Reduced mother-to-child transmission rates of HIV between 2017 and 2020 in Kenya. What changed?

Background: In 205 health facilities, mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) rates were reduced from 7.4% to 2.1% between 2017 and 2020, respectively.

What are the prospects for the hormonal IUD in the public sector? A mixed-method study of the user population in Zambia.

Background: The levonorgestrel-releasing intrauterine device (IUD)-also known as the hormonal IUD-is a highly effective contraceptive method that has not been widely available in the public sector in Zambia. Early introduction efforts can provide critical insights into the characteristics of users, reasons for method choice, and experiences getting their method.

Methods: We conducted a survey with 710 public sector clients who received a hormonal IUD, copper IUD, implant or injectable in two provinces of Zambia, and additional in-depth interviews with 29 women.

Improved HIV case finding among key populations after differentiated data driven community testing approaches in Zambia.

Introduction: Open Doors, an HIV prevention project targeting key populations in Zambia, recorded low HIV positivity rates (9%) among HIV testing clients, compared to national adult prevalence (12.3%), suggesting case finding efficiency could be improved. To close this gap, they undertook a series of targeted programmatic and management interventions.

Health care providers' attitudes toward and experiences delivering oral PrEP to adolescent girls and young women in Kenya, South Africa, and Zimbabwe.

Background: In Kenya, South Africa, and Zimbabwe, oral pre-exposure prophylaxis (PrEP) is recommended for adolescent girls and young women (AGYW) at high risk of HIV. Health providers play a critical role in the uptake and effective use of sexual and reproductive health services; however, few published studies have explored providers' attitudes toward and experiences delivering PrEP to AGYW.

Methods: We conducted a cross-sectional qualitative study, interviewing 113 providers at 36 public, private, and nongovernmental health facilities in Kenya, South Africa, and Zimbabwe that were offering PrEP during the research period or were likely to offer PrEP in the future.

Factors affecting uptake of the levonorgestrel-releasing intrauterine device: A mixed-method study of social franchise clients in Nigeria.

Background: Despite the positive characteristics of the levonorgestrel-releasing intrauterine device (IUD)-a long-acting, highly effective contraceptive with important non-contraceptive attributes-the method has not been widely available in low- and middle-income countries. This study of hormonal IUD, copper IUD, implant and injectable users in Nigeria compares their characteristics, reasons for method choice, and experiences obtaining their method.

Methods: We conducted a phone survey with 888 women who received a hormonal IUD, copper IUD, contraceptive implant or injectable from 40 social franchise clinics across 18 states in Nigeria.

Expanding long-acting contraceptive options: a prospective cohort study of the hormonal intrauterine device, copper intrauterine device, and implants in Nigeria and Zambia.

Background: 30 years after the introduction of the levonorgestrel-releasing intrauterine device in Europe, several sub-Saharan African countries are seeking to broaden access to this contraceptive method. In this study, we aimed to assess 12-month continuation of the hormonal intrauterine device, copper intrauterine device, and implants, as well as to assess women's experiences and satisfaction using these methods in the private sector in Nigeria and the public sector in Zambia.

Methods: We did a prospective cohort study of long-acting reversible contraceptive users across 40 private sector clinics in Nigeria and 21 public sector clinics in Zambia.

Test and Prevent: Evaluation of a Pilot Program Linking Clients With Negative HIV Test Results to Pre-exposure Prophylaxis in Zimbabwe.

Background: As HIV testing increases worldwide, programs are reaching individuals without HIV infection who are at risk of exposure and may be candidates for oral pre-exposure prophylaxis (PrEP). Although linkage of individuals with HIV infection to treatment is a global priority (referred to as "test and treat"), less attention is given to individuals with negative HIV test results. We developed the "Test and Prevent" pilot program to intentionally link at-risk clients with negative HIV test results to PrEP services.

Task Sharing of Injectable Contraception Services in Pakistan: A Randomized Controlled Trial.

Provision of injectable contraceptive services by lay health workers is endorsed by normative bodies, but support for this practice is not universal. We assessed whether lay providers (lady health workers, LHWs) could perform as well as clinically trained providers (family welfare workers, FWWs) on appropriate screening, counseling, and injection of intramuscular and subcutaneous depot medroxyprogesterone acetate (DMPA) using a randomized controlled trial. In the urban sample (n = 355), 88 percent of FWW DMPA clients were appropriately screened versus 77 percent of LHW clients (noninferiority test p = 0.

Oral preexposure prophylaxis continuation, measurement and reporting.

Objective: The aim of this study was to appropriately plan for rollout and monitor impact of oral preexposure prophylaxis (PrEP). It is important to understand PrEP continuation and come to a consensus on how best to measure PrEP continuation. This study reviews data on PrEP continuation to document how it is reported, and to compare continuation over time and across populations.

Factors influencing uptake, continuation, and discontinuation of oral PrEP among clients at sex worker and MSM facilities in South Africa.

Background: South Africa became the first country in Africa to introduce oral PrEP in June 2016. The National Department of Health has used a phased approach to rollout, allowing for a dynamic learn-and-adapt process which will lead ultimately to scale-up. Phased rollout began with provision of oral PrEP at facilities providing services to sex workers in 2016 and was expanded in 2017, first to facilities providing services to MSM and then to students at selected university campus clinics, followed by provision at primary health care facilities.

Using the Unmanned Aerial Vehicle Delivery Decision Tool to Consider Transporting Medical Supplies via Drone.

We developed an unmanned aerial vehicle (UAV) Delivery Decision Tool to help health system decision makers identify their transport challenges and explore the potential utility and impact of UAVs on the broader health system.

Reaching at-risk women for PrEP delivery: What can we learn from clinical trials in sub-Saharan Africa?

Introduction: ARV-based pre-exposure prophylaxis (PrEP) has the potential to avert many new HIV infections, yet little is known about how to reach women at high risk for HIV infection and motivate them to initiate PrEP. Clinical trials have succeeded in recruiting at-risk participants, evidenced by control arm HIV incidence ≥3% (defined by the World Health Organization as "substantial risk"). We examined experiences from HIV prevention trials to document recruitment strategies and identify practical, potentially effective strategies for reaching women in real-world PrEP delivery.

Generativity Among Elderly in a Rural Area of Maharashtra, India: Correlates and Relationship With Quality of Life Approved.

Generativity, "a concern for others and a need to contribute something to the next generation," is a dimension of successful aging in and of itself, but also predicts other positive health outcomes. We examine its manifestations and correlates among elderly in rural India and assess the association between generativity and quality of life (QoL). Three hundred and forty-eight rural Indian elderly completed an interviewer-assisted questionnaire assessing generativity, QoL, and other personal and familial factors.

The Relationship Between BMI and Work-Related Musculoskeletal (MSK) Injury Rates is Modified by Job-Associated Level of MSK Injury Risk.

Objective: The aim of this study was to examine the relationship between body mass index (BMI) and occupational musculoskeletal (MSK) injury rates, and the statistical interaction between BMI and occupational exposure to MSK hazards (measured by level of MSK injury risk based on job category).

Methods: Using 17 years of data from 38,214 university and health system employees, multivariate Poisson regression modeled the interaction between BMI and MSK injury risk on injury rates.

Results: A significant interaction between BMI and MSK injury risk was observed.

Evaluating the effects of organizational and educational interventions on adherence to clinical practice guidelines in a low-resource primary-care setting in Kenya.

Background: Mid-level care providers serve as the backbone of primary care in many parts of sub-Saharan Africa. Despite this, research suggests that the quality and consistency of this care is uneven. This study assessed the degree to which a set of four simple, low-cost interventions could improve adherence to a set of clinical quality measures (CQMs) associated with four common health conditions seen in a resource-constrained primary care setting.

Prevalence of occupational injury and its contributing factors among rubber tappers in Galle, Sri Lanka.

Background: Rubber tapping involves carrying heavy loads, navigating rough terrain, and using sharp tools. However, little is known about occupational injury among this vulnerable working population.

Objective: To assesses the prevalence, severity, and contributing factors associated with occupational injury among Sri Lankan rubber tappers and to identify possible interventions to improve occupational safety.

Prevalence and risk factors of musculoskeletal disorders among Sri Lankan rubber tappers.

Background: Rubber tapping exposes workers to risk factors for musculoskeletal disorders (MSDs).

Objectives: This cross-sectional study assessed the prevalence and factors associated with MSDs among Sri Lankan rubber tappers.

Methods: Questionnaires were administered to 300 rubber tappers to measure MSDs and potential associated factors.