A Model for the Roll-Out of Comprehensive Adult Male Circumcision Services in African Low-Income Settings of High HIV Incidence: The ANRS 12126 Bophelo Pele Project

Bertrand Auvert and colleagues describe the large-scale roll-out of adult male circumcision through a program in South Africa

Processes and dynamics of linkage to care from mobile/outreach and facility‑based HIV testing models in hard‑to‑reach settings in rural Tanzania. Qualitative findings of a mixed methods study

BACKGROUND: Like other countries, Tanzania instituted mobile and outreach testing approaches to address low HIV testing rates at health facilities and enhance linkage to care. Available evidence from hard-to-reach rural settings of Mbeya region, Tanzania suggests that clients testing HIV+ at facility-based sites are more likely to link to care, and to link sooner, than those testing at mobile sites. This paper (1) describes the populations accessing HIV testing at mobile/outreach and facility-based testing sites, and (2) compares processes and dynamics from testing to linkage to care between these two testing models from the same study context. METHODS: An explanatory sequential mixed-method study (a) reviewed records of all clients (n = 11,773) testing at 8 mobile and 8 facility-based testing sites over 6 months; (b), reviewed guidelines; (c) observed HIV testing sites (n = 10) and Care and Treatment Centers (CTCs) (n = 8); (d) applied questionnaires at 0, 3 and 6 months to a cohort of 1012 HIV newly-diagnosed clients from the 16 sites; and (e) conducted focus group discussions (n = 8) and in-depth qualitative interviews with cohort members (n = 10) and health care providers (n = 20). RESULTS: More clients tested at mobile/outreach than facility-based sites (56% vs 44% of 11,733, p < 0.001). Mobile site clients were more likely to be younger and male (p < 0.001). More clients testing at facility sites were HIV positive (21.5% vs. 7.9% of 11,733, p < 0.001). All sites in both testing models adhered to national HIV testing and care guidelines. Staff at mobile sites showed more proactive efforts to support linkage to care, and clients report favouring the confidentiality of mobile sites to avoid stigma. Clients who tested at mobile/outreach sites faced longer delays and waiting times at treatment sites (CTCs). CONCLUSIONS: Rural mobile/outreach HIV testing sites reach more people than facility based sites but they reach a different clientèle which is less likely to be HIV +ve and appears to be less “linkage-ready”. Despite more proactive care and confidentiality at mobile sites, linkage to care is worse than for clients who tested at facility-based sites. Our findings highlight a combination of (a) patient-level factors, including stigma; and (b) well-established procedures and routines for each step between testing and initiation of treatment in facility-based sites. Long waiting times at treatment sites are a further barrier that must be addressed

Multi criteria decision making approach for strategic evaluation of environmental trade-off solution in logistics : A case study at Northvolt

The purpose of this thesis is to investigate to what extent the environmental agenda should be taken into consideration during the project phase of logistics at Northvolt. The objective is to build an optimization model for route planning with a trade-off solution for three criteria; cost, emission and time. An abductive research approach is used. The empirical data was collected quantitatively in accordance with cross-industry standard process for data mining. The results obtained from the optimization model were based on an emission calculation framework and weights assigned to the three selected criteria by five decision makers. These results are compared to an as-is analysis of current and of historical transportations as well as to expected future transportations. These results provide insights and emphasize the importance of agility in decision making aiming at the reduction of emissions. The analysis shows that increased costs do not have a clear correlation with reduced emissions or transportation time. It also demonstrates that transporting goods on sea would increase the transportation time but decrease the emissions. The conclusions of the study are that costs can be reduced by 8%, emissions by 6% and transportation time by 14%, compared to their current operations. Short-term recommendations address the need of being agile in the route planning and analyse each shipment individually where the weights of the criteria should be alternated depending on the status of the project. This requires increased communication with the installation team on site and negotiation of contractual rates from additional ports in Sweden. Long-term recommendations emphasise the importance of developing and using emission key performance indicators to set targets in combination with a strategy in order to steer daily operations.

Context and correlates of providing assistance with someone’s first injection in the AIDS linked to the IntraVenous Experience cohort, Baltimore, MD

BackgroundThe social processes around initiating injection may be well-suited to intervention, yet there is substantial heterogeneity in the reported experiences of people who inject drugs (PWID) who assist with another individual's first drug injection. We aimed to describe the lifetime prevalence and context of providing initiation assistance among a cohort of PWID.MethodsParticipants of the AIDS Linked to the IntraVenous Experience (ALIVE) cohort of PWID in Baltimore, Maryland (n=848) were surveyed during 2019-2020 about assisting with another person's first injection. Associations between factors related to injection risk and history of providing assistance were estimated using logistic regression models adjusted for sociodemographic and behavioral characteristics.ResultsAt baseline, participants were primarily male (66.1%), black (82.9%), aged a median of 42 years, and had been injecting a median of 18 years. Overall, 19% (n=157) of participants reported ever providing assistance for a median of 2 people (Interquartile Range: 1-4). Having hepatitis C infection (adjusted Odds Ratio [95% Confidence Interval]: 2.5 [1.4-4.6]), syringe sharing (2.2 [1.2-3.9]), and injecting ≥3 times per day (2.0 [1.2-3.4]) at study enrollment were associated with a history of assistance. Participants primarily assisted friends (58.0%), acquaintances (29.9%), and partners (21.7%). Common reasons for assisting were the other person's lack of injection knowledge (73.7%) or sharing drugs (44.9%). Additional reasons included to prevent injury.ConclusionPWID with a history of assisting with another person's first injection exhibited heightened vulnerability to infections and more frequent substance use. Expanding implementation of interventions with an emphasis on harm reduction is needed

Emissioner från småskalig värmeproduktion med biobränslen : Ett samordnat projekt som berör hälsopåverkande partikel- och tungmetallutsläpp från tradionella och alternativa biobränslen

Godkänd; 2011; 20111010 (andbra