Changing hearts and minds: Results from a multi-country gender and sexual diversity training

Engaging key populations, including gender and sexual minorities, is essential to meeting global targets for reducing new HIV infections and improving the HIV continuum of care. Negative attitudes toward gender and sexual minorities serve as a barrier to political will and effective programming for HIV health services. The President’s Emergency Plan for AIDS Relief (PEPFAR), established in 2003, provided Gender and Sexual Diversity Trainings for 2,825 participants including PEPFAR staff and program implementers, U.S. government staff, and local stakeholders in 38 countries. The outcomes of these one-day trainings were evaluated among a subset of participants using a mixed methods pre- and post-training study design. Findings suggest that sustainable decreases in negative attitudes toward gender and sexual minorities are achievable with a one-day training

Interactive malaria education intervention and its effect on community participant knowledge : the malaria awareness program in Vhembe District, Limpopo, South Africa

Malaria is preventable and treatable, yet remains the most prevalent parasitic endemic disease in Africa. This article analyzes prospective observational data from the Malaria Awareness Program (MAP), an interactive malaria education initiative led by home-based care workers to improve participant knowledge of malaria as a precursor to increased uptake of malaria control interventions in the Vhembe District, Limpopo, South Africa. Between 2012 and 2016, 1,330 individuals participated in MAP. MAP's effectiveness was measured through pre- and post-participation surveys assessing knowledge in malaria transmission, symptoms, prevention, and treatment. The primary analysis assessed differences in knowledge between individuals who completed MAP (n = 499) and individuals who did not complete MAP (n = 399). The adjusted odds of correct malaria knowledge score versus partially correct or incorrect score among MAP completers was 3.3 and 2.8 times greater for transmission and prevention, respectively (p values<.001). A subanalysis assessed knowledge improvement among participants who completed both pre- and post-MAP intervention surveys (n = 266). There was a 21.4% and 10.5% increase in the proportion of participants who cited correct malaria transmission and prevention methods, respectively. Future research should assess behavioral changes toward malaria prevention and treatment as a result of an intervention and examine incidence changes in the region.The Malaria Awareness Program was funded by DukeEngage, Duke ChangeWorks, Gephardt Institute for Public Service Cantor Social Change Grant, The Resolution Project, University of Miami Butler Center for Service, and private donations.http://journals.sagepub.com/home/qchhj2018School of Health Systems and Public Health (SHSPH

Determinants of infant breastfeeding practices in Nepal: a national study

Abstract Background Optimal breastfeeding practices, reflected by early initiation and feeding of colostrum, avoidance of prelacteal feeds, and continued exclusivity or predominance of breastfeeding, are critical for assuring proper infant nutrition, growth and development. Methods We used data from a nationally representative survey in 21 district sites across the Mountains, Hills and Terai (southern plains) of Nepal in 2013. Determinants of early initiation of breastfeeding, feeding of colostrum, prelacteal feeding and predominant breastfeeding were explored in 1015 infants < 12 months of age. Prelacteal feeds were defined as food/drink other than breast milk given to newborns in first 3 days. Predominant breastfeeding was defined as a child < 6 months of age is mainly breastfed, not fed solid/semi-solid foods, infant formula or non-human milk, in the past 7 days. Adjusted prevalence ratios (APR) and 95% confidence intervals (CI) were estimated, using log Poisson regression models with robust variance for clustering. Results The prevalence of breastfeeding within an hour of birth, colostrum feeding, prelacteal feeding and predominant breastfeeding was 41.8, 83.5, 32.7 and 57.2% respectively. Compared to infants not fed prelacteal feeds, infants given prelacteal feeds were 51% less likely to be breastfed within the first hour of birth (APR 0.49; 95% CI 0.36, 0.66) and 55% less likely to be predominantly breastfed (APR 0.45; 95% CI 0.32, 0.62). Infants reported to have received colostrum were more likely to have begun breastfeeding within an hour of birth (APR 1.26; 95% CI 1.04, 1.54) compared to those who did not receive colostrum. Infants born to mothers ≥ 20 years of age were less likely than adolescent mothers to initiate breastfeeding within 1 hour of birth. Infants in the Terai were 10% less likely to have received colostrum (APR 0.90; 95% CI 0.83, 0.97) and 2.72 times more likely to have received prelacteal feeds (APR 2.72; 95% CI 1.67, 4.45) than those in the Mountains. Conclusions Most infants in Nepal receive colostrum but less than half initiate breastfeeding within an hour of birth and one-third are fed prelacteal feeds, which may negatively affect breastfeeding and health throughout early infancy

Characteristics associated with death of people with TB referred from hospital to local clinic for treatment initiation in rural South Africa.

This analysis considers deaths as all people who died during the study duration irrespective of time awaiting linkage to care or linkage to care status. People who died (n = 76) includes 43 and 33 people who died before and after linking to care, respectively. (DOCX)</p

Characteristics associated with time to linkage from hospital referral to local treatment initiation for TB in rural South Africa.

This is based on complete case dataset (n = 669). (DOCX)</p

Patient flow diagram for study participants.

The patient flow diagram represents the cohort of people diagnosed with drug-sensitive TB at each study hospital between August 1, 2017 and April 30, 2018 who were followed via record review for establishing linkage to care. All participants were followed for a minimum of four months after TB diagnosis. Since the follow-up time varied for patients, not all patients had completed treatment by the time of record review.</p

Time from hospital referral to presentation for initiation of treatment in rural South African clinics.

The black line represents the proportion of people who were referred from hospitals to local clinics for TB treatment and had successfully linked to care, by the number of days post-discharge shown on the x-axis. Of the 647 who linked to care, the plot does not include 90 people with missing or invalid date of presentation. The median time to linkage for the 557 people who linked to care and had a valid date of presentation was 4 days (IQR: 1, 14).</p

Characteristics associated with death of people with TB referred from hospital to local clinic for treatment initiation in rural South Africa.

This is based on complete case dataset (n = 669). This analysis considers deaths as all people who died during the study duration irrespective of time awaiting linkage to care or linkage to care status. Factors associated with death in the complete case analysis. People who died (n = 55) includes 24 and 31 people who died before and after linking to care, respectively. (DOCX)</p

Characteristics associated with time to linkage from hospital referral to local treatment initiation for TB in rural South Africa.

This is based on complete case dataset. (n = 669). This analysis used competing-risk accelerated failure time model after imputing median time to linkage for missing values. Death was treated as an event with competing risk. Time to linkage to care was censored at 90 days. (DOCX)</p

Study hospitals.

In the study population, 52.2% had transferred-in to care from another facility, of whom 84% came from a hospital, 14% a clinic or private doctor, and data was missing for the remaining 1%. The 56 primary care clinics were purposively chosen based on volume of TB cases in the year prior to study, completeness of TB record keeping, and willingness to participate. (DOCX)</p