Empowering peer outreach workers in an HIV prevention and care program for Kenyan gay, bisexual, and other men who have sex with men: challenges and opportunities in the Anza Mapema Study

Gay, bisexual, and other men who have sex with men (MSM) are at high risk for human immunodeficiency virus (HIV) infection. In rights-constrained settings with pervasive stigma, peer outreach workers play a key role in recruitment and retention of MSM in HIV research, prevention, and treatment programs. We explored factors affecting the empowerment of peers in an HIV prevention and care study for MSM in Kisumu, Kenya, with the goal of improving program services and supporting good participatory practice. The Anza Mapema study, conducted from 8/2015-10/2017, aimed to enroll 700 MSM in a comprehensive package of find, test, link and retain in HIV prevention and care interventions, with quarterly follow-up over 12 months. Seventeen mostly heterosexual salaried staff implemented the clinical and research components of the study, while 13 gay and bisexual peers facilitated recruitment, retention, and participant education, supported by a monthly stipend. A community advisory board provided feedback on program methods and performance. In-depth interviews with peers and staff at two timepoints were used to obtain feedback and make program improvements. Thematic analysis was conducted, and results were presented to peers and staff for discussion and triangulation. Despite mutual appreciation of peers’ contributions to the project, peers and staff had different goals and vision for Anza Mapema. While staff focused on implementing the study protocol, peers envisioned broader programming including community-building activities, advocacy, mental health and substance use services, and economic empowerment. From the outset, power disparities and power struggles between peers and staff favored the staff, as peers were younger, less educated, and had lower compensation for their time. While peers appreciated the opportunity to help their community and the free health services provided by the project, they voiced concerns about stigmatizing attitudes from some staff, insufficient training, exclusion from decision-making, minimal representation on the study team, and lack of opportunities for advancement. Staff were supportive of peer’s requests but felt constrained by limited funding and rigid study timelines. Peers’ concerns were addressed at least in part through monthly team meetings with program leadership, weekly meetings with outreach coordinators, additional training, the promotion of one peer to a salaried position, and the development of community-building activities and a support group for participants who struggled with alcohol and drugs. Integration of gay and bisexual peers into HIV research and programming is critical in rights-constrained settings but challenged by disparities in power between peers and staff. Empowerment of peers is an important component of good participatory practice, and requires attention to training, inclusion in decision-making, opportunities for advancement, and support for community-building. Future studies that rely on peers for participant recruitment and retention should address these issues and make peer empowerment an overt component of the program.&nbsp

Empowering peer outreach workers in an HIV prevention and care program for Kenyan gay, bisexual, and other men who have sex with men: challenges and opportunities in the Anza Mapema Study

Gay, bisexual, and other men who have sex with men (MSM) are at high risk for human immunodeficiency virus (HIV) infection. In rights-constrained settings with pervasive stigma, peer outreach workers play a key role in recruitment and retention of MSM in HIV research, prevention, and treatment programs. We explored factors affecting the empowerment of peers in an HIV prevention and care study for MSM in Kisumu, Kenya, with the goal of improving program services and supporting good participatory practice. The Anza Mapema study, conducted from 8/2015-10/2017, aimed to enroll 700 MSM in a comprehensive package of find, test, link and retain in HIV prevention and care interventions, with quarterly follow-up over 12 months. Seventeen mostly heterosexual salaried staff implemented the clinical and research components of the study, while 13 gay and bisexual peers facilitated recruitment, retention, and participant education, supported by a monthly stipend. A community advisory board provided feedback on program methods and performance. In-depth interviews with peers and staff at two timepoints were used to obtain feedback and make program improvements. Thematic analysis was conducted, and results were presented to peers and staff for discussion and triangulation. Despite mutual appreciation of peers’ contributions to the project, peers and staff had different goals and vision for Anza Mapema. While staff focused on implementing the study protocol, peers envisioned broader programming including community-building activities, advocacy, mental health and substance use services, and economic empowerment. From the outset, power disparities and power struggles between peers and staff favored the staff, as peers were younger, less educated, and had lower compensation for their time. While peers appreciated the opportunity to help their community and the free health services provided by the project, they voiced concerns about stigmatizing attitudes from some staff, insufficient training, exclusion from decision-making, minimal representation on the study team, and lack of opportunities for advancement. Staff were supportive of peer’s requests but felt constrained by limited funding and rigid study timelines. Peers’ concerns were addressed at least in part through monthly team meetings with program leadership, weekly meetings with outreach coordinators, additional training, the promotion of one peer to a salaried position, and the development of community-building activities and a support group for participants who struggled with alcohol and drugs. Integration of gay and bisexual peers into HIV research and programming is critical in rights-constrained settings but challenged by disparities in power between peers and staff. Empowerment of peers is an important component of good participatory practice, and requires attention to training, inclusion in decision-making, opportunities for advancement, and support for community-building. Future studies that rely on peers for participant recruitment and retention should address these issues and make peer empowerment an overt component of the program.&nbsp

Building Capacity for Cancer Research in the Era of COVID-19: Implementation and Results From an International Virtual Clinical Research Training Program in Zambia

DOI: 10.1200/GO.21.00372 JCO Global Oncology no. 8 (2022) Published online May 20, 2022. PMID: 35594499https://openworks.mdanderson.org/mozart/1024/thumbnail.jp

Perspectives of Zambian Clinical Oncology Trainees in the MD Anderson and Zambia Virtual Clinical Research Training Program (MOZART)

Published in The Oncologist, 2022;, oyac110, https://doi.org/10.1093/oncolo/oyac110 PMID 35689473https://openworks.mdanderson.org/mozart/1025/thumbnail.jp

Améliorer la détection précoce du cancer du sein par la formation des prestataires de soins de santé primaires en Côte d'Ivoire

International audienceObjectives: To improve breast cancer early detection in Côte d'Ivoire, we designed, implemented, and evaluated the Breast Health Program educational curriculum (BHP EC) for primary healthcare providers (PCPs). Methods: In-depth interviews to identify breast cancer early detection strategies were conducted with key stakeholders, audio-recorded, transcribed, coded, analyzed via hybrid analysis, and used to design the BHP EC. The program was implemented as a one-day educational session for PCPs, who completed pre- and post-session surveys. Data were analyzed using descriptive statistics and Fisher’s exact test. Results: Interviews were conducted with 18 participants: 7 (39%) physicians, 5 (28%) medical students, 4 (22%) nurses and midwives, 2 (11%) cancer survivors. Barriers to early detection included: limited breast cancer awareness (50%), lack of patient follow-up/support after primary care presentation (50%), financial barriers (39%), lack of coordination in diagnosis and treatment (22%), no mammography or biopsy capacity within public healthcare (11%). BHP EC topics included: breast cancer/benign breast disease management, patient communication/support, clinical breast exam (CBE), financial navigation. 36 PCPs from 5 healthcare centers attended the BHP EC: 75% were female; the mean age was 41.3 years (SD 7.2); 9 (28%) physicians, 6 (17%) nurses, 18 (50%) midwives, 3 (8%) medical students. At baseline, 18 (50%) PCPs felt qualified to evaluate patients with breast complaints compared with 32 (89%) post session (p = 0.003). 15 (42%) felt qualified to help patients overcome barriers to diagnosis at baseline compared with 31 (86%) after BHP EC (p = 0.006). There were no differences in CBE confidence (27 (75%) vs. 32 (89%)) or patient referral for diagnostic workup (29 (81%) vs. 34 (94%)) pre- and post-BHP EC (p > 0.05). Conclusions: BHP EC resulted in improved breast cancer early detection knowledge and confidence. Future work includes program expansion and evaluation of the impact on time to diagnosis.Objectifs : Pour améliorer la détection précoce du cancer du sein en Côte d'Ivoire, nous avons conçu, mis en œuvre et évalué le programme éducatif du Programme de santé du sein (BHP EC) destiné aux prestataires de soins de santé primaires (PCP). Méthodes : Des entretiens approfondis visant à identifier les stratégies de détection précoce du cancer du sein ont été menés avec les principales parties prenantes, enregistrés, transcrits, codés, analysés au moyen d'une analyse hybride et utilisés pour concevoir le programme d'enseignement du BHP. Le programme a été mis en œuvre sous la forme d'une session éducative d'une journée pour les PCP, qui ont répondu à des enquêtes avant et après la session. Les données ont été analysées à l'aide de statistiques descriptives et du test exact de Fisher. Résultats : Des entretiens ont été menés avec 18 participants : 7 (39 %) médecins, 5 (28 %) étudiants en médecine, 4 (22 %) infirmières et sages-femmes, 2 (11 %) survivants du cancer. Les obstacles à la détection précoce étaient les suivants : sensibilisation limitée au cancer du sein (50 %), manque de suivi/soutien des patientes après une consultation en soins primaires (50 %), obstacles financiers (39 %), manque de coordination dans le diagnostic et le traitement (22 %), absence de capacité de mammographie ou de biopsie dans le système de santé public (11 %). Les sujets abordés dans le cadre du programme BHP EC étaient les suivants : gestion du cancer du sein/des maladies bénignes du sein, communication/soutien avec les patients, examen clinique des seins (ECS), navigation financière. 36 PCP de 5 centres de santé ont participé à l'EC BHP : 75% étaient des femmes ; l'âge moyen était de 41,3 ans (SD 7,2) ; 9 (28%) médecins, 6 (17%) infirmières, 18 (50%) sages-femmes, 3 (8%) étudiants en médecine. Au départ, 18 (50 %) PCP se sentaient qualifiés pour évaluer les patientes se plaignant des seins, contre 32 (89 %) après la session (p = 0,003). 15 (42%) se sentaient qualifiés pour aider les patientes à surmonter les obstacles au diagnostic au départ, contre 31 (86%) après l'EC BHP (p = 0,006). Il n'y avait pas de différences dans la confiance en l'ICB (27 (75 %) contre 32 (89 %)) ou dans l'orientation des patients vers un bilan diagnostique (29 (81 %) contre 34 (94 %)) avant et après l'EC BHP (p > 0,05). Conclusions : Le programme BHP EC a permis d'améliorer les connaissances et la confiance en matière de détection précoce du cancer du sein. Les travaux futurs comprennent l'expansion du programme et l'évaluation de l'impact sur le délai de diagnostic

Améliorer la détection précoce du cancer du sein par la formation des prestataires de soins de santé primaires en Côte d'Ivoire

International audienceObjectives: To improve breast cancer early detection in Côte d'Ivoire, we designed, implemented, and evaluated the Breast Health Program educational curriculum (BHP EC) for primary healthcare providers (PCPs). Methods: In-depth interviews to identify breast cancer early detection strategies were conducted with key stakeholders, audio-recorded, transcribed, coded, analyzed via hybrid analysis, and used to design the BHP EC. The program was implemented as a one-day educational session for PCPs, who completed pre- and post-session surveys. Data were analyzed using descriptive statistics and Fisher’s exact test. Results: Interviews were conducted with 18 participants: 7 (39%) physicians, 5 (28%) medical students, 4 (22%) nurses and midwives, 2 (11%) cancer survivors. Barriers to early detection included: limited breast cancer awareness (50%), lack of patient follow-up/support after primary care presentation (50%), financial barriers (39%), lack of coordination in diagnosis and treatment (22%), no mammography or biopsy capacity within public healthcare (11%). BHP EC topics included: breast cancer/benign breast disease management, patient communication/support, clinical breast exam (CBE), financial navigation. 36 PCPs from 5 healthcare centers attended the BHP EC: 75% were female; the mean age was 41.3 years (SD 7.2); 9 (28%) physicians, 6 (17%) nurses, 18 (50%) midwives, 3 (8%) medical students. At baseline, 18 (50%) PCPs felt qualified to evaluate patients with breast complaints compared with 32 (89%) post session (p = 0.003). 15 (42%) felt qualified to help patients overcome barriers to diagnosis at baseline compared with 31 (86%) after BHP EC (p = 0.006). There were no differences in CBE confidence (27 (75%) vs. 32 (89%)) or patient referral for diagnostic workup (29 (81%) vs. 34 (94%)) pre- and post-BHP EC (p > 0.05). Conclusions: BHP EC resulted in improved breast cancer early detection knowledge and confidence. Future work includes program expansion and evaluation of the impact on time to diagnosis.Objectifs : Pour améliorer la détection précoce du cancer du sein en Côte d'Ivoire, nous avons conçu, mis en œuvre et évalué le programme éducatif du Programme de santé du sein (BHP EC) destiné aux prestataires de soins de santé primaires (PCP). Méthodes : Des entretiens approfondis visant à identifier les stratégies de détection précoce du cancer du sein ont été menés avec les principales parties prenantes, enregistrés, transcrits, codés, analysés au moyen d'une analyse hybride et utilisés pour concevoir le programme d'enseignement du BHP. Le programme a été mis en œuvre sous la forme d'une session éducative d'une journée pour les PCP, qui ont répondu à des enquêtes avant et après la session. Les données ont été analysées à l'aide de statistiques descriptives et du test exact de Fisher. Résultats : Des entretiens ont été menés avec 18 participants : 7 (39 %) médecins, 5 (28 %) étudiants en médecine, 4 (22 %) infirmières et sages-femmes, 2 (11 %) survivants du cancer. Les obstacles à la détection précoce étaient les suivants : sensibilisation limitée au cancer du sein (50 %), manque de suivi/soutien des patientes après une consultation en soins primaires (50 %), obstacles financiers (39 %), manque de coordination dans le diagnostic et le traitement (22 %), absence de capacité de mammographie ou de biopsie dans le système de santé public (11 %). Les sujets abordés dans le cadre du programme BHP EC étaient les suivants : gestion du cancer du sein/des maladies bénignes du sein, communication/soutien avec les patients, examen clinique des seins (ECS), navigation financière. 36 PCP de 5 centres de santé ont participé à l'EC BHP : 75% étaient des femmes ; l'âge moyen était de 41,3 ans (SD 7,2) ; 9 (28%) médecins, 6 (17%) infirmières, 18 (50%) sages-femmes, 3 (8%) étudiants en médecine. Au départ, 18 (50 %) PCP se sentaient qualifiés pour évaluer les patientes se plaignant des seins, contre 32 (89 %) après la session (p = 0,003). 15 (42%) se sentaient qualifiés pour aider les patientes à surmonter les obstacles au diagnostic au départ, contre 31 (86%) après l'EC BHP (p = 0,006). Il n'y avait pas de différences dans la confiance en l'ICB (27 (75 %) contre 32 (89 %)) ou dans l'orientation des patients vers un bilan diagnostique (29 (81 %) contre 34 (94 %)) avant et après l'EC BHP (p > 0,05). Conclusions : Le programme BHP EC a permis d'améliorer les connaissances et la confiance en matière de détection précoce du cancer du sein. Les travaux futurs comprennent l'expansion du programme et l'évaluation de l'impact sur le délai de diagnostic

Breast cancer early diagnosis detection of breast cancer through education of primary healthcare providers in Côte D'Ivoire.

e18767 Background: In Côte d'Ivoire, > 70% of women with breast cancer present with stage III/IV disease. To improve early detection, we designed and implemented an educational curriculum (EC; the Breast Health Program) for primary healthcare providers (PCPs). Methods: We performed in-depth interviews with key stakeholders to identify barriers and facilitators of breast cancer early detection. Interviews were audio-recorded, transcribed, double-coded and analyzed via thematic analysis. The EC was designed based on interview results and implemented during a one-day educational session for PCPs. Participating PCPs completed pre- and post-session surveys to assess knowledge. Data were analyzed using Fisher’s exact test. All p-values were two-sided. Results: Eighteen stakeholders participated in the interviews: 7 (39%) physicians, 5 (28%) medical students, 3 nurses, 2 cancer survivors, and 1 midwife. Identified barriers to early detection included: lack of awareness-raising campaigns to encourage earlier presentation (50%), need for patient follow-up and support after presentation to primary healthcare centers (50%), financial barriers (39%), delays due to lack of coordination in diagnosis and treatment (22%), and lack of mammography and biopsy capacity outside of the private sector (11%). Based on the interviews, the following topics were included in the EC: breast cancer and benign breast disease diagnosis and treatment, patient communication/support, clinical breast exam (CBE), symptom management, and financial navigation to assist patients access diagnosis. A total of 36 PCPs from five healthcare centers attended the educational session: 75% were female; the mean age was 41.3 years (SD 7.2); Nine (28%) were physicians, 6 (17%) nurses, 18 (50%) midwives; the median years of work experience was 7 years (range 3-32). At baseline, 18 (50%) PCPs felt qualified to evaluate patients with breast complaints; 10 (28%) did not, vs. 32 (89%) and 2 (6%) respectively at follow-up (χ2 = 8.75 p = 0.003). 15 (42%) providers felt qualified to help patients overcome barriers to diagnosis, and eleven (31%) felt unqualified/neutral at baseline, vs. 31 (86%) and 4 (11%) respectively at follow-up (χ2 = 7.67, p = 0.006). There were no statistically significant differences between baseline-follow-up in feeling qualified to perform CBE (27 (75%) vs. 32 (89%)) or ability to refer patients for diagnostic workup (29 (81%) vs. 34 (94%)). Conclusions: We identified multiple barriers to early breast cancer detection in Côte d’Ivoire. The EC was effective in improving confidence among PCPs and evaluation of breast complaints and addressing barriers to cancer diagnosis. There were no differences in feeling qualified to perform CBE or ability to refer patients to diagnostic workup, which were high at baseline. Future work includes expanding the program reach and evaluating impact on time to diagnosis

Treatment default amongst patients with tuberculosis in urban Morocco: predicting and explaining default and post-default sputum smear and drug susceptibility results.

Public tuberculosis (TB) clinics in urban Morocco.Explore risk factors for TB treatment default and develop a prediction tool. Assess consequences of default, specifically risk for transmission or development of drug resistance.Case-control study comparing patients who defaulted from TB treatment and patients who completed it using quantitative methods and open-ended questions. Results were interpreted in light of health professionals' perspectives from a parallel study. A predictive model and simple tool to identify patients at high risk of default were developed. Sputum from cases with pulmonary TB was collected for smear and drug susceptibility testing.91 cases and 186 controls enrolled. Independent risk factors for default included current smoking, retreatment, work interference with adherence, daily directly observed therapy, side effects, quick symptom resolution, and not knowing one's treatment duration. Age >50 years, never smoking, and having friends who knew one's diagnosis were protective. A simple scoring tool incorporating these factors was 82.4% sensitive and 87.6% specific for predicting default in this population. Clinicians and patients described additional contributors to default and suggested locally-relevant intervention targets. Among 89 cases with pulmonary TB, 71% had sputum that was smear positive for TB. Drug resistance was rare.The causes of default from TB treatment were explored through synthesis of qualitative and quantitative data from patients and health professionals. A scoring tool with high sensitivity and specificity to predict default was developed. Prospective evaluation of this tool coupled with targeted interventions based on our findings is warranted. Of note, the risk of TB transmission from patients who default treatment to others is likely to be high. The commonly-feared risk of drug resistance, though, may be low; a larger study is required to confirm these findings