Hope Groups: a protocol for a cluster randomized controlled trial of psychosocial, mental health, and parenting support groups for Ukrainian caregivers during war and conflict

Background: In 2021, more than two-thirds of the world’s children lived in a conflict-affected country. In 2022, 13 million Ukrainians were forced to flee their homes after Russia’s full-scale invasion. Hope Groups are a 12-session psychosocial, mental health, and parenting support intervention designed to strengthen parents, caregivers, and children affected by war and crisis. The primary objective of this study is to evaluate the effectiveness of Hope Groups among Ukrainians affected by war, compared to a wait-list control group. This protocol describes a promising decentralized intervention delivery model and an innovative research design, which estimates the causal effect of Hope Groups while prioritizing prompt delivery of beneficial services to war-affected participants. Methods: This protocol describes a pragmatic cluster randomized controlled trial (RCT) among Ukrainians externally displaced, internally displaced within Ukraine, and living at home in war-affected areas. This study consists of 90 clusters with 4–7 participants per cluster, totaling approximately n = 450 participants. Intervention clusters will receive 12-session Hope Groups led by peer facilitators, and control clusters will be wait-listed to receive the intervention after the RCT concludes. Clusters will be matched on the facilitator performing recruitment and intervention delivery. Primary outcomes are caregiver mental health, violence against children, and positive parenting practices. Secondary outcomes include prevention of violence against women and caregiver and child well-being. Outcomes will be based on caregiver report and collected at baseline and endline (1-week post-intervention). Follow-up data will be collected among the intervention group at 6–8 weeks post-intervention, with aims for quasi-experimental follow-ups after 6 and 12 months, pending war circumstances and funding. Analyses will utilize matching techniques, Bayesian interim analyses, and multi-level modeling to estimate the causal effect of Hope Groups in comparison to wait-list controls. Discussion: This study is the first known randomized trial of a psychosocial, mental health, and parenting intervention among Ukrainians affected by war. If results demonstrate effectiveness, Hope Groups hold the potential to be adapted and scaled to other populations affected by war and crisis worldwide. Additionally, methodologies described in this protocol could be utilized in crisis-setting research to simultaneously prioritize the estimation of causal effects and prompt delivery of beneficial interventions to crisis-affected populations. Trial registration: This trial was registered on Open Science Framework on November 9, 2023. Registration: OSF.IO/UVJ67

Five-year trends in epidemiology and prevention of mother-to-child HIV transmission, St. Petersburg, Russia: results from perinatal HIV surveillance

<p>Abstract</p> <p>Background</p> <p>The HIV epidemic in Russia has increasingly involved reproductive-aged women, which may increase perinatal HIV transmission.</p> <p>Methods</p> <p>Standard HIV case-reporting and enhanced perinatal HIV surveillance systems were used for prospective assessment of HIV-infected women giving birth in St. Petersburg, Russia, during 2004-2008. Trends in social, perinatal, and clinical factors influencing mother-to-child HIV transmission stratified by history of injection drug use, and rates of perinatal HIV transmission were assessed using two-sided χ²or Cochran-Armitage tests.</p> <p>Results</p> <p>Among HIV-infected women who gave birth, the proportion of women who self-reported ever using injection drugs (IDUs) decreased from 62% in 2004 to 41% in 2008 (<it>P </it>< 0.0001). Programmatic improvements led to increased uptake of the following clinical services from 2004 to 2008 (all <it>P </it>< 0.01): initiation of antiretroviral prophylaxis at ≤28 weeks gestation (IDUs 44%-54%, non-IDUs 45%-72%), monitoring of immunologic (IDUs 48%-64%, non-IDUs 58%-80%) and virologic status (IDUs 8%-58%, non-IDUs 10%-75%), dual/triple antiretroviral prophylaxis (IDUs 9%-44%, non-IDUs 14%-59%). After initial increase from 5.3% (95% confidence interval [CI] 3.5%-7.8%) in 2004 to 8.5% (CI 6.1%-11.7%) in 2005 (<it>P </it>< 0.05), perinatal HIV transmission decreased to 5.3% (CI 3.4%-8.3%) in 2006, and 3.2% (CI 1.7%-5.8%) in 2007 (<it>P </it>for trend <0.05). However, the proportion of women without prenatal care and without HIV testing before labor and delivery remained unchanged.</p> <p>Conclusions</p> <p>Reduced proportion of IDUs and improved clinical services among HIV-infected women giving birth were accompanied by decreased perinatal HIV transmission, which can be further reduced by increasing outreach and HIV testing of women before and during pregnancy.</p

Orphans & Vulnerable Children Chapel: Susan Hillis

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Achieving Sustainability inCalifornia’s CentralValley

This report analyzes the barriers and catalysts to sustainable growth and development in Central Valley cities at a crucial time of rapid population growth in that region. Sustainability has been described as “the current object of planning’s fascination” (Campbell 1996), yet the term’s exact meaning remains vague. This report aims to clarify the concept of sustainability as applied to cities in California’s Central Valley and identify some of the major factors influencing a city’s ability to achieve sustainability goals. The Central Valley is at a critical juncture: the 2009 population of about seven million people is expected to grow to 12 million people by 2040, according to California Department of Finance estimates. “By developed world standards, such growth is phenomenal,” outstripping any other region in California, the United States, and even Mexico (Johnson and Hayes 2004; p.7). It’s timely to assess the capacity of Central Valley cities to manage the economic, social, and environmental problems associated with this rapid population growth in a sustainable manner. The issues discussed in this report will take on added urgency as California’s response to climate change—including state laws like SB 375 and AB 32—encourage local governments to take action to reduce emissions

Achieving Sustainability inCalifornia’s CentralValley

This report analyzes the barriers and catalysts to sustainable growth and development in Central Valley cities at a crucial time of rapid population growth in that region. Sustainability has been described as “the current object of planning’s fascination†(Campbell 1996), yet the term’s exact meaning remains vague. This report aims to clarify the concept of sustainability as applied to cities in California’s Central Valley and identify some of the major factors influencing a city’s ability to achieve sustainability goals. The Central Valley is at a critical juncture: the 2009 population of about seven million people is expected to grow to 12 million people by 2040, according to California Department of Finance estimates. “By developed world standards, such growth is phenomenal,†outstripping any other region in California, the United States, and even Mexico (Johnson and Hayes 2004; p.7). It’s timely to assess the capacity of Central Valley cities to manage the economic, social, and environmental problems associated with this rapid population growth in a sustainable manner. The issues discussed in this report will take on added urgency as California’s response to climate change—including state laws like SB 375 and AB 32—encourage local governments to take action to reduce emissions.UCD-ITS-RR-09-06, Civil Engineering