Implementing HIV/AIDS Education: Impact of Teachers' Training on HIV/AIDS Education in Bangladesh

School-based HIV/AIDS education is a common and well-proven intervention strategy for providing information on HIV/AIDS to young people. However, lack of skills among teachers for imparting sensitive information to students can lead to programme failure in terms of achieving goals. A cross-sectional study was conducted among teachers to identify the factors that support or hinder their role in HIV/AIDS education. A self-administered questionnaire was used for interviewing teachers from randomly-selected schools in two adjacent districts in Bangladesh. Based on exposure to teachers\u2019 training, the districts were divided into control and intervention areas and the teachers\u2019 ability, skill, and their participation in HIV/AIDS education were compared between the districts. Trained teachers in the intervention schools were more likely to participate, less likely to face difficulties, and more likely to use interactive teaching methods in HIV/ AIDS classes compared to the controls who did not receive any training. Inadequate allocation of time for conducting the HIV/AIDS class was found to be barriers to HIV/AIDS education that suggest the need to provide teachers with more support in terms of training and logistics

X-Ray Computed Tomography Inspection of the Stardust Heat Shield

The "Stardust" heat shield, composed of a PICA (Phenolic Impregnated Carbon Ablator) Thermal Protection System (TPS), bonded to a composite aeroshell, contains important features which chronicle its time in space as well as re-entry. To guide the further study of the Stardust heat shield, NASA reviewed a number of techniques for inspection of the article. The goals of the inspection were: 1) to establish the material characteristics of the shield and shield components, 2) record the dimensions of shield components and assembly as compared with the pre-flight condition, 3) provide flight infonnation for validation and verification of the FIAT ablation code and PICA material property model and 4) through the evaluation of the shield material provide input to future missions which employ similar materials. Industrial X-Ray Computed Tomography (CT) is a 3D inspection technology which can provide infonnation on material integrity, material properties (density) and dimensional measurements of the heat shield components. Computed tomographic volumetric inspections can generate a dimensionally correct, quantitatively accurate volume of the shield assembly. Because of the capabilities offered by X-ray CT, NASA chose to use this method to evaluate the Stardust heat shield. Personnel at NASA Johnson Space Center (JSC) and Lawrence Livermore National Labs (LLNL) recently performed a full scan of the Stardust heat shield using a newly installed X-ray CT system at JSC. This paper briefly discusses the technology used and then presents the following results: 1. CT scans derived dimensions and their comparisons with as-built dimensions anchored with data obtained from samples cut from the heat shield; 2. Measured density variation, char layer thickness, recession and bond line (the adhesive layer between the PICA and the aeroshell) integrity; 3. FIAT predicted recession, density and char layer profiles as well as bondline temperatures Finally suggestions are made as to future uses of this technology as a tool for non-destructively inspecting and verifying both pre and post flight heat shields

Implementing HIV/AIDS Education: Impact of Teachers' Training on HIV/AIDS Education in Bangladesh

School-based HIV/AIDS education is a common and well-proven intervention strategy for providing information on HIV/AIDS to young people. However, lack of skills among teachers for imparting sensitive information to students can lead to programme failure in terms of achieving goals. A cross-sectional study was conducted among teachers to identify the factors that support or hinder their role in HIV/AIDS education. A self-administered questionnaire was used for interviewing teachers from randomly-selected schools in two adjacent districts in Bangladesh. Based on exposure to teachers’ training, the districts were divided into control and intervention areas and the teachers’ ability, skill, and their participation in HIV/AIDS education were compared between the districts. Trained teachers in the intervention schools were more likely to participate, less likely to face difficulties, and more likely to use interactive teaching methods in HIV/ AIDS classes compared to the controls who did not receive any training. Inadequate allocation of time for conducting the HIV/AIDS class was found to be barriers to HIV/AIDS education that suggest the need to provide teachers with more support in terms of training and logistics

Retention of female volunteer community health workers in Dhaka urban slums: A case-control study

This article was published in The Journal of Health Policy and Planning [©2012 Published by Oxford Journal] and the definite version is available at: http://doi.org/10.1093/heapol/czr059 The Article's website is at: http://heapol.oxfordjournals.org/content/27/6/477Alam, K., Tasneem, S., & Oliveras, E. (2012). Retention of female volunteer community health workers in dhaka urban slums: A case-control study. Health Policy and Planning, 27(6), 477-486. doi:10.1093/heapol/czr059Introduction Volunteer community health workers (CHWs) are one approach to addressing the health workforce shortage in developing countries. BRAC, a large NGO in Bangladesh, is a pioneer in using female volunteer CHWs as core workers in its successful health programmes. After 25 years of implementing the CHW model in rural areas, BRAC is now using CHWs in urban slums of Dhaka through Manoshi, a community-based maternal and child health project. However, high dropout rates among CHWs in the slums suggested a need to better understand factors associated with their retention, and consequently recommend strategies for increasing their retention.Methods This mixed-method study included a case-control design to assess factors relating to the retention of volunteer CHWs, and focus group discussions (FGDs) to explore solutions to problems. In total, 542 current and 146 dropout CHWs participated in the survey. Six FGDs were held with groups of current and groups of dropout CHWs.Results Financial incentives were the main factor linked to CHW retention. CHWs who joined with the expectation of income were almost twice as likely to remain as CHWs. This finding was reinforced by the inverse association between wealth quintile of the CHWs and retention; the poorest CHWs were significantly more likely to stay in the programme than the richest. However, social prestige, community approval and household responsibilities were important non-financial factors associated with CHW retention. Restructuring and expansion of existing financial incentives to better compensate CHWs were recommended by CHWs to improve their retention.Conclusions Factors found to be important in this study are similar to those from earlier studies in rural areas. While the data indicate that financial incentives are the most commonly discussed factor regarding CHW retention in urban slums, the results also suggest other avenues that could be strengthened to improve their retention.Publishe

Meeting the needs of adolescents living with HIV through home based care: Lessons learned from Tanzania

© 2014 Elsevier Ltd. Home based care is central to HIV care and support throughout Africa. Most programs have not addressed the unique needs of adolescents living with HIV, who display lower retention in HIV care and treatment adherence. This study examined the experiences of adolescents living with HIV in Tanzania in order to identify ways to improve home based care to better meet their needs. Methods: We conducted a qualitative study in Dar es Salaam and Tanga Region consisting of in-depth interviews with 14 adolescents living with HIV, 10 primary caregivers, and 12 providers assigned to their households. Interviews examined adolescents' experiences of growing up with HIV, perceptions of current home based care, and challenges in increasing acceptability of services. Results: We found the program did not align well with adolescents' expectations. Adolescents felt home based care to be more relevant to their caregivers and did not form independent relationships with providers. They expressed anxiety that participation might lead to inadvertent disclosure of their status and consequent discrimination. Both adolescents and their caregivers felt disappointment that no material or financial support was available despite widespread poverty, although they appreciated receiving psychosocial support and practical referrals. Providers demonstrated motivation to work with adolescents but acknowledged lacking requisite skills such as ways to communicate with young people and key messages to deliver. Conclusions: Despite challenges, we identified feasible adaptations to make home based care more adolescent-centered. These include actively engaging adolescents in program design, improving provider training in communication with adolescents, and proactively addressing unrealistic expectations. Finally, increasing referral links to a wider range of services could improve program effectiveness by integrating it into a broader development approach

Clinic-based surveillance of adverse pregnancy outcomes to identify induced abortions in Accra, Ghana

Reliable measures of induced abortion remain elusive, especially when the public perception is that the procedure is immoral or improper. This study draws on interviews using a modified preceding birth technique (PBT) with women attending antenatal and maternity clinics in Accra to compare rates of adverse pregnancy outcomes (stillbirths, miscarriages, and induced abortions) with rates from a household maternity history and the Ghana Demographic and Health Survey. The reports from the antenatal clinics produced some of the highest rates for adverse outcomes of pregnancy. In light of the generally high coverage of antenatal services found even in developing countries, the method based on the PBT holds promise for the improvement of reports of miscarriage and abortion worldwide

A Cost-Effectiveness Analysis of Community Health Workers in Mozambique

Introduction: Community health worker (CHW) programs are a key strategy for reducing mortality and morbidity. Despite this, there is a gap in the literature on the cost and cost-effectiveness of CHW programs, especially in developing countries. Methods: This study assessed the costs of a CHW program in Mozambique over the period 2010-2012. Incremental cost-effectiveness ratios, comparing the change in costs to the change in 3 output measures, as well as gains in efficiency were calculated over the periods 2010-2011 and 2010-2012. The results were reported both excluding and including salaries for CHWs. Results: The results of the study showed total costs of the CHW program increased from US$1.34 million in 2010 to US$1.67 million in 2012. The highest incremental cost-effectiveness ratio was for the cost per beneficiary covered including CHW salaries, estimated at US$47.12 for 2010-2011. The smallest incremental cost-effectiveness ratio was for the cost per household visit not including CHW salaries, estimated at US$0.09 for 2010-2012. Adding CHW salaries would not only have increased total program costs by 362% in 2012 but also led to the largest efficiency gains in program implementation; a 56% gain in cost per output in the long run as compared with the short run after including CHW salaries. Conclusions: Our findings can be used to inform future CHW program policy both in Mozambique and in other countries, as well as provide a set of incremental cost per output measures to be used in benchmarking to other CHW costing analyses