21 research outputs found
Recommended from our members
Application of individual-level and health system-level implementation science approaches to HIV and TB prevention in Uganda
HIV and TB remain leading causes of death and disability across the globe. Highly efficacious HIV and TB prevention methods have created opportunities to prevent morbidity and mortality. Advancements in the availability of pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) have created opportunities to prevent HIV among those at high risk. Additionally, TB remains a leading cause of death among people with HIV. Isoniazid preventive therapy (IPT) reduces the incidence of active TB by approximately 40-60% but despite the breadth of evidence suggesting the benefits of IPT for people with HIV, uptake of IPT has been slow. Given the burden of TB and HIV globally, and the availability of medications to prevent HIV and treat latent TB, implementation science interventions provide an opportunity to do more to get these medications to those who need them most.In the second chapter of this dissertation, I evaluate the feasibility and preliminary effectiveness of integrating HIV prevention services into existing youth clubs in rural Uganda. As part of the intervention, we provided HIV prevention services, including access to PrEP and PEP. In addition, we taught multiple educational topics, including sexual and reproductive health, vocational training, and life skills, at these clubs over six months. In the third and fourth chapters of this dissertation, I focus on results from an implementation science intervention that was focused on the mid-level manager level of the health system in Uganda. These chapters used data from the SEARCH-IPT study in Uganda, which included a 3-year intervention among mid-level health managers with collaborative groups and leadership and management trainings to improve the uptake of TB preventive therapy for people with HIV. Overall, this body of work evaluates multiple aspects of individual-level and health system-level interventions to prevent HIV and TB infection in Uganda
Recommended from our members
Geographical, social, and political contexts of tuberculosis control and intervention, as reported by mid-level health managers in Uganda: ‘The activity around town’
Training district-level health officers and other mid-level health system managers revealed multiple contextual factors across political, administrative, and social axes affecting tuberculosis (TB) and TB control in Uganda. Individual relationships between local health, political, and media leaders affect efforts to inform the public and provide services, yet greater administrative coordination between national-level logistics, implementing partner funding, and local needs is required. Social challenges to TB control include high population mobility, local industries, poverty with high-density living and social venues, and misinformation about TB. Capitalizing on implementation knowledge and sharing data can overcome social geographic challenges to TB-prevention planning through strategic healthcare capacity-building at the district level
Barriers and Enablers to COVID-19 Vaccination in San Francisco's Spanish-Speaking Population
Populations at high risk for COVID-19- including Spanish speakers-may face additional barriers to obtaining COVID-19 vaccinations; by understanding their challenges, we can create more equitable vaccine interventions. In this study, we used interviews to identify barriers and enablers to COVID-19 vaccine uptake among participants in the San Francisco Department of Public Health contact tracing program. Data analysis employed Capability, Opportunity, Motivation Behavior model (COM-B) and the Behavior Change Wheel framework as guides to target barriers with interventions and supporting policies. This paper presents data from interviews focused on COVID-19 vaccine uptake that was part of a project to improve COVID-19 preventive behaviors in San Francisco. We completed seventeen interviews between February and May 2021; six (35%) were completed in English and 11 (65%) in Spanish. Barriers to vaccine uptake included an unprepared health system, fear of side effects, limited knowledge, and conflicting information. Behavioral factors influencing vaccine uptake were mainly related to physical opportunity, automatic motivation, and psychological capability. Interventions that could address the most significant number of barriers included education, enablement, and environmental restructuring. Finally, communication and marketing policies that use diverse multi-lingual social media and environmental planning that includes accessible vaccine sites for people with disabilities, literacy barriers, and limited English proficiency could significantly increase vaccination. Public health departments should tailor interventions to high-risk populations by understanding the specific barriers they face. This exploratory study suggests how implementation science can provide frameworks to achieve this