Enhanced health systems to improve uptake of early infant diagnosis of HIV among post-partum women in primary health care in Blantyre, District Malawi

In many African countries, low utilisation of health services after birth contributes to significant gaps in HIV testing for HIV-exposed infants (HEIs). Initiatives to improve early infant diagnosis (EID) have emerged. However, health practitioners may not always achieve the implementation of evidence-based practices. In our formative assessment of the implementation of EID services in Blantyre in 2020, several factors contributed to the low uptake of EID services. We, therefore, set out to evaluate the effectiveness and acceptability of an intervention called enhanced health system (EEHS) strategy among postnatal women in primary care clinics in Blantyre, Malawi, to improve the uptake of EID. We present the formative process of co-designing the EEHs Intervention. Overall our study uses an embedded mixed-method, with a before and after design. We used stakeholder consultation to develop the EEHs intervention, which will further evaluate its effectiveness and acceptability. We had seven meetings with policy experts and the prevention of mother-to-child transmission program manager. We conducted a two-day consultation workshop guided by the Behaviour Change Wheel model. We included eight healthcare workers (HCWs), four women with HEIs, five management team members, two representatives from implementing partners, and a policy expert. Preparations for the workshop included stakeholder mapping, networking, workshop logistics, managing power dynamics, authorisation and invitations for attendees. Our discussion of the EID implementation formative study findings and stakeholders' experiences with EID services identified implementation gaps in enrollment and HIV testing of HEIs and a lack of coordination among HCWs. While; failure to identify and track HEIs, returning HEIs without HIV tests due to limited capacity of the point of care equipment, and insufficient motivation and teamwork among HCWs were underlying factors. Stakeholders proposed using unique labels to identify HEIs, active screening, a booking system for point-of-care HIV testing and an equipped focal person as the main components of the EEHs intervention. Stakeholder consultation is required when developing a context-appropriate intervention. It provides a platform for learning from stakeholders' experiences and understanding the system and aspects of the context critical for developing appropriate interventions. We will evaluate the effectiveness and acceptability of EEHs intervention

Associations between schizotypal traits and antisocial behaviours in a sub-Saharan sample

Schizophrenic symptoms have often been associated with antisocial behaviours (ASBs). Most studies have focused on violence. The association between schizophrenia and violence is often confounded by socio demographic characteristics of patients. Overemphasis on diagnosis, rather than traits, and the traditional focus on violence may have obscured associations between psychotic features and antisocial behaviour. In this study, an analogue sample (n = 604, females = 54.4%, mean age = 21.46, SD = 5.89) completed self-report measures of schizotypy and antisocial behaviours. The aim was to identify the strength of associations between different schizotypal traits/symptoms (unusual experiences, cognitive disorganisation, impulsivity & introvertive anhedonia) and different forms of antisocial behaviour (rule breaking, physical aggression & social aggression). Differential patterns of association between genders were also considered. Traits akin to positive symptoms were more strongly associated with antisocial behaviours. Impulsive non-conformity was associated with rule breaking, physical aggression and social aggression for both males and females whilst unusual experiences traits were associated with physical and social aggression in both males and females but had only a weak (gender-nonspecific) association with rule breaking. Finally, cognitive disorganisation was not associated with any class of ASB for males but was associated with physical and social aggression in females. These specific associations could inform the development of more targeted treatment approaches for specific types of ASBs in males and females

“I wanted evidence that my status had changed, so that is why I tested”: experiences with HIV self-testing among female sex workers in Malawi

Maximising HIV testing among female sex workers (FSWs) is an established global health priority. HIV self-testing (HIVST) seems to have the potential to address issues of confidentiality, privacy and convenience among this key population. HIVST, however, may result in unintended consequences as its implementation unfolds in a complex sex work context characterised by unequal power relations, stigma and high HIV prevalence. This study aimed to explore the experiences of FSWs with HIVST in the context of retesting and antiretroviral usage in Blantyre, Malawi. We used an ethnographic approach to understand meanings and views around HIV self-testing and retesting. We found high levels of retesting, especially among those on antiretroviral, two of which received ‘false negative’ results. We identified three broad narratives: (1) retesting in response to experiences in the sex work context, (2) retesting driven by the desire to self-monitor HIV negative status, and (3) retesting in the hope of sero-reversion. The experiences of these women indicate that the implementation of HIV self-testing in the context of sex work is complex with potential for unintended harms such as coercive testing. HIVST programmes must include clear and appropriate messaging to reduce retesting while on ART and ensure effective strategies are in place to address FSW concerns and anxieties about the accuracy of their HIV positive test results

Immunization with lytic polysaccharide monooxygenase CbpD induces protective immunity against Pseudomonas aeruginosa pneumonia

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Association of DASH Diet With Cardiovascular Risk Factors in Youth With Diabetes Mellitus: The SEARCH for Diabetes in Youth Study

We have shown that adherence to the Dietary Approaches to Stop Hypertension (DASH) diet is related to blood pressure in youth with type 1 and type 2 diabetes mellitus. We explored the impact of the DASH diet on other cardiovascular disease risk factors

The epidemiology and transmission of methicillin-resistant Staphylococcus aureus in the community in Singapore: study protocol for a longitudinal household study.

BACKGROUND/AIM: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most common multidrug-resistant organisms in healthcare settings worldwide, but little is known about MRSA transmission outside of acute healthcare settings especially in Asia. We describe the methods for a prospective longitudinal study of MRSA prevalence and transmission. METHODS: MRSA-colonized individuals were identified from MRSA admission screening at two tertiary hospitals and recruited together with their household contacts. Participants submitted self-collected nasal, axilla and groin (NAG) swabs by mail for MRSA culture at baseline and monthly thereafter for 6 months. A comparison group of households of MRSA-negative patients provided swab samples at one time point. In a validation sub-study, separate swabs from each site were collected from randomly selected individuals, to compare MRSA detection rates between swab sites, and between samples collected by participants versus those collected by trained research staff. Information on each participant's demographic information, medical status and medical history, past healthcare facilities usage and contacts, and personal interactions with others were collected using a self-administered questionnaire. DISCUSSION/CONCLUSION: Understanding the dynamics of MRSA persistence and transmission in the community is crucial to devising and evaluating successful MRSA control strategies. Close contact with MRSA colonized patients may to be important for MRSA persistence in the community; evidence from this study on the extent of community MRSA could inform the development of household- or community-based interventions to reduce MRSA colonization of close contacts and subsequent re-introduction of MRSA into healthcare settings. Analysis of longitudinal data using whole-genome sequencing will yield further information regarding MRSA transmission within households, with significant implications for MRSA infection control outside acute hospital settings