Modelling the effects of condom use and antiretroviral therapy in controlling HIV/AIDS among heterosexuals, homosexuals and bisexuals.

A deterministic compartmental sex-structured HIV/AIDS model for assessing the effects of homosexuals and bisexuals in heterosexual settings in which homosexuality and bisexuality issues have remained taboo is presented. We extend the model to focus on the effects of condom use as a single strategy approach in HIV prevention in the absence of any other intervention strategies. Initially, we model the use of male condoms, followed by incorporating the use of both the female and male condoms. The model includes two primary factors in condom use to control HIV which are condom efficacy and compliance. Reproductive numbers for these models are computed and compared to assess the effectiveness of male and female condom use in a community. We also extend the basic model to consider the effects of antiretroviral therapy as a single strategy. The results from the study show that condoms can reduce the number of secondary infectives and thus can slow the development of the HIV/AIDS epidemic. Further, we note from the study that treatment of AIDS patients may enlarge the epidemic when the treatment drugs are not 100% effective and when treated AIDS patients indulge in risky sexual behaviour. Thus, the treatment with amelioration of AIDS patients should be accompanied with intense public health educational programs, which are capable of changing the attitude of treated AIDS patients towards safe sex. It is also shown from the study that the use of condoms in settings with the treatment may help in reducing the number of secondary infections thus slowing the epidemic

Applying Alternative Teaching Methods to Impart a Rounded, Liberal Arts and Sciences (LAS) Education: Students’ Reflections on the Role of Magazines as Instructional Tools

In a constantly and rapidly changing social world, students from all disciplines ought to attain a rounded education within the tradition of a “Liberal Arts and Sciences” (LAS) context. Students outside of the natural sciences must be encouraged to appreciate the place of those sciences in their lives. Conversely, students in the natural sciences must be encouraged to envision the role of other subjects in their lives. In order to accomplish this, however, we need to go beyond basic instructional approaches by applying alternatives such as using magazines and newspapers. This paper reports students’ reflections on the use of newspapers as supplementary instructional materials to enhance learning. Data were collected from an introductory liberal arts physics course using a survey instrument. The survey had five descriptive measures: student perceptions; creativity based on activities learned; ability to link concepts learned in class to articles in the news journal; ability to impart knowledge acquired; and identifying lessons based on a case study of a selected news article from the newspaper. Student reflections indicate that magazines can effect a positive learning experience and stimulate curiosity to read. It is concluded that this approach can be used to enhance student motivation and persistence in introductory classes, particularly in schools where resources are limited. Keywords: improvisation, Liberal Arts and Science education, magazines, student reflections

Modelling within Host Parasite Dynamics of Schistosomiasis

Schistosomiasis infection is characterized by the presence of adult worms in the portal and mesenteric veins of humans as part of a complex migratory cycle initiated by cutaneous penetration of the cercariae shed by infected freshwater snails. The drug praziquantel is not always effective in the treatment against schistosomiasis at larvae stage. However, our simulations show that it is effective against mature worms and eggs. As a result, the study and understanding of immunological responses is key in understanding parasite dynamics. We therefore introduce quantitative interpretations of human immunological responses of the disease to formulate mathematical models for the within-host dynamics of schistosomiasis. We also use numerical simulations to demonstrate that it is the level of T cells that differentiates between either an effective immune response or some degree of infection. These cells are responsible for the differentiation and recruitment of eosinophils that are instrumental in clearing the parasite. From the model analysis, we conclude that control of infection is much attributed to the value of a function f, a measure of the average number of larvae penetrating a susceptible individual having hatched from an egg released by an infected individual. This agrees with evidence that there is a close association between the ecology, the distribution of infection and the disease

Using the Pathways Community HUB Care Coordination Model to Address Chronic Illnesses: A Case Study

Background/Objectives: Ohio communities are developing and expanding care coordination initiatives to integrate care for low-income pregnant women. Some of these initiatives are guided by the Pathways Community HUB model, which uses community healthworkers to address health, social, and behavioral risks for at-risk populations. This study documents the development, challenges andmanagement responses, and lessons learned from implementing a Pathways Community HUB care coordination program for anotherpopulation -- low-income adults with chronic disease risks.Methods: The study utilizes data extracted from the Care Coordination Systems (CCS) database used in Lucas County, Ohio between2015 and 2017 and interviews with program managers. Based on CCS data and insights from those interviewed, we describe the development and accomplishments of a Pathways Community HUB program for adults with chronic illnesses and identify challenges and lessons learned.Results: The Toledo/Lucas County program addressed more than half of 3,515 identified health and behavioral risks for 651 low-income adults in the program during its first two years of operation. Key challenges included building community support, establishing capacities to coordinate care, and sustaining the program over time. Establishing community networks to support program services and developing multiple funding sources are key lessons for long-term program sustainability.Conclusions: Documenting challenges and successes of existing programs and extracting lessons to guide implementation of similarpublic health efforts can potentially improve delivery of interventions. The Pathways Community HUB model has demonstrated success in addressing risks among at-risk adults. However, more comprehensive assessments of the model across different populations are warranted

Understanding early uptake of PrEP by female sex workers in Zimbabwe.

Female sex workers (FSW) are prioritised for increased access to pre-exposure prophylaxis (PrEP), although rates of uptake remain sub-optimal, particularly across Southern Africa. In the first two years of its availability in Zimbabwe, 37.1% of FSW in trial sites initiated PrEP and received at least one re-supply. We conducted a qualitative study on perceptions of PrEP among 19 early users selected from sites with varying rates of PrEP initiation. Narrative interviews examined the pathways taken by FSW from hearing about PrEP, through their decision to start taking it, and early experiences. FSW appreciated PrEP's introduction within familiar and trusted "friendly" services tailored for sex workers and valued positive encouragement from clinic staff and peers over negative influence from family members. They also found PrEP difficult to understand at first, and feared side effects and rare adverse complications described in information leaflets. While FSW identified individual strategies for remembering to take their medication, they also relied on structured peer adherence support, leading some FSW to actively promote the method to other FSW as "PrEP champions". Information on how early users experience a new prevention technology such as PrEP can inform design of interventions that leverage existing support structures and target key barriers

Risk factors of mortality in neonates with neonatal encephalopathy in a tertiary newborn care unit in Zimbabwe over a 12-month period

Neonatal encephalopathy (NE) accounts for ~23% of the 2.4 million annual global neonatal deaths. Approximately 99% of global neonatal deaths occur in low-resource settings, however, accurate data from these low-resource settings are scarce. We reviewed risk factors of neonatal mortality in neonates admitted with neonatal encephalopathy from a tertiary neonatal unit in Zimbabwe. A retrospective review of risk factors of short-term neonatal encephalopathy mortality was conducted at Sally Mugabe Central Hospital (SMCH) (November 2018 -October 2019). Data were gathered using a tablet-based data capture and quality improvement newborn care application (Neotree). Analyses were performed on data from all admitted neonates with a diagnosis of neonatal encephalopathy, incorporating maternal, intrapartum, and neonatal risk predictors of the primary outcome: mortality. 494/2894 neonates had neonatal encephalopathy on admission and were included. Of these, 94 died giving a neonatal encephalopathy-case fatality rate (CFR) of 190 per 1000 admitted neonates. Caesarean section (odds ratio (OR) 2.95(95% confidence interval (CI) 1.39-6.25), convulsions (OR 7.13 (1.41-36.1)), lethargy (OR 3.13 (1.24-7.91)), Thompson score "11-14" (OR 2.98 (1.08-8.22)) or "15-22" (OR 17.61 (1.74-178.0)) were significantly associated with neonatal death. No maternal risk factors were associated with mortality. Nearly 1 in 5 neonates diagnosed with neonatal encephalopathy died before discharge, similar to other low-resource settings but more than in typical high-resource centres. The Thompson score, a validated, sensitive and specific tool for diagnosing neonates with neonatal encephalopathy was an appropriate predictive clinical scoring system to identify at risk neonates in this setting. On univariable analysis time-period, specifically a period of staff shortages due to industrial action, had a significant impact on neonatal encephalopathy mortality. Emergency caesarean section was associated with increased mortality, suggesting perinatal care is likely to be a key moment for future interventions

Risk factors of mortality in neonates with neonatal encephalopathy in a tertiary newborn care unit in Zimbabwe over a 12-month period

Neonatal encephalopathy (NE) accounts for ~23% of the 2.4 million annual global neonatal deaths. Approximately 99% of global neonatal deaths occur in low-resource settings, however, accurate data from these low-resource settings are scarce. We reviewed risk factors of neonatal mortality in neonates admitted with neonatal encephalopathy from a tertiary neonatal unit in Zimbabwe. A retrospective review of risk factors of short-term neonatal encephalopathy mortality was conducted at Sally Mugabe Central Hospital (SMCH) (November 2018 -October 2019). Data were gathered using a tablet-based data capture and quality improvement newborn care application (Neotree). Analyses were performed on data from all admitted neonates with a diagnosis of neonatal encephalopathy, incorporating maternal, intrapartum, and neonatal risk predictors of the primary outcome: mortality. 494/2894 neonates had neonatal encephalopathy on admission and were included. Of these, 94 died giving a neonatal encephalopathy-case fatality rate (CFR) of 190 per 1000 admitted neonates. Caesarean section (odds ratio (OR) 2.95(95% confidence interval (CI) 1.39-6.25), convulsions (OR 7.13 (1.41-36.1)), lethargy (OR 3.13 (1.24-7.91)), Thompson score "11-14" (OR 2.98 (1.08-8.22)) or "15-22" (OR 17.61 (1.74-178.0)) were significantly associated with neonatal death. No maternal risk factors were associated with mortality. Nearly 1 in 5 neonates diagnosed with neonatal encephalopathy died before discharge, similar to other low-resource settings but more than in typical high-resource centres. The Thompson score, a validated, sensitive and specific tool for diagnosing neonates with neonatal encephalopathy was an appropriate predictive clinical scoring system to identify at risk neonates in this setting. On univariable analysis time-period, specifically a period of staff shortages due to industrial action, had a significant impact on neonatal encephalopathy mortality. Emergency caesarean section was associated with increased mortality, suggesting perinatal care is likely to be a key moment for future interventions

Condom use among young women who sell sex in Zimbabwe: a prevention cascade analysis to identify gaps in HIV prevention programming

Introduction: Adolescent girls and young women (AGYW), including those who sell sex in sub-Saharan Africa, are especially vulnerable to HIV. Reaching them with effective prevention is a programmatic priority. The HIV prevention cascade can be used to track intervention coverage, and identify gaps and opportunities for programme strengthening. The aim of this study was to characterise gaps in condom use and identify reasons underlying these gaps among young women who sell sex (YWSS) in Zimbabwe using data from enrolment into an impact evaluation of the DREAMS programme. DREAMS provided a package of biomedical, social and economic interventions to AGYW aged 10 to 24 with the aim of reducing HIV incidence. Methods: In 2017, we recruited YWSS aged 18 to 24 using respondent-driven sampling in six sites across Zimbabwe. We measured knowledge about efficacy of, access to, and effective (consistent) use of condoms with the most recent three sexual partners, separately by whether YWSS self-identified as female sex workers (FSW) or not. Among YWSS without knowledge about efficacy of, not having access to, and not effectively using condoms, we described the potential reasons underlying the gaps in the condom cascade. To identify socio-demographic characteristics associated with effective condom use, we used logistic regression modelling. All analyses were RDS-II weighted and restricted to YWSS testing HIV-negative at enrolment. Results: We enrolled 2431 YWSS. Among 1842 (76%) YWSS testing HIV-negative, 66% (n = 1221) self-identified as FSW. 89% of HIV-negative YWSS demonstrated knowledge about efficacy of condoms, 80% reported access to condoms and 58% reported using condoms consistently with the three most recent sexual partners. Knowledge about efficacy of and effective use of condoms was similar regardless of whether or not YWSS self-identified as FSW, but YWSS self-identifying as FSW reported better access to condoms compared to those who did not (87% vs 68%; age- and site-adjusted (adjOR) = 2.69; 95% CI: 2.01 to 3.60; p < 0.001). Women who reported experiencing sexual violence in the past year and common mental disorder in the past week were less likely to use condoms consistently (43% vs. 60%; adjOR = 0.49; 95% CI: 0.35 to 0.68; p < 0.001) and (51% vs. 61%; adjOR = 0.76; 95% CI: 0.60 to 0.97; p = 0.029), respectively. Conclusions: Despite high knowledge about efficacy of and access to condoms, there remain large gaps in self-reported consistent condom use among YWSS. Addressing the structural determinants of YWSS' inconsistent condom use, including violence, could reduce this gap. YWSS who do not self-identify as FSW have less access to condoms and may require additional programmatic intervention. Keywords: HIV prevention; HIV prevention cascade; Zimbabwe; condom cascade; female sex worker; sub-Saharan Africa; young women who sell sex

Enhancing national prevention and treatment services for sex workers in Zimbabwe: a process evaluation of the SAPPH-IRe trial.

Targeted HIV interventions for female sex workers (FSW) combine biomedical technologies, behavioural change and community mobilization with the aim of empowering FSW and improving prevention and treatment. Understanding how to deliver combined interventions most effectively in sub-Saharan Africa is critical to the HIV response. The Sisters' Antiretroviral Programme for Prevention of HIV: an Integrated Response (SAPPH-Ire) randomized controlled trial in Zimbabwe tested an intervention to improve FSW engagement with HIV services. After 2 years, results of the trial showed no significant difference between study arms in proportion of FSW with HIV viral load ≥1000 copies/ml as steep declines occurred in both. We present the results of a process evaluation aiming to track the intervention's implementation, assess its feasibility and accessibility, and situate trial results within the national HIV policy context. We conducted a mixed methods study using data from routine programme statistics, qualitative interviews with participants and respondent driven surveys. The intervention proved feasible to deliver and was acceptable to FSW and providers. Intervention clinics saw more new FSW (4082 vs 2754), performed over twice as many HIV tests (2606 vs 1151) and nearly double the number of women were diagnosed with HIV (1042 vs 546). Community mobilization meetings in intervention sites also attracted higher numbers. We identified some gaps in programme fidelity: offering pre-exposure prophylaxis took time to engage FSW, viral load monitoring was not performed, and ratio of peer educators to FSW was lower than intended. During the trial, reaching FSW with HIV testing and treatment became a national priority, leading to increasing attendance at both intervention and control clinics. Throughout Zimbabwe, antiretroviral therapy coverage improved and HIV-stigma declined. Zimbabwe's changing HIV policy context appeared to contribute to positive improvements across the HIV care continuum for all FSW over the course of the trial. More intense community-based interventions for FSW may be needed to make further gains

Comparative Analysis of Participation of Teachers of STEM and Non-STEM Subjects in Professional Development

School administrators continuously consider teacher professional development (PD) as one of the key strategies to improving teachers’ pedagogical skills. Modern proposals for advancing education by improving student learning outcomes are centered on high quality professional development for teachers. However, teachers face a number of barriers when it comes to participation in PD. Also, students in K-12 levels taking Science, Technology, Engineering, and Mathematics (STEM) and non-STEM subjects often report different learning experiences, most of which influence their decisions to enroll in STEM or non-STEM career-related programs in higher education. Understanding factors that influence the differential in teacher participation in PD is a critical step towards addressing student interest in STEM careers. Using the cross-sectional survey data from the Teaching and Learning International Survey of 2013, this study compared the participation of middle school STEM and non-STEM teachers in PD activities in the US. A bivariate analysis was used to compare STEM subject teachers versus non-STEM subject teachers’ participation in PD activities, its impact, and challenges. The findings showed that PD participation was higher among teachers of STEM subjects, but not significantly different from those for non-STEM subjects. Out-field teaching (no formal training of subject taught) accounted for 10.3% of the survey participants. Further, conflict with one’s work schedule was one of the major barriers to PD participation for teachers