserved communities. These findings provide valuable considerations for teams navigating the priority of health equity and community engagement as part of our learning from the pandemic to support the development of FHNs across different faith communities, not just for vaccine uptake, but to support the broader health and well-being of communities more widely
Sociobehavioural factors associated with SARS-CoV-2 infection and COVID-19 vaccine effectiveness against medically attended, symptomatic SARS-CoV-2 infection in the Philippines: a prospective case-control study (FASCINATE-P study).
Get PDFOBJECTIVE: We examined sociobehavioural factors associated with SARS-CoV-2 infection and estimated COVID-19 vaccine effectiveness against symptomatic SARS-CoV-2 infection in the Philippines. Such studies are limited in low- and middle-income countries, especially in Asia and the Pacific. METHODS: A case-control study was conducted in two hospitals in Manila, Philippines, from March 2022 to June 2023. Sociobehavioural factors and vaccination history were collected. PCR-positive individuals were cases, while PCR-negative individuals were controls. Adjusted odds ratios (aORs) were calculated to examine associations between sociobehavioural factors/vaccination and medically attended SARS-CoV-2 infection. RESULTS: The analysis included 2489 individuals (574 positive cases, 23.1%; 1915 controls, 76.9%; median age [interquartile range]: 35 [27-51] years). Although education and household income were not associated with infection, being a health-care worker was (aOR: 1.45; 95% confidence interval [CI]: 1.03-2.06). The odds of infection were higher among individuals who attended gatherings of five or more people compared to those who attended smaller gatherings (aOR: 2.58; 95% CI: 1.14-5.83). Absolute vaccine effectiveness for vaccination status was not estimated due to a high risk of bias, for example, unascertained prior infection. Moderate relative vaccine effectiveness for the first booster (32%; 95% CI: -120-79) and the second booster (48%; 95% CI: -23-78) were observed (both with wide CI), albeit with a waning trend after half a year. DISCUSSION: The higher odds of infection among health-care workers emphasize the importance of infection prevention and control measures. Moderate relative vaccine effectiveness with a waning trend reiterates the need for more efficacious vaccines against symptomatic infection caused by circulating variants and with longer duration of protection
Comparison of antibiotic provision associated with acute sore throat symptom management in community pharmacies in Wales and England: a natural policy experiment.
Get PDFBACKGROUND: Acute sore throat is managed in community pharmacies in England and Wales under different clinical pathways: Acute Sore Throat Pharmacy First (ASTPF) and Sore Throat Test and Treat (STTT), respectively. ASTPF launched in 2024 and allows antibiotic supply with FeverPAIN scores 4 and 5. STTT launched in 2018 and allows antibiotic supply with FeverPAIN ≥2 or Centor ≥3, if point-of-care testing confirms presence of group A Streptococcus (GAS). OBJECTIVES: To compare antibiotic supply rates of ASTPF and STTT, between 1 February 2024 and 30 July 2024, covering the first 6 months of ASTPF. METHODS: A descriptive study using anonymized individual-level data from electronic pharmacy records of STTT and anonymized population-level aggregate data from electronic records of ASTPF consultations meeting the gateway criteria for reimbursement. RESULTS: During the study period, 317 864 ASTPF and 27 684 STTT consultations were recorded across participating pharmacies, representing 551.0 and 874.9 consultations per 100 000 population in England (57 690 300) and Wales (3 164 400), respectively. The antibiotic supply rate was 72.7% (95% CI: 72.5% to 72.8%) for ASTPF and 29.9% (95% CI: 29.4% to 30.5%) for STTT. CONCLUSIONS: In this natural experiment in two similar healthcare systems with pharmacy-led sore throat services, we found different rates of antibiotic supply. Differences could be attributable to service implementation, pharmacists' initial training, engagement with GPs, pathway differences (e.g. gateway criteria and use of point-of-care tests), symptom severity, or most likely a combination of multiple factors. This early analysis suggests adapting the ASTPF pathway, to include point-of-care testing, could lead to reductions in unnecessary antibiotic supply
How to incorporate social vulnerability into epidemic mathematical modelling: recommendations from an international Delphi.
Get PDFEpidemic mathematical modelling plays a crucial role in understanding and responding to infectious disease epidemics. However, these models often neglect social vulnerability (SV): the social, economic, political, and health system inequalities that inform disease dynamics. Despite its importance in health outcomes, SV is not routinely included in epidemic modelling. Given the critical need to include SV but limited direction, this paper aimed to develop research recommendations to incorporate SV in epidemic mathematical modelling. Using the Delphi technique, 22 interdisciplinary experts from 12 countries were surveyed to reach consensus on research recommendations. Three rounds of online surveys were completed, consisting of free-text and seven-point Likert scale questions. Descriptive statistics and inductive qualitative analyses were conducted. Consensus was reached on 27 recommendations across seven themes: collaboration, design, data selection, data sources, relationship dynamics, reporting, and calibration and sensitivity. Experts also identified 92 indicators of SV with access to sanitation (n = 14, 6.1 %), access to healthcare (n = 12, 5.3 %), and household density and composition (n = 12, 5.3 %) as the most frequently cited. Given the recent focus on the social determinants of pandemic resilience, this study provides both process and technical recommendations to incorporate SV into epidemic modelling. SV's inclusion provides a more holistic view of the real world and calls attention to communities at risk. This supports forecasting accuracy and the success of policy and programmatic interventions
The association between 25-hydroxyvitamin D and parathyroid hormone in adolescents living with HIV in southern Africa: a cross-sectional study.
Get PDFLow vitamin D associated with high parathyroid hormone (PTH) is common in HIV infection. We determined the association between total 25(OH)D and PTH in adolescents living with HIV, in Zambia and Zimbabwe. Adolescents (11-19 years) perinatally infected with HIV and established on antiretroviral therapy for ≥ 6 months were recruited into a cross-sectional study. Socio-demographic and clinical characteristics were recorded, anthropometry measured and fasted serum concentrations of 1,25(OH)2D, total 25(OH)D and intact PTH measured. The association between total 25(OH)D and PTH was examined using natural cubic spline regression. 842 participants (female: 53·2%) with a median age of 15·5 (IQR: 13·2-17·9) years were enrolled. Median antiretroviral therapy duration was 9·8 (IQR: 6·3-12·3) years, and 165/841 had an HIV viral-load >60 copies/ml. Stunting (height-for-age z-score 75 nmol/l may need to be achieved to improve bone health; investigation is needed in future research studies
Comparison of Telephone and In-Person Interview Modalities: Duration, Richness, and Costs in the Context of Exploring Determinants of Equitable Access to Community Health Services in Meru, Kenya
Get PDFBackground
Our research team conducted phenomenological interviews in Kenya with people who were not able to access community eye health services, aiming to explore the barriers and ideas for potential service modifications. We conducted an embedded study that compared in-person and telephone interview modalities in terms of time requirements, costs, and data richness.
Methods
A team of six interviewers conducted 31 in-person interviews and 31 telephone interviews using the same recruitment strategy, topic guide, and analytic matrix for each interview. We compared the mean duration; mean number of themes reported by each participant; total number of themes reported; interviewer rating of perceived richness; interviewer rating of perceived ease of building rapport; number of days taken by the team to complete all interviews; and all costs associated with conducting the interviews in each modality.
Results
In-person interviews were 44% more expensive and took 60% longer to complete than our telephone interviews (requiring 5 days and 3 days respectively). The average in-person interview lasted 110 seconds longer than the average telephone interview ( p = .05) and generated more words and themes. However, the full set of interviews from both approaches identified similar numbers of barriers ( p = .14) and the same number of solutions ( p = .03). Interviewers universally felt that the in-person approach was associated with better rapport and higher quality data ( p = .01). Triangulation of themes revealed good agreement, with 88% of all solutions occurring in both sets of interviews, and no areas of thematic dissonance.
Conclusions
The in-person approach required more time and financial resources, but generated more words and themes per person, and was perceived to afford richer data by interviewers. However, this additional richness did not translate into a greater number of themes that our team can act upon to improve services
Inclusive health for people with disabilities in Chile: a national health system assessment.
Get PDFBACKGROUND: Globally, one in six people have disabilities. They often experience health inequities and many of them arise from system-level failures. This study aimed to assess the inclusion of people with disabilities in the health system of Chile and define recommendations for improvement on the basis of the evidence. METHODS: A health system assessment was conducted between June and November 2023 following the Missing Billion Disability-Inclusive Health Systems Framework and System Level Assessment Toolkit. The assessment was led by the Ministry of Health and conducted by a task team, including organizations of people with disabilities. Mixed methods were used to collect data on nine system-level and service delivery components for a set of 33 indicators, including through a health policy review, systematic review, key informant interviews and a scoping review. Scores were assigned to indicators, components and the overall health system. With this assessment, key recommendations were developed and agreed upon on the basis of a prioritization analysis of impact and feasibility during workshops. RESULTS: The Chilean health system was assessed to have a low progress towards disability-inclusive health. Among system-level components, intermediate progress has been made in governance, health financing and data and evidence. However, progress in leadership on disability seems low. Among service delivery components, the accessibility of health facilities and rehabilitation and assistive technology showed the best results. However, there were notable gaps in the autonomy and awareness and ability to afford care by people with disabilities, and the capacity of human resources to support this group. The task team defined priority actions in governance, leadership, and human resources. CONCLUSIONS: Short-term actions for the country should involve foundational governance on inclusive health, strengthened leadership of people with disabilities, and mandatory training of healthcare workers to improve healthcare access among this population. Future reassessments should be conducted to monitor and evaluate progress on effective healthcare coverage and health status among people with disabilities
Living in the shadows: the persistence of secrecy in young people living with HIV on antiretroviral therapy, a qualitative study of the BREATHER Plus trial
Get PDFUnderstanding antimicrobial resistance in Campylobacter isolates from poultry environments in Gujarat, India
Get PDFCampylobacter, a pathogen responsible for human gastroenteritis on a global scale, is primarily spread through the consumption of contaminated chicken meat. Antimicrobial treatments are commonly required in response to campylobacteriosis, highlighting the risk posed by antimicrobial resistance (AMR) in Campylobacter to food safety and public health. Monitoring and understanding AMR trends is crucial for effective risk assessment and development of management strategies. The current investigation examines the physical and genetic traits of AMR in Campylobacter species found in the caeca of chickens. Samples were collected from chicken farms and live chicken retail outlets across eight major cities in Gujarat, India. Selective culture from 750 samples found 21 of 250 samples from farms (8.4 %) and 56 of 500 samples from outlets (11.2 %) contained Campylobacter spp., confirmed by multiplex PCR and Sanger sequencing. Campylobacter coli was most common, detected in 56 samples (7.5%), with Campylobacter jejuni detected in 21 samples (2.8%). As per phenotypic assay, all the isolates were resistant to antibiotics ampicillin/sulbactam, followed by azithromycin (94.44%). Genomes were sequenced from a subset of 16 C. coli and 2 C. jejuni isolates for identification of antimicrobial resistance genes (ARGs). Eleven isolates hosted fluoroquinolone and tetracycline resistance genes. Macrolide resistance genes, such as macB, were found in 94.4% of genomes. The results of the current research highlight a high occurrence of ARG carriage in C. jejuni and C. coli, suggesting that resistance to macrolides, quinolones, and tetracyclines is common. The genotype-phenotype concordance observed was 76.39% whereas, remaining discordance (23.61%) observed was due to the six AMR genes, of which two genes were found truncated length while the remaining genes had complete lengths but had mutations. In-depth examination of the linkage between genetic and phenotypic AMR traits can support development of future strategies and policies to address the growing problem of antibiotic resistance and protect public health
Acute Impact of Nonoptimal Ambient Temperatures on Plasma Levels of 3000 Proteins in Chinese Adults.
Get PDFNonoptimal ambient temperatures (i.e., cold and heat) are leading environmental determinants of major diseases worldwide, but the underlying pathological mechanisms are still poorly understood. We used distributed-lag nonlinear models to examine the associations of cold (5th percentile: -2.1 °C) and heat (95th percentile: 29.5 °C) with 2923 plasma proteins in 3926 adults from 10 areas across China. Overall, 949 proteins were significantly (5% false discovery rate) associated with ambient temperature, including 387 (216/171 down/upregulated) with cold, 770 (656/114 down/upregulated) with heat, and 208 with both cold and heat. Above the median reference temperature (17.7 °C), the associations were largely linear, while below it, they were nonlinear with attenuation below 5 °C, potentially reflecting mediation by heating. Among the 949 proteins, >80% were also associated with systolic blood pressure and incident ischemic heart disease risk and enriched in relevant pathological pathways (e.g., inflammation, immunity, and platelet aggregation). Our study provided a novel atlas of plasma proteins associated with nonoptimal temperatures in Chinese adults