A qualitative study trialling the acceptability of new hepatitis C prevention messages for people who inject drugs: symbiotic messages, pleasure and conditional interpretations

Aim: Prevention of hepatitis C (HCV) remains a public health challenge. A new body of work is emerging seeking to explore and exploit "symbiotic goals" of people who inject drugs (PWID). That is, strategies used by PWID to achieve other goals may be doubly useful in facilitating the same behaviours (use of sterile injecting equipment) required to prevent HCV. This project developed and trialled new HCV prevention messages based on the notion of symbiotic messages. Method: New HCV prevention messages were developed in a series of 12 posters after consultation with staff from needle and syringe programs (NSPs) and a drug user organisation. Two posters were displayed each week for a 6-week period within one NSP. NSP staff and clients were invited to focus groups to discuss their responses to the posters. Results: A total of four focus groups were conducted; one group of seven staff members and three groups of clients with a total of 21 participants. Responses to each of the posters were mixed. Staff and clients interpreted messages in literal ways rather than as dependent on context, with staff concerned that not all HCV prevention information was included in any one message; while clients felt that some messages were misleading in relation to the expectations of pleasure. Clients appreciated the efforts to use bright imagery and messages that included acknowledgement of pleasure. Clients were not aware of some harm reduction information contained in the messages (such as "shoot to the heart"), and this generated potential for misunderstanding of the intended message. Clients felt that any message provided by the NSP could be trusted and did not require visible endorsement by health departments. Conclusions: While the logic of symbiotic messages is appealing, it is challenging to produce eye-catching, brief messages that provide sufficient information to cover the breadth of HCV prevention. Incorporation of symbiotic messages in conversations or activities between staff and clients may provide opportunities for these messages to be related to the clients' needs and priorities and for staff to provide HCV prevention information in accord with their professional ethos

Health communication messaging about HPV vaccine in Papua New Guinea.

Objective: The type of health education messages that communities and individuals seek to have communicated about the human papillomavirus (HPV) vaccine is important if vaccine programmes are to succeed, especially in settings such as Papua New Guinea (PNG), which have a high burden of cervical cancer, low health literacy and negative experiences of earlier vaccination programmes. This study sought to identify the health education messages that are viewed as most appropriate in such a context. Methodology: A qualitative study using gender-specific focus group discussions (N = 21) and semi-structured interviews (N = 82) was undertaken in three sites in PNG. Sites included both rural and urban locations in Milne Bay, Eastern Highlands and Western Highlands Provinces. Results: Two divergent discourses emerged. One group of participants, largely young people, felt communication messages should stress that HPV is a preventable sexually transmitted infection, which can cause cervical cancer. The other group, mainly members of the older population, believed that messaging should focus on the vaccine as a prevention strategy for cervical cancer. A small minority wanted both aspects of the vaccine discussed. Conclusion: Sensitivity needs to be taken when engaging with communities which have negative experiences of earlier infant immunisation programmes. Ensuring that the health communication needs and priorities of different sections of the populations are taken into account is key to the successful introduction and roll-out of HPV vaccination in this setting

HPV vaccination in Papua New Guinea to prevent cervical cancer in women: Gender, sexual morality, outsiders and the de-feminization of the HPV vaccine

First study of HPV vaccine acceptability in Papua New Guinea and the Pacific. Evidence of strong support for the vaccination of both girls and boys against HPV in Papua New Guinea. Local beliefs and concerns about HPV immunisation may impact acceptability in Papua New Guinea. Suspicion of Western medicine and health care workers reported in rural areas

Assessing COVID-19 testing strategies in K-12 schools in underserved populations: Study protocol for a cluster-randomized trial

BACKGROUND: Since March 2020, COVID-19 has disproportionately impacted communities of color within the United States. As schools have shifted from virtual to in-person learning, continual guidance is necessary to understand appropriate interventions to prevent SARS-CoV-2 transmission. Weekly testing of students and staff for SARS-CoV-2 within K-12 school setting could provide an additional barrier to school-based transmission, especially within schools unable to implement additional mitigation strategies and/or are in areas of high transmission. This study seeks to understand the role that weekly SARS-CoV-2 testing could play in K-12 schools. In addition, through qualitative interviews and listening sessions, this research hopes to understand community concerns and barriers regarding COVID-19 testing, COVID-19 vaccine, and return to school during the COVID-19 pandemic. METHODS/DESIGN: Sixteen middle and high schools from five school districts have been randomized into one of the following categories: (1) Weekly screening + symptomatic testing or (2) Symptomatic testing only. The primary outcome for this study will be the average of the secondary attack rate of school-based transmission per case. School-based transmission will also be assessed through qualitative contact interviews with positive contacts identified by the school contact tracers. Lastly, new total numbers of weekly cases and contacts within a school-based quarantine will provide guidance on transmission rates. Qualitative focus groups and interviews have been conducted to provide additional understanding to the acceptance of the intervention and barriers faced by the community regarding SARS-CoV-2 testing and vaccination. DISCUSSION: This study will provide greater understanding of the benefit that weekly screening testing can provide in reducing SARS-CoV-2 transmission within K-12 schools. Close collaboration with community partners and school districts will be necessary for the success of this and similar studies. TRIAL REGISTRATION: NCT04875520 . Registered May 6, 2021

A diagnosis of hepatitis C - insights from a study on patients' experiences.

BACKGROUND: Previous research has documented patient experiences of hepatitis C virus (HCV) diagnosis to be without sufficient pretest and post-test discussions - health professionals have expressed a need for training in this area. OBJECTIVE: This study aimed to examine the diagnosis experiences of 24 people diagnosed with HCV in the preceding 2 years. METHODS: Face-to-face interviews of 24 participants (recruited through advertising) were conducted. RESULTS: Overall, the HCV diagnosis experience of participants was poor. Participant narratives of HCV diagnosis were characterised by confusion in relation to tests that were performed and the implications of test results. Post-test discussions were inadequate - there was a reported lack of information, support and referral provided to participants. DISCUSSION: Most clinicians do not receive specialised training in hepatitis C but may be involved in diagnoses in their careers. The impact of negative diagnosis experiences for patients can be serious and long term. These findings highlight areas of suboptimal diagnosis experience and suggest training and support needs of health professionals

Community-based rehabilitation in Fiji : evaluation of the competency, assessment, and local solutions (CAL) programme

Background: Approximately 12 000 people with a disability live in the developing country of Fiji, yet only 0.2% of those requiring services have access to them. The competency based training, assessment and consultancy, and local/community participation activities (CAL) programme is a 3 year programme aiming to address the needs of children with disabilities in Fiji. It supports immediate health solutions, skill development for community rehabilitation assistants (CRAs), health workers, parents and teachers, and culminating in sustainability. Objectives: To evaluate the first 2 years of the CAL programme regarding efficiency, quality and effectiveness and to make recommendations for ongoing sustainability and improved implementation. Design: A multiple stakeholder case study design was utilised, allowing evaluation of the programme in its real world setting. Participants/Setting: Stakeholders including families, CRAs, teachers, health workers and representatives of external stakeholder organisations. Materials/Methods: A multi-faceted mixed method data collection approach was utilised. Quantitative and qualitative data was collected using semi-structured questionnaires (n = 53), interviews (n = 4), focus groups (n = 3 with 41 participants), record reviews and field observations. Quantitative data was collated with descriptive statistics and qualitative data transcribed and thematically coded. Results: Efficiency – CRAs (13 i.e. 100% completion), teachers and health care workers have been trained through the programme and are now implementing assessments, detailed individualised rehabilitation goals and plans, and interventions. Quality – High program satisfaction rates were reported by all stakeholders (75% to 94%), with identified program strengths including knowledge gain, service provision, sustainability, community approach and expertise of facilitators. Contextual factors identified that may influence ongoing success of the programme included policy, legislative, political, access and financial issues. Parents report feeling more confident and informed. Stakeholders commonly recommended that further outcome improvement could be achieved by training more people. Effectiveness – 77% of participants felt that community perception of disability had changed for the better as a result of the programme. 100% of CRAs reported skill transfer to children with disabilities and their families, and 100%of children assessed are now provided with a detailed action plan including functional goals. Participants reported greater confidence, communication skills, assessment skills and skills in developing and actioning appropriate plans for their clients. Conclusions/Clinical Implications: The CAL programme is producing positive outcomes. Recommendations include: continuation and extension of the programme; increasing number of CRAs trained; ongoing communication with stakeholders to raise awareness of the programme; inclusion of outcome measures to evaluate effectiveness; and a focus during the third year on future sustainability of the programme

Safety in the silence: Hepatitis C risk and prevention in three networks of Australians who inject drugs

Hepatitis C is a significant public health issue in Australia, as it is in many countries around the world. In the last few years, the field of social research on hepatitis C has expanded to more explicitly acknowledge and address the broad range of factors that influence health and risk in the context of hepatitis C transmission. Rhodes (2002, 2009) risk environment framework has been particularly influential in this regard, identifying policy, economic, physical and social environments that operate at micro- and macro-levels of influence. However, little research has explored in detail the micro-social dimensions of hepatitis C risk and prevention. Employing a social network analysis design, combining qualitative interviews and participatory social network mapping, this study generated new insights into how social network factors influenced the sharing and reuse of injecting equipment within particular networks of people who inject drugs. The networks were recruited from three geographically and socially diverse settings in Australia. The first network was located in inner city Sydney, an area with a demographically diverse population; the second in outer suburban Sydney, in an area with high numbers of Vietnamese migrant Australians; and the third in a regional city in New South Wales, in an area with high numbers of economically marginalised young people. The analysis focused on exploring the different perspectives shared by network members regarding hepatitis C-related knowledge, communication and network dynamics. A pervasive silence was observed in all networks regarding hepatitis C, accompanied by remarkable variation in knowledge of hepatitis C between network members. However, despite this range in knowledge and restriction in communication, evidence was also found of network members actively working to prevent hepatitis C transmission in their networks, particularly through peer distribution of sterile injecting equipment. Nonetheless, the normalisation of hepatitis C within these networks of people who inject drugs did not necessarily result in a reduction in hepatitis C-related stigma. Further research is needed to consider how these related social network-level factors influence hepatitis C transmission in a diverse range of other networks of people who inject drugs, to strengthen the potential for harm reduction approaches to acknowledge and learn from these informal responses to hepatitis C risk

Making meaning out of objects : self, connectedness and belonging among sexuality diverse men and transgender women in Papua New Guinea

Objects in our everyday lives range from the mundane to the highly significant and can be understood and interpreted in various ways. In a Pacific society such as Papua New Guinea, making meaning out of objects and storytelling provides great insight into (our) culture. However, much of the attention given to material culture historically and culturally in Papua New Guinea is directed at documenting objects from the past, and often the objects possessed by cis-gender men. Much less attention has been given to the material culture of individuals and communities of sexuality diverse men and transgender women in Papua New Guinea. As part of a life history study among sexuality diverse men and transgender women in Papua New Guinea this chapter explores meanings of objects significant to these people. These non-human objects, sometimes reflecting significant people and relationships, speak to kinship and family, identity and self-courage, justice and human rights, providing new insights into the lives of Papua New Guineans, frequently framed via discourses of risk

Gender diversity among 'boys' in Papua New Guinea : memories of sameness and difference in early childhood

Childhood is a time when children begin to constitute themselves as gendered subjects largely according to social norms that are rigidly framed within dominant discourses of heteronormative binary gender. This paper is based on the life histories of 42 sexuality and gender diverse adult men and transgender women conducted in PNG. Findings offer insight into the ways in which boys transgressed gender norms through dress, play, work within the home and in dance. We argue that gender transgression in childhood is not a contemporary phenomena and such childhood experiences of boys in PNG should be recognised as part of the country's rich cultural diversity