A. Cockcroft

B. Maswabi

N. Andersson

R. van der Wal

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A n n a l s o f G l o b a l H e a l t h , V O L . 8 3 , N O . 1 , 2 0 1 7 Lancet Poster Competition FinalistsJ a n u a r y eF e b r u a r y 2 0 1 7 : 3 – 1 15Methods: We have created a low-cost videolaryngoscope bycombining a smartphone-compatible endoscope with a 3D printedhyper-angulated blade. The technology was iteratively designedusing SolidWorks  3D modeling software, and printed with theDremel 3D20 Idea Builder using biocompatible PLA. The deviceis reusable and costs $25. It was designed, manufactured and testedat United Mission Hospital, Tansen, Nepal.Findings: The “Tansen Videolaryngoscope” was tested againsta conventional Macintosh direct laryngoscope (DL) in a CPArlene airway manikin model. The study involved 32 participants withno prior videolaryngoscopy experience and varying levels of intubat-ing skill. We found improved Cormack-Lehane grade of view onlaryngoscopy (Videolaryngoscopy: 2.63 (SD: 1.54), Direct: 3.75(SD: 1.14), p¼ .0035), and increased “ease of use” with our device(Videolaryngoscope: 1.31 (SD: .47), Direct: 2.28 (SD: .92), p¼0.0000047). There was not a statistically significant difference inthe intubation success rate, time to visualize cords or time to passET tube between both laryngoscopes.Interpretation: A smartphone compatible endoscope combinedwith a 3D printed blade provides a good basis for low-cost videolar-yngoscopy. This work illustrates the potential for medical innova-tion in resource limited settings using simple, inexpensivetechnology. Further trials in a “difficult airway” manikin, followedby testing in patients, could enable this simple, low cost optionfor videolaryngoscopy to be clinically available in the near future.Source of Funding: None.Abstract #: LAN.005Getting High Quality Data to Drive Programs: How is theQuality of the Data Collection System Associated with theQuality of Routine Health Data in Malawi?R. O’Hagan1, M. Marx2, K. Finnegan3, P. Naphini4, K. Ng’ambi5,K. Laija6, E. Wilson2, L. Park2, S. Wachepa7, J. Smith6, L. Gombwa6,A. Misomali8, T. Mleme6, S. Yosefe4; 1Johns Hopkins Bloomberg Schoolof Public Health, Baltimore, Maryland, USA, 2Johns Hopkins Bloom-berg School of Public Health, Baltimore, USA, 3Johns HopkinsUniversity, Baltimore, Maryland, USA, 4Ministry of Health, Malawi,Lilongwe, Malawi, 5Ministry of Economic Planning and Development,Lilongwe, Malawi, 6National Statistical Office, Zomba, Malawi,7National Statistical Office, Zomba, Malawi, 8Johns Hopkins Bloom-berg School of Public Health, Lilongwe, MalawiBackground: Routine data can be a rich source of information forhealth systems. However, the perceived and actual quality of routinehealth data in low- and middle-income countries hinders its use forpolicy and programming. We conducted a data quality assessment(DQA) with the aim of characterizing the quality of routine datain Malawi’s health system and identifying associated systems-levelfactors.Methods: The DQA was led by the Central Monitoring and Eval-uation Division of the Ministry of Health of Malawi. It was con-ducted in 15 randomly selected districts, stratified by zone. Thesample included 16 hospitals, 90 randomly selected health centres,and 16 district health offices (DHOs), including one district withtwo DHOs. Registers, monthly reports, and computerized recordswere reviewed for five service areas: antenatal care (ANC4), familyplanning, HIV testing and counseling (HTC), and acute respiratoryinfection (ARI) and pneumonia diagnosis. Interviews were conduct-ed with facility and district personnel to assess current HealthManagement Information System (HMIS) functioning.Data quality was characterized within four domains: availability;completeness; consistency; and validity. Analysis of variance andmultiple linear regression were used to measure the associationbetween data quality and facility and DHO performance inHMIS functional areas.Findings: Data quality varied across service areas; median verifica-tion ratios, comparing register and report totals, ranged from 0.78[IQR 0.25 e 1.07] for ARI to 1.00 [IQR 0.96-1.00] for HTC.Procedures required by Malawi’s HMIS policy are not implementedat many facilities: only 60% of facilities report receiving a docu-mented supervisory visit for HMIS in the six months precedingthe assessment. Adherence to data quality practices is low, witha mean score of 0.51 out of 1.00 [SD 0.30]. Half of facilities havea full-time statistical clerk; however, employment of statistical clerksat facilities is not significantly associated with the availability orcompleteness of data.Interpretation: These findings can guide improvements in Mala-wi’s HMIS, including increased awareness of and adherence to exist-ing policies. The associations between systems-level factors and dataquality can inform efforts to strengthen HMIS in other LMICs.Source of Funding: Funding was provided by Global AffairsCanada, the World Health Organization, Save the Children, andthe Supporting Service Delivery Integration (SSDI) project.Abstract #: LAN.006Bottlenecks and Red Tape Reduce Access to GovernmentSupport Programs by Botswana’s Most Vulnerable YoungWomenR. van der Wal1, A. Cockcroft2, B. Maswabi3, N. Andersson4; 1McGillUniversity, Montreal, Québec, Canada, 2McGill University, Gabarone,Botswana, 3CIET Trust Botswana, Gabarone, Botswana, 4McGillUniversity, Montreal, CanadaBackground: Botswana’s HIV prevalence is among the highestworldwide, with young women disproportionately affected. Structuralbarriers such as poverty, lack of education, and gender violence meanthat young women are unable to implement HIV-prevention choices.Transactional and age disparate sex increase their HIV risk. A nationalstructural intervention, implemented as a stepped-wedge clusterrandomized controlled trial (ISRCTN54878784), aims to prepareyoung women to apply to available government support programsand to align the programs in favour of young women. Records reviewrevealed that these programs don’t reach the most vulnerable.Methods: An exploratory study reviewed demand- and supply-sidechallenges to accessing government support programs in the firstintervention district. All participants gave verbal consent andreceived assurances of anonymity. A young woman from the districtand a local researcher undertook semi-structured interviews with 18Lancet Poster Competition Finalists A n n a l s o f G l o b a l H e a l t h , V O L . 8 3 , N O . 1 , 2 0 1 7J a n u a r yeF e b r u a r y 2 0 1 7 : 3 – 1 16young women (not in school/at work). The first author interviewed4 local service providers. Thematic analysis relied on Nvivo.Findings: The most vulnerable young women experience seriousdifficulties accessing government support programs. Lack of self-confidence and ambiguous navigating procedures block institutionalassistance. Long delays in processing applications and lack of feed-back on application status are discouraging. Successful candidatesexperienced community-level barriers like third parties unwillingto collaborate. Although motivated to help young women, serviceproviders complained about youth attitudes and behaviour nega-tively affecting support program success-rates. Agricultural supportprograms may be incompatible with ambitions of youth unwillingto stay in rural areas. Lack of financial, material, and humanresources hamper effective assistance and follow-up of applicants.Lack of available program placements and funding contribute todelays in support. Despite their ideas for improvement, serviceproviders believe that effective change depends on political will,and national-level coordination and direction.Interpretation: The available programs involved at least five lineministries; lack of coordination results in service gaps, overlap andcompetition, contributing to confusion among clients. Local serviceproviders could improve vulnerable young women’s access toprograms by providing targeted and accessible assistance in applica-tion procedures, followed by timely and transparent feedback onapplication status. Stakeholder-constructed solutions are needed toovercome identified structural barriers.Source of Funding: Canadian IDRC grant nr: 107531-001.Abstract #: LAN.007Crowdsourcing to Promote HIV Testing among MSM inChina: A Pragmatic Stepped Wedge Randomized ControlledTrial of a Crowdsourced InterventionT. Zhang1, W. Tang2, T. SESH study group2, J. Tucker3; 1LoyolaUniversity Chicago Stritch School of Medicine, Forest Park, IL, USA,2UNC Project-China, Guangzhou, China, 3University of North Car-olina at Chapel Hill, Chapel Hill, NC, USAProgram/Project Purpose: Improving HIV testing for marginal-ized populations is critical to controlling the HIV epidemic.However, the HIV testing rate among men who have sex withmen (MSM) in China remains consistently low. Crowdsourcing,the process of shifting individual tasks to a group, has been increas-ingly adopted to enhance public health programs and may be a usefultool for spurring innovation in HIV testing campaigns. Wedesigned a multi-site study to develop a crowdsourced HIV testpromotion campaign and evaluate its effectiveness against conven-tional campaigns among MSM in China.Structure/Method/Design: The intervention was developed usingcrowdsourcing at multiple stages and is being evaluated with a step-ped wedge randomized controlled trial (RCT). Intervention devel-opment consisted of a nationwide crowdsourcing contest followedby a designathon. The crowdsourcing contest solicited campaigncontent through an open call, judging, and recognition of finalistentries, which became materials for the designathon. The designa-thon adopted the concept of a hackathon and allowed individualsto collaborate on designing a comprehensive HIV test promotioncampaign. The design elements of the winning entry were includedin a HIV test promotion campaign to be evaluated through a steppedwedge RCT. Eight major metropolitan cities in China will berandomized to sequentially initiate intervention in groups of twoat 3-month intervals.Outcome & Evaluation: 1347 MSM who are 16 years of age orover, live in the intervention city, did not have HIV testing in thepast 3 months, and are not living with HIV were recruited. Recruit-ment took place through banner advertisements on a large gaydating app along with other social media platforms. The interven-tion is ongoing. Participants will complete one follow-up surveyevery 3 months for 12 months to evaluate their HIV testing uptakein the past 3 months as the primary outcome.Going Forward: Our large-scale RCT can improve understandingof crowdsourcing’s long-term effectiveness in public healthcampaigns, expand HIV testing coverage among a key population,and inform intervention design in related public health fields.This study has been registered on ClinicalTrials.gov(NCT02796963) and obtained IRB approvals from the GuangdongProvincial Center for Skin Diseases and STI Control, University ofNorth Carolina at Chapel Hill, and University of California SanFrancisco.Source of Funding: NIH (#1R01AI114310-01).Abstract #: LAN.008HIV Therapy without HBV Co-management in EthiopiaFosters Emergence of Unintended HBV Drug Resistance andVaccine Evasive VariantsY.B. Akal1, M. Maier2, U.G. Liebert2; 1University of Gondar,Gondar, Amhara Regional state, Ethiopia, 2Institute of Virology,Medical Faculty, Leipzig University, Germany, Leipzig, GermanyBackground: Hepatitis B virus (HBV) drug resistance and vaccineescape gene mutants were determined in patients with human immu-nodeficiency virus (HIV) co-infection and antiretroviral therapy(ART) exposure of with unknown HBV status. Moreover, the recip-rocal HIV drug resistance profiles were examined in HBV-HIV co-infected patients who developed HBV drug resistance.Methods: A total of 161 hepatitis B surface antigen (HBsAg) posi-tive sera from HIV co-infected with and without ART exposure anddrug naïve HBV mono-infected individuals were characterizedusing direct sequencing.Findings: In 35 out of 161 study subjects (21.7%) HBV drug resis-tance mutations (DRMs) were detected with a frequency of 1.2%rtT184S, 6.2% rtV173L, 10.6% rtL180M, 10.6% rtM204V/I and8.1% rtI233V which confer resistance mainly for entecavir, lamivu-dine and adefovir. The prevalence of the major DRMs in HBV-HIV co-infected individuals (with no significance difference amongART status) was higher than mono-infected individuals (41.4% vs.10.7%). In contrast, none of HIV-1 patients showed no nucleos(t)ide reverse transcriptase inhibitors (NTRIs) drug resistance.However, 62.5% of them developed non NRTIs resistance muta-tions which confer resistance to nevirapine, efavirenz, etravirine

Bottlenecks and Red Tape Reduce Access to Government Support Programs by Botswana’s Most Vulnerable Young Women

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Bottlenecks and Red Tape Reduce Access to Government Support Programs by Botswana’s Most Vulnerable Young Women

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