Task shifting and integration of HIV care into primary care in South Africa: The development and content of the streamlining tasks and roles to expand treatment and care for HIV (STRETCH) intervention

Background: Task shifting and the integration of human immunodeficiency virus (HIV) care into primary care services have been identified as possible strategies for improving access to antiretroviral treatment (ART). This paper describes the development and content of an intervention involving these two strategies, as part of the Streamlining Tasks and Roles to Expand Treatment and Care for HIV (STRETCH) pragmatic randomised controlled trial. Methods: Developing the intervention: The intervention was developed following discussions with senior management, clinicians, and clinic staff. These discussions revealed that the establishment of separate antiretroviral treatment services for HIV had resulted in problems in accessing care due to the large number of patients at ART clinics. The intervention developed therefore combined the shifting from doctors to nurses of prescriptions of antiretrovirals (ARVs) for uncomplicated patients and the stepwise integration of HIV care into primary care services. Results: Components of the intervention: The intervention consisted of regulatory changes, training, and guidelines to support nurse ART prescription, local management teams, an implementation toolkit, and a flexible, phased introduction. Nurse supervisors were equipped to train intervention clinic nurses in ART prescription using outreach education and an integrated primary care guideline. Management teams were set up and a STRETCH coordinator was appointed to oversee the implementation process. Discussion: Three important processes were used in developing and implementing this intervention: active participation of clinic staff and local and provincial management, educational outreach to train nurses in intervention sites, and an external facilitator to support all stages of the intervention rollout

Fusing drug enforcement: a study of the El Paso Intelligence Center

This article examines the evolution of the El Paso Intelligence Center (EPIC), a key intelligence component of the Drug Enforcement Administration, to shed light on fusion efforts in drug enforcement. Since 1974, EPIC has strived to fuse the resources and capabilities of multiple government agencies to counter drug trafficking and related threats along the Southwest US border. While undergoing a steady growth, the Center has confronted a host of challenges that illuminate the uses and limits of multi-agency endeavors in drug enforcement. An evaluative study of the Center shows that it is well aligned with the federal government priorities in the realm of drug enforcement; however the extent to which the Center’s activities support the government’s efforts in this domain is not so clear. The Center needs to improve the way it reviews its own performance to better adapt and serve its customers

Big data and data repurposing – using existing data to answer new questions in vascular dementia research

Introduction: Traditional approaches to clinical research have, as yet, failed to provide effective treatments for vascular dementia (VaD). Novel approaches to collation and synthesis of data may allow for time and cost efficient hypothesis generating and testing. These approaches may have particular utility in helping us understand and treat a complex condition such as VaD. Methods: We present an overview of new uses for existing data to progress VaD research. The overview is the result of consultation with various stakeholders, focused literature review and learning from the group’s experience of successful approaches to data repurposing. In particular, we benefitted from the expert discussion and input of delegates at the 9th International Congress on Vascular Dementia (Ljubljana, 16-18th October 2015). Results: We agreed on key areas that could be of relevance to VaD research: systematic review of existing studies; individual patient level analyses of existing trials and cohorts and linking electronic health record data to other datasets. We illustrated each theme with a case-study of an existing project that has utilised this approach. Conclusions: There are many opportunities for the VaD research community to make better use of existing data. The volume of potentially available data is increasing and the opportunities for using these resources to progress the VaD research agenda are exciting. Of course, these approaches come with inherent limitations and biases, as bigger datasets are not necessarily better datasets and maintaining rigour and critical analysis will be key to optimising data use

Health Care for Veterans: Suicide Prevention

[Excerpt] Congress has attempted to address the problem of suicide among veterans through legislation and oversight hearings, both on prevention of veteran suicide specifically and on veteran mental health more broadly. A task as challenging as preventing suicide requires collaboration among federal agencies, state and local governments, other organizations, communities, and individuals. This report, however, focuses on activities of the Veterans Health Administration (VHA) within the Department of Veterans Affairs (VA). The VHA’s approach to suicide prevention is based in part on the National Strategy for Suicide Prevention, which involves multiple federal departments, including the VA, Defense (DOD), and Education (ED), as well as several agencies within Health and Human Services (HHS). While this CRS report focuses on suicide prevention efforts of the VHA, activities of other entities are discussed as they relate to VHA activities. This CRS report begins with a brief overview of the public health framework for suicide prevention, which forms the basis for both the National Strategy for Suicide Prevention and the VHA’s approach to suicide prevention. The three subsequent parts of the report correspond to the three major components of the public health framework: (1) suicide surveillance, (2) suicide risk factors and protective factors, and (3) suicide prevention interventions. The final section addresses potential issues for Congress, and the Appendix summarizes provisions of public laws addressing suicide prevention among veterans

Dual diagnosis: a community perspective

This report presents a community inquiry project concerned with addressing Dual Diagnosis needs in the urban communities of Finglas and Cabra, North Dublin. The study was funded by the Social Inclusion/ Addiction Service, CH09, Health Service Executive and Finglas/Cabra Local Drug & Alcohol Task Force. This Participatory Action Research study involved a process in which the research participants were in partnership with the research team for the duration of the study. This project had two research cycles over a nine-month period. In the first month of the study, the community research group (CRG) was established to oversee, support and participate in the research process. This group included members of the community such as service users, their family members and service providers. Throughout this inquiry, central to all activities, was the importance of ensuring that there was a shared community conversation about the local Dual Diagnosis needs. This study achieved this using Participatory Action Research methods. The first cycle comprised of an Open Dialogue Community Forum and three focus groups. Participants included local residents, service users, community representatives, local health, and social care professionals. During this cycle, participants shared personal experiences of Dual Diagnosis and the difficulties in accessing appropriate treatment and care, which often lacks compassion for individuals seeking help. Family members spoke about the effect Dual Diagnosis has had on their own and on their relatives’ lives. Professionals shared their experiences of working and supporting clients with Dual Diagnosis. Findings in this cycle mirrored those from the international literature. For example, no joined up policy, restricted and inappropriate service access, limited family support, a lack of intra agency collaboration, organisational struggles for professionals to liaise across services and agencies in relation to collaborative care. Cycle two focused on how the communities and local organisations can provide effective care for people with Dual Diagnosis and their families, along with required government directives. A second Open Dialogue Forum identified the required actions at community, organisational and governmental level. The findings are summarised across three main domains: Community response; Organisational requirements; Governmental responsibility. This research provides a community insight into the impact of Dual Diagnosis. It highlights ways to address Dual Diagnosis through a series of interconnecting actions supported by governmental and policy change. Additionally, the findings have implications for the two communities and national policy makers. Notably, this work contributes to the dialogue surrounding the unmet needs of those who experience Dual Diagnosis. Of particular relevance to this research is the process by which the community was galvanised and the representative stakeholders brought together in dialogue. Crucially, this process was deemed a significant outcome of this research in that it facilitated the emergence of mutually agreed findings. The community stakeholders can now establish a process towards enacting the required changes to develop provision for people with Dual Diagnosis and their families. This research demonstrates that the community experience of Dual Diagnosis is complex and impactful. Importantly, it appears that there are systemic issues effecting the two communities’ ability to respond to Dual Diagnosis. It is rare for research to present the shared voices of service users, their families and those they seek help from about the impact of a challenging condition like Dual Diagnosis. This collective voice needs acknowledgment as it is grounded in the shared desire to address the needs of those with Dual Diagnosis from a community and local organisational level while signposting both policy and operational changes to drive and facilitate this