HIV testing intervention development among men who have sex with men in the developed world

HIV testing is a ‘gateway’ technology, enabling access to treatment and HIV prevention. Biomedical approaches to prevention, such as pre-exposure prophylaxis and treatment as prevention, require accurate and regular HIV test results. HIV testing also represents a powerful ‘teachable moment’ for behavioural prevention. An increasing range of HIV tests and the emergence of self-managed diagnostic technologies (e.g. self-testing) means there is now considerable diversification of when, where and how results are available to those who test. These changes have profound implications for intervention development and, indeed, health service redesign. This paper highlights the need for better ways of conceptualising testing in order to capitalise on the health benefits that diverse HIV testing interventions will bring. A multidimensional framework is proposed to capture ongoing developments in HIV testing among men who have sex with men and focus on the intersection of: (1) the growing variety of HIV testing technologies and the associated diversification of their pathways into care; (2) psychosocial insights into the behavioural domain of HIV testing; and (3) better appreciation of population factors associated with heterogeneity and concomitant inequities. By considering these three aspects of HIV testing in parallel, it is possible to identify gaps, limitations and opportunities in future HIV testing-related interventions. Moreover, it is possible to explore and map how diverse interventions may work together having additive effects. Only a holistic and dynamic framework that captures the increasing complexity of HIV testing is fit for purpose to deliver the maximum public health benefit of HIV testing

Design Matters: Development and Validation of the Online Course Design Elements (OCDE) Instrument

Course design is critical to online student engagement and retention. This study focused on the development and validation of an online course design elements (OCDE) instrument with 38 Likert-type scale items in five subscales: (a) overview, (b) content presentation, (c) interaction and communication, (d) assessment and evaluation, and (e) learner support. The validation process included implementation with 222 online instructors and instructional designers in higher education. Three models were evaluated which included a one-factor model, five-factor model, and higher-order model. The five-factor and higher-order models aligned with the development of the OCDE. The frequency of use of OCDE items was rated above the mean 4.0 except for two items on collaboration and self-assessment. The overall OCDE score was related to self-reported levels of expertise but not with years of experience. The findings have implications for the use of this instrument with online instructors and instructional designers in the design of online courses

Effectiveness of English Learners Computer-Based Testing Accommodations: A Meta-Analysis

With the increased number of English learners (ELs) participating in large-scale state testing, there has been an increased focus on fairness in testing for these students. Test accommodations have shown promise in eliminating barriers and improving accessibility, and computer-based testing (CBT) allows individual customization of tests with built-in accessibility features. Most research on testing accommodations focuses on paper-based tests, but CBT is the most predominant mode of delivering large-scale state assessments. This study aims to synthesize research on the validity and effectiveness of CBT accommodations for EL students. Meta-analysis methodology was used to summarize the findings from previous CBT studies. Eight studies out of 292 studies met the inclusion criteria. The results indicated that CBT accommodations did not influence non-EL test scores, providing evidence for the validity of EL test accommodations. There was a .12 standard deviation improvement in EL test scores for EL students who had CBT accommodations. The grade level of EL moderated the effectiveness of the accommodation, with elementary students demonstrating higher effects than middle and high school students. The findings of this study are similar to those studies that examined paper-based accommodations

Intern and Mentor Perceptions of the Internship Experience

For more than twenty-five years reform efforts have been pervasively pursued across the nation to improve student achievement at the K-12 level. It is generally agreed that the impetus for these reform efforts was the publication of the report, A Nation at Risk, in 1983(National Commission on Excellence in Education, 1983). This report, which concluded that a “rising tide of mediocrity” was sweeping across the educational system served as the clarion call that spurned the national efforts to reform and improve America’s schools. Although these reform efforts have covered nearly every aspect of schooling and taken a variety of forms, fundamentally they have addressed how schools are governed, organized, and operated for the purpose of improving teaching and learning. Additionally, and most important, these reform efforts have focused upon the quality of personnel in the schools, especially teachers and administrators, because reformers have argued that they are the most important resource for effecting significant school improvement. Given the emphasis on the quality of personnel, many of the reform efforts have addressed the quality of both pre-service and professional development programs for teachers and administrators. Of these, the focus, structure, content, and quality of the preservice programs have received the most attention

Principal Interns’ Level of Involvement and Perceived Knowledge and Skills Developed During the Internship Process

The review of the literature clearly shows that the exploration of a critical question is missing from the analysis of internships: Do interns who experience higher levels of involvement develop higher levels of knowledge and skills? In this study, learning experiences are defined as the type of involvement (i.e., low-involvement or high-involvement). The purpose of this study is to examine if higher levels of intern involvement result in the acquisition of higher levels of perceived knowledge and skills. Survey research method was used to assess the principle interns’ level of involvement in a set of specified activities and to assess the relative importance of each kind of involvement

An Analysis of School Counselors Time Spent on ASCA Aligned Activities

The high prevalence of youth aging out of the foster care system and the numerous poor outcomes they experience during the transition to emerging adulthood has been well documented. Although addressing the complex needs and concerns of this distinct population can be difficult, mental health counselors maintain the philosophical tenants and training strengths necessary to successfully serve youth aging out of foster care. This article aims to provide counselors with the historical context, developmental framework, and specific challenges needed to better understand this population, as well as suggested counseling implications to address their unique needs by reviewing relevant literature

Risk perception, safer sex practices and PrEP enthusiasm: Barriers and facilitators to oral HIV pre-exposure prophylaxis in Black African and Black Caribbean women in the UK

Objectives: UK Black African/Black Caribbean women remain disproportionately affected by HIV. Although oral pre-exposure prophylaxis (PrEP) could offer them an effective HIV prevention method, uptake remains limited. This study examined barriers and facilitators to PrEP awareness and candidacy perceptions for Black African/Black Caribbean women to help inform PrEP programmes and service development. Methods: Using purposive sampling through community organisations, 32 in-depth, semi-structured interviews were conducted with Black African/Black Caribbean women living in London and Glasgow between June and August 2018. Participants (aged 19–63) included women of varied HIV statuses to explore perceptions of sexual risk and safer sex, sexual health knowledge and PrEP attitudes. A thematic analysis guided by the Social Ecological Model was used to explore how PrEP perceptions intersected with wider safer sex understandings and practices. Results: Four key levels of influence shaping safer sex notions and PrEP candidacy perceptions emerged: personal, interpersonal, perceived environment and policy. PrEP-specific knowledge was low and some expressed distrust in PrEP. Many women were enthusiastic about PrEP for others but did not situate PrEP within their own safer sex understandings, sometimes due to difficulty assessing their own HIV risk. Many felt that PrEP could undermine intimacy in their relationships by disrupting the shared responsibility implicit within other HIV prevention methods. Women described extensive interpersonal networks that supported their sexual health knowledge and shaped their interactions with health services, though these networks were influenced by prevailing community stigmas. Conclusions: Difficulty situating PrEP within existing safer sex beliefs contributes to limited perceptions of personal PrEP candidacy. To increase PrEP uptake in UK Black African/Black Caribbean women, interventions will need to enable women to advance their knowledge of PrEP within the broader context of their sexual health and relationships. PrEP service models will need to include trusted ‘non-sexual health-specific’ community services such as general practice

How can we make self-sampling packs for sexually transmitted infections and bloodborne viruses more inclusive? a qualitative study with people with mild learning disabilities and low health literacy

Objectives: 1.5 million people in the UK have mild to moderate learning disabilities. STIs and bloodborne viruses (BBVs) are over-represented in people experiencing broader health inequalities, which include those with mild learning disabilities. Self-managed care, including self-sampling for STIs/BBVs, is increasingly commonplace, requiring agency and health literacy. To inform the development of a partner notification trial, we explored barriers and facilitators to correct use of an STI/BBV self-sampling pack among people with mild learning disabilities. Methods: Using purposive and convenience sampling we conducted four interviews and five gender-specific focus groups with 25 people (13 women, 12 men) with mild learning disabilities (July-August 2018) in Scotland. We balanced deductive and inductive thematic analyses of audio transcripts to explore issues associated with barriers and facilitators to correct use of the pack. Results: All participants found at least one element of the pack challenging or impossible, but welcomed the opportunity to undertake sexual health screening without attending a clinic and welcomed the inclusion of condoms. Reported barriers to correct use included perceived overly complex STI/BBV information and instructions, feeling overwhelmed and the manual dexterity required for blood sampling. Many women struggled interpreting anatomical diagrams depicting vulvovaginal self-swabbing. Facilitators included pre-existing STI/BBV knowledge, familiarity with self-management, good social support and knowing that the service afforded privacy. Conclusion: In the first study to explore the usability of self-sampling packs for STI/BBV in people with learning disabilities, participants found it challenging to use the pack. Limiting information to the minimum required to inform decision-making, € easy read' formats, simple language, large font sizes and simpler diagrams could improve acceptability. However, some people will remain unable to engage with self-sampling at all. To avoid widening health inequalities, face-to-face options should continue to be provided for those unable or unwilling to engage with self-managed care

Improving HIV Pre Exposure Prophylaxis (PrEP) uptake and initiation: process evaluation and recommendation development from a national PrEP programme

HIV pre-exposure prophylaxis (PrEP) is key to HIV transmission elimination but implementation is challenging and under-researched. We undertook a process evaluation of the first 2years of a national PrEP program to explore barriers and facilitators to implementation and to develop recommendations to improve implementation, focusing on PrEP uptake and initiation. Stage 1 involved semi-structured telephone interviews and focus groups (September 2018-July 2019) with geographically and demographically diverse patients seeking/using/declining/stopping PrEP (n =39), sexual healthcare professionals (n =54), community-based organisation service users (n =9) and staff (n =15) across Scotland. We used deductive thematic analysis, to derive and then map key barriers and facilitators to priority areas that experts agreed would enhance uptake and initiation. In Stage 2, we used analytic tools from implementation science to systematically generate evidence-based, theoretically-informed recommendations to enhance uptake and initiation of PrEP. Barriers and facilitators were multi-levelled and interdependent. Barriers included the rapid pace of implementation without additional resource, and a lack of familiarity with PrEP prescribing. Facilitators included opportunities for acquisition of practice-based knowledge and normalisation of initiation activities. We refined our 68 'long-list' recommendations to 41 using expert input and the APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity) criteria. Examples include: provision of PrEP in diverse settings to reach all in need; co-produced, culturally sensitive training resources for healthcare professionals, with focused content on non-daily dosing; meaningful collaborative working across all stakeholders. These evidence-based, theory informed recommendations provide a robust framework for optimising PrEP uptake and initiation in diverse settings to ensure PrEP reaches all who may benefit