Cost of a diagonal sexual and reproductive health package to enhance reproductive health among female sex workers in Durban, South Africa

Background and objectives: In response to HIV epidemic in Sub- Saharan Africa, there has been widespread concern about the structure and delivery of Sexual Reproductive Health (SRH) and HIV services to improve outcomes among high-risk groups, including sex workers. The ‘Diagonal Interventions to Fast-Forward Enhanced Reproductive health’ (DIFFER) project was conceptualised based on the hypothesis that integrating vertical SRH interventions targeted to FSW, with horizontal health systems strengthening, is likely to be more effective and cost-effective than current practice. The aim of the study was to measure the cost of designing and delivering a SRH package for female sex workers in Durban, South Africa, as part of the DIFFER project. / Methods: We measured the total and incremental costs of the DIFFER intervention package in Durban from a provider perspective, using a combination of ingredients and activity based costing approaches. An excel-based data capture tool was developed to collect the intervention package cost data. The intervention costs were collected prospectively from the project accounts of the implementing agencies and costs to the public health providers were collected via key informant interviews using a cost data capture form and subsequently entered into the spreadsheet. The total and average annual costs, as well as total and average annual costs per sex worker covered were estimated. All costs were adjusted for inflation, discounted and converted to 2016 International dollar. / Results: Total and average annual program costs of implementing the DIFFER intervention in Durban were INT$411,239 (INT$ 428,461, including services provided to the general population) and INT$256,594 (INT$ 273,816, including services provided to the general population) respectively. The total cost and average annual cost per sex worker covered were INT$117 and INT$ 73 respectively. Staff costs accounted for the largest proportion of the intervention cost, comprising more than 80% of the total cost, following by material and supplies, accounting for 10% of costs. / Conclusion: The DIFFER intervention package in Durban is a low cost intervention and likely to be cost-effective and sustainable. The intervention can be considered for replication and scale-up in South Africa and similar settings elsewhere

Conflicting theories on addiction aetiology and the strengths and limitations of substance use disorder disease modelling

A lack of cross-disciplinary unanimity prevails within addiction research. Theories conceptualizing addiction through the three-stage brain disease model contest other theories that substance use disorder is of behavioural or genetic origin. The reverberations of this lack of consensus are noticeable throughout addiction research and within the foundations of disease modelling. The availability of methods to investigate substance use disorder are inconsistent and sometimes unrepresentative. This review discusses theories of addiction aetiology, available models for addiction research and the strengths and limitations of current practical experimental methods of study

Ultralow-light-level color image reconstruction using high-efficiency plasmonic metasurface mosaic filters

As single-photon imaging becomes progressively more commonplace in sensing applications such as low-light-level imaging, three-dimensional profiling, and fluorescence imaging, there exist a number of fields where multispectral information can also be exploited, e.g., in environmental monitoring and target identification. We have fabricated a high-transmittance mosaic filter array, where each optical filter was composed of a plasmonic metasurface fabricated in a single lithographic step. This plasmonic metasurface design utilized an array of elliptical and circular nanoholes, which produced enhanced optical coupling between multiple plasmonic interactions. The resulting metasurfaces produced narrow bandpass filters for blue, green, and red light with peak transmission efficiencies of 79%, 75%, and 68%, respectively. After the three metasurface filter designs were arranged in a 64×64 format random mosaic pattern, this mosaic filter was directly integrated onto a CMOS single-photon avalanche diode detector array. Color images were then reconstructed at light levels as low as approximately 5 photons per pixel, on average, via the simultaneous acquisition of low-photon multispectral data using both three-color active laser illumination and a broadband white-light illumination source

SDSS-IV MaNGA: the “G-dwarf problem” revisited

The levels of heavy elements in stars are the product of enhancement by previous stellar generations, and the distribution of this metallicity among the population contains clues to the process by which a galaxy formed. Most famously, the “G-dwarf problem” highlighted the small number of low-metallicity G-dwarf stars in the Milky Way, which is inconsistent with the simplest picture of a galaxy formed from a “closed box” of gas. It can be resolved by treating the Galaxy as an open system that accretes gas throughout its life. This observation has classically only been made in the Milky Way, but the availability of high-quality spectral data from SDSS-IV MaNGA and the development of new analysis techniques mean that we can now make equivalent measurements for a large sample of spiral galaxies. Our analysis shows that high-mass spirals generically show a similar deficit of low-metallicity stars, implying that the Milky Way’s history of gas accretion is common. By contrast, low-mass spirals show little sign of a G-dwarf problem, presenting the metallicity distribution that would be expected if such systems evolved as pretty much closed boxes. This distinction can be understood from the differing timescales for star formation in galaxies of differing masses

Lost Opportunities to Reduce Periconception HIV Transmission: Safer Conception Counseling By South African Providers Addresses Perinatal but not Sexual HIV Transmission

Introduction: Safer conception strategies create opportunities for HIV-serodiscordant couples to realize fertility goals and minimize periconception HIV transmission. Patient–provider communication about fertility goals is the first step in safer conception counseling. Methods: We explored provider practices of assessing fertility intentions among HIV-infected men and women, attitudes toward people living with HIV (PLWH) having children, and knowledge and provision of safer conception advice. We conducted in-depth interviews (9 counselors, 15 nurses, 5 doctors) and focus group discussions (6 counselors, 7 professional nurses) in eThekwini District, South Africa. Data were translated, transcribed, and analyzed using content analysis with NVivo10 software. Results: Among 42 participants, median age was 41 (range, 28–60) years, 93% (39) were women, and median years worked in the clinic was 7 (range, 1–27). Some providers assessed women's, not men's, plans for having children at antiretroviral therapy initiation, to avoid fetal exposure to efavirenz. When conducted, reproductive counseling included CD4 cell count and HIV viral load assessment, advising mutual HIV status disclosure, and referral to another provider. Barriers to safer conception counseling included provider assumptions of HIV seroconcordance, low knowledge of safer conception strategies, personal feelings toward PLWH having children, and challenges to tailoring safer sex messages. Conclusions: Providers need information about HIV serodiscordance and safer conception strategies to move beyond discussing only perinatal transmission and maternal health for PLWH who choose to conceive. Safer conception counseling may be more feasible if the message is distilled to delaying conception attempts until the infected partner is on antiretroviral therapy. Designated and motivated nurse providers may be required to provide comprehensive safer conception counseling

SDSS-IV MaNGA: spatially resolved dust attenuation in spiral galaxies

Dust attenuation in star-forming spiral galaxies affects stars and gas in different ways due to local variations in dust geometry. We present spatially resolved measurements of dust attenuation for a sample of 232 such star-forming spiral galaxies, derived from spectra acquired by the SDSS-IV MaNGA survey. The dust attenuation affecting the stellar populations of these galaxies (obtained using full spectrum stellar population fitting methods) is compared with the dust attenuation in the gas (derived from the Balmer decrement). Both of these attenuation measures increase for local regions of galaxies with higher star formation rates; the dust attenuation affecting the stellar populations increases more so than the dust attenuation in the gas, causing the ratio of the dust attenuation affecting the stellar populations to the dust attenuation in the gas to decrease for local regions of galaxies with higher star formation rate densities. No systematic difference is discernible in any of these dust attenuation quantities between the spiral arm and inter-arm regions of the galaxies. While both the dust attenuation in the gas and the dust attenuation affecting the stellar populations decrease with galactocentric radius, the ratio of the two quantities does not vary with radius. This ratio does, however, decrease systematically as the stellar mass of the galaxy increases. Analysis of the radial profiles of the two dust attenuation measures suggests that there is a disproportionately high concentration of birth clouds (incorporating gas, young stars and clumpy dust) nearer to the centres of star-forming spiral galaxies.Comment: 17 pages, 8 figures, accepted for publication in Monthly Notices of the Royal Astronomical Societ

Services just for men? Insights from a national study of the well men services pilots.

Men continue to have a lower life expectancy in most countries compared to women. Explanations of this gendered health inequality tend to focus on male risk taking, unhealthy lifestyle choices and resistance to seeking help from health services. In the period 2005-2008 the Scottish Government funded a nationwide community health promotion programme aimed at improving men's health, called Well Men Service Pilots (henceforth WMS)

Changes in household food and drink purchases following restrictions on the advertisement of high fat, salt, and sugar products across the Transport for London network: A controlled interrupted time series analysis.

Funder: Cancer Research UKBACKGROUND: Restricting the advertisement of products with high fat, salt, and sugar (HFSS) content has been recommended as a policy tool to improve diet and tackle obesity, but the impact on HFSS purchasing is unknown. This study aimed to evaluate the impact of HFSS advertising restrictions, implemented across the London (UK) transport network in February 2019, on HFSS purchases. METHODS AND FINDINGS: Over 5 million take-home food and drink purchases were recorded by 1,970 households (London [intervention], n = 977; North of England [control], n = 993) randomly selected from the Kantar Fast Moving Consumer Goods panel. The intervention and control samples were similar in household characteristics but had small differences in main food shopper sex, socioeconomic position, and body mass index. Using a controlled interrupted time series design, we estimated average weekly household purchases of energy and nutrients from HFSS products in the post-intervention period (44 weeks) compared to a counterfactual constructed from the control and pre-intervention (36 weeks) series. Energy purchased from HFSS products was 6.7% (1,001.0 kcal, 95% CI 456.0 to 1,546.0) lower among intervention households compared to the counterfactual. Relative reductions in purchases of fat (57.9 g, 95% CI 22.1 to 93.7), saturated fat (26.4 g, 95% CI 12.4 to 40.4), and sugar (80.7 g, 95% CI 41.4 to 120.1) from HFSS products were also observed. Energy from chocolate and confectionery purchases was 19.4% (317.9 kcal, 95% CI 200.0 to 435.8) lower among intervention households than for the counterfactual, with corresponding relative reductions in fat (13.1 g, 95% CI 7.5 to 18.8), saturated fat (8.7 g, 95% CI 5.7 to 11.7), sugar (41.4 g, 95% CI 27.4 to 55.4), and salt (0.2 g, 95% CI 0.1 to 0.2) purchased from chocolate and confectionery. Relative reductions are in the context of secular increases in HFSS purchases in both the intervention and control areas, so the policy was associated with attenuated growth of HFSS purchases rather than absolute reduction in HFSS purchases. Study limitations include the lack of out-of-home purchases in our analyses and not being able to assess the sustainability of observed changes beyond 44 weeks. CONCLUSIONS: This study finds an association between the implementation of restrictions on outdoor HFSS advertising and relative reductions in energy, sugar, and fat purchased from HFSS products. These findings provide support for policies that restrict HFSS advertising as a tool to reduce purchases of HFSS products