Public Health Commons^™

Factors Influencing Hiv Care Outcomes Among Adolescents Living With Hiv In Rural South Africa, Lindsey M. Filiatreau, Audrey Pettifor, Jess Edwards, Nkosinathi Masilela, Rhian Twine, F. Xavier Gómez-Olivé, Nicole Haberland, Chodziwadziwa Whiteson Kabudula, Sheri A. Lippman, Kathleen Kahn

HIV and AIDS

In the Agincourt Health and Socio-Demographic Surveillance System (HDSS) site in rural Mpumalanga Province, South Africa the Project SOAR team hypothesized that HIV status disclosure, individuals’ prior healthcare seeking experiences, history of depression and overall emotional well-being, experiences with domestic and intimate partner violence, and substance use could contribute to poor levels of treatment adherence among adolescents living with HIV. The overall objective of this study was to better understand HIV care outcomes among HIV-positive adolescents in the Agincourt HDSS in the era of universal test and treat so we can better inform HIV care programs targeting this vulnerable population.

The Power And Process Of Shifting Gender Norms: Insights From A Randomized Controlled Trial In South Africa, Nicole Haberland, Julie Pulerwitz, Ann Gottert, Audrey Pettifor, Sheri A. Lippman, Dean Peacock, Lumbwe Chola, Ryan Wagner, Anna M. Leddy, Rebecca West, Mi-Suk Kang Dufour, Jennifer Hove, Rhian Twine, Rhandzekile Mathebula, Dumisani Rebombo, Angelica Pino, F. Xavier Gómez-Olivé, Chodziwadziwa Whiteson Kabudula, Nkosinathi Masilela, Aimée Julien, Kathryn Spielman, Kathleen Kahn

HIV and AIDS

This Project SOAR report summarizes findings from a randomized controlled trial of Tsima ra rihanyu (“working together for health”), a three-year community mobilization program for treatment as prevention that aimed to address the social barriers to HIV testing and treatment in Mpumalanga Province, South Africa. In this report, the authors explore the types of gender norms that are salient for women and men, how these relate to HIV testing and treatment, and the pathways through which gender norms operate to affect women’s and men’s HIV service use and experience and perpetration of intimate partner violence.

Improving Pmtct Outcomes For Mother-Infant Pairs Through Community-Facility Linkage: Results From A Mixed Methods Study In Malawi, Michael Herce, Jess Edwards, Stephanie M. Topp, Michael Eliya, Nicole Carbone, Lauren Zalla, Jennifer Tseka, Maga Chagomerana, Mina C. Hosseinipour, Innocent Mofolo

HIV and AIDS

To improve MIP care retention in Malawi, several prevention of mother-to-child transmission of HIV (PMTCT) care delivery models have emerged to strengthen community-facility linkage (CFL), a concept defined as any “formalized connection between a health facility and the communities it serves to support improved health outcomes.” Similar to other settings in sub-Saharan Africa, three models have been widely implemented to complement Malawi’s National PMTCT Programme: 1) mentor mothers; 2) expert clients; and 3) community health workers. While the rationale underpinning these models has been substantiated by evidence generated from general antiretroviral therapy and PMTCT programs across SSA, a clear and …

Optimizing Maternal, Newborn, And Child Health Outcomes Through Use Of Multidisciplinary 'Improve' Teams In Lesotho: Costing Component, Adebiyi Adesina, Rachael Linder, Lori Bollinger

HIV and AIDS

This study builds on the USAID-funded prevention of mother-to-child transmission service delivery program (IMPROVE) already being implemented by Elizabeth Glaser Pediatric AIDS Foundation in Lesotho. Rather than designing a suite of entirely new services and delivery platforms, the intervention (conducted under Project SOAR) focused on improving existing services and strengthening the connection between facility- and community-based care. This brief describes the approach and key quantitative findings of the costing component of the IMPROVE intervention from the service provider perspective.

Assessment Of Community-Based Art Service Model Linking Female Sex Workers To Hiv Care And Treatment In Blantyre And Mangochi, Malawi, Lung Vu, Brady Zieman, Adamson Muula, Vincent Samuel, Lyson Tenthani, David Chilongozi, Simon Sikwese, Grace Kumwenda, Scott Geibel

HIV and AIDS

The Population Council and partners (through Project SOAR) conducted this study to assess whether acquiring antiretroviral treatment medication through community-based drop-in centers would appeal to female sex workers in this context, to describe any observed effects on treatment outcomes, and to identify opportunities for improvement should this model be selected for future scale-up.

Hiv Knowledge, Service Utilization, And Exposure To Dreams Among Male Partners Of Adolescent Girls And Young Women In Malawi, Project Soar

HIV and AIDS

Project SOAR, in collaboration with the Center of Reproductive Health at the University of Malawi College of Medicine, conducted qualitative research in the Zomba and Machinga districts to understand how programs can better engage men living with HIV in care, treatment, and support services. This brief summarizes findings on men’s knowledge of HIV, use of HIV services, stigma, and exposure to PEPFAR’s DREAMS (Determined Resilient Empowered AIDS-free Mentored and Safe) program which took a multi-sectoral approach to reduce HIV risk among adolescent girls and young women and their male partners.

Optimizing Maternal And Child Health Outcomes Through Use Of Multidisciplinary 'Improve' Teams In Lesotho, Appolinaire Tiam, Vincent Tukei, Lauren Greenberg, Shannon Viana, Heather Hoffman, Laura Guay, Ramatlapeng Thabelo, Tsietso Mots'oane, Matsepeli Nchephe

HIV and AIDS

The “Integrated Management Team to Improve Maternal-Child Outcomes” (IMPROVE) intervention is a comprehensive, evidence-based strategy to improve maternal and child health (MCH) outcomes through patient-centered, participatory service delivery and multidisciplinary management teams (MDT). The intervention includes three key approaches: (1) multidisciplinary, integrated management teams of facility- and community-based health care and lay workers; (2) Joint Positive Health Dignity, and Prevention (PHDP)-focused counseling for patients and skills-building training and job aids for health workers; and (3) increased early community-based counseling and support for patients. This report summarizes the key findings from the implementation of this intervention in Lesotho (under Project SOAR), …

Leveraging Adaptive Implementation Strategies To Achieve Universal Coverage Of Antiretroviral Therapy In Senegal, Gnilane Turpin, Carrie E. Lyons, Sidy Mokhtar Ndiaye, Nuria Gallego Marquez, Nika Elmi, Nguissali Turpin, Penda Dieng, Daouda Diouf, Stefan Baral

HIV and AIDS

This report summarizes findings from a study Project SOAR conducted to develop and assess the feasibility, fidelity, and cost-effectiveness of a universal coverage of antiretroviral treatment intervention among people living with HIV who are not virally suppressed in Dakar and Ziguinchor, Senegal.

Characteristics And Relationship Dynamics Of Male Partners Of Adolescent Girls And Young Women In Malawi, Project Soar

HIV and AIDS

Project SOAR, in collaboration with the Center of Reproductive Health at the University of Malawi College of Medicine, conducted qualitative research in the Zomba and Machinga districts to understand how programs can better engage men living with HIV in care, treatment, and support services. This brief summarizes findings on men’s characteristics, the types and dynamics of their sexual relationships, and their vulnerabilities and environmental stressors.

Building Assets Toolkit: Developing Positive Benchmarks For Adolescent Girls—Instruction Guide [Arabic], Judith Bruce, Sarah Engebretsen, Kimberly Glazer

Poverty, Gender, and Youth

English Summary:
The Building Assets Toolkit is an approach for developing programs for specific segments of girls that will prepare them to better face the challenges of growing up. It will help program managers understand the needs of the girls in their community, engage stakeholders at different levels and with different viewpoints, and build concrete and meaningful programming for adolescent girls. The toolkit contains all the materials needed to help make a preliminary assessment of the assets a girl should acquire and the age by which she should acquire them. This document contains the Building Assets Toolkit’s List of …

Building Assets Toolkit: Developing Positive Benchmarks For Adolescent Girls—Asset Cards [Arabic], Judith Bruce, Sarah Engebretsen, Kimberly Glazer

Poverty, Gender, and Youth

[In Arabic] The Building Assets Toolkit is an approach for developing programs for specific segments of girls that will prepare them to better face the challenges of growing up. It will help program managers understand the needs of the girls in their community, engage stakeholders at different levels and with different viewpoints, and build concrete and meaningful programming for adolescent girls.

This document contains the Building Assets Toolkit’s Asset Cards (110), set of Age Cards (age 6 to 20), and Program Planning Worksheet (sample provided). The Age Cards are to be printed out and placed according to the instructions. The …

Reproductive Health Care In The Time Of Covid-19: Perspectives Of Poor Women And Service Providers From Rahim Yar Khan, Punjab, Iram Kamran, Tahira Parveen, Rehan M. Niazi, Irfan Masood

Reproductive Health

This study was conducted by the Population Council in Rahim Yar Khan district of Punjab, with the support of the United Nations Population Fund (UNFPA), to uncover urgently needed evidence about the challenges and needs of poor women and health care providers during the COVID-19 pandemic. Over 200 poor women—beneficiaries of the Benazir Income Support Programme (BISP), one of the largest social protection programs in the world—and 60 public and private sector health care providers participated in this investigation of BISP beneficiaries’ knowledge of COVID-19, the effects of the pandemic on their lives, mental health and wellbeing, and their access …

Characterizing The Unmet Hiv Prevention Needs And Hiv Risk Vulnerabilities Of Adolescent Girls And Young Women In Ethiopia, Carly A. Comins, Sheree Schwartz, Stefan Baral, Andargachew Mulu

HIV and AIDS

Although the disparity in HIV prevalence among young women and their male counterparts is not new, there is increasing recognition that addressing the unmet HIV prevention needs among AGYW is necessary to achieve epidemic control. In Ethiopia, data characterizing unmet HIV prevention needs and HIV risk vulnerabilities among AGYW, particularly out of school AGYW, have been limited. Armauer Hansen Research Institute and Johns Hopkins Bloomberg School of Public Health through Project SOAR conducted an integrated HIV biobehavioral survey (IBBS) focused on out-of-school adolescent girls and young women (AGYW) aged 15–24 years to assess AGYW HIV risk vulnerability. The purpose of …

Bangladesh: Covid-19 Knowledge, Attitudes, Practices & Needs—Responses From Three Rounds Of Data Collection Among Adolescent Girls In Districts With High Rates Of Child Marriage, Sajeda Amin, Ubaidur Rob, Sigma Ainul, Md. Irfan Hossain, Forhana Rahman Noor, Iqbal Ehsan, Mehnaz Manzur

Poverty, Gender, and Youth

From April 20–30, 2020, during a nationwide lockdown, the Population Council Bangladesh conducted the first round of a rapid phone-based survey on COVID-19 knowledge, attitudes, and practices. The survey randomly selected girls who had provided phone numbers during enrollment in a skills-building program that began before the pandemic. The survey’s objective was to assess the impact of COVID-19 on adolescent lives and to design programs that would contribute to protecting girls and meet social distancing guidelines imposed by the government. Phone interviews were conducted with 479 girls living in the districts of Chapainawabganj, Kushtia, and Sherpur who were participants in …

Scales To Measure Motivation Among Community Health Workers, And Trust And Empowerment Among Their Clients: A Guide, Frontline Health Project

Reproductive Health

This How-To Guide presents five multi-item scales to measure motivation among community health workers (CHWs), as well as clients' trust in CHWs, and empowerment within community health systems. The scales presented are intended for use in community health programs and in combination with other indicators in the CHW Performance Measurement Framework (published by the Frontline Health project in 2019) for routine data monitoring to improve quality and accountability in community health.

Experiences Among Adults And Adolescents During The Covid-19 Pandemic From Four Locations Across Kenya—Study Description, Timothy Abuya, Karen Austrian, Adan Isaac, Beth Kangwana, Faith Mbushi, Eva Muluve, Daniel Mwanga, Thoai Ngo, Mercy Nzioki, Rhoune Ochako, Jessie Pinchoff, Ben Tidwell, John Wanyungu, Corinne White

Poverty, Gender, and Youth

To control the spread of coronavirus, the COVID-19 National Emergency Response Committee (NERC) in Kenya, chaired by the Ministry of Health (MOH), has implemented prevention and mitigation measures. To inform the Government of Kenya’s shorter- and longer-term response strategies, the Population Council COVID-19 study team utilizes rapid phone-based surveys to collect information on knowledge, attitudes, practices and needs among a longitudinal cohort of heads of household sampled from existing prospective cohort studies. The first was carried out across five Nairobi urban informal settlements; the baseline survey (n=2,009) was conducted March 30–31 with subsequent follow-up surveys conducted April 13–14 (n=1,764), May …

Gender Integration In Social And Behavior Change, Debora B. Freitas Lopez, Sanyukta Mathur, Haley Brightman, Kathryn Berryman, Kamden Hoffmann

Poverty, Gender, and Youth

This document is a review of recent social and behavior change-focused program literature focusing on the integration of gender considerations into health and non-health social and behavior change interventions. The review revealed eight promising practices: employing a gender perspective throughout the program cycle to improve outcomes; synchronizing gender strategies to ensure inclusion of men and women, boys and girls; addressing gendered health disparities that affect service use; reducing harmful traditional practices; ensuring community involvement and accountability for promotion of gender equality; considering gender during emergency preparedness and response; accounting for intersecting gendered vulnerabilities that influence health and development outcomes; and …

Evaluating The Inclusion Of Family Planning Within The National Health Insurance Benefits Package In Ghana, Kamil Fuseini, Augustine Ankomah

Reproductive Health

Contraceptive use in Ghana has remained low despite annual increases since 2012. Having a high unmet need for family planning (FP) suggests that there may be barriers to access and uptake. Over time, several policies, including Ghana’s Costed Implementation Plan from 2015–20, have suggested FP initiatives to improve contraceptive use yet they have not been entirely implemented. Further, although FP was included in the health insurance act passed in 2003, amended in 2008, and revised in 2012, which indicated that health-care benefits include FP, people continue to pay out of pocket for services at National Health Insurance Authority facilities because …

Frontline Health: Harmonizing Metrics, Advancing Evidence, Accelerating Policy—Project Overview Brief, Frontline Health Project

Reproductive Health

Despite decades of technological and medical progress globally, half the world’s population still lacks access to essential health care due to insufficient numbers and types of health workers, especially in remote settings. There is growing recognition that well-supported community health workers (CHWs) are essential for effective delivery of primary health care (PHC). Despite broad consensus on the importance of CHWs, few countries have successfully integrated them as part of PHC at scale, and many lack official statistics on the performance of CHW programs. USAID, UNICEF, and the Bill & Melinda Gates Foundation developed a Memorandum of Understanding to collaborate on …

Best Bets: Vouchers For Rights-Based, Voluntary Family Planning—International Evidence On Financing Of Family Planning, Benjamin Bellows, Moazzam Ali, Ali M. Mir

Reproductive Health

To meet the FP2020 and Sustainable Development Goals (SDGs), significant investments are required by countries and donors in priority areas, including sustainable financing, reaching all adolescents, expanding availability of services to the poorest and hard-to-reach populations, and improving the quality and increasing the range of methods available. Studies show that vouchers can substantially contribute to SDG goals by expanding contraceptive access and choice among underserved populations. Vouchers can be an effective financing tool to enhance equity, increase access, and improve the quality of FP services available to underserved populations within Pakistan.

Structural And Behavior Change Interventions To Improve Experience Of Care For Sick Very Young Children (0 To 24 Months Of Age) And Their Parents In Hospital Settings In Kenya—Preliminary Results: Baseline Provider Survey, Breakthrough Research

Sexual and Reproductive Health, Rights, and Choices

No abstract provided.

Population Council-Led Partnership Influences National And Global Efforts To End Female Genital Mutilation/Cutting, Population Council

Research Utilization and Impact Briefs

The Evidence to End FGM/C program has filled critical data gaps, bolstered local capacity, and strengthened stakeholder relationships over the past five years. Through a collaborative, African-led approach, the program informed high-level national policy dialogue in several countries, including Kenya and Nigeria, and contributed to UNFPA’s new global estimates of girls at risk for FGM/C.

Ica Foundation Supports Lng Ius Access In Low- And Middle-Income Countries, Population Council

Research Utilization and Impact Briefs

The Population Council has developed and introduced several of the world’s most effective and popular contraceptive methods, including the levonorgestrel-releasing intrauterine system (LNG IUS). Through the International Contraceptive Access (ICA) Foundation, a public-private foundation based in Finland, the Council supports LNG IUS distribution to women in over 35 low- and middle-income countries (LMICs) in partnership with international and local organizations. Over 150,000 LNG IUS units have been delivered to date at no cost, laying the groundwork for method introduction in LMICs and further expanding access to safe, long-acting, reversible contraception.

Project Soar Research Informs National Policy Change In Tanzania Expanding Access To Hiv Services For Marginalized Populations, Population Council

Research Utilization and Impact Briefs

A recent Project SOAR study evaluated community-based delivery of antiretroviral treatment to female sex workers (FSWs) in Tanzania, demonstrating the value of this approach to improve HIV care. Informed by these findings, the Government of Tanzania changed national guidance to allow for community-based HIV treatment to better meet the needs of marginalized populations, including FSWs.

Orientation Des Programmes Pour Le Changement Social Et De Comportement À Travers L'Écoute Sociale Et Le Suivi Social, Breakthrough Research

Poverty, Gender, and Youth

Cette note de recherche offre des conseils pratiques quant à la manière d'utiliser l'écoute sociale et le suivi social comme outils permettant d’orienter les programmes de changement social et de comportement (CSC). Elle est destinée aux agents de mise en œuvre des programmes CSC au niveau mondial et régional, aux évaluateurs et aux bailleurs de fonds dans les pays prioritaires soutenus par l'USAID. Cette note donne un aperçu de l'écoute sociale et du suivi social et explique comment ces méthodes peuvent constituer des outils importants dans la collecte de renseignements concernant les connaissances et les attitudes de publics cibles, ainsi …

Assessing Community Capacity Strengthening To Sustain Integrated Social Behavior Change Programming In Northwestern Nigeria, Breakthrough Research

Reproductive Health

Qualitative research by Breakthrough RESEARCH is evaluating efforts to prepare communities, through a community capacity strengthening approach, to sustain community social and behavior change programming to promote healthy family behaviors in northwestern Nigeria. This community capacity strengthening approach, implemented by Breakthrough ACTION Nigeria, engages local leaders and community organizations—specifically Ward Development Committees (WDCs)—to increase community capacities to coordinate local health systems to strengthen services and promote positive social norms and individual behaviors for improved health outcomes.

Facing Covid-19: Knowledge, Attitudes, Practices, And Challenges Of Healthcare Providers, Population Council

Reproductive Health

This research brief describes findings from the Population Council study Reproductive Healthcare in the Time of COVID-19: Perspectives of Poor Women and Service Providers from Rahim Yar Khan, Punjab with the support of the United Nations Population Fund (UNFPA). During this study, 60 health care providers that represented 60 unique health facilities in Punjab’s Rahim Yar Khan district were interviewed by telephone, to evaluate how much they know about COVID-19 symptoms, prevention, and treatment, as well as their individual attitudes, practices, and challenges during the ongoing pandemic. To assess how the situation evolved during the critical first three months of …

Poor Women's Reproductive Health And Family Planning Challenges And Needs During The Covid-19 Pandemic, Population Council

Reproductive Health

This research brief describes findings from the Population Council study Reproductive Healthcare in the Time of COVID-19: Perspectives of Poor Women and Service Providers from Rahim Yar Khan, Punjab with the support of the United Nations Population Fund (UNFPA). The study conducted 164 interviews by telephone with beneficiaries of the Benazir Income Support Programme (BISP) in Rahim Yar Khan, Pakistan, previously surveyed in 2019, to determine how much those most vulnerable to the effects of COVID-19 know about the disease and its effects, in addition to understanding the pandemic’s effects on their lives, including their mental health and well-being as …

Midline Report: Accelerating Action To End Child Marriage In Bangladesh, Masuma Billah, Eashita Haque, Surojit Kundu, Md. Saddam Hossain, Momoe Makino, Sajeda Amin

Poverty, Gender, and Youth

This report describes results from the midline survey of Accelerating Action to End Child Marriage in Bangladesh. The objective of the program is to identify effective and scalable approaches to end child marriage by empowering girls and communities. To bring about social norms change, the program experiments with alternative means of community engagement that can be offered in conjunction with skills-development opportunities for adolescent girls. The program is being assessed in a multi-arm cluster randomized trial. This report explores the impact on the prevalence of child marriage in two districts of Bangladesh as well as on a range of other …

High Impact Practices—Detecting And Managing Hypertension In The Extended Postnatal Period: Preventing Postnatal Pre-Eclampsia And Eclampsia, Charlotte E. Warren

Reproductive Health

The Population Council developed High Impact Practice (HIP) briefs for three strategies that show promise for improving prevention, detection, and management of Hypertensive Disorders in Pregnancy (HDPs). This brief focuses on one of those strategies: detecting and managing hypertension in the extended postnatal period. Key points presented are: the extended postnatal period provides an opportunity to monitor a woman’s blood pressure (BP) and check for persistent hypertension; if BP is measured routinely at any contact with the health system during the extended postnatal period, hypertension is more likely to be detected and managed appropriately; women with pre-eclampsia have a 3.7-fold …