49 research outputs found
Global health delivery 2.0: using open-access technologies for transparency and operations research.
No full textDuncan Maru and colleagues at Nyaya Health describe several simple Web 2.0 strategies they have implemented during the course of delivering medical and public health services in rural Nepal
PLoS Med
No full textR36 CI000607/CI/NCPDCID CDC HHS/United StatesT32 GM07205/GM/NIGMS NIH HHS/United States19956665PMC277735
A prospective controlled trial of routine opt-out HIV testing in a men's jail.
No full textApproximately 10 million Americans enter jails annually. The Centers for Disease Control and Prevention now recommends routine opt-out HIV testing in these settings. The logistics for performing routine opt-out HIV testing within jails, however, remain controversial. The objective of this study was to evaluate the optimal time to routinely HIV test newly incarcerated jail detainees using an opt-out strategy.This prospective, controlled trial of routine opt-out HIV testing was conducted among 298 newly incarcerated male inmates in an urban men's jail in New Haven, Connecticut. 298 sequential entrants to the men's jail over a three week period in March and April 2008 were assigned to be offered routine opt-out HIV testing at one of three points after incarceration: immediate (same day, n = 103), early (next day, n = 98), or delayed (7 days, n = 97). The primary outcome was the proportion of men in each group consenting to testing.Routine opt-out HIV testing was significantly higher for the early (53%: AOR = 2.6; 95% CI = 1.5 to 4.7) and immediate (45%: AOR = 2.3; 95% CI = 1.3 to 4.0) testing groups compared to the delayed (33%) testing group. The immediate and early testing groups, however, did not significantly differ (p = 0.67). In multivariate analyses, factors significantly associated with routine opt-out HIV testing were assignment to the 'early' testing group (p = 0.0003) and low (bond > or = $5,000, immigration or federal charges or pre-sentencing > 30 days) likelihood of early release (p = 0.04). Two subjects received preliminary positive results and one of them was subsequently confirmed HIV seropositive.In this men's jail where attrition was high, routine opt-out HIV testing was not only feasible, but resulted in the highest rates of HIV testing when performed within 24 hours of incarceration.ClinicalTrials.gov NCT00624247
Medication Persistence of HIV-infected Drug Users on Directly Administered Antiretroviral Therapy
No full text
Clinical Outcomes of Hepatitis C Treatment in a Prison Setting: Feasibility and Effectiveness for Challenging Treatment Populations
No full textRoutine opt-out HIV testing strategies in a female jail setting: a prospective controlled trial.
No full textTen million Americans enter jails annually. The objective was to evaluate new CDC guidelines for routine opt-out HIV testing and examine the optimal time to implement routine opt-out HIV testing among newly incarcerated jail detainees.This prospective, controlled trial of routine opt-out HIV testing was conducted among 323 newly incarcerated female inmates in Connecticut's only women's jail. 323 sequential entrants to the women's jail over a five week period in August and September 2007 were assigned to be offered routine opt-out HIV testing at one of three points after incarceration: immediate (same day, n = 108), early (next day, n = 108), or delayed (7 days, n = 107). The primary outcome was the proportion of women in each group consenting to testing.Routine opt-out HIV testing was significantly highest (73%) among the early testing group compared to 55% for immediate and 50% for 7 days post-entry groups. Other factors significantly (p = 0.01) associated with being HIV tested were younger age and low likelihood of early release from jail based on bond value or type of charge for which women were arrested.In this correctional facility, routine opt-out HIV testing in a jail setting was feasible, with highest rates of testing if performed the day after incarceration. Lower testing rates were seen with immediate testing, where there is a high prevalence of inability or unwillingness to test, and with delayed testing, where attrition from jail increases with each passing day.ClinicalTrials.gov NCT00624247
Poor follow-up rates at a self-pay northern Indian tertiary AIDS clinic
No full textAbstract Background In many developing countries, out-of-pocket payment remains a primary mechanism by which patients infected with HIV access treatment. In India, this has been changing as the National AIDS Control Organization (NACO) has been rolling out free antiretroviral therapy throughout the country since 2004. The vast majority of patients, however, remain without access to free medicines. Methods A retrospective chart review was performed on data obtained from a registry of ninety-three (93) patients attending a self-pay clinic at the All India Institute of Medical Sciences in Delhi, India. Multivariable Cox proportional hazard and logistic regression models were explored to assess the relationship between lost-to-follow-up status and the predictor variables: age, sex, household income, baseline CD4 count, and distance from clinic. Results Lost-to-follow-up rates were very high; 68% (63/93) were lost-to-follow-up till the time of chart review, including 59% (55/93) who were lost within one year. In both regression models, younger age, low baseline CD4 counts, and low income level were significantly associated with increased risk of lost-to-follow-up. Additionally, there was a significant interaction between income and CD4 counts. The patients with both low CD4 counts and low income level were more likely to be lost-to-follow-up than would be predicted by each covariable alone. Conclusion In this small cohort of AIDS patients attending a self-pay antiretroviral clinic at a large tertiary care center in Delhi, India, follow-up rates were quite poor. Poorer patients tended to present to clinic with more depressed CD4 counts and were less likely to be retained in care. These findings indicate that greater strides must be taken to improve the recruitment and retention of poor patients. The expansion of free antiretrovirals is one step among many necessary to achieve this objective.</p
Turning a blind eye: the mobilization of radiology services in resource-poor regions
No full textAbstract While primary care, obstetrical, and surgical services have started to expand in the world's poorest regions, there is only sparse literature on the essential support systems that are required to make these operations function. Diagnostic imaging is critical to effective rural healthcare delivery, yet it has been severely neglected by the academic, public, and private sectors. Currently, a large portion of the world's population lacks access to any form of diagnostic imaging. In this paper we argue that two primary imaging modalities--diagnostic ultrasound and X-Ray--are ideal for rural healthcare services and should be scaled-up in a rapid and standardized manner. Such machines, if designed for resource-poor settings, should a) be robust in harsh environmental conditions, b) function reliably in environments with unstable electricity, c) minimize radiation dangers to staff and patients, d) be operable by non-specialist providers, and e) produce high-quality images required for accurate diagnosis. Few manufacturers are producing ultrasound and X-Ray machines that meet the specifications needed for rural healthcare delivery in resource-poor regions. A coordinated effort is required to create demand sufficient for manufacturers to produce the desired machines and to ensure that the programs operating them are safe, effective, and financially feasible.</p
"A Symbol of the New African": Drum magazine, popular culture and the formation of black urban subjectivity in 1950s South Africa.
No full textPhDThis thesis examines the emergence of black urban subjectivity in South Africa
during the 1950s, focussing on the ways in which popular American genres were
utilised in the construction of black urban identities that served as a means of
resistance to apartheid. At the centre of this process was Drum magazine:
founded in South Africa in 1951 , it became the largest selling magazine on the
African continent in 1956. Drum's success was due to the way in which it
enabled the relocation of black identity from the "traditional" towards the
"modern'. The 1940s gave rise to widespread migration of black South Africans
from rural to urban areas and this newly urbanised community was seeking
models of black urban identity. Yet the Nationalist government was attempting
to curtail the emergence of a black urban proletariat, which posed a threat to
white political supremacy. Through apartheid legislation black identity was
constructed as essentially tribal and rural. As a means of resisting this, urbanised
black South Africans turned to, and appropriated, readily available forms of
American culture. Drum published Americanised images and stories: gangsters,
black detectives, black comic heroes, and pulp romances. This popular material
appeared alongside some of the finest investigative journalism ever published.
While Drum magazine is widely acknowledged as having provided a platform
for the emergence of black South African writing in English, its popular content
has been dismissed by critics as apolitical escapism, imitation and capitulation to
American culture. This thesis challenges the dismissal of the popular that has
dominated analyses of Drum since the 1960s, arguing that such a position denies
the agency of local writers and audiences. My analysis reveals that American
forms were adopted in critically discerning ways and chosen for their ability to
convey local meaning and create positions from which to resist aparthei
