Selling a service: experiences of peer supporters while promoting exclusive infant feeding in three sites in South Africa

<p>Abstract</p> <p>Background</p> <p>Even though it has been shown that peer support to mothers at home helps to increase exclusive breastfeeding, little is known about the experiences of peer supporters themselves and what is required of them to fulfil their day-to-day tasks. Therefore, a community-based randomised control trial using trained "lay" women to support exclusive infant feeding at home was implemented in three different sites across South Africa. The aim of this paper is to describe the experiences of peer supporters who promote exclusive infant feeding.</p> <p>Methods</p> <p>Three focus group discussions were held, in a language of their choice, with peer supporters. These meetings focused on how the peer educators utilised their time in the process of delivering the intervention. Data from the discussions were transcribed, with both verbatim and translated transcripts being used in the analysis.</p> <p>Results</p> <p>Unlike the services provided by mainstream health care, peer supporters had to market their services. They had to negotiate entry into the mother's home and then her life. Furthermore, they had to demonstrate competence and come across as professional and trustworthy. An HIV-positive mother's fear of being stigmatised posed an added burden - subsequent disclosure of her positive status would lead to an increased workload and emotional distress. Peer supporters spent most of their time in the field and had to learn the skill of self-management. Their support-base was enhanced when supervision focused on their working conditions as well as the delivery of their tasks. Despite this, they faced other insurmountable issues, such as mothers being compelled to offer their infants mixed feeding simultaneously due to normative practices and working in the fields postpartum.</p> <p>Conclusion</p> <p>Designers of peer support interventions should consider the skills required for delivering health messages and the skills required for selling a service. Supportive supervision should be responsive both to the health care task and the challenges faced in the process of delivering it.</p> <p>Trial registration</p> <p>NCT00297150.</p

A new paradigm evaluating cost per cure of HCV infection in the UK

Background: New interferon (IFN)-free treatments for hepatitis C are more effective, safer but more expensive than current IFN-based therapies. Comparative data of these, versus current first generation protease inhibitors (PI) with regard to costs and treatment outcomes are needed. We investigated the real-world effectiveness, safety and cost per cure of 1st generation PI-based therapies in the UK. Methods: Medical records review of patients within the HCV Research UK database. Patients had received treatment with telaprevir or boceprevir and pegylated interferon and ribavirin (PR). Data on treatment outcome, healthcare utilisation and adverse events (AEs) requiring intervention were collected and analysed overall and by subgroups. Costs of visits, tests, therapies, adverse events and hospitalisations were estimated at the patient level. Total cost per cure was calculated as total median cost divided by SVR rate. Results: 154 patients from 35 centres were analysed. Overall median total cost per cure was £44,852 (subgroup range,: £35,492 to £107,288). Total treatment costs were accounted for by PI: 68.3 %, PR: 26.3 %, AE management: 5.4 %. Overall SVR was 62.3 % (range 25 % to 86.2 %). 36 % of patients experienced treatment-related AEs requiring intervention, 10 % required treatment-related hospitalisation. Conclusions: This is the first UK multicentre study of outcomes and costs of PI-based HCV treatments in clinical practice. There was substantial variation in total cost per cure among patient subgroups and high rates of treatment-related discontinuations, AEs and hospitalisations. Real world safety, effectiveness and total cost per cure for the new IFN free combinations should be compared against this baseline

Evaluation of the Sustainability of an Intervention to Increase HIV Testing

BACKGROUND Sustainability—the routinization and institutionalization of processes that improve the quality of healthcare—is difficult to achieve and not often studied. OBJECTIVE To evaluate the sustainability of increased rates of HIV testing after implementation of a multi-component intervention in two Veterans Health Administration healthcare systems. DESIGN Quasi-experimental implementation study in which the effect of transferring responsibility to conduct the provider education component of the intervention from research to operational staff was assessed. PATIENTS Persons receiving healthcare between 2005 and 2006 (intervention year) and 2006 and 2007 (sustainability year). MEASUREMENTS Monthly HIV testing rate, stratified by frequency of clinic visits RESULTS The monthly adjusted testing rate increased from 2% at baseline to 6% at the end intervention year and then declined reaching 4% at the end of the sustainability year. However, the stratified, visit-specific testing rate for persons newly exposed to the intervention (i.e., having their first through third visits during the study period) increased throughout the intervention and sustainability years. Increases in the proportion of visits by patients who remained untested despite multiple, prior exposures to the intervention accounted for the aggregate attenuation of testing during the sustainability year. Overall, the percentage of patients who received an HIV test in the sustainability year was 11.6%, in the intervention year 11.1%, and in the pre-intervention year 5.0% CONCLUSIONS Provider education combined with informatics and organizational support had a sustainable effect on HIV testing rates. The effect was most pronounced during patients' early contacts with the healthcare system.Health Services Research & Development Service (SDP 06–001

Hadron-Hadron Interactions from Nf=2+1+1N_f=2+1+1 Lattice QCD: isospin-2 ππ\pi\pi scattering length

We present results for the $I=2$ $\pi\pi$ scattering length using $N_f=2+1+1$ twisted mass lattice QCD for three values of the lattice spacing and a range of pion mass values. Due to the use of Laplacian Heaviside smearing our statistical errors are reduced compared to previous lattice studies. A detailed investigation of systematic effects such as discretisation effects, volume effects, and pollution of excited and thermal states is performed. After extrapolation to the physical point using chiral perturbation theory at NLO we obtain $M_\pi a_0=-0.0442(2)_\mathrm{stat}(^{+4}_{-0})_\mathrm{sys}$.Comment: Edited for typos, overhauled figures, more detailed comparison to existing lattice result

The asteroseismic ground-based observational counterpart of CoRoT

We present different aspects of the ground-based observational counterpart of the CoRoT satellite mission. We give an overview of the selected asteroseismic targets, the numerous instruments and observatories involved, and the first scientific results.Comment: 3 pages, 2 tables, 1 figure, to be published in the conference proceedings 'Stellar Pulsation: Challenges for Theory and Observation' (31 May - 5 June, Santa Fe, New Mexico, US), publishers: American Institute of Physic