Reproductive Health Care in Carceral Facilities: Identifying What We Know and Opportunities for Further Research

With increased attention on and awareness about the rights of incarcerated people, their reproductive rights and other health issues are also gaining traction in national discourse. Reproductive health care is critical for incarcerated people, especially as approximately half are parents of minor children (Ghandnoosh, Stammen, and Muhitch 2021) and 3 to 4 percent of women have been reported to be pregnant upon admission to state and federal prisons (Maruschak 2008). Furthermore, prisons have violated people's reproductive freedom and physical autonomy with inhumane practices such as forced sterilization and the restraining of pregnant people* during labor. Despite its importance, research on reproductive health care access in prisons is limited. In this brief, we provide an overview of what is known about reproductive health care in carceral settings and explore opportunities for further research

Enhancing the provision of livestock marketing information in Somaliland

The economy of Somaliland depends on livestock, which employs about 70% of the population and contributes approximately 60% of GDP and 85% of export earnings. The principal export markets are the Kingdom of Saudi Arabia, Yemen, Oman, Egypt and the United Arab Emirates. Exports to these markets have shown a steady growth in the last four years. Despite recent growth in export volumes, livestock trade takes place in an environment characterized by an underdeveloped legal framework, contract uncertainty and high information costs among other factors. Trade is guided by informal traditional institutions, customs and religious practices that serve as alternatives to formal contracting. The Livestock Marketing Information System (LMIS) was initiated in 2007 to address the constraint of high market information cost. The purpose of the LMIS is to provide timely current information to livestock producers, traders, government officials and other development partners. It collects and disseminates data from three livestock markets (Hargeisa, Burao and Tog Wajaale), the port of Berbera and crossborder market of Lowya Caddo. It is implemented by the Somaliland Chamber of Commerce, Industries and Agriculture, in collaboration with the Ministry of Livestock, Ministry of Commerce, Ministry of Finance, the municipalities of Hargeisa, Burao and Tog Wajaale, with the technical support of Terra Nuova and funding from Danish Government. Although several agricultural market information systems exist in developing countries, the validity, reliability and impact of information they generate vary and depend on a number of factors. Some of these include technology used, technical capability of personnel, protocol employed in data capturing, management and transmission among others. Despite the Somaliland LMIS being in operation for eight year, there has been no attempt to evaluate its validity and reliability. To redress this concern, this study provides an appraisal of the validity of the Somaliland LMIS as a decision making tool for stakeholders, identifies its strengths and weaknesses and offers recommendations for improvement. The validity of the system was assessed by focussing on three areas. First, by evaluating the proportion of total Somaliland livestock exports that are traded through the monitored markets. This enabled understand how the LMIS covers the target population. Second, by analysing the extent to which the trends in volumes of livestock traded in monitored markets is explained by shocks and opportunities in both local and international markets; and third by evaluating the type of trends that exist in livestock prices and the main drivers of these trends. Data used were obtained from the LMIS database, comprising weekly traded volumes, weekly price data for different grades of small ruminants, cattle and camels, and weekly export trader numbers for a period 2007–12. The study shows that the LMIS has provided valid data and information over time, noting that the data series exhibited direct and strong relations with shocks and opportunities that have occurred in local and international markets. The LMIS’s coverage has been high and consistent for small ruminants, although modest for cattle and camels. A vector autoregressive model applied to quantify the effects of seasonal and occasional factors on price revealed that whereas prices of small ruminants and camels have exhibited secular and upwards trends over time, those of cattle have remained the same. In addition, market structure, seasonal effects as well as shock events were found to only affect the prices of small ruminants. The report presents preliminary recommendations for public and private sectors, with some predicated on further study

Mannitol-facilitated CNS entry of rAAV2 vector significantly delayed the neurological disease progression in MPS IIIB mice

The presence of the blood-brain barrier (BBB) presents the most critical challenge in therapeutic development for mucopolysaccharidosis (MPS) IIIB, a lysosomal storage disease with severe neurological manifestation, because of alpha-N-acetylglucosaminidase (NaGlu) deficiency. Earlier, we showed a global central nervous system (CNS) transduction in mice by mannitol-facilitated entry of intravenous (IV)-delivered recombinant adeno-associated viral serotype 2 (rAAV2) vector. In this study, we optimized the approach and showed that the maximal transduction in the CNS occurred when the rAAV2 vector was IV injected at 8 min after mannitol administration, and was approximately 10-fold more efficient than IV delivery of the vector at 5 or 10 min after mannitol infusion. Using this optimal (8 min) regimen, a single IV infusion of rAAV2-CMV-hNaGlu vector is therapeutically beneficial for treating the CNS disease of MPS IIIB in adult mice, with significantly extended survival, improved behavioral performance, and reduction of brain lysosomal storage pathology. The therapeutic benefit correlated with maximal delivery to the CNS, but not peripheral tissues. This milestone data shows the first effective gene delivery across the BBB to treat CNS disease. The critical timing of vector delivery and mannitol infusion highlights the important contribution of this pretreatment to successful intervention, and the long history of safe use of mannitol in patients bodes well for its application in CNS gene therapy

Identifying Adolescents at Highest Risk of ART Non-adherence, Using the World Health Organization-Endorsed HEADSS and HEADSS+ Checklists

Brief tools are necessary to identify adolescents at greatest risk for ART non-adherence. From the WHO's HEADSS/HEADSS+ adolescent wellbeing checklists, we identify constructs strongly associated with non-adherence (validated with viral load). We conducted interviews and collected clinical records from a 3-year cohort of 1046 adolescents living with HIV from 52 South African government facilities. We used least absolute shrinkage and selection operator variable selection approach with a generalized linear mixed model. HEADSS constructs most predictive were: violence exposure (aOR 1.97, CI 1.61; 2.42, p < 0.001), depression (aOR 1.71, CI 1.42; 2.07, p < 0.001) and being sexually active (aOR 1.80, CI 1.41; 2.28, p < 0.001). Risk of non-adherence rose from 20.4% with none, to 55.6% with all three. HEADSS+ constructs were: medication side effects (aOR 2.27, CI 1.82; 2.81, p < 0.001), low social support (aOR 1.97, CI 1.60; 2.43, p < 0.001) and non-disclosure to parents (aOR 2.53, CI 1.91; 3.53, p < 0.001). Risk of non-adherence rose from 21.6% with none, to 71.8% with all three. Screening within established checklists can improve identification of adolescents needing increased support. Adolescent HIV services need to include side-effect management, violence prevention, mental health and sexual and reproductive health

Screening and supporting through schools: educational experiences and needs of adolescents living with HIV in a South African cohort

BACKGROUND: Many adolescents living with HIV remain disconnected from care, especially in high-prevalence settings. Slow progressors-adolescents infected perinatally who survive without access to lifesaving treatment-remain unidentified and disconnected from heath systems, especially in high-prevalence settings. This study examines differences in educational outcomes for ALHIV, in order to i) identify educational markers for targeting HIV testing, counselling and linkages to care, and ii) to identify essential foci of educational support for ALHIV. METHODS: Quantitative interviews with N = 1063 adolescents living with HIV and N = 456 HIV-free community control adolescents (10-19 year olds) included educational experiences (enrolment, fee-free school, school feeding schemes, absenteeism, achievement), physical health, cognitive difficulties, mental health challenges (depression, stigma, and trauma), missing school to attend clinic appointments, and socio-demographic characteristics. Voluntary informed consent was obtained from adolescents and caregivers (when adolescent < 18 years old). Analyses included multivariate logistic regressions, controlling for socio-demographic covariates, and structural equation modelling using STATA15. RESULTS: ALHIV reported accessing educational services (enrolment, free schools, school feeding schemes) at the same rates as other adolescents (94, 30, and 92% respectively), suggesting that school is a valuable site for identification. Living with HIV was associated with poorer attendance (aOR = 1.7 95%CI1.1-2.6) and educational delay (aOR1.7 95%CI1.3-2.2). Adolescents who reported educational delay were more likely to be older, male, chronically sick and report more cognitive difficulties. A path model with excellent model fit (RMSEA = 0.027, CFI 0.984, TLI 0.952) indicated that living with HIV was associated with a series of poor physical, mental and cognitive health issues which led to worse educational experiences. CONCLUSION: Schools may provide an important opportunity to identify unreached adolescents living with HIV and link them into care, focusing on adolescents with poor attendance, frequent sickness, low mood and slow learning. Key school-based markers for identifying unreached adolescents living with HIV may be low attendance, frequent sickness, low mood and slow learning. Improved linkages to care for adolescents living with HIV, in particular educational support services, are necessary to support scholastic achievement and long-term well-being, by helping them to cope with physical, emotional and cognitive difficulties