Is the promise of methadone Kenya's solution to managing HIV and addiction? A mixed-method mathematical modelling and qualitative study.

BACKGROUND AND OBJECTIVES: Promoted globally as an evidence-based intervention in the prevention of HIV and treatment of heroin addiction among people who inject drugs (PWID), opioid substitution treatment (OST) can help control emerging HIV epidemics among PWID. With implementation in December 2014, Kenya is the third Sub-Saharan African country to have introduced OST. We combine dynamic mathematical modelling with qualitative sociological research to examine the 'promise of methadone' to Kenya. METHODS, SETTING AND PARTICIPANTS: We model the HIV prevention impact of OST in Nairobi, Kenya, at different levels of intervention coverage. We draw on thematic analyses of 109 qualitative interviews with PWID, and 43 with stakeholders, to chart their narratives of expectation in relation to the promise of methadone. RESULTS: The modelled impact of OST shows relatively slight reductions in HIV incidence (5-10%) and prevalence (2-4%) over 5 years at coverage levels (around 10%) anticipated in the planned roll-out of OST. However, there is a higher impact with increased coverage, with 40% coverage producing a 20% reduction in HIV incidence, even when accounting for relatively high sexual transmissions. Qualitative findings emphasise a culture of 'rationed expectation' in relation to access to care and a 'poverty of drug treatment opportunity'. In this context, the promise of methadone may be narrated as a symbol of hope-both for individuals and community-in relation to addiction recovery. CONCLUSIONS: Methadone offers HIV prevention potential, but there is a need to better model the effects of sexual HIV transmission in mediating the impact of OST among PWID in settings characterised by a combination of generalised and concentrated epidemics. We find that individual and community narratives of methadone as hope for recovery coexist with policy narratives positioning methadone primarily in relation to HIV prevention. Our analyses show the value of mixed methods approaches to investigating newly-introduced interventions

The Student Movement Volume 106 Issue 14: Climb Every Mountain, Tube Every Hill

HUMANS Getting to Know AU\u27s New Photography Professor Dan Weber. Interviewed by Karenna Lee Interview with BSCF President Khaylee Sands, Interviewed by: Timmy Duado Military to Music: Interview with Marcus Carter, Interviewed by: Grace No ARTS & ENTERTAINMENT Black Entertainers Who Inspire Me, Hannah Cruse In the Words of AU: Why Black Art is Important, Solana Campbell Know Your Roots by Marcel Mattox, Interviewed by: Kaela McFadden NEWS Embracing the New Normal, Jenae Rogers Mask Off: Andrews University Updates Covid-19 Guidelines, Abigail Lee Panic: Understanding the War Over Ukraine, Chris Ngugi Winter Storms Flurry Through the Midwest and the South, Nathan Mathieu IDEAS Kanye West and Paternal Accountability: Why it Matter, Alyssa Henriquez Should Joe Biden Cancel Student Debt? Who Has to Save The World?, Qualyn Robinson PULSE Cardinals vs. Golden Eagles: A Few Last Flights at the Season\u27s End, Alannah Tjhatra Fun Weekend Winter Activities, Shania Watts Thoughts on the Beijing 2022 Winter Olympics, Kaela McFadden THE LAST WORD Please Lamson Hall, Can I Have Some More?, Abigail Leehttps://digitalcommons.andrews.edu/sm-106/1013/thumbnail.jp

Building capacity in implementation science research training at the University of Nairobi.

BACKGROUND: Health care systems in sub-Saharan Africa, and globally, grapple with the problem of closing the gap between evidence-based health interventions and actual practice in health service settings. It is essential for health care systems, especially in low-resource settings, to increase capacity to implement evidence-based practices, by training professionals in implementation science. With support from the Medical Education Partnership Initiative, the University of Nairobi has developed a training program to build local capacity for implementation science. METHODS: This paper describes how the University of Nairobi leveraged resources from the Medical Education Partnership to develop an institutional program that provides training and mentoring in implementation science, builds relationships between researchers and implementers, and identifies local research priorities for implementation science. RESULTS: The curriculum content includes core material in implementation science theory, methods, and experiences. The program adopts a team mentoring and supervision approach, in which fellows are matched with mentors at the University of Nairobi and partnering institutions: University of Washington, Seattle, and University of Maryland, Baltimore. A survey of program participants showed a high degree satisfaction with most aspects of the program, including the content, duration, and attachment sites. A key strength of the fellowship program is the partnership approach, which leverages innovative use of information technology to offer diverse perspectives, and a team model for mentorship and supervision. CONCLUSIONS: As health care systems and training institutions seek new approaches to increase capacity in implementation science, the University of Nairobi Implementation Science Fellowship program can be a model for health educators and administrators who wish to develop their program and curricula

The Student Movement Volume 106 Issue 15: AU Theatre Wing Presents Pride and Prejudice

HUMANS Matchmaking by SASA - Details on the New Club Event!, Interviewed by: Irina Gagiu Meeting AU\u27s New Librarian, Katherine Van Arsdale Bell, Interviewed by: Grace No My Future Plans: Hannah Castillo, Interviewed by: Lauren Kim ARTS & ENTERTAINMENT Creative Spotlight: Students of the AU Theatre Wing, Interviewed by: Megan Napod New Artist Releases: Evin Nazya-Musgrove, Eli Wilson, & Jonathan Lutterodt, Solana Compbell The One Inch Barrier, Steven Injety NEWS Herbert Blomstedt Comes to Andrews University, Abigail Lee It\u27s for the Effect: A Student Response, Chris Ngugi Worship Concert, Healing Together , Andrew Pak IDEAS Are Attention Spans Decreasing?, Elizabeth Getahun Do I Have to Be a Parent?, Angelina Nesmith Naming the Familiar: Emotions, Experiences, & our Insufficient Language, Alexander Navarro PULSE Checking Out Rate My Professors , Gloria Oh Dorm Policies, Alannah Tjhatra Lessons I\u27ve Learned on My Year Abroad, Terika Williams THE LAST WORD A Friend, Taylor Uphushttps://digitalcommons.andrews.edu/sm-106/1014/thumbnail.jp

The Student Movement Volume 107 Issue 15: Moving Forward: AU Rings in Black History Month

HUMANS Current Book Reads, Anna Pak Interview with Kayla Goodman, Lamson Student Dean, Interviewed by: Grace No Meet Julaine Phillips, BSCF Vice President, Interviewed by: Grace No ARTS & ENTERTAINMENT Creatives on Campus: Black History Month, Mora Martin Currently: You People, Jonathon Woolford-Hunt Shining Talent at Young Artists Concert 2023, Aiko J. Ayala Rios NEWS BSCF\u27s IMPACT Vespers Kicks off Black History Month, Andrew Francis Death of Tyre Nichols: Catalyst for Change or Recurring Event?, Hannah Cruse Honors Agape Feast, Gloria Oh Pre-Vet Club Fundraisers for Stray Cats, Alannah Tjhatra IDEAS I Don\u27t Understand Poetry, T Bruggemann Open AI\u27s Chat GPT. Gabriela Francisco The Diasporic Black History Month, Elizabeth Getahun PULSE A Glance into the Office of Innovation & Entrepreneurship, Gloria Oh Duality in Spirituality: A Shift in Perspective, Wambui Karanja Our Food: Can We Cook It?. Charisse Lapubla LAST WORD Black in (Almost) Every Language, Chris Ngugihttps://digitalcommons.andrews.edu/sm-107/1014/thumbnail.jp

'Relief of oppression': An organizing principle for researchers' obligations to participants in observational studies in the developing world

<p>Abstract</p> <p>Background</p> <p>A central question in the debate about exploitation in international research is whether investigators and sponsors from high-income countries (HIC) have obligations to address background conditions of injustice in the communities in which they conduct their research, beyond the healthcare and other research-related needs of participants, to aspects of their basic life circumstances.</p> <p>Discussion</p> <p>In this paper, we describe <b>t</b>he Majengo sexually transmitted disease (STD) Cohort study, a long-term prospective, observational cohort of sex workers in Nairobi, Kenya. Despite important scientific contributions and a wide range of benefits to the women of the cohort, most of the women have remained in the sex trade during their long-standing participation in the cohort, prompting allegations of exploitation. The Majengo STD cohort case extends the debate about justice in international research ethics beyond clinical trials into long-term observational research. We sketch the basic features of a new approach to understanding and operationalizing obligations of observational researchers, which we call 'relief of oppression'. 'Relief of oppression' is an organizing principle, analogous to the principle of harm reduction that is now widely applied in public health practice. Relief of oppression aims to help observational researchers working in conditions of injustice and deprivation to clarify their ethical obligations to participants. It aims to bridge the gap between a narrow, transaction-oriented account of avoiding exploitation and a broad account emphasizing obligations of reparation for historic injustices. We propose that relief of oppression might focus researchers' consideration of benefits on those that have some relevance to background conditions of injustice, and so elevate the priority of these benefits, in relation to others that might be considered and negotiated with participants, according to the degree to which the participating communities are constrained in their realization of fundamental freedoms.</p> <p>Summary</p> <p>The over-arching aim of relief of oppression is that, within the range of benefits negotiated over time with the local communities and organizations, an increasing proportion reflects a shared interest in improving participants' fundamental freedoms. We describe how harm reduction serves as a useful analogy for how we envision relief of oppression functioning in international research.</p

Assessing the Real-Time Impact of COVID-19 on TB and HIV Services: The Experience and Response from Selected Health Facilities in Nairobi, Kenya

There was concern that the COVID-19 pandemic would adversely affect TB and HIV programme services in Kenya. We set up real-time monthly surveillance of TB and HIV activities in 18 health facilities in Nairobi so that interventions could be implemented to counteract anticipated declining trends. Aggregate data were collected and reported monthly to programme heads during the COVID-19 period (March 2020–February 2021) using EpiCollect5 and compared with monthly data collected during the pre-COVID period (March 2019–February 2020). During the COVID-19 period, there was an overall decrease in people with presumptive pulmonary TB (31.2%), diagnosed and registered with TB (28.0%) and in those tested for HIV (50.5%). Interventions to improve TB case detection and HIV testing were implemented from August 2020 and were associated with improvements in all parameters during the second six months of the COVID-19 period. During the COVID-19 period, there were small increases in TB treatment success (65.0% to 67.0%) and referral of HIV-positive persons to antiretroviral therapy (91.2% to 92.9%): this was more apparent in the second six months after interventions were implemented. Programmatic interventions were associated with improved case detection and treatment outcomes during the COVID-19 period, suggesting that monthly real-time surveillance is useful during unprecedented events

Evenness mediates the global relationship between forest productivity and richness

1. Biodiversity is an important component of natural ecosystems, with higher species richness often correlating with an increase in ecosystem productivity. Yet, this relationship varies substantially across environments, typically becoming less pronounced at high levels of species richness. However, species richness alone cannot reflect all important properties of a community, including community evenness, which may mediate the relationship between biodiversity and productivity. If the evenness of a community correlates negatively with richness across forests globally, then a greater number of species may not always increase overall diversity and productivity of the system. Theoretical work and local empirical studies have shown that the effect of evenness on ecosystem functioning may be especially strong at high richness levels, yet the consistency of this remains untested at a global scale. 2. Here, we used a dataset of forests from across the globe, which includes composition, biomass accumulation and net primary productivity, to explore whether productivity correlates with community evenness and richness in a way that evenness appears to buffer the effect of richness. Specifically, we evaluated whether low levels of evenness in speciose communities correlate with the attenuation of the richness–productivity relationship. 3. We found that tree species richness and evenness are negatively correlated across forests globally, with highly speciose forests typically comprising a few dominant and many rare species. Furthermore, we found that the correlation between diversity and productivity changes with evenness: at low richness, uneven communities are more productive, while at high richness, even communities are more productive. 4. Synthesis. Collectively, these results demonstrate that evenness is an integral component of the relationship between biodiversity and productivity, and that the attenuating effect of richness on forest productivity might be partly explained by low evenness in speciose communities. Productivity generally increases with species richness, until reduced evenness limits the overall increases in community diversity. Our research suggests that evenness is a fundamental component of biodiversity–ecosystem function relationships, and is of critical importance for guiding conservation and sustainable ecosystem management decisions