Project YES! Youth Engaging for Success: A randomized controlled trial testing a peer mentoring approach among HIV-positive adolescents and young adults in Ndola, Zambia

This research addresses the gaps in knowledge about how to best support adolescents and young adults transitioning to HIV self-management in the context of both child-focused and adult-focused HIV care settings. Johns Hopkins University, in partnership with the Arthur Davison Children’s Hospital, implemented this study through the USAID-funded Project SOAR (led by the Population Council)

A high-performance 8 nV/root Hz 8-channel wearable and wireless system for real-time monitoring of bioelectrical signals

Background: It is widely accepted by the scientific community that bioelectrical signals, which can be used for the identification of neurophysiological biomarkers indicative of a diseased or pathological state, could direct patient treatment towards more effective therapeutic strategies. However, the design and realisation of an instrument that can precisely record weak bioelectrical signals in the presence of strong interference stemming from a noisy clinical environment is one of the most difficult challenges associated with the strategy of monitoring bioelectrical signals for diagnostic purposes. Moreover, since patients often have to cope with the problem of limited mobility being connected to bulky and mains-powered instruments, there is a growing demand for small-sized, high-performance and ambulatory biopotential acquisition systems in the Intensive Care Unit (ICU) and in High-dependency wards. Finally, to the best of our knowledge, there are no commercial, small, battery-powered, wearable and wireless recording-only instruments that claim the capability of recording electrocorticographic (ECoG) signals. Methods: To address this problem, we designed and developed a low-noise (8 nV/√Hz), eight-channel, battery-powered, wearable and wireless instrument (55 × 80 mm2). The performance of the realised instrument was assessed by conducting both ex vivo and in vivo experiments. Results: To provide ex vivo proof-of-function, a wide variety of high-quality bioelectrical signal recordings are reported, including electroencephalographic (EEG), electromyographic (EMG), electrocardiographic (ECG), acceleration signals, and muscle fasciculations. Low-noise in vivo recordings of weak local field potentials (LFPs), which were wirelessly acquired in real time using segmented deep brain stimulation (DBS) electrodes implanted in the thalamus of a non-human primate, are also presented. Conclusions: The combination of desirable features and capabilities of this instrument, namely its small size (~one business card), its enhanced recording capabilities, its increased processing capabilities, its manufacturability (since it was designed using discrete off-the-shelf components), the wide bandwidth it offers (0.5 – 500 Hz) and the plurality of bioelectrical signals it can precisely record, render it a versatile and reliable tool to be utilized in a wide range of applications and environments

“Project YES! has…given me a task to reach undetectable”: Qualitative findings from a peer mentoring program for youth living with HIV in Zambia

This dataset presents qualitative results from 40 in-depth interviews conducted with youth participants as part of the Project YES! (Youth Engaging for Success) project in Zambia

Intimate partner violence polyvictimisation and HIV among coupled women in Zambia: Analysis of a population-based survey

Women in sub-Saharan Africa are disproportionately at risk for the dual epidemics of intimate partner violence (IPV) and HIV. Little is known about how specific violence profiles affect women’s HIV risk, limiting effective intervention. We analysed couples’ data from the Zambia Demographic and Health Survey 2013–2014 to evaluate relationships among IPV, male partner HIV status and women’s HIV status. We considered the individual and combined effects of physical, sexual, emotional, and high controlling behaviour violence and accumulated violence exposure, respectively. Among partnered women, 48.9% (n = 2,812) experienced IPV victimisation, of whom 52.1% (n = 1,465) reported polyvictimisation (experiencing two or more violence types). Female HIV prevalence was 13.2%. Adjusted for demographics, HIV was significantly higher for women who experienced three (17.3%, aPR 1.33, 95%CI: 1.04–1.69, p = 0.02) or four (22.1%, aPR 1.66, 95%CI: 1.23–2.26, p ≤ 0.01) types versus no IPV. Violence including emotional and/or high controlling victimisation was associated with female HIV infection (aPR: 1.31, 95%CI: 1.09–1.57, p = 0.01). Physical and/or sexual violence victimisation in the absence of other victimisation was not associated with HIV (aPR: 0.92, 95%CI:0.73–1.15, p = 0.46). IPV and HIV interventions are incomplete without addressing emotional and controlling IPV and the role of coercive relationship dynamics in transmission risk

Mouse breast cancer model-dependent changes in metabolic syndrome-associated phenotypes caused by maternal dioxin exposure and dietary fat

Diets high in fat are associated with increased susceptibility to obesity and metabolic syndrome. Increased adipose tissue that is caused by high-fat diets (HFD) results in altered storage of lipophilic toxicants like 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), which may further increase susceptibility to metabolic syndrome. Because both TCDD and HFD are associated with increased breast cancer risk, we examined their effects on metabolic syndrome-associated phenotypes in three mouse models of breast cancer: 7,12-dimethylbenz[a]anthracene (DMBA), Tg(MMTV-Neu)202Mul/J (HER2), and TgN(MMTV-PyMT)634Mul/J (PyMT), all on an FVB/N genetic background. Pregnant mice dosed with 1 μg/kg of TCDD or vehicle on gestational day 12.5 were placed on a HFD or low-fat diet (LFD) at parturition. Body weights, percent body fat, and fasting blood glucose were measured longitudinally, and triglycerides were measured at study termination. On HFD, all cancer models reached the pubertal growth spurt ahead of FVB controls. Among mice fed HFD, the HER2 model had a greater increase in body weight and adipose tissue from puberty through adulthood compared with the PyMT and DMBA models. However, the DMBA model consistently had higher fasting blood glucose levels than the PyMT and HER2 models. TCDD only impacted serum triglycerides in the PyMT model maintained on HFD. Because the estrogenic activity of the HFD was three times lower than that of the LFD, differential dietary estrogenic activities did not drive the observed phenotypic differences. Rather, the HFD-dependent changes were cancer model dependent. These results show that cancer models can have differential effects on metabolic syndrome-associated phenotypes even before cancers arise

"Adolescents do not only require ARVs and adherence counseling": A qualitative investigation of health care provider experiences with an HIV youth peer mentoring program in Ndola, Zambia.

IntroductionAdolescents and young adults (AYAs) living with HIV face unique challenges and have poorer health outcomes than adults with HIV. Project YES! was a youth-led initiative to promote HIV self-management and reduce stigma among AYAs in four Ndola, Zambia clinics. Clinic health care providers (HCPs) were involved in multiple intervention aspects, including serving as expert resources during AYA and caregiver group meetings, facilitating resistance test-based AYA antiretroviral drug changes, meeting with participants referred through a safety protocol, and guiding a subset of participants' physical transition from pediatric to adult clinic settings. This study aimed to understand HCP insights on facilitators and barriers to implementing Project YES! and scaling up a clinic-based, youth-focused program.MethodsA trained interviewer conducted ten in-depth interviews with participating HCPs from November-December 2018 and analyzed data, identifying key themes. These themes were examined in terms of two implementation science outcomes-acceptability and feasibility-to inform scalability.ResultsHCPs found peer mentoring valuable for AYAs with HIV and the bimonthly caregiver meetings beneficial to AYA caregivers. HCPs voiced a desire for more involvement in specific processes related to patient clinical care, such as drug changes. HCPs' experiences with the study safety protocol, including referrals for youth experiences of violence, shifted their views of AYAs and informed their understanding of key issues youth face. Considering this, many HCPs requested more resources to support AYAs' varied needs. HCPs noted limited time and clinic space as implementation barriers but felt the program was valuable overall.ConclusionsHCPs concluded youth peer mentoring was highly acceptable and feasible, supporting scale-up of youth-led interventions addressing the multi-faceted needs of AYAs living with HIV. Continued provider involvement in resistance test-based antiretroviral drug changes, considered in the context of health system and clinic policy, would enhance long-term success of the program at scale