Population-Level Benefits from Providing Effective HIV Prevention Means to Pregnant Women in High Prevalence Settings

Background:HIV prevalence among pregnant women in Southern Africa is extremely high. Epidemiological studies suggest that pregnancy increases the risk of HIV sexual acquisition and that HIV infections acquired during pregnancy carry higher risk of mother-to-child transmission (MTCT). We analyze the potential benefits from extending the availability of effective microbicide to pregnant women (in addition to non-pregnant women) in a wide-scale intervention.Methods and Findings:A transmission dynamic model was designed to assess the impact of microbicide use in high HIV prevalence settings and to estimate proportions of new HIV infections, infections acquired during pregnancy, and MTCT prevented over 10 years. Our analysis suggests that consistent use of microbicide with 70% efficacy by 60% of non-pregnant women may prevent approximately 40% and 15% of new infections in women and men respectively over 10 years, assuming no additional increase in HIV risk to either partner during pregnancy (RRHIV/preg = 1). It may also prevent 8-15% MTCT depending on the increase in MTCT risk when HIV is acquired during pregnancy compared to before pregnancy (RRMTCT/preg). Extending the microbicides use during pregnancy may improve the effectiveness of the intervention by 10% (RRHIV/preg = 1) to 25% (RRHIV/preg = 2) and reduce the number of HIV infections acquired during pregnancy by 40% to 70% in different scenarios. It may add between 6% (RRHIV/preg = 1, RRMTCT/preg = 1) and 25% (RRHIV/preg = 2, RRMTCT/preg = 4) to the reduction in the residual MTCT.Conclusion:Providing safe and effective microbicide to pregnant women in the context of wide-scale interventions would be desirable as it would increase the effectiveness of the intervention and significantly reduce the number of HIV infections acquired during pregnancy. The projected benefits from covering pregnant women by the HIV prevention programs is more substantial in communities in which the sexual risk during pregnancy is elevated. © 2013 Dimitrov et al

Barriers to participation in mental health research: are there specific gender, ethnicity and age related barriers?

<p>Abstract</p> <p>Background</p> <p>It is well established that the incidence, prevalence and presentation of mental disorders differ by gender, ethnicity and age, and there is evidence that there is also differential representation in mental health research by these characteristics. The aim of this paper is to a) review the current literature on the nature of barriers to participation in mental health research, with particular reference to gender, age and ethnicity; b) review the evidence on the effectiveness of strategies used to overcome these barriers.</p> <p>Method</p> <p>Studies published up to December 2008 were identified using MEDLINE, PsycINFO and EMBASE using relevant mesh headings and keywords.</p> <p>Results</p> <p>Forty-nine papers were identified. There was evidence of a wide range of barriers including transportation difficulties, distrust and suspicion of researchers, and the stigma attached to mental illness. Strategies to overcome these barriers included the use of bilingual staff, assistance with travel, avoiding the use of stigmatising language in marketing material and a focus on education about the disorder under investigation. There were very few evaluations of such strategies, but there was evidence that ethnically matching recruiters to potential participants did not improve recruitment rates. Educational strategies were helpful and increased recruitment.</p> <p>Conclusion</p> <p>Mental health researchers should consider including caregivers in recruitment procedures where possible, provide clear descriptions of study aims and describe the representativeness of their sample when reporting study results. Studies that systematically investigate strategies to overcome barriers to recruitment are needed.</p

Ethical considerations in prehospital ambulance based research : qualitative interview study of expert informants

Abstract: Background: Prehospital ambulance based research has unique ethical considerations due to urgency, time limitations and the locations involved. We sought to explore these issues through interviews with experts in this research field. Methods: We undertook semi-structured interviews with expert informants, primarily based in the UK, seeking their views and experiences of ethics in ambulance based clinical research. Participants were questioned regarding their experiences of ambulance based research, their opinions on current regulations and guidelines, and views about their general ethical considerations. Participants were chosen because they were actively involved in, or in their expert capacity (e.g. law) expressed an interest in, ambulance based research. Results: Fourteen participants were interviewed including principal investigators, researchers, ethicists and medical lawyers. Five major themes were identified: Capacity, Consent, Clinical Considerations, Consultation and Regulation. Questions regarding consent and capacity were foremost in the discussions as all participants highlighted these as areas for concern. The challenges and use of multiple consent models reflected the complexity of research in this environment. The clinical theme referred to the role of paramedics in research and how research involving ambulance services is increasingly informing improvements to patient care and outcomes and reducing the burden on hospital services. Most felt that, although current regulations were fit for purpose, more specific guidance on implementing these in the ambulance setting would be beneficial. This related closely to the theme of consultation, which examined the key role of ethics committees and other regulatory bodies, as well as public engagement. Conclusions: By interviewing experts in research or ethics in this setting we were able to identify key concerns and highlight areas for future development such as improved guidance

[Editorials] The journal of technology in human services turns a new page

2017-2018 > Academic research: refereed > Publication in refereed journalAccepted ManuscriptPublishe

Tackling COVID-19 is a crucible for privacy [ACADEMIC PAPER]

Laws and norms around privacy take a significant amount of time to be established, but can often unravel at lightning speed. As a part of the global response to the COVID19 crisis in the United States and Western Europe, governments are relaxing carefully crafted privacy protections such as the US's Health Insurance Portability and Accountability Act (HIPAA) and the EU's General Data Protection Regulation (GDPR). While the crisis is temporary, it is easy to foresee how privacy changes made in the crucible of COVID19 could have a long lasting impact on our civil liberties once we go back to shaking hands. During the current crisis, we have seen a massive uptake in the use of digital tools to engage in all manner of contacts, typically made in person. Everything from doctors’ visits, dance classes, secondary education classes as well as all the adult employment activities have rapidly moved online without considering the massive data extraction activities of these private for-profit companies. Tools such as Zoom, Google Hangouts, WhatsApp, WeChat and even TikTok are experiencing unprecedented implementations across a range of sectors that have never before considered using video as a facilitator. Uncomfortable questions around location data being shared with governmental agencies are now being asked, but the tech adoption is happening before society has had a chance to grapple with its answer. In other words, a significant portion of the general public is now reliant on digital tools that have not fully considered user privacy. Because one’s personal data is an abstract concept which exists outside of most individual’s day-to-day purview, it is difficult for citizens to conceptualize the risks of relaxing individual data and privacy protections. How does one hold onto their data responsibility, under what conditions might it be useful for consumers to offer their data for use in unintended arenas? What are the digital protections one might expect in a pandemic

Pharmacotherapy for Depressed Pregnant Women:Overcoming Obstacles to Gathering Essential Data

Approximately 3% of pregnant women take antidepressant medications. Information on the impact of antidepressants on short- and long-term maternal and offspring outcomes is highly desirable but neglected. The position that the dearth of treatment information is of greater concern than the risks to pregnant subjects involved in medical research is gaining support. Mandating the collection of reproductive outcome data in exposed childbearing women is an overdue step toward societal responsibility to our most vulnerable members

Technology in Social Work Education: Educators’ Perspectives on the NASW Technology Standards for Social Work Education and Supervision

The latest National Association of Social Workers (NASW) Technology Standards (2017) offer updated guidance for thinking about the use of technology in social work practice, with brief interpretations. Standard 4.0 specifically addresses social work education and the role of educators and supervisors in maintaining professional standards related to technology mediated practice and educational settings. The purpose of this document is to adjust the interpretations from a mostly risk-averse and micro-practice focus to a perspective that also acknowledges the potential strengths of technology in work at micro and macro levels of practice and social work education, supervision and continuing education