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What happened with preexposure prophylaxis uptake among female sex workers in Zimbabwe? Implications for future prevention programmes.
Get PDFAfter much optimism surrounding the introduction of oral pre-exposure prophylaxis (PrEP) there have been many disappointments around its unrealised promise, particularly for high-risk women in sub-Saharan Africa. Even when uptake has been high, adherence and retention often prove low, markedly so when confirmed by biomarkers. The main reasons for suboptimal use are anxiety about being mistaken for someone living with HIV, dislike of and difficulty maintaining daily pill-taking, and low risk perception. Among female sex workers (FSW) additional barriers include supply disruptions due to mobility, fear of violence from clients, and discrimination within health settings. Our AMETHIST trial was among studies yielding contradictory results; despite high PrEP uptake among FSW, out of 569 women tested in the endline survey just 2 (0.04%) had protective levels in dried blood samples
Using normalisation process theory to understand implementation of effective early-onset type 2 diabetes treatment and care within England: a qualitative study.
Get PDFBACKGROUND: Despite increasing prevalence, early-onset type 2 diabetes (EOT2D) has received little clinical and qualitative research attention within England. This qualitative study aimed to explore and understand the unmet needs of people living with early-onset type 2 diabetes (PEOT2D) and their diabetes care within England. METHODS: Using semi-structured interviews, data was collected, transcribed and analysed from 25 PEOT2D and 25 healthcare professionals (HCPs). Taking an abductive approach, data for both cohorts were analysed and interpreted according to four constructs of Normalisation Process Theory (NPT): coherence (sense-making), cognitive participation (engagement), collective action (enactment) and reflexive monitoring (formal and informal appraisal). RESULTS: Our findings revealed several unmet needs in current treatment and care for PEOT2D. The main unmet need was access to specialist care. Having GP (general practitioner) practices as their main caregivers presented a significant barrier to this population successfully carrying out their diabetes self-care. HCPs in specialist roles expressed similar views and were keen to see PEOT2D receive access to holistic and specialist care via a multidisciplinary team. Data interpretation according to the four constructs of NPT found that implementation of this approach would involve fostering an environment of support that allowed HCPs across the primary and secondary interface to do the following: (1) provide consultations incorporating person-centred care, shared decision-making, and non-judgemental and non-stigmatising behaviours and (2) work in an integrated and synchronous manner using streamlined referrals, interprofessional collaborations and team-based learning. Provision of tailored financial, human (additional staffing) and learning resources was found to be integral to allow creation of tailored multidisciplinary teams, and individual and collective skill enhancement of both specialist and primary care providers. CONCLUSION: Although both PEOT2D and specialist care providers are keen for young adults with EOT2D to receive access to specialist and holistic care, there are several resource barriers that must be addressed to allow implementation of their desired approach to treatment and care. Further qualitative research with primary care providers (for example, GPs and practice nurses) involved in EOT2D care is needed to understand if (and how) their views and experiences differ from those providing specialist care
Predictors of HIV testing and status disclosure among young adolescents in postconflict settings: findings from a pre-post study design in Nimule per-urban town of South Sudan.
Get PDFOBJECTIVE: To assess HIV testing and status disclosure rates and explore their associated predictors among young adolescents (10-17 years) who received health education through the Orphans and Vulnerable Children programme in Nimule, South Sudan. DESIGN: A pre-post evaluation study with data collected at baseline (December 2020) and at the endline (December 2022). SETTING: The study was conducted in Nimule, a densely populated periurban town characterised by high HIV prevalence and substantial cross-border movement between Uganda and South Sudan, making it a relevant setting for an HIV prevention project. INTERVENTION: The primary intervention was HIV risk education delivered through forty peer-led health clubs. Adolescents were screened for HIV risk factors and referred for HIV and other sexually transmitted infection testing at health facilities. PARTICIPANTS: The study included young adolescents aged 10-17 years recruited from HIV-affected households within 17 neighbourhoods in Nimule periurban town. Informed consent was obtained from both caregivers and adolescents. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was self-reported HIV testing and status disclosure. Binary logistic regression was used to assess the association between the study outcome variables and associated sociodemographic factors. RESULTS: A total of 557 (73.0%) of the 768 enrolled adolescents were surveyed at baseline and endline, including 301 (54.0%) females and 276 (46.0%) males. The median age was 14 years (IQR: 11-16) at baseline and 15 years (IQR: 12-17) at endline.HIV testing increased from 315 (56.7%) at baseline to 557 (100%). The odds of undisclosed HIV status were 49% lower at endline adjusted OR (aOR) 0.51 (95% CI 0.92, 0.67; p<0.001). Status disclosure was nearly universal, with 557 (100%) at baseline and 556 (99.8%) at endline. Male adolescents aOR 0.77 (95% CI: 0.59, 0.99; p<0.04) and those cared for by their siblings or other relatives were less likely to know their HIV status (aOR 0.59; 95% CI: 0.41, 0.84; p<0.003). CONCLUSIONS: Male gender and being cared for by siblings or other relatives were strong predictors of lower HIV testing and status disclosure. These findings underscore the importance of targeting efforts towards this category of adolescents in postconflict and resource-limited settings like South Sudan while leveraging peer-led HIV education interventions in conflict-affected settings
'Community people are the most powerful resources': qualitative critical realist analysis and framework to support co-produced responses to zoonotic disease threats with(in) Nepali communities.
Get PDFBACKGROUND: Co-production between researchers, service providers, and members of affected communities is an old concept renewed by current efforts to decolonise global health, reduce exploitative practices, and develop more sustainable, context-relevant interventions to address global health issues. Working with communities- how ever defined- is central to healthcare improvement but engaging with communities and identifying priorities remains challenging for disease control professionals. Co-production aims to help ensure community members have some control over the design and implementation of any intervention, and greater ownership of processes and outcomes. We aimed to identify what would encourage co-production of activities to prevent potential transmission of zoonoses. METHODS: In this qualitative study, we (British and Nepali researchers) interviewed 73 participants from six communities across Nepal, with 10 participating in photovoice. We also interviewed 20 healthcare professionals and policymakers, 14 representing human and six representing animal health. We interpreted data using reflexive thematic analysis. RESULTS: Thirty-nine people in six communities participated in interviews, with another 34 in 5 focus groups. We generated three overarching themes: (i) constrained healthcare-seeking behaviours, (ii) experience of community programmes, and (iii) community priorities and co-production. Community participants, despite strong opinions and desire to participate in disease control interventions, had experienced little or no attempt by intervention organisers to engage them in design, implementation, evaluation, or accountability. Most had no experience of programmes at all. Participants highlighted the significance of working in 'local' languages, respecting religious and cultural realities, relating initiatives to lived experience, and ensuring that local leaders are involved. CONCLUSIONS: Meaningful co-production requires recognising communities- through legitimate leadership/representation- as expert and equal partners who can 'work alongside' at all stages of any initiative. Implications from this research include the importance of promoting trust in communities through inclusion of influential community members (community health volunteers, traditional medicine practitioners, women's group leaders); the use of indigenous languages; the acceptability of different media for interventions (theatre, drama); and the need to be pragmatic about available resources, to manage the expectations of community members
Infections and cognitive function, depression, and frailty: a cross-sectional study in the longitudinal aging study in India (LASI).
Get PDFINTRODUCTION: Infections may be associated with an increased risk of poor brain health and frailty among older people, but evidence from low-and-middle-income countries (LMICs) is limited. We aimed to investigate associations between nine infections and cognition, depression, and frailty in India. METHODS: We conducted a cross-sectional study using data from Wave 1 (2017–2019) of the Longitudinal Aging Study in India (LASI) survey of adults (≥ 45years) from 35 of India’s 36 states and union territories. Data were collected via face-to-face interviews and direct health measurements. We investigated the association between nine infections, either self-reported ever (periodontal disease) or in the two years before interview (jaundice/hepatitis, malaria, tuberculosis, typhoid, chikungunya, diarrhoea/gastroenteritis, dengue, urinary tract infection [UTI]), and measured global cognitive function, depression, and frailty. We used survey-weighted multivariable logistic regression to compare odds of impaired cognition, depression, and frailty in people with and without infections, overall and for individual infections. RESULTS: We included 64,682 respondents; median age 59 years (IQR:50–67), 53.5% female, 35% reported at least one infection. After controlling for demographic, social/environmental and lifestyle factors, and chronic health conditions, we saw evidence of associations between infection and both depression (OR: 1.28 [95%CI: 1.22–1.35]) and frailty (OR: 1.74 [95%CI: 1.65–1.84]). UTIs were associated with the highest odds of both depression (OR: 1.33 [95%CI: 1.14, 1.55) and frailty (OR: 2.94 [95%CI: 2.51, 3.44]). Reporting at least one infection was associated with reduced odds of impaired cognition (OR: 0.80 [95%CI: 0.74–0.86]). CONCLUSIONS: Our results suggest infections are associated with increased depression and frailty in adults over 45 in India. Our finding of association between reported infections and better cognition, is potentially explained by preferential infection recall in those with better cognition. Longitudinal studies are needed to investigate potential causal links between infections and adverse brain health and frailty and guide interventions to improve the health of older people in India and other LMICs. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-025-23490-w
'Female Genital Schistosomiasis: Translational Challenges and Opportunities' - outputs and actions from a consultative, collaborative and translational workshop.
Get PDFFemale genital schistosomiasis (FGS) is a chronic disease manifestation of the waterborne parasitic infection Schistosoma haematobium that affects up to 56 million women and girls, predominantly in sub-Saharan Africa. Starting from early childhood, this stigmatizing gynaecological condition is caused by the presence of Schistosoma eggs and associated toxins within the genital tract. Schistosoma haematobium typically causes debilitating urogenital symptoms, mostly as a consequence of inflammation, which includes bleeding, discharge and lower abdominal pelvic pain. Chronic complications of FGS include adverse sexual and reproductive health and rights outcomes such as infertility, ectopic pregnancy and miscarriage. FGS is associated with prevalent human immunodeficiency virus and may increase the susceptibility of women to high-risk human papillomavirus infection. Across SSA, and even in clinics outside endemic areas, the lack of awareness and available resources among both healthcare professionals and the public means FGS is underreported, misdiagnosed and inadequately treated. Several studies have highlighted research needs and priorities in FGS, including better training, accessible and accurate diagnostic tools, and treatment guidelines. On 6 September, 2024, LifeArc, the Global Schistosomiasis Alliance and partners from the BILGENSA Research Network (Genital Bilharzia in Southern Africa) convened a consultative, collaborative and translational workshop: 'Female Genital Schistosomiasis: Translational Challenges and Opportunities'. Its ambition was to identify practical solutions that could address these research needs and drive appropriate actions towards progress in tackling FGS. Here, we present the outcomes of that workshop - a series of discrete translational actions to better galvanize the community and research funders
Relationship Breakup Impact on Mental Health and Safer Sex Among Men Who Have Sex with Men in the United Kingdom
Get PDFThis study investigated the impact of breakup recency and relationship status on mental health (anxiety, depression, suicidal ideation, possible alcohol dependence, sexual unhappiness, worry about drug use) and safer sex (sexual assertiveness and non-steady condomless partners) among men who have sex with men (MSM) in the United Kingdom (UK). We analyzed data from 11,763 UK-based MSM in the European MSM Internet Survey. ANOVAs were run to explore differences in mental health across breakup recency (5 years ago). Logistic regressions (adjusting for age and HIV status) were used to compare partnered MSM on mental health and safer sex with MSM who had broken up in the last 6 months. ANOVAs revealed significant downward trends for anxiety/depression (F(1) = 11.384, G = -0.061, p < 0.001) and alcohol dependence (F(1) = 10.679, G = -0.084, p < 0.001), decreasing as time passed since the breakup. Sexual unhappiness followed a reverse pattern (F(1) = 82.15, G = 0.137, p < 0.001). Logistic regressions showed that compared to partnered MSM, those who broke up within the past 6 months reported significantly higher levels of anxiety/depression (aOR = 1.55, p < 0.001), suicidal ideation (aOR = 1.63, p < 0.001), alcohol dependence (aOR = 1.21, p < 0.001), and sexual unhappiness (aOR = 1.66, p < 0.001). MSM who have recently experienced breakups may face temporary mental/sexual health challenges, warranting targeted support
A paternal lactate dehydrogenase critically enhances male gametogenesis and malaria transmission.
Get PDFMalaria blood stage parasite development relies on glycolysis to generate ATP, which requires pyruvate to lactate conversion by an essential lactate dehydrogenase enzyme (LDH1). Conversely, parasites developing in the mosquito employ mitochondrial chemiosmosis for ATP production. The source of ATP during transition from vertebrate to insect is less clear; gametes form in the mosquito midgut lumen within minutes of gametocyte ingestion, and while female gametes possess a mitochondrion, this organelle is absent from male gametes (microgametes). Here, we investigate a second LDH enzyme (LDH2) found exclusively in male gametocytes and microgametes. Knockout of Plasmodium berghei LDH2 expression reduces the number and size of exflagellation centres and radically diminishes oocyst development in Anopheles stephensi mosquitoes. Our data indicate that LDH2 supplements LDH1 activity to facilitate the cytokinesis step of male gametogenesis, while LDH1 alone is sufficient for motility of free-swimming microgametes. Our results point to a key role for glycolytic ATP production in microgamete formation and function and identify LDH activity as a potential malaria transmission-blocking drug target
Concurrent validity, test-retest reliability, and normative properties of the ignite app: A cognitive assessment for frontotemporal dementia.
Get PDFOBJECTIVE: Digital biomarkers can provide frequent, real-time monitoring of health-related behavior and could play an important role in the assessment of cognition in frontotemporal dementia (FTD). However, the validity and reliability of digital biomarkers as measures of cognitive function must first be determined. METHOD: The Ignite cognitive app contains iPad-based measures of executive function, social cognition, and other domains affected in FTD. Here we describe the normative properties of the Ignite tests, evaluate associations with gold-standard neuropsychological tests, and investigate test-retest reliability through two healthy control studies. Over 2,000 cognitively normal adults aged 20-80 years were recruited to complete the Ignite app remotely. A separate cohort of 98 healthy controls completed Ignite at two timepoints (7 days apart), a pen and paper neuropsychology battery, and a User Experience Questionnaire. RESULTS: Significant associations were found between age and performance on several Ignite measures of processing speed (r = 0.42-0.56, p 90%) rated the app favorably, stating it was enjoyable and easy to complete unsupervised. CONCLUSIONS: These findings offer early support for the validity of the Ignite tests suggesting they measure the intended cognitive processes, capture a stable picture of performance over time, and are well accepted in healthy controls. This work supports the feasibility of administering the app remotely and its potential utility as a cognitive tool in FTD; however, validation is ongoing, and further work is required before Ignite can be used as an endpoint in clinical trials. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
Decentralising healthcare for diabetes and hypertension from secondary to primary level in a humanitarian setting in Kurdistan, Iraq: a qualitative study.
Get PDFBACKGROUND: Experts suggest that Non-Communicable Disease (NCD) care is best delivered at the primary level, including in humanitarian crisis settings. In many crisis-affected countries, NCD care is predominantly delivered by specialists at secondary care level, and there is limited evidence on decentralising NCD care in such settings. We aimed to explore health actor and patient experiences of decentralising diabetes and hypertension (DM/HTN) care from a hospital to primary care clinics in the humanitarian setting of Duhok, Kurdistan Region of Iraq. METHODS AND RESULTS: We conducted a qualitative study including 30 semi-structured interviews with a purposive sample of patients (n = 16), healthcare providers (n = 7), and key stakeholders (n = 7) involved in the decentralisation project. Guided by a conceptual framework, data were analysed thematically using deductive and inductive approaches. The decentralisation project achieved its stated goals of (a) increasing patients' access to DM/HTN care, by reducing cost and distance, and (b) decreasing workload at secondary care level. The approach appeared acceptable from patient, provider and stakeholder perspectives. Key health system inputs were put in place to support the decentralisation project, including medicines, equipment and health workforce training, but gaps remained. While access and quality seemed to improve, integration, continuity and sustainability were more challenging to achieve. Key systemic challenges to sustainability included a lack of health financing, and weak national supply chains and information systems. Patients' trust in the service was important and was closely linked to having access to a continuous supply of trusted medications. CONCLUSIONS: While it is possible to decentralise diabetes and hypertension care from secondary to primary level in a humanitarian setting, multiple contextual factors must be considered, including supply chain strengthening and adaptation to existing workforce capacity. Our study findings may inform other actors exploring the decentralisation of NCD care elsewhere in Iraq and in other humanitarian settings