Positive Impact of Increases in Condom Use among Female Sex Workers and Clients in a Medium HIV Prevalence Epidemic: Modelling Results from Project SIDA1/2/3 in Cotonou, Benin

Background A comprehensive, HIV prevention programme (Projet Sida1/2/3) was implemented among female sex workers (FSWs) in Cotonou, Benin, in 1993 following which condom use among FSWs increased threefold between 1993 and 2008 while FSW HIV prevalence declined from 53.3% to 30.4%. Objective Estimate the potential impact of the intervention on HIV prevalence/incidence in FSWs, clients and the general population in Cotonou, Benin. Methods and Findings A transmission dynamics model parameterised with setting-specific bio-behavioural data was used within a Bayesian framework to fit the model and simulate HIV transmission in the high and low-risk population of Cotonou and to estimate HIV incidence and infections averted by SIDA1/2/3. Our model results suggest that prior to SIDA1/2/3 commercial sex had contributed directly or indirectly to 93% (84–98%) of all cumulative infections and that the observed decline in FSWs HIV prevalence was more consistent with the self-reported post-intervention increase in condom use by FSWs than a counterfactual assuming no change in condom use after 1993 (CF-1). Compared to the counterfactual (CF-1), the increase in condom use may have prevented 62% (52–71%) of new HIV infections among FSWs between 1993 and 2008 and 33% (20–46%) in the overall population. Conclusions Our analysis provides plausible evidence that the post-intervention increase in condom use during commercial sex significantly reduced HIV prevalence and incidence among FSWs and general population. Sex worker interventions can be effective even in medium HIV prevalence epidemics and need to be sustained over the long-term

Assessing the potential impact of disruptions due to COVID-19 on HIV among key and lower-risk populations in the largest cities of Cameroon and Benin

Background: The COVID-19 pandemic indirectly impacts HIV epidemiology in Central/West Africa. We estimated the potential impact of COVID-19-related disruptions to HIV prevention/treatment services and sexual partnerships on HIV incidence and HIV-related deaths among key populations including female sex workers (FSW), their clients, men who have sex with men (MSM), and overall. Setting: Yaoundé (Cameroon) and Cotonou (Benin). Methods: We used mathematical models of HIV calibrated to city- and risk-population-specific demographic/behavioural/epidemic data. We estimated the relative change in 1-year HIV incidence and HIV-related deaths for various disruption scenarios of HIV prevention/treatment services and decreased casual/commercial partnerships, compared to a scenario without COVID-19. Results: A 50% reduction in condom use in all partnerships over 6 months would increase 1-year HIV incidence by 39%, 42%, 31% and 23% among MSM, FSW, clients, and overall in Yaoundé respectively, and 69%, 49% and 23% among FSW, clients and overall respectively in Cotonou. Combining a 6-month interruption of ART initiation and 50% reduction in HIV prevention/treatment use would increase HIV incidence by 50% and HIV-related deaths by 20%. This increase in HIV infections would be halved by a simultaneous 50% reduction in casual and commercial partnerships. Conclusions: Reductions in condom use following COVID-19 would increase infections among key populations disproportionately, particularly FSW in Cotonou, who need uninterrupted condom provision. Disruptions in HIV prevention/treatment services have the biggest impacts on HIV infections and deaths overall, only partially mitigated by equal reductions in casual/commercial sexual partnerships. Maintaining ART provision must be prioritised to minimise short-term excess HIV-related deaths

Facteurs predicteurs de l'usage de medicaments et substances addictives chez les adolescents des lycees et colleges prives a Cotonou en 2016, Benin

Contexte: L’adolescence est une période critique où souvent se fait l’expérimentation de plusieurs substances psychoactives. L’usage de ces substances en milieu scolaire privé par les adolescents pose un véritable problème de santé publique non encore contrôlé d’aucune mesure de prévention et de promotion au sein des communautés à Cotonou.Objectif: Etudier les facteurs prédicteurs de l’usage de médicaments et substances addictives chez les adolescents dans le milieu scolaire privé à Cotonou au Bénin.Méthode: Il s’agit d’une étude transversale à visée analytique où les données ont été collectées par questionnaire auto-administré auprès de 296 garçons et 181 filles âgés de 11 à 19 ans des lycées et collèges privés de Cotonou, sélectionnés par la technique de sondage à deux degrés. Les facteurs prédicteurs des usages ont été identifiés par la régression logistique binaire. Pour toutes les interprétations statistiques, le seuil de signification choisi était de 5%.Résultats: L’âge moyen des élèves adolescents enquêtés était de 15,22 ± 2,23 ans. Des élèves enquêtés, 67,3 % ont déjà fait un usage abusif de médicaments et de substances addictives, significativement beaucoup plus (p<0,0001) parmi les garçons (82,1 %) comparativement aux filles (43,1 %). Le modèle de prédiction par la logistique binaire a rapporté le sexe, la vie en famille, le niveau de classe et l’âge comme étant les meilleurs prédicteurs de ces usages chez les adolescents en milieu scolaire privé à Cotonou en 2016.Conclusion: Nos résultats montrent l'ampleur de l’usage de médicaments et de substances addictives chez les adolescents en milieu scolaire privé à Cotonou et l'existence d’un potentiel risque d'abus, d’addiction et de dépendance. Ces facteurs de prédiction de ce comportement identifiés serviront tous les acteurs du développement à  la mise en place de stratégies adéquates de prévention et de promotion contre ce phénomèneMots clés: Adolescents, mésusage, drogues, surveillance, milieu scolaire, BéninEnglish Title: Predictors of medicines and addictive substances use in private secondary schools by adolescents in Cotonou, 2006, BeninEnglish AbstractContext: Adolescence is a critical period when often several psychoactive substances are experienced. The use of these substances in private school setting by adolescents raises a major public health issue not yet controlled by any prevention/promotion measures in Cotonou communities.Objective: To study the predictors of medicines and addictive substances use among adolescents in private school setting in Cotonou, Benin.Method: This is a cross-sectional analytical study in which the data were collected by self-administered questionnaire from 296 boys and 181 girls aged 11 to 19 from private secondary schools in Cotonou, selected by two-stage sampling procedure. The use predictors were identified by binary logistic regression. For all statistical interpretations, 5% was the selected two-tailed alpha thresholdResults: The mean age of the adolescent students was 15.22 ± 2.23 years. Of the surveyed students, 67.3% had already misused drug and addictive substance, significantly higher (p <0.0001) in boys (82.1%) than in girls (43.1%). The binary logistics prediction model reported sex, family life, class level and age as the best predictors of these uses among adolescents in private school setting in Cotonou in 2016.Conclusion: Our results show the extent of drugs and addictive substances use among adolescents in private schools in Cotonou and the existence of a potential risk of abuse, addiction and dependence. These identified behavioral predictors will serve all of development actors for implementating adequate strategies of prevention and promotion against this attitude.Keywords: Adolescents, misuse, drugs, inspection, school setting, Beni

Climate vulnerability mapping: A systematic review and future prospects

Maps synthesizing climate, biophysical and socioeconomic data have become part of the standard tool-kit for communicating the risks of climate change to society. Vulnerability maps are used to direct attention to geographic areas where impacts on society are expected to be greatest and that may therefore require adaptation interventions. Under the Green Climate Fund and other bilateral climate adaptation funding mechanisms, donors are investing billions of dollars of adaptation funds, often with guidance from modelling results, visualized and communicated through maps and spatial decision support tools. This paper presents the results of a systematic review of 84 studies that map social vulnerability to climate impacts. These assessments are compiled by interdisciplinary teams of researchers, span many regions, range in scale from local to global, and vary in terms of frameworks, data, methods, and thematic foci. The goal is to identify common approaches to mapping, evaluate their strengths and limitations, and offer recommendations and future directions for the field. The systematic review finds some convergence around common frameworks developed by the Intergovernmental Panel on Climate Change, frequent use of linear index aggregation, and common approaches to the selection and use of climate and socioeconomic data. Further, it identifies limitations such as a lack of future climate and socioeconomic projections in many studies, insufficient characterization of uncertainty, challenges in map validation, and insufficient engagement with policy audiences for those studies that purport to be policy relevant. Finally, it provides recommendations for addressing the identified shortcomings

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways