Process evaluation of an intervention to improve HIV treatment outcomes among children and adolescents.

SETTING: Children and adolescents with HIV encounter challenges in initiation and adherence to antiretroviral therapy (ART). A community-based support intervention of structured home visits, aimed at improving initiation, adherence and treatment, was delivered by community health workers (CHWs) to children and adolescents newly diagnosed with HIV. OBJECTIVES: To 1) describe intervention delivery, 2) explore CHW, caregiver and adolescents' perceptions of the intervention, 3) identify barriers and facilitators to implementation, and 4) ascertain treatment outcomes at 12 months' post-HIV diagnosis. DESIGN: We drew upon: 1) semi-structured interviews (n = 22) with 5 adolescents, 11 caregivers and 6 CHWs, 2) 28 CHW field manuals, and 3) quantitative data for study participants (demographic information and HIV clinical outcomes). RESULTS: Forty-one children received at least a part of the intervention. Of those whose viral load was tested, 26 (n = 32, 81.3%) were virally suppressed. Interviewees felt that the intervention supported ART adherence and strengthened mental health. Facilitators to intervention delivery were convenience and rapport between CHWs and families. Stigma, challenges in locating participants and inadequate resources for CHWs were barriers. CONCLUSION: This intervention was helpful in supporting HIV treatment adherence among adolescents and children. Facilitators and barriers may be useful in developing future interventions

Challenges and opportunities for conducting a vaccine trial during the COVID-19 pandemic in the United Kingdom

The COVID-19 pandemic has resulted in unprecedented challenges for healthcare systems worldwide. It has also stimulated research in a wide range of areas including rapid diagnostics, novel therapeutics, use of technology to track patients and vaccine development. Here, we describe our experience of rapidly setting up and delivering a novel COVID-19 vaccine trial, using clinical and research staff and facilities in three National Health Service Trusts in Cambridgeshire, United Kingdom. We encountered and overcame a number of challenges including differences in organisational structures, research facilities available, staff experience and skills, information technology and communications infrastructure, and research training and assessment procedures. We overcame these by setting up a project team that included key members from all three organisations that met at least daily by teleconference. This group together worked to identify the best practices and procedures and to harmonise and cascade these to the wider trial team. This enabled us to set up the trial within 25 days and to recruit and vaccinate the participants within a further 23 days. The lessons learned from our experiences could be used to inform the conduct of clinical trials during a future infectious disease pandemic or public health emergency

Business Management 1A

Exam paper for Business Managemen

'Kusvika taparadzaniswa nerufu' (Until death do us part).

A cross-sectional study of 7 667 non-virgins between 15 and 54 years of age was carried out to assess the protective effect of marriage against HIV acquisition in a rural population in Zimbabwe, whilst taking into account gender-differentials in risk factors for seroconversion. Persons in stable first marriages and long-term consensual cohabiting unions had higher odds of HIV infection than never-married people but a lower risk than those who had been divorced or widowed, even after adjusting for known confounders and significant risk factors for infection. Partner-related risk factors appear to play a more pivotal role in determining HIV prevalence in females than for males, for whom personal sexual behaviour risk factors are more dominant

Does the type of treatment supporter influence tuberculosis treatment outcomes in Zimbabwe? [Short communication]

Zimbabwe is one of the world’s 22 high tuberculosis(TB) burden countries, and ⩾60% of its TB patients are infected with the human immunodeficiency virus (HIV).1 In 2010, the treatment success rate for new sputum smear-positive TB patients was 81%, lower than the 90% rate recommended by the new Global Plan to Stop TB.The World Health Organization’s (WHO’s) Stop TB strategy recommends supervised treatment and support,including direct observation of treatment (DOT), ensuring that every dose of medication is swallowed under observation. The Zimbabwean National TB Guidelines recommend that DOT should be provided, in order of priority, by a health facility-based worker, a trained community worker or a family member/relative as a last resort, with the belief that untrained family members/relatives might not be the best people to perform DOT. However, health facility-based DOT may be challenging due to distances travelled by patients,time spent away from home/work and transport costs.Studies in Thailand, Nepal, Malawi and Tanzania have shown that family- or community-based DOT is associated with good treatment outcomes.There is no published information on whether TB treatment outcomes are infl uenced by different types of DOT supporter in Zimbabwe. We therefore conducted this study in a district of Zimbabwe to describe 1) the number and proportions of registered TB patients receiving different types of DOT in relation to baseline characteristics and 2) the association of different types of DOT with TB treatment outcomes