Re-Engineering Primary Health Care: A Formative Process Evaluation of rPHC Implementation in King Sabata Dalindyebo sub-District in the Eastern Cape Province of South Africa

In 2010, the Department of Health of South Africa launched a “Re-engineering Primary Health Care” (rPHC) initiative, aiming to shift the focus of primary health care to a health-promoting community-based model. At the heart of the program are ward-based primary health care outreach teams, comprised of generalist community health workers (CHWs) supervised by facility-based nurses. With the support of the Eastern Cape Department of Health (ECDOH), ICAP at Columbia University conducted a formative process evaluation to describe the implementation of ward-based rPHC activities in one sub-district between January 2012 and December 2013. King Sabato Dalyindebo (KSD) sub-district of OR Tambo District was selected by ECDOH as the evaluation location. The process evaluation used both qualitative and quantitative methods, including in-depth interviews with implementers and nurses, focus group discussions with CHWs and community members, structured surveys of knowledge and satisfaction completed by nurses and CHWs, and review of existing DOH data on training and service delivery. Key findings included: 1. Ward-based outreach teams were launched by December 2013. By the end of 2013, KSD sub-district had trained, staffed and launched ward-based outreach teams in all 35 wards, with more than 100 CHWs engaged in community-level activities. 2. Outreach, counseling, and adherence support services were being delivered to communities. CHW encouraged community members to seek facility-level health care services, and assisted in the identification and referral of HIV and tuberculosis (TB) defaulters, linking these patients back to treatment. 3. The outreach teams have added value, but their performance has not been rigorously evaluated. Although implementers and nurses indicated that investments in CHW training had improved the capacity of outreach teams, quality had yet to be assessed. Community members were deeply appreciative of CHW outreach services, but noted some concerns about confidentiality. Lower-than-expected CHW test scores on the evaluation surveys suggest that retention of knowledge may be a challenge. CHWs reported low levels of field-based supervision and minimal feedback or performance reviews, and fewer than half the CHWs rated their own team’s work as good or excellent. 4. Household profiling data have yet to be utilized to guide programming. Although a very large amount of household “profiling” data had been collected, implementers and DOH noted concerns about data quality. In addition, information about the prevalence and distribution of illness had not been aggregated or analyzed by the sub-district or District DOH, and there were substantial backlogs in the aggregation of descriptive data about rPHC activities (e.g., number and type of visits) and entry into the Demographic and Health Information System (DHIS). This prevented DOH from using the data to inform policy or guide programs. In summary, the rPHC program has tremendous potential to link communities with prevention, care and treatment services. The process evaluation highlighted achievements and challenges, as well as areas where intensified support could have substantive impact

Multidisciplinary Baseline Assessment of Homosexual Men with and without Human Immunodeficiency Virus Infection. I. Overview of Study Design

Although much is known about the virus believed by most experts to be the cause of the acquired immunodeficiency syndrome and about its pathogenic actions, major areas of ignorance remain. Among these are the reasons for the varying time between infection with human immunodeficiency virus and development of acquired imunodeficiency syndrome, the relationship between neurologic and medical aspects of the disease, the time course of neuropsychological findings, and the prevalence of psychiatric morbidity. We assessed 124 homosexual men who were positive for human immunodeficiency virus and 84 who were negative for the virus. In this article we describe the study design, method of recruitment, and medical and demographic characteristics of the cohort, which will be followed up for 5 years

The Helicobacter pylori Genome Project : insights into H. pylori population structure from analysis of a worldwide collection of complete genomes

Helicobacter pylori, a dominant member of the gastric microbiota, shares co-evolutionary history with humans. This has led to the development of genetically distinct H. pylori subpopulations associated with the geographic origin of the host and with differential gastric disease risk. Here, we provide insights into H. pylori population structure as a part of the Helicobacter pylori Genome Project (HpGP), a multi-disciplinary initiative aimed at elucidating H. pylori pathogenesis and identifying new therapeutic targets. We collected 1011 well-characterized clinical strains from 50 countries and generated high-quality genome sequences. We analysed core genome diversity and population structure of the HpGP dataset and 255 worldwide reference genomes to outline the ancestral contribution to Eurasian, African, and American populations. We found evidence of substantial contribution of population hpNorthAsia and subpopulation hspUral in Northern European H. pylori. The genomes of H. pylori isolated from northern and southern Indigenous Americans differed in that bacteria isolated in northern Indigenous communities were more similar to North Asian H. pylori while the southern had higher relatedness to hpEastAsia. Notably, we also found a highly clonal yet geographically dispersed North American subpopulation, which is negative for the cag pathogenicity island, and present in 7% of sequenced US genomes. We expect the HpGP dataset and the corresponding strains to become a major asset for H. pylori genomics

Trauma and Growth: Impact of AIDS Activism

Introduction. Our goal was to assess the long-term impact of AIDS activism of ACT UP/New York on the current adjustment of those who were members during its peak years (1987–1992), including assessment of trauma sequelae as well as posttraumatic growth. Methods. A 90-minute semistructured interview and 6 validated self-report scales were administered. We relied on purposive and snowball sampling to recruit potential participants. Areas covered include demographics, ACT UP participation, and psychiatric problems. Self-report scales provided approximate diagnoses of PTSD and depression, as well as coping, optimism, and related concepts. Results. Participants included 102 men (40% HIV-positive) and 23 women. Seventeen percent reported current symptoms suggesting PTSD, slightly above the range in general population studies. Symptoms consistent with depression were reported by 8% overall, with higher rates for HIV+ men. Enhanced sense of self, belief in change, and empowerment were reported by 93% of respondents, independent of concurrent PTSD or depression. Conclusions. Twenty-eight years later, ACT UP study participants recall their activist days during the AIDS epidemic as the peak experience of their lives. While some continue to have symptoms of stress and depression, most found that their activism has enriched their subsequent lives

Things I Have Learned (So Far) Some Things You Learn Aren't So

ABSTRACT This is an account of what I have learned (so far) about the application of statistics to psychology and the other sociobiomedical sciences. It includes the principles "less is more" (fewer variables, more highly targeted issues, sharp rounding off), "simple is better" (graphic representation, unit weighting for linear composites), and "some things you learn aren't so." I have learned to avoid the many misconceptions that surround Fisherian null hypothesis testing. I have also learned the importance of power analysis and the determination of just how big (rather than how statistically significant) are the effects that we study. Finally, I have learned that there is no royal road to statistical induction, that the informed judgment of the investigator is the crucial element in the interpretation of data, and that things take time