Behaviour change and water quality

While access to drinking water in India has increased over the past decade, the tremendous adverse impact of unsafe water on health continues. Twenty one percent of communicable diseases in India are estimated to be water related. The highest mortality from diarrhoea is in children under the age of five, and there is an urgent need for focused interventions to prevent diarrhoeal disease in this age group. Despite investments in water and sanitation infrastructure, many low-income communities in India and other developing countries continue to lack access to safe drinking water, proper sanitation and sewerage systems, garbage collection networks, and information and education on healthy hygiene and sanitation practices. Currently available strategies and technologies to make water safe to drink are unaffordable and inaccessible to most low-income households, particularly those without a regular piped water supply

Investigation of False Positive Results with an Oral Fluid Rapid HIV-1/2 Antibody Test

BACKGROUND: In March 2004, the OraQuick® rapid HIV antibody test became the first rapid HIV test approved by the US Food and Drug Administration for use on oral fluid specimens. Test results are available in 20 minutes, and the oral fluid test is non-invasive. From August 2004–June 2005, we investigated a sudden increase in false-positive results occurring in a performance study of OraQuick® oral-fluid rapid HIV tests in Minnesota. METHODOLOGY/PRINCIPAL FINDINGS: In a field investigation, we reviewed performance study data on oral-fluid and whole-blood OraQuick® rapid HIV test device lots and expiration dates and assessed test performance and interpretation with oral-fluid and whole-blood specimens by operators who reported false-positive results. We used multivariate logistic regression to evaluate client demographic and risk characteristics associated with false-positive results. Next, we conducted an incidence study of false-positive OraQuick rapid HIV tests in nine US cities and tested both oral-fluid and finger-stick whole-blood specimens from clients; reactive tests were confirmed with Western blot. Sixteen (4.1%) false-positive oral-fluid results occurred in the performance study from April 15, 2004 through August 31, 2004 with unexpired devices from six test lots among 388 HIV-uninfected clients (specificity, 95.9%; 95% CI: 93.4–97.6). Three test operators who had reported false-positive results performed and interpreted the test according to package-insert instructions. In multivariate analysis, only older age was significantly associated with false-positive results (adjusted odds ratio = 4.5, 95% CI: 1.2–25.7). In the incidence study, all valid oral-fluid and whole-blood results from 2,268 clients were concordant and no false-positive results occurred (100% specificity). CONCLUSIONS/SIGNIFICANCE: The field investigation did not identify a cause for the increase in false-positive oral-fluid results, and the incidence study detected no false-positive results. The findings suggest this was an isolated cluster; the test's overall performance was as specified by the manufacturer

HIV Transmission in a State Prison System, 1988–2005

INTRODUCTION: HIV prevalence among state prison inmates in the United States is more than five times higher than among nonincarcerated persons, but HIV transmission within U.S. prisons is sparsely documented. We investigated 88 HIV seroconversions reported from 1988-2005 among male Georgia prison inmates. METHODS: We analyzed medical and administrative data to describe seroconverters' HIV testing histories and performed a case-crossover analysis of their risks before and after HIV diagnosis. We sequenced the gag, env, and pol genes of seroconverters' HIV strains to identify genetically-related HIV transmission clusters and antiretroviral resistance. We combined risk, genetic, and administrative data to describe prison HIV transmission networks. RESULTS: Forty-one (47%) seroconverters were diagnosed with HIV from July 2003-June 2005 when voluntary annual testing was offered. Seroconverters were less likely to report sex (OR [odds ratio] = 0.02, 95% CI [confidence interval]: 0-0.10) and tattooing (OR = 0.03, 95% CI: <0.01-0.20) in prison after their HIV diagnosis than before. Of 67 seroconverters' specimens tested, 33 (49%) fell into one of 10 genetically-related clusters; of these, 25 (76%) reported sex in prison before their HIV diagnosis. The HIV strains of 8 (61%) of 13 antiretroviral-naïve and 21 (40%) of 52 antiretroviral-treated seroconverters were antiretroviral-resistant. DISCUSSION: Half of all HIV seroconversions were identified when routine voluntary testing was offered, and seroconverters reduced their risks following their diagnosis. Most genetically-related seroconverters reported sex in prison, suggesting HIV transmission through sexual networks. Resistance testing before initiating antiretroviral therapy is important for newly-diagnosed inmates

Willingness of Men Who Have Sex with Men (MSM) in the United States to Be Circumcised as Adults to Reduce the Risk of HIV Infection

BACKGROUND: Circumcision reduces HIV acquisition among heterosexual men in Africa, but it is unclear if circumcision may reduce HIV acquisition among men who have sex with men (MSM) in the United States, or whether MSM would be willing to be circumcised if recommended. METHODS: We interviewed presumed-HIV negative MSM at gay pride events in 2006. We asked uncircumcised respondents about willingness to be circumcised if it were proven to reduce risk of HIV among MSM and perceived barriers to circumcision. Multivariate logistic regression was used to identify covariates associated with willingness to be circumcised. RESULTS: Of 780 MSM, 133 (17%) were uncircumcised. Of these, 71 (53%) were willing to be circumcised. Willingness was associated with black race (exact odds ratio [OR]: 3.4, 95% confidence interval [CI]: 1.3-9.8), non-injection drug use (OR: 6.1, 95% CI: 1.8-23.7) and perceived reduced risk of penile cancer (OR: 4.7, 95% CI: 2.0-11.9). The most commonly endorsed concerns about circumcision were post-surgical pain and wound infection. CONCLUSIONS: Over half of uncircumcised MSM, especially black MSM, expressed willingness to be circumcised. Perceived risks and benefits of circumcision should be a part of educational materials if circumcision is recommended for MSM in the United States

Women\u27s groups and COVID-19: An evidence review on savings groups in Africa

This paper presents emerging evidence from studies in diverse contexts in sub-Saharan Africa —with a deep dive into Nigeria and Uganda—on how COVID-19 has affected women’s groups and how these groups have helped mitigate the gendered effects of the pandemic’s and the associated policy responses’ consequences up until April 2021. The synthesis presents evidence that savings groups found ways to continue operating, provided leadership opportunities for women during the pandemic, and mitigated some of the negative economic consequences of COVID-19 on individual savings group members. Savings, credit, and group support from other members all likely contributed to the ability of groups to positively affect women’s group member’s resilience during COVID-19. However, savings groups themselves often faced financial challenges because of decreased savings, which sometimes resulted in the depletion of group assets. These findings are consistent with a recent evidence synthesis on how past covariate shocks affected women’s groups and their members. We conclude the paper by presenting various policy recommendations to enable savings groups to achieve improvements in women’s empowerment and economic outcomes and research recommendations to address some of the current evidence-gaps on how COVID-19 is affecting women’s groups and their members

Zimbabwe (2008): Multiple Concurrent Partnerships in Zimbabwe

PSI/Z conducted a cross sectional population based survey (August-September 2008). Male and female respondents aged 15-49 years were randomly sampled from households in both urban and rural areas. The study sample was selected in two stages. In the first stage, enumeration areas (EAs) were randomly selected using probability proportionate to size. EAs are geographic areas used for sampling purposes. In the second stage, households within the selected EAs were selected using simple random sampling. In households where more than one eligible respondent was available, a respondent was randomly selected using the Kish grid method. Analysis was performed using SPSS version 16 and results presented in PSI Dashboard format. Means were reported using UNIANOVA; separate models were run in which the variable of interest was the outcome and controls were age, education, sex, residence and socio-economic status. The segmentation model was based on binary logistic regression in which explanatory variables were dropped if found not to significantly contribute to explanation of the variance. Adjusted means or proportions were presented for explanatory variables which remained in the final logistic regression model, adjusting for significant explanatory variables in the model

Demographic characteristics, behavioral risk factors, HIV testing history, and use of prevention services among 780 men who have sex with men who attended Gay Pride and Minority Gay Pride events in 7 U.S. cities by circumcision status – 2006.

*<p>Respondents could select more than one race.</p>†<p>Other race includes American Indians/Alaskan Native, Asians/Native Hawaiians/Pacific Islanders, and people reporting “other” race.</p>‡<p>Two respondents reported >10 male partners.</p>§<p>For this question, n = 777 because 3 respondents answered ‘don't know.’</p

Willingness to be circumcised among 127 uncircumcised men who have sex with men not known to be HIV-infected who attended Gay Pride and Minority Gay Pride events in 7 U.S. cities – 2006.

*<p>Median age of respondents was 33 years.</p

Demographic characteristics, behavioral risk factors, HIV testing history, and use of prevention services and agreement with perceived risks and benefits of circumcision and willingness to be circumcised among 133 uncircumcised men who have sex with men not known to be HIV-infected who attended Gay Pride and Minority Gay Pride events in 7 U.S. cities by willingness to be circumcised as an adult – 2006.

*<p>Respondents could select more than one race.</p>†<p>Other race includes American Indians/Alaskan Native, Asians/Native Hawaiians/Pacific Islanders, and people reporting “other” race.</p>‡<p>Five uncircumcised respondents did not provide data for the perceived risks and benefits statements, therefore N = 127.</p

2wT app follow up actions for HCWs.

New initiates on antiretroviral therapy (ART) are at high risk of treatment discontinuation, putting their health at risk. In low- and middle-income countries, like Malawi, appropriate digital health applications (apps) must fit into local clinic, connectivity and resource constraints. We describe the human centered design (HCD) and development process of an open-source, hybrid, two-way texting (2wT) system to improve ART retention. We detail the critical role of diverse healthcare workers (HCWs) in the HCD process to inform app usability, create buy-in, and ensure appropriate optimization for the local context. We optimized 2wT usability and acceptability over three HCD phases: 1) informal feedback sessions with diverse 2wT stakeholders, 2) a small pilot, and 3) key informant interviews. Phase one included four sessions with diverse HCWs, including “expert ART clients”, clinical, technical, supervisory, and evaluation teams to inform 2wT design. In phase 2, a small pilot with 50 participating ART clients aimed to inform implementation improvement. Phase three included interviews with ten HCWs to deepen understanding of 2wT acceptability and usability, documenting strengths and weaknesses to inform optimization. Multi-phase feedback sessions with HCWs helped refine 2wT language and message timing for both weekly and tailored client-specific visit reminders. The pilot led to improvements in educational materials to guide client responses and ease interaction with HCWs. In interviews, the HCWs appreciated the HCD co-creation process, suggested ways to increase access for low-literacy clients or those without consistent phone access, and felt integrating 2wT with other eHealth platforms would improve scalability. Inclusion of HCWs across phases of HCD design, adaption, and optimization increased 2wT usability and acceptability among HCWs in this setting. Engaging HCWs into 2wT co-ownership from inception appears successful in co-creation of an app that will meet HCW needs, and therefore, enhance support for 2wT clients to attend visits and remain in care.</div