Understanding the Unique Barriers and Facilitators that Affect Men’s Initiation and Retention in HIV Care: A Qualitative Study to Inform Interventions for Men Across the Treatment Cascade in Malawi

Men in sub-Saharan Africa are underrepresented in antiretroviral therapy (ART) programs. Our secondary analysis of 40 in-depth interviews with Malawian men living with HIV examined barriers and facilitators for ART initiation versus retention. Interviewees included men who never initiated or initiated ART late (initiation respondents, n = 19); and men who initiated ART but were late for an appointment (retention respondents, n = 21). Transcribed interviews were coded using deductive and inductive coding techniques and analyzed using constant comparison methods. Long wait times, frequent facility visits, and insufficient in-clinic privacy were barriers for initiation and retention. Poor knowledge of ART was primarily a barrier for initiation; unexpected travel was a barrier for retention. Key facilitators for initiation and retention included previous positive experiences with health facilities. Having examples of successful men using ART primarily facilitated initiation; support from spouses and male peers facilitated retention. Results may inform interventions to increase men’s engagement in ART services

Movements of sub-adult Chinook salmon, Oncorhynchus tshawytscha, in Puget Sound, Washington, as indicated by ultrasonic tracking

Salmonids show a wide variety of migration patterns. Such variation is especially prevalent in Chinook salmon, Oncorhynchus tshawytscha. This species migrates to coastal and open ocean waters, and the tendency to use these different marine environments varies markedly among populations. For example, some Chinook salmon that enter Puget Sound do not migrate to the sea as juveniles in their first year but rather remain as “residents” through (at least) the following Spring. Known locally as blackmouth, these fish are the focus of extensive sport fisheries. In this study, we used acoustic telemetry to examine questions surrounding resident Chinook salmon in Puget Sound. The overall objective of this study was to determine the extent to resident and migratory behavior patterns are distinct or ends of a continuum of movement patterns, and then characterize the movements of resident fish. We first assessed the proportion of fish, caught and tagged as immature residents (inferred from the locations and dates of capture), that remained within Puget Sound and the proportion that moved to the coastal region, and tested the hypotheses that origin (wild or hatchery), location and season of tagging, fish size and condition factor would influence the tendency to remain resident. Second, we characterized the movements by resident fish with Puget Sound at a series of different spatial scales: movement among the major basins, travel rates, and areas of concentration within Puget Sound. Third, we tested the model of seasonal north-south movement patterns by examining the distribution of detections over the whole area and year. Because residents represent a significant portion of the Puget Sound Chinook salmon Evolutionarily Significant Unit, currently listed as Threatened under the U. S. Endangered Species Act, better understanding of their movements in Puget Sound will help identify critical habitat use patterns and evaluate fishery management objectives as the species crosses jurisdictional boundaries

Women's (health) work: A population-based, cross-sectional study of gender differences in time spent seeking health care in Malawi.

BACKGROUND:There has been a notable expansion in routine health care in sub-Saharan Africa. While heath care is nominally free in many contexts, the time required to access services reflects an opportunity cost that may be substantial and highly gendered, reflecting the gendered nature of health care guidelines and patterns of use. The time costs of health care use, however, have rarely been systematically assessed at the population-level. METHODS:Data come from the 2015 wave of a population-based cohort study of young adults in southern Malawi during which 1,453 women and 407 men between the ages of 21 and 31 were interviewed. We calculated the time spent seeking health care over a two-month period, disaggregating findings by men, recently-pregnant women, mothers with children under two years old, and "other women". We then extrapolated the time required for specific services to estimate the time that would be needed for each subpopulation to meet government recommendations for routine health services over the course of a year. RESULTS:Approximately 60% of women and 22% of men attended at least one health care visit during the preceding two months. Women spent six times as long seeking care as did men (t = -4.414, p<0.001), with an average 6.4 hours seeking care over a two-month period compared to 1 hour for men. In order to meet government recommendations for routine health services, HIV-negative women would need to spend between 19 and 63 hours annually seeking health care compared to only three hours for men. An additional 40 hours would be required of HIV-positive individuals initiating antiretroviral care. CONCLUSIONS:Women in Malawi spend a considerable amount of time seeking routine health care services, while men spend almost none. The substantial time women spend seeking health care exacerbates their time poverty and constrains opportunities for other meaningful activities. At the same time, few health care guidelines pertain to men who thus have little interaction with the health care system. Additional public health strategies such as integration of services for those services frequently used by women and specific guidelines and outreach for men are urgently needed

Short-term effectiveness of HIV care coordination among persons with recent HIV diagnosis or history of poor HIV outcomes.

The New York City HIV Care Coordination Program (CCP) combines multiple evidence-based strategies to support persons living with HIV (PLWH) at risk for, or with a recent history of, poor HIV outcomes. We assessed the comparative effectiveness of the CCP by merging programmatic data on CCP clients with population-based surveillance data on all New York City PLWH. A non-CCP comparison group of similar PLWH who met CCP eligibility criteria was identified using surveillance data. The CCP and non-CCP groups were matched on propensity for CCP enrollment within four baseline treatment status groups (newly diagnosed or previously diagnosed and either consistently unsuppressed, inconsistently suppressed or consistently suppressed). We compared CCP to non-CCP proportions with viral load suppression at 12-month follow-up. Among the 13,624 persons included, 15∙3% were newly diagnosed; among the 84∙7% previously diagnosed, 14∙2% were consistently suppressed, 28∙9% were inconsistently suppressed, and 41∙6% were consistently unsuppressed in the year prior to baseline. At 12-month follow-up, 59∙9% of CCP and 53∙9% of non-CCP participants had viral load suppression (Relative Risk = 1.11, 95%CI:1.08-1.14). Among those newly diagnosed and those consistently unsuppressed at baseline, the relative risk of viral load suppression in the CCP versus non-CCP participants was 1.15 (95%CI:1.09-1.23) and 1.32 (95%CI:1.23-1.42), respectively. CCP exposure shows benefits over no CCP exposure for persons newly diagnosed or consistently unsuppressed, but not for persons suppressed in the year prior to baseline. We recommend more targeted case finding for CCP enrollment and increased attention to viral load suppression maintenance