Public Health Commons^™

Tackling Stunting And Anemia In Egypt, Abeer Alanwar, Hend Ahmed, Sabreen Mahmoud, Wessam Adly

Papers, Posters, and Presentations

Stunting and anemia rates in children between the age of 0-24 months (0-2 years) have been two of the most persistent public health problems facing the Egyptian society and government. Based on the researchers' analysis of the problem, current policies, and on the opportunities Egypt has, this policy paper targets the Egyptian Ministry of Health and Population and recommends reformulating a specific nutrition policy to tackle stunting and anemia as well providing awareness and education about the appropriate IYCF and to give high priority to strengthening the health provision of the required micronutrients in family care units (FCU), as well …

Addressing Stigma And Gender Inequities To Strengthen Hiv And Aids Programming: A Focus On Key Populations, Population Council

HIV and AIDS

Over the past 20 years, the Population Council has generated evidence around the types of stigma experienced by key populations at higher risk for HIV, and has designed and tested strategies aimed at reducing stigma and improving HIV programs and outcomes. Key populations (KPs), such as female sex workers, men who have sex with men, transgender individuals, and people who use drugs, often face multiple stigmas that reinforce one another. Evidence generated by the Population Council has shown that addressing and reducing stigma faced by KPs is a crucial step toward improving HIV prevention and treatment outcomes. This brief summarizes …

Are Services Meeting The Holistic Family Planning Needs Of Female Sex Workers Living With Hiv In Tanzania?, Project Soar

HIV and AIDS

Women of reproductive age living with HIV need access to comprehensive, voluntary family planning (FP) services to support their decisions about whether and when to have children. Contraceptive need is particularly acute among HIV-positive female sex workers who are often socially and economically disadvantaged. Furthermore, many HIV-positive female sex workers intend to have children some day, but may not be aware of strategies to minimize the risk of HIV transmission to infants and partners (i.e., “safer conception”). This activity brief describes a Project SOAR study in Tanzania that will contribute to the evidence base by conducting research that describes these …

Assessing The Feasibility, Acceptability, And Costs Of Diagnosing Hiv At Birth In Lesotho And Rwanda, Michelle M. Gill, Heather Hoffman, Majoalane Mokone, Lynne Mofenson, Michel Tchuenche, Steven Forsythe

HIV and AIDS

Infant HIV diagnosis as early as possible in a child’s life followed by immediate antiretroviral treatment (ART) could stem the progressive rise in infant mortality among HIV-positive infants, particularly as several studies have suggested that an increased proportion of perinatal infections may occur in utero when maternal ART is received during pregnancy. This Project SOAR study leveraged two existing cohort studies to address some critical questions related to very early infant diagnosis. The objective was to determine the feasibility, acceptability, and costs associated with the addition of birth HIV testing to the routine testing algorithm for infants born to HIV-positive …

Benchmark Assessment Of Orphaned And Vulnerable Children In Areas Of The Zambia Family (Zamfam) Project—Brief, Michael Mbizvo, Paul C. Hewett

HIV and AIDS

The US Agency for International Development and US President’s Emergency Plan for AIDS Relief (PEPFAR) are supporting the Zambia Family (ZAMFAM) project to strengthen comprehensive, integrated service delivery and support to children living with, affected by, or vulnerable to HIV/AIDS (OVC) in the Lusaka, Copperbelt, Southern, and Central Provinces of Zambia. To inform that effort, Project SOAR conducted a benchmark survey among beneficiaries in the four provinces of the ZAMFAM program. The benchmark survey measured the status and conditions of OVC and their families. This brief provides a summary of the findings outlined in the final report on the needs …

Benchmark Assessment Of Orphaned And Vulnerable Children In Areas Of The Zambia Family (Zamfam) Project, Michael Mbizvo, Paul C. Hewett, Nkomba Kayeyi, Lyson Phiri, Saziso N. Mulenga, Bwalya Mushiki, Mwelwa Chibuye

HIV and AIDS

The US Agency for International Development and US President’s Emergency Plan for AIDS Relief (PEPFAR) are supporting the Zambia Family (ZAMFAM) project to strengthen comprehensive, integrated service delivery and support to children living with, affected by, or vulnerable to HIV/AIDS (OVC) in the Lusaka, Copperbelt, Southern, and Central Provinces of Zambia. To inform that effort, Project SOAR conducted a benchmark survey among beneficiaries in the four provinces of the ZAMFAM program. The benchmark survey measured the status and conditions of OVC and their families. The findings provide a deeper understanding of the needs of OVC families and the gaps in …

Can Depression Screening Be Integrated Into Busy Hiv Clinics In Malawi? Early Results Demonstrate Its Feasibility And Acceptability, Project Soar—Malawi Mental Health

HIV and AIDS

Integration of depression screening and treatment into HIV care may prove critical to achievement of the 90–90–90 goals in Malawi and elsewhere in the region. Project SOAR has partnered with the Malawi Ministry of Health to implement and evaluate the integration of a depression management program into HIV care in Malawi. This brief focuses on initial results from the screening phase, which show that more than 90 percent of patients have been appropriately screened for depression. Based on a first round of qualitative interviews, the program has been well received by clinic staff and patients. The brief lists key lessons …

Characterizing The Unmet Hiv Prevention Needs And Hiv Risk Vulnerabilities Of Adolescent Girls And Young Women In Ethiopia, Project Soar

HIV and AIDS

Adolescent girls and young women (AGYW) in Ethiopia, as well as across Eastern and Southern Africa, experience a disproportionate level of new HIV infections. AGYW who are out of school face a particular set of vulnerabilities, especially those living away from parents. Unfortunately, data characterizing unmet HIV prevention needs and risk vulnerabilities among AGYW, especially out-of-school AGYW, are lacking given the challenges in reaching and studying this population. To address this gap, Project SOAR is conducting an integrated HIV biobehavioral survey focused on out-of-school AGYW in three high HIV prevalence settings of Ethiopia. Study findings will inform HIV prevention and …

Does A Community-Based, Hiv Service Delivery Model Improve Female Sex Workers’ Care And Treatment Outcomes In Tanzania?, Project Soar

HIV and AIDS

Female sex workers living (FSWs) with HIV face significant challenges in accessing HIV care and, once started on antiretroviral therapy (ART), remaining in care and adhering to treatment. These challenges include attending regular medical appointments because of time and cost constraints, providers’ stigmatizing attitudes, and poor service quality due to crowded ART clinics, long waiting times, and a lack of clinicians. This brief describes a community-based model of ART delivery THAT Project SOAR, Sauti, the National AIDS Control Programme, and the National Institute of Medical Research are designing, implementing, and evaluating, in order to help mitigate the barriers HIV-positive FSWs …

Female Sex Workers Living With Hiv In Tanzania Have Both A Need For Contraception And A Desire To Have Children In The Future, Project Soar

HIV and AIDS

HIV-positive women often have critical family planning (FP) needs in addition to HIV-related care, treatment, and prevention concerns. In sub-Saharan Africa, unintended pregnancy is common among HIV-positive women. At the same time, many women living with HIV want to have children some day, and there are various “safer conception” strategies available to help HIV-affected individuals and couples get pregnant while minimizing the risk of HIV transmission to seronegative partners and the baby. This brief describes the fertility-related needs and desires of female sex workers living with HIV in Tanzania, highlighting results indicating that health services should help women meet both …

Health And Socioeconomic Well-Being Of Young People Living With Hiv In Zambia: Evaluating The Zamfam Project, Project Soar

HIV and AIDS

The US Agency for International Development and US President’s Emergency Plan for AIDS Relief are supporting the Zambia Family (ZAMFAM) project to strengthen comprehensive, integrated service delivery and support to children living with, affected by, or vulnerable to HIV/AIDS in the Lusaka, Copperbelt, Southern, and Central Provinces of Zambia. Project SOAR is conducting a three-year prospective cohort study of young people living with (YPLHIV) and their primary caregivers/guardians in Central Province where the ZAMFAM project is being implemented, and in Eastern Province where there are no ongoing ZAMFAM activities for comparison. The information collected in the study focused on key …

Implementing The Hiv “Treat All” Guidelines In Namibia: Patient And Health Provider Perspectives, Project Soar

HIV and AIDS

In late 2015, the World Health Organization announced new treatment guidelines recommending that anyone who has tested positive for HIV should begin antiretroviral therapy (ART) as soon as possible. In light of this policy, the government of Namibia included “treat all” in the 2016 National Guidelines for ART, and began nationwide implementation in April 2017. Project SOAR is generating evidence on how the national rollout of the treat all guidelines and decentralization of ART services affect client-level treatment outcomes, quality of ART services, and treatment costs in Namibia. This brief summarizes the perspectives of clients and providers regarding ART service …

Male Partners Of Adolescent Girls And Young Women: Relationship Characteristics And Hiv Risk—Findings From Dreams Implementation Science Research, Population Council

HIV and AIDS

Adolescent girls and young women (AGYW) in South Africa, as in many countries, are particularly vulnerable to HIV for a variety of reasons, including economic disadvantage and unequal power dynamics in sexual relationships with their male partners—many of whom are older and engage in high-risk behaviors. In an effort to learn more about men’s relationships with AGYW and how HIV services can better engage them, the Population Council is conducting implementation science research in KwaZulu-Natal Province. This brief reports findings from a 2017 baseline survey with nearly 1,000 men. An endline survey is planned for mid-late 2018, and will focus …

Optimizing Implementation Of Universal Hiv Treatment Coverage For People Living With Hiv In Senegal, Project Soar

HIV and AIDS

Senegal plans a rapid scale up of HIV treatment for all people living with HIV (PLHIV), regardless of CD4 count or viral suppression. However, limited data exist on how to achieve sustained viral suppression among PLHIV in real world contexts where significant barriers to effective antiretroviral therapy (ART) delivery, uptake, and adherence persist. This brief describes a universal coverage ART intervention Project SOAR is conducting among PLHIV who are not virally suppressed. The findings from this study will inform the rollout of Senegal’s national test and treat strategy.

Reducing Provider-Held Stigma And Improving Young Client Satisfaction In Strengthening Integrated Delivery Of And Access To Comprehensive Hiv And Sexual/Reproductive Health And Support Services For Msm In Lagos, Nigeria, Population Council

HIV and AIDS

Riding on the success of the one-stop shop community health center, in 2016 the Elton John AIDS Foundation engaged the Population Council to implement an integrated model providing comprehensive HIV and sexual and reproductive health and support services to men who have sex with men (MSM) in Lagos, Nigeria. The two-year project was designed to deploy a “hub and spoke” peer-led (or peer navigation) model to integrate comprehensive MSM-friendly HIV and sexual and reproductive health (SRH) services in public health facilities in Lagos state. This brief summarizes findings from the study which sought to reach 9,500 MSM with HIV testing …

Strengthening Capacity To Prevent Hiv Among Adolescent Girls And Young Women: Supporting Dreams-Like Programming, Project Soar

HIV and AIDS

Many adolescent girls and young women (AGYW) lack opportunities and access to resources, and experience the harms of discriminatory gender norms. Despite decades of investment in HIV prevention, many AGYW remain invisible, underserved, and at disproportionate risk of HIV infection. The DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) Partnership aims to significantly reduce HIV infections among AGYWs. DREAMS originally launched in 2014 focusing on 10 high-burden countries in sub-Saharan Africa. In 2017, five additional countries known as DREAMS-Like countries—Botswana, Cote d’Ivoire, Haiti, Namibia, and Rwanda—received support for DREAMS activities. This brief describes the technical assistance Project SOAR is providing …

Understanding The Dynamics Of Hiv Testing Services In South African Primary Care Facilities, Tonderai Mabuto, Bhakti Hansoti, Salome Charalambous, Christopher Hoffmann

HIV and AIDS

Facility-based HIV testing services remains underutilized in many settings, including South Africa—even in the context of opt-out testing. Additionally, linkages to care are often not made in a timely manner after an HIV diagnosis, limiting access to ART and the possibility of viral suppression. This brief summarizes findings from formative research conducted by Project SOAR and The Aurum Institute to understand the dynamics of HIV testing services and the key constraints to its optimal delivery.

What Do We Know About The Hiv Risk Characteristics Of Adolescent Girls And Young Women In Kenya? Findings From Dreams Implementation Science Research, Population Council

HIV and AIDS

The Population Council is conducting implementation science research in Kenya to build needed evidence to inform community-based, girl-centered interventions. DREAMS programs in Kenya are implementing a core package of interventions in the highest HIV-burden areas to address HIV risk among adolescent girls and young women (AGYW)—a population in which AIDS is the leading cause of death in the region. This brief summarizes key findings from a survey of 1,778 AGYW, more than half of whom are enrolled in DREAMS programming.

What Do We Know About The Hiv Risk Characteristics Of Adolescent Girls And Young Women In Zambia? Findings From Dreams Implementation Science Research, Population Council

HIV and AIDS

The Population Council is conducting implementation science research in Zambia and other countries across sub-Saharan Africa to build needed evidence to inform community-based, girl-centered HIV-prevention programming. Critical to this process is understanding adolescent girls’ and young women’s (AGYWs’) knowledge, attitudes, sexual behaviors, and characteristics of their sexual partnerships that may put them at risk of HIV acquisition. This results brief summarizes key findings from a cross-sectional survey of 1,915 AGYW, half of whom were 15–19 years old and the other half 20–24 years old, residing in urban districts of Lusaka and Ndola. The findings in this brief were shared at …

Health Literacy Best Practices In Policy Development, Stacie Lee Trueheart

Walden Dissertations and Doctoral Studies

Low health literacy is a problem the U.S. faces and, like health care itself, is a complex issue stemming from patient demographics and the healthcare providers being very diverse. Tools have been developed to mitigate the risks of low health literacy, however, without formal policy. The purpose of this qualitative case study was to explore and compare commonalities in health literacy best practices of organizations that are recognized as leaders in health literacy and are addressing low health literacy in their communities. By comparing the organizations' abilities to implement standards of plain language and health literacy tools/guidelines, best practice and …

African American Women Caring For Loved Ones With Alzheimer's Disease And Dementia, Lisa M. Forbes

Walden Dissertations and Doctoral Studies

Abstract

In 2016, a dramatic shift occurred in demographics in the United States because the oldest people in the baby boomer generation, which consists of people born between 1946 and 1964, reached age 65. The larger aging population and longer lifespans have produced an increased need for care and services. There are an estimated 5.4 million Americans of varying ages living with a diagnosis of dementia or Alzheimer's disease. Diagnoses of Alzheimer's disease are more prevalent among African Americans than other ethnicities. With little research found on culturally appropriate interventions for specific ethnic groups, a more detailed review of the …

Challenges Of Aging With The Hiv Virus And Comorbidities, Rommie Navylia Abele

Walden Dissertations and Doctoral Studies

Since the introduction of antiretroviral therapy, the survival rate of infected HIV patients has been on the rise with a predicted increase by 2030. The longer a person lives with the virus, the more prone to HIV-associated chronic diseases he or she becomes, but it is not clear whether these diseases are solely from aging with the virus or from long-term use of antiretroviral therapy. Scientists demonstrated that the introduction of antiretroviral therapy led to an increased life expectancy yet early onset of comorbidities; however, they failed to address the challenges that people 50 years old or older face, as …

Complementary Infant Feeding Practices In Afghanistan, Hasibullah Na Niayesh

Walden Dissertations and Doctoral Studies

Children are at greater risk of malnutrition in Afghanistan than they are in many other countries. Malnutrition impairs the mental and physical growth of more than 50% of children in Afghanistan. It also exacerbates the risks of mortality by 45% in infants and children in Afghanistan. The purpose of this study was to determine the association between mothers' knowledge, attitudes, and practices regarding complementary feeding and malnutrition in children in Afghanistan. The precaution adoption process model served as a theoretical framework in this quantitative cross-sectional research study. Data analyzed were collected from 306 mothers and children at 6 randomly selected …

Cultural Perspectives On African American Adolescent Sexual Risk Behavior In Central Mississippi, Debra Suzette Smith

Walden Dissertations and Doctoral Studies

In 2015, Mississippi had the 3rd highest adolescent birth rate in the United States, high rates of sexually transmitted diseases, and enduring racial disparities between African American and White teenagers. Few researchers have described the immediate cultural environment to determine how it may influence the sexual behaviors and attitudes of African American teens. The purpose of this qualitative ethnographic study was to describe the sociocultural environment of African American adolescents in Mississippi that influences their sexual behavior by exploring the knowledge, feelings, experiences and beliefs of African American adults. The social cognitive theory was used as a theoretical framework to …

Exploring What It Is Like To Be An Undocumented Alien In Seek Of Healthcare, Eliany C. Torrez Pon

Honors Undergraduate Theses

Currently, there are about 11.8 million undocumented aliens in the United States who are not eligible for public insurance or any type of private coverage obtained through the American Health Care Act of 2017. This creates barriers to healthcare for this large population and has negative implications for the healthcare system. Despite the availability of clinics and low-cost healthcare, this group tends to underuse resources or seek healthcare for emergencies only which leads to increased cost totaling approximately $1.1 billion a year. The goal of this qualitative study is to better understand what it is like to be an undocumented …

Insights And Evidence Gaps In Girl-Centered Programming: A Systematic Review, Nicole Haberland, Katharine Mccarthy, Martha Brady

Poverty, Gender, and Youth

Increased attention to the needs of adolescent girls has led to a growing number of programs in low- and middle-income countries. Questions remain, however, about what aspects of program design are most effective. This hinders efforts to effectively allocate resources, scale up programs, and replicate results across settings. This review looks at how the number of program components, involvement of supporting actors who influence the lives of girls, supplemental “booster” activities, intervention exposure level, and community saturation level influenced outcomes for girls. While findings suggest the importance of multicomponent programs and longer program exposure, each area requires further rigorous research …

Delivering Impact For Adolescent Girls: Emerging Findings From Population Council Research, Population Council

Poverty, Gender, and Youth

Despite numerous global commitments to invest in improving the lives of adolescent girls, questions remain as to what package of interventions can deliver the best outcomes. This report synthesizes findings from nine recent Population Council impact evaluations, conducted around the world, which indicate that empowerment and asset-building interventions for adolescent girls can improve education, health, economic, social capital, gender-equitable attitude, and violence outcomes for girls. The report includes implications for programs and investment, and identifies open questions for further research and evaluation.

Modeling Geographic Factors And Assessing Their Accuracy In Identifying Health Disparities In Fayette County, Ian Jones

Lewis Honors College Capstone Collection

The purpose of this capstone is to conduct a review of existing literature to determine the effects of a variety of geographic variables on health and wellness. The student will use their findings to create a visual aid to displaying these geographic factors and their distributions within Fayette County. Furthermore, the student will analyze the intersection of these variables to predict potential pockets of discrepancy within Fayette County. Based on this analysis, the student will propose possible interventions with a basis in current literature. This project will provide the student with the opportunity to conduct a study of existing literature, …

Early Results Demonstrate The Importance Of Early Treatment Of Hiv And The Feasibility And Acceptability Of Community-Based Antiretroviral Treatment Delivery For Female Sex Workers In Tanzania, Project Soar

HIV and AIDS

Project SOAR in collaboration with the National AIDS Control Program of the government of Tanzania, National Institute of Medical Research, and Jhpiego’s Sauti Program, is conducting implementation science research to investigate the delivery of community-based antiretroviral treatment (ART) services to female sex workers (FSWs) in Tanzania. This brief summarizes key findings from a baseline survey administered to a cohort of FSWs enrolled in the study, qualitative interviews with FSWs conducted three months after the start of the community-based ART services, and routine monitoring data. Early findings support the feasibility and acceptability of Sauti’s community-based antiretroviral treatment model—important first steps in …

Feasibility And Acceptability Of Hiv Self-Testing Among Men Who Have Sex With Men In Nigeria, Population Council

HIV and AIDS

HIV self-testing (HIVST) provides an alternative to facility-based HIV testing services, particularly for key populations such as men who have sex with men (MSM), who face barriers to testing due to stigma, discrimination, and criminalization. This brief reports on a study in Nigeria that demonstrates high acceptability for HIVST among MSM. Lessons learned from this study indicate that the scale-up of HIVST in Nigeria must include provision of adequate pre- and post-test counseling information, as well as the availability of helpline support to improve linkage to care for those who test positive. Future research should explore how HIV retesting can …