International Public Health Commons^™

Exposure To Gender-Based Violence And Depressive Symptoms Among Transgender Women In Cambodia: Findings From The National Integrated Biological And Behavioral Survey 2016, Siyan Yi, Sovannary Tuot, Srean Chhim, Pheak Chhoun, Phalkun Mun, Gitau Mburu

Background: Transgender women are at significant risk of HIV, and they face intersecting barriers to health, social, and legal services. However, data regarding the unique needs and experiences of transgender women are globally scant. This study examined the relationship between gender-based violence and depressive symptoms among transgender women in Cambodia.

Methods: This cross-sectional study included 1375 sexually active transgender women recruited by using the respondent-driven sampling method in the capital city of Phnom Penh and 12 provinces between December 2015 and February 2016. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression scale (CES-D). Multivariate regression analysis was …

Factors Associated With Viral Non-Suppression Among Adolescents Living With Hiv In Cambodia: A Cross-Sectional Study, Kolab Chhim, Gitau Mburu, Sovannary Tuot, Ratana Sopha, Vohith Khol, Pheak Chhoun, Siyan Yi

Background

Adolescents living with HIV on antiretroviral therapy (ART) have worse treatment adherence, viral suppression, and mortality rates compared to adults. This study investigated factors associated with viral non-suppression among adolescents living with HIV in Cambodia.

Methods

A cross-sectional study was conducted in August 2016 among 328 adolescents living with HIV aged 15–17 years who were randomly selected from 11 ART clinics in the capital city of Phnom Penh and 10 other provinces. Clinical and immunological data, including CD4 count and viral load, were obtained from medical records at ART clinics. Adolescents were categorized as having achieved viral suppression if …

Gender Disparities In The Association Between Socio-Demographics And Non-Communicable Disease Risk Factors Among Adults With Disabilities In Shanghai, China, Youran Zhang, Gang Chen, Qi Zhang, Jun Lu, Huijiong Yu

Community & Environmental Health Faculty Publications

BACKGROUND. Non-communicable disease (NCD) risk factors can co-exist with disability and cause a greater burden on the health status of adults with disabilities. A lack of egalitarian social policies in China may result in gender disparities in the NCD risk factors of adults with disabilities. However, little is known about the gender disparities in the association between socio-demographics and NCD risk factors among adults with disabilities in China; consequently, we examined this association among adults with disabilities in Shanghai, China.

METHODS. We used the health examination data of 44,896 adults with disabilities in Shanghai in 2014. Descriptive analyses and …

Social-Support Needs Among Adolescents Living With Hiv In Transition From Pediatric To Adult Care In Cambodia: Findings From A Cross-Sectional Study, Graham Toth, Gitau Mburu, Sovannary Tuot, Vohith Khol, Chanrith Ngin, Pheak Chhoun, Siyan Yi

BACKGROUND: Understanding the circumstances of adolescents living with HIV is critical in designing adolescent-friendly services that will facilitate successful transition from pediatric to adult care. This study describes access, utilization and ongoing social support needs among adolescents living with HIV aged 15-17 in transition from pediatric to adult HIV care in Cambodia.

METHODS: A cross-sectional study was conducted among 328 adolescents, randomly selected from 11 antiretroviral therapy (ART) clinics across the country. Descriptive analyses were conducted to summarize their characteristics, access to social support and ongoing support needs among male and female adolescents.

RESULTS: Mean age of the study participants …

Social And Behavioural Factors Associated With Risky Sexual Behaviours Among University Students In Nine Asean Countries: A Multi-Country Cross-Sectional Study, Siyan Yi, Vannarath Te, Supa Pengpid, Karl Peltzer

While university students are potential human resources, this population group is particularly involved in health risk behaviours. Preventing risky sexual behaviours among them would contribute to prevention of HIV, sexually transmitted infections (STIs), and unwanted pregnancies, which have posed a great burden on population health. This study was therefore conducted to identify social and behavioural factors associated with risky sexual behaviours among university students in nine ASEAN countries. A multi-country, cross-sectional study was conducted in 2015 among university students by a network of researchers in the selected countries. A convenient sampling method and stratified random sampling procedures were employed to …

Engaging Male Partners Of Adolescent Girls And Young Women In Hiv Services In Malawi: Findings From Dreams Implementation Science Research, Project Soar

HIV and AIDS

Important contributors to adolescent girls' and young women's (AGYWs') vulnerability to HIV are the power differentials in their sexual relationships with male partners. Therefore, engaging male partners of AGYWs is important in reducing HIV incidence among these women. Project SOAR, in collaboration with the Center of Reproductive Health at the University of Malawi College of Medicine, conducted qualitative research in the districts of Zomba and Machinga in Malawi to: 1) identify and locate the types of men who have sexual relationships with AGYW; 2) understand the challenges to and facilitators of accessing HIV services among AGYWs’ male partners; and 3) …

Sexual Behaviors, Hiv Knowledge, Hiv Testing Attitudes And Recent Hiv Testing Among Female Entertainment Workers In Cambodia: A Cross-Sectional Study, Siyan Yi, Sovannary Tuot, Pheak Chhoun, Khuondyla Pal, Kolab Chhim, Chanrith Ngin, Carinne M. Brody

BACKGROUND: In Cambodian context, female entertainment workers (FEWs) are young women working at establishments such as karaoke bars, restaurants, beer gardens or massage parlors. FEWs may sell sex to male patrons and are considered a high-risk group for HIV. This study aimed to identify factors associated with recent HIV testing among FEWs in Cambodia to inform future prevention activities.

METHODS: Data were collected in 2014 as part of the evaluation of a larger HIV prevention project. A two-stage cluster sampling method was used to select participants from Phnom Penh and Siem Reap for face-to-face interviews using a structured questionnaire. A …

Social And Behavioural Factors Associated With Depressive Symptoms Among University Students In Cambodia: A Cross-Sectional Study, Chanrith Ngin, Khuondyla Pal, Sovannary Tuot, Pheak Chhoun, Rosa Yi, Siyan Yi

OBJECTIVE: To explore social and behavioural factors associated with depressive symptoms among university students in Cambodia.

DESIGN: Cross-sectional study.

SETTINGS: Two public universities-one in the capital city of Phnom Penh and another in Battambang provincial town.

PARTICIPANTS: This study included 1359 students randomly selected from all departments in the two universities using a multistage cluster sampling method for a self-administered questionnaire survey in 2015.

PRIMARY OUTCOME MEASURE: Depressive symptoms measured by using the Center for Epidemiologic Studies Depression scale. All measures in the study were self-reported.

RESULTS: The proportion of students with depressive symptoms and severe depressive symptoms were 50.6% …

Rwanda: Hiv/Aids, Alissa Anderson

Global Public Health

Rwanda is a small country in Africa. Rwanda has had many conflicts within its borders with wars, genocide, and disease. One of Rwanda’s current threats is HIV/AIDS. This disease is spreading through its population, and making it easier for other diseases; such as hepatitis and tuberculosis, to spread as well. Rwanda is a country that is putting into effect many efforts to decrease its HIV/AIDS population by means of education, campaigns, and treatments regarding the disease. In this article, I use peer reviewed and reliable articles to show the past and current issues that Rwanda has to face with the …

Microcephaly, Christianne E. Albers

Global Issues in Public Health

Microcephaly is a noncommunicable condition causing the head of an infant to be smaller than what is typical. Microcephaly can cause delays in developmental milestones and/or can cause other conditions such as epilepsy, cerebral palsy, learning disabilities, hearing loss and vision problems. Microcephaly is found more frequently in certain populations of the world than others, specifically those with an increased number of cases with Zika virus. Women need to take preventative measures to ensure their unborn child is safe from the Zika virus. The Zika virus is not the only way microcephaly can occur. Many other causes like exposure to …

Characterizing Performance Improvement In Primary Care Systems In Mesoamerica: A Realist Evaluation Protocol [Version 1; Referees: 1 Approved], Wolfgang Munar

Global Health Faculty Publications

Background. Improving performance of primary care systems in low- and middle-income countries (LMICs) may be a necessary condition for achievement of universal health coverage in the age of Sustainable Development Goals. The Salud Mesoamerica Initiative (SMI), a large-scale, multi-country program that uses supply-side financial incentives directed at the central-level of governments, and continuous, external evaluation of public, health sector performance to induce improvements in primary care performance in eight LMICs. This study protocol seeks to explain whether and how these interventions generate program effects in El Salvador and Honduras.

Methods. This study presents the protocol for a study …

Youth Paying For Sex: What Are The Associated Factors? Findings From A Cross-Sectional Study In Cambodia, Soaman Dizechi, Carinne M. Brody, Sovannary Tuot, Chhorvann Chhea, Vonthanak Saphonn, Kunthearith Yung, Siyan Yi

BACKGROUND: At-risk male youth in Cambodia who purchase sex are at greater risk for HIV compared to the general population. Factors associated with paying for sex among youth are poorly studied, both globally and in Cambodia. This study aimed to identify specific factors associated with transactional sex with women among most-at-risk male youth in Cambodia.

METHODS: This cross-sectional questionnaire survey was conducted with 405 sexually active male youth aged 16-24 recruited at 'hotspots' in the capital city of Phnom Penh and seven provinces. We collected data on demographic factors, sexual behaviors, HIV testing and other potential factors. Multivariable logistic regression …

Gender-Transformative Bandebereho Couples' Intervention To Promote Male Engagement In Reproductive And Maternal Health And Violence Prevention In Rwanda: Findings From A Randomized Controlled Trial., Kate Doyle, Ruti G Levtov, Gary Barker, Gautam G Bastian, Jeffrey B Bingenheimer, Shamsi Kazimbaya, Anicet Nzabonimpa, Julie Pulerwitz, Felix Sayinzoga, Vandana Sharma, Dominick Shattuck

Prevention and Community Health Faculty Publications

BACKGROUND: Rigorous evidence of the effectiveness of male engagement interventions, particularly on how these interventions impact relationship power dynamics and women's decision-making, remains limited. This study assessed the impact of the Bandebereho gender-transformative couples' intervention on impact on multiple behavioral and health-related outcomes influenced by gender norms and power relations.

METHODS: We conducted a multi-site randomised controlled trial in four Rwandan districts with expectant/current fathers and their partners, who were randomised to the intervention (n = 575 couples) or control group (n = 624 couples). Primary outcomes include women's experience of physical and sexual IPV, women's attendance and men's accompaniment …

Why It Worked: Participants' Insights Into An Mhealth Antiretroviral Therapy Adherence Intervention In China., Lora L Sabin, Lauren Mansfield, Mary Bachman Desilva, Taryn Vian, Zhong Li, Xie Wubin, Allen L Gifford, Yiyao Barnoon, Christopher J Gill

Global Health Faculty Publications

Background: Few Antiretroviral Therapy (ART) adherence trials investigate the reasons for intervention success or failure among HIV-positive individuals.

Objectives: To conduct qualitative research to explore the reasons for effectiveness of a 6-month mHealth (mobile health) trial that improved adherence among ART patients in China. The intervention utilized Wireless Pill Containers (WPCs) to provide, real-time SMS reminders, WPC-generated adherence reports, and report-informed counseling.

Methods: We conducted in-depth interviews with 20 intervention-arm participants immediately following the trial. Sampling was purposeful to ensure inclusion of participants with varied adherence histories. Questions covered adherence barriers and facilitators, and intervention experiences. We analyzed data in …

Modeling The Relationship Between Women’S Perceptions And Future Intention To Use Institutional Maternity Care In The Western Highlands Of Guatemala, Emily Peca, John Sandberg

Global Health Faculty Publications

Background

Despite global gains, women in hard-to-reach areas are at a relatively higher risk of death and disability related to childbirth. Traditional methods of measuring satisfaction may mask negative experiences (such as disrespect and abuse) that can drive down demand for institutional care. Better measurement of women’s perceptions of care quality, especially among marginalized populations with historically low utilization of institutional care, are needed to inform how to improve services and foster greater utilization of (potentially life-saving) clinical care.

Methods

A population-based household survey was conducted in 15 purposively selected villages in the rural Western Highlands of Guatemala among women …

Increased Antibiotic Resistance Of Escherichia Coli In Nicaragua: Potential Causes And Future Implications, Ryan S. Paukert

Theses and Graduate Projects

Since 1987, no new structural class of antibiotic has been introduced into human medicine. Aside from the absence of a new structural class of antibiotics, there has been a startlingly low number of new antibiotics approved since 1987. With the lack of new antibiotics, finding current antibiotics that are effective is becoming an alarming challenge due to the worldwide emergence of antibiotic resistance. Antibiotic-resistant bacteria presents a major threat to public health because they reduce the effectiveness of antibiotic treatment leading to increased morbidity, mortality, and healthcare expenditure. Without treatment for common infections, like uropathogenic Escherichia coli (UPEC), resistant infections …

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 …