HIV vulnerability of men and women who inject drugs in Kumasi, Ghana

This study was implemented by Boston University in collaboration with the Kwame Nkrumah University of Science and Technology with support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 2010. The content and views expressed here are the authors’ and do not necessarily reflect the opinion or policy of USAID or the U.S. Government.Reducing vulnerability to HIV infection among key populations in Ghana is a major goal for the National AIDS Control Program (NACP) and the GAC. While a number of studies have explored HIV risk behaviours among several key vulnerable populations in Ghana including female sex workers, men who have sex with men, and prisoners, little is known about the drug use and sexual vulnerability of people who inject drugs (PWID). In addition, no programs have been implemented to reduce the vulnerability among this population. This report provides the findings from a qualitative study that aimed to understand the social, economic and behavioral vulnerability to HIV of PWID in Kumasi and to inform the development and implementation of HIV prevention programs for this population. The research was conducted by a collaborative team comprised of researchers from Boston University’s Center for Global and Health and Development (CGHD) and the Kwame Nkrumah University of Science and Technology (KNUST) School of Medical Sciences. It is one of nine studies under the Operations Research on Key Populations project funded by the United States Agency for International Development (USAID). The study was designed and carried out in collaboration with the Ghana AIDS Commission (GAC).Support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 201

"I can decide to use the property I have to make money": HIV vulnerability of bar workers and bar patrons in Kumasi, Ghana

This study was implemented by Boston University in collaboration with the Kwame Nkrumah University of Science and Technology with support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 2010. The content and views expressed here are the authors’ and do not necessarily reflect the opinion or policy of USAID or the U.S. Government.This report provides the findings from a qualitative study exploring the social, economic and behavioral vulnerability to HIV of women working in bars and restaurants in Kumasi, Ghana’s second largest city. This research was conducted by a collaborative team comprised of researchers from Boston University’s Center for Global and Health and Development (CGHD) and the Kwame Nkrumah University of Science and Technology (KNUST) School of Medical Sciences. It is one of nine studies under the Operations Research on Key Populations project funded by the United States Agency for International Development (USAID). The study was designed and carried out in collaboration with the Ghana AIDS Commission (GAC). Reducing vulnerability to HIV infection among key populations in Ghana is a major goal for the National AIDS Control Program (NACP) and the GAC. While a number of studies have explored HIV risk behaviours among self-identified female sex workers and their partners in Ghana, little is known about the vulnerability of women working in small bars and restaurants who may be involved in transactional sex. Further, we have little information about how best to reach this population with services that will enable them and their clientele to protect themselves from HIV and reduce other vulnerabilities related to their health and well-being. To address this gap, this study aimed to explore behavioural, social, and economic factors that contribute to HIV vulnerability; types and extent of transactional sex; the relationship between alcohol/drug use, unsafe sex and transactional sex; and the health and social service needs of this population. The study findings are meant to inform the development and implementation of HIV prevention programs for bar workers and bar patrons.Support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 201

The Ghana retention on ART study (ROARS): keeping HIV-positive patients on antiretroviral therapy

This study was implemented by Boston University in collaboration with the Kwame Nkrumah University of Science and Technology with support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 2010. The content and views expressed here are the authors’ and do not necessarily reflect the opinion or policy of USAID or the U.S. Government.This report presents the findings of a study that employed qualitative research methods to explore the beliefs, attitudes, and behaviors of people living with HIV (PLHIV) in Ghana who are either in care and on antiretroviral therapy (ART), or are no longer in care and have been lost to follow-up. The study was designed to deepen our understanding of the challenges ART patients face in continuing on ART in Ghana and to contribute information with the potential to improve retention in care and outcomes for PLHIV in Ghana.This study was carried out by a collaborative team of researchers based at Boston University’s Center for Global and Health and Development (CGHD) and the Kwame Nkrumah University of Science and Technology’s (KNUST) School of Medical Sciences. The team conducted this research in Kumasi, Ghana’s second largest urban center. It is a component of the ‘Operations Research among Key Populations in Ghana’ project funded by the United States Agency for International Development (USAID). We designed and conducted the research in collaboration with the Ghana AIDS Commission (GAC).Expanding access to ART among HIV-positive individuals has been a major goal of the Ghana AIDS Commission and Ghana Health Service. Since 2005, Ghana has scaled up ART rapidly; by 2011, 150 health facilities were providing ART to over 60,000 people, an increase from fewer than 5,000 just six years earlier. At the same time, like in most countries in sub-Saharan Africa, ensuring that those who begin ART remain on treatment has proven a major challenge. Previous studies suggest that retention in care for 12 months or longer is approximately 70-80% in Ghana, similar to the rate in many other low-resource settings. While research elsewhere in sub-Saharan Africa indicates that a number of barriers affect retention in care, little research on this topic has been conducted in Ghana. Given that ART is currently the only known way to prolong life for PLHIV, it is critical to identify barriers that affect different groups of patients and to find ways to support them in remaining on treatment.This study was motivated by a desire to increase understanding of the challenges of and facilitators to retention in care among individuals on ART in Kumasi, Ghana. We conducted it in collaboration with the Suntreso Government Hospital, one of Kumasi’s largest medical facilities, and specifically with the hospital’s STI (sexually transmitted infection)/HIV clinic, which has experienced high levels of patient dropout from care and treatment. Together with staff at the clinic, we designed this research with the aim of contributing to understanding of the range of barriers PLHIV in Ghana experience trying to stay on treatment, the reasons they default, and the types of supports they believe would help themselves and other patients remain on or return to treatment if they do default. Our hope is that the study’s findings will add in a meaningful way to the evidence base on strategies and approaches for improving retention in treatment, thereby maximizing the potential benefits of ART, for PLHIV in Ghana.Support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 201

Poor power quality is a major barrier to providing optimal care in special neonatal care units (SNCU) in Central India [version 1; peer review: 2 approved]

Background: Approximately 25% of all neonatal deaths worldwide occur in India. The Indian Government has established Special Neonatal Care Units (SNCUs) in district and sub-district level hospitals to reduce neonatal mortality, but mortality rates have stagnated. Reasons include lack of personnel and training and sub-optimal quality of care. The role of medical equipment is critical for the care of babies, but its role in improving neonatal outcomes has not been well studied.  Methods: In a qualitative study, we conducted seven focus group discussions with SNCU nurses and pediatric residents and thirty-five key informant interviews and with pediatricians, residents, nurses, annual equipment maintenance contractors, equipment manufacturers, and Ministry of Health personnel in Maharashtra between December 2019 and November 2020. The goal of the study was to understand challenges to SNCU care. In this paper, we focus on current gaps and future needs for SNCU equipment, quality of the power supply, and use of SNCU equipment. Results: Respondents described a range of issues but highlighted poor power quality as an important cause of equipment malfunction. Other concerns were lack of timely repair that resulted in needed equipment being unavailable for neonatal care. Participants recommended procuring uninterrupted power supply (UPS) to protect equipment, improving quality/durability of equipment to withstand constant use, ensuring regular proactive maintenance for SNCU equipment, and conducting local power audits to discern and address the causes of power fluctuations. Conclusions: Poor power quality and its negative impact on equipment function are major unaddressed concerns of those responsible for the care and safety of babies in SNCUs in Central India. Further research on the power supply and protection of neonatal equipment is needed to determine a cost-effective way to improve access to supportive care in SNCUs and desired improvements in neonatal mortality rates

‘It opened my eyes, my ears, and my heart’: Codesigning a substance use disorder treatment programme

Abstract Background Pregnant and parenting women have low engagement and poor retention in substance use disorder (SUD) treatment. The aim of this study was to analyse the implementation of an adapted experience‐based codesign (EBCD) process involving SUD treatment staff and pregnant or parenting women with lived experience (WWLE) of SUD to launch a residential treatment service where women could coreside with their children and receive long term comprehensive treatment for dual diagnosis of SUD and mental illness. Methods A process evaluation was conducted utilising five data sources: two sets of semistructured interviews with WWLE and SUD treatment staff, ethnographic observation and transcripts from group events, and meeting minutes. Based on the Integrated Promoting Action on Research in Health Services framework constructs (context, recipients, facilitation, innovation) researchers applied thematic analysis to determine main themes within each construct. Results The full sample across the implementation totalled 34 individuals (WWLE = 13 and SUD staff = 21). The EBCD process engaged both cohorts and supported group cohesion and collaborative brainstorming. WWLE felt respected, emotionally safe to share, and empowered by participation. A cohesive, multidisciplinary codesign planning group, inclusive of WWLE, supported a more equitable codesign process. The need for a virtual platform due to the COVID‐19 pandemic impeded human connection and relationship building. The complex environment of residential regulations and uncertainties during start‐up phase of an organisation presented implementation challenges. Conclusion These results highlight the feasibility of, and challenges to, effectively engaging WWLE in a codesign process. The findings also demonstrated a positive influence on WWLE's feelings of empowerment. Identified themes reinforce the purposeful components within EBCD that enhance participation, along with new insights to inform successful codesign with a vulnerable population. The author's team included a WWLE who collaborated throughout the full scope of the research process, enriching the overall research and ensuring the authenticity of the presentation of women in recovery's perspective. Utilising the codesign approach to design and implement new services should improve health equity by enhancing patient engagement and retention in care. Patient Contribution Parenting WWLE of residential SUD treatment were involved in the full scope of the research process and the implementation being evaluated. For the actual codesign work WWLE were key members of the codesign planning team that met weekly throughout the implementation to plan, implement, problem solve and adapt the process over an 18 month timeframe. As is appropriate for codesign the actual ongoing workgroup participants had average 50% WWLE participation. For the research team, this research is a culmination of the lead author's doctoral dissertation. One member of the five‐person dissertation committee was a recovery coach and a WWLE. She was an active participant across the entire research process overseeing and influencing the research design, conduct of the study, analysis, interpretation of findings and approval of the final manuscript. The findings were member checked with the larger codesign planning group that had additional WWLE members

Variability and validity of intimate partner violence reporting by couples in Tanzania

<div><p>In recent years, major global institutions have amplified their efforts to address intimate partner violence (IPV) against women—a global health and human rights violation affecting 15–71% of reproductive aged women over their lifetimes. Still, some scholars remain concerned about the validity of instruments used for IPV assessment in population-based studies. In this paper, we conducted two validation analyses using novel data from 450 women-men dyads across nine villages in Northern Tanzania. <u>First</u>, we examined the level of inter-partner agreement in reporting of men’s physical, sexual, emotional and economic IPV against women in the last three and twelve months prior to the survey, ever in the relationship, and during pregnancy. <u>Second</u>, we conducted a convergent validity analysis to compare the relative efficacy of men’s self-reports of perpetration and women’s of victimization as a valid indicator of IPV against Tanzanian women using logistic regression models with village-level clustered errors. We found that, for every violence type across the recall periods of the last three months, the last twelve months and ever in the relationship, at least one in three couples disagreed about IPV occurrences in the relationship. Couples’ agreement about physical, sexual and economic IPV during pregnancy was high with 86–93% of couples reporting concordantly. Also, men’s self-reported perpetration had statistically significant associations with at least as many validated risk factors as had women’s self-reported victimization. This finding suggests that men’s self-reports are at least as valid as women’s as an indicator of IPV against women in Northern Tanzania. We recommend more validation studies are conducted in low-income countries, and that data on relationship factors affecting IPV reports and reporting are made available along with data on IPV occurrences. Keywords: Intimate partner violence; measurement; validity; survey research; Tanzania.</p></div

Female and male partners' characteristics, n = 450 couples, Tanzania, 2015–2016.

<p>Female and male partners' characteristics, n = 450 couples, Tanzania, 2015–2016.</p

Prevalence of physical, sexual, economic, emotional or any form of violence in the last three months, as reported by men, women, either men or women, and both men and women, n = 450 couples, Tanzania, 2015–2016.

<p>Prevalence of physical, sexual, economic, emotional or any form of violence in the last three months, as reported by men, women, either men or women, and both men and women, n = 450 couples, Tanzania, 2015–2016.</p

Percentage distribution of couples' cordordant and discordant reporting of four types of IPV in the last three or twelve months prior to the survey, ever in the relationship, or during pregnancy, Tanzania, 2015.

<p>Percentage distribution of couples' cordordant and discordant reporting of four types of IPV in the last three or twelve months prior to the survey, ever in the relationship, or during pregnancy, Tanzania, 2015.</p