Community-based Treatment Programs Research Articles

Training is an Important Factor for Community Health Workers in Performing KOSPEN Health Screening Activities in Malaysia: Community Health Workers (KOSPEN) 2016

Abstract Introduction: Community health workers (CHW) or volunteers are health workers who are trained but do not possess a professional certificate. They are community members who live and work in that particular community. The Ministry of Health Malaysia had initiated a community-based intervention programme, Healthy Community Empowers the Nation or ‘Komuniti Sihat Pembina Negara’ (KOSPEN) in October 2013. In this programme, CHWs main task is to conduct non-communicable diseases (NCD) risk factor screening. Methods: Data from the “Evaluation of the implementation of KOSPEN programme in Malaysia 2016” was used. It is a cross-sectional study which was carried out in randomly selected KOSPEN localities throughout Malaysia. Logistic regression analysis was applied to determine factors associated with not performing KOSPEN screening activities by the volunteers. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 20. Results: A total of 700 volunteers were included in this study. Most of the volunteers were female (65.7%) and were aged 50-59 years (30.9%), followed by those aged 40-49 (27.1%). Majority had secondary education (65.3%), employed (55.7%.) and were married (80.4%). Multivariate logistic regression showed that volunteers who never attended training (aOR 2.79; 95% CI:1.66, 4.67) and who felt the content of the training module was inadequate (aOR 2.693; 95% CI: 1.46, 4.98) were more likely to not perform screening activities in the community. Conclusion: Attendance of the training should be a pre-requisite to qualify as a volunteer. Improvement to the training module should done to increase comprehensibility of the modules among the volunteers. Keywords: KOSPEN-community health workers-NCD screening-community-based intervention

The epidemiology of traumatic brain injuries sustained by children under 10 years of age presenting to a tertiary hospital in Soweto, South Africa.

Traumatic brain injury (TBI) in the paediatric population is a significant contributor to death and disability worldwide. In sub-Saharan Africa, death and disability from TBI are still superseded by infectious disease. Mechanisms of injury differ by region and socioeconomics, but in general, falls, road traffic collisions (RTCs), being 'struck by/against objects' and non-accidental injuries (NAIs) are responsible for most cases. To: (i) quantify the burden of TBI in terms of demographics, causes and severity; (ii) explore resource utilisation regarding length of stay, computed tomography (CT) brain scan use and multidisciplinary participation; (iii) interrogate possible temporal patterns of injury; and (iv) thus identify potential targets for community-based prevention strategies. In a 5-year retrospective review of all children aged <10 years admitted with TBI between September 2013 and August 2018, demographics, date of injury, mechanism of injury, severity of TBI based on the Glasgow Coma Scale, and requirement for a CT brain scan were collected for each patient. Outcomes were reported as discharge, transfer or death. Outcomes for children sustaining isolated TBI were compared with those for children sustaining TBI with polytrauma. A total of 2 153 patients were included, with a mean (standard deviation) age of 4.6 (2.7) years and a male/female ratio of 1.7:1. RTCs were the most frequent cause of injury at 59% (80% of these were pedestrian-vehicle collisions), followed by falls at 24%. Mild TBIs accounted for 87% of admissions, moderate injuries for 6%, and severe injuries for 7%. Polytrauma was associated with increased severity of TBI. The cohort had a 2.3% mortality. NAIs accounted for 6% of injuries and carried a 4% mortality. The median (interquartile range) duration of hospitalisation was 1 (1 - 3) days, ranging from <24 hours to 132 days. CT scans were performed on 43% of admitted patients, and 48% of patients had consultations with another medical or allied medical discipline. Injuries were more frequent during the summer months and over weekends. Infants aged <1 year were identified as a group particularly vulnerable to injury, specifically NAI. Paediatric TBI was demonstrated to be a resource-intensive public health concern. From the results, we identified potential primary prevention targets that could perhaps be incorporated into broader community-based intervention programmes. We also identified a need to study long-term consequences of mild TBI further in our paediatric population.

Effect of community-based nutritional counseling intervention on children's eating habits.

Aim:This study aimed to assess the outcome of community-based nutritional counseling interventions on eating habits of rural-dwelling children.Methods:A group-randomized trial design was used in this study. A total of 108 rural-dwelling children from a community in the Enugu North agricultural zone, Enugu State, who participated in the study. The children were randomly assigned to 2 groups: the treatment group (n = 54) and the no-treatment control group (n = 54). The child eating behavior questionnaire was used for data collection. Parents of the participating children within each study group completed the child eating behavior questionnaire at 3 time points. The data collected were analyzed using an independent sample t test at a probability level of .05.Result:The outcome of the study showed that the children's eating habits in the treatment group improved positively following the community-based nutritional counseling intervention. The positive gain from exposure to the community-based nutritional counseling intervention program was sustained during follow-up for children in the treatment group compared with the no-treatment group.Conclusion:The community-based nutrition counseling intervention carried out among children in rural communities had a positive adjustment in children's eating habits. The intervention requires the constant collaboration of professional childhood educators, caregivers, home economists, school staff, healthcare specialists, families, and the children themselves. Furthermore, there is a need for future long-term evaluations of the effects of community-based nutritional counseling interventions on children's nutrition and eating habits.

Happy Talk: A pilot effectiveness study of a targeted-selective speech-language and communication intervention for children from areas of social disadvantage.

Despite the public health implications of language difficulties associated with social disadvantage, there is a dearth of effectiveness studies investigating the effects of targeted speech and language programmes in this area. To determine the effects of a targeted selective community-based child language intervention programme (Happy Talk), which simultaneously engaged with parents and early childhood educators, in the Republic of Ireland. A mixed methods methodology was applied with quantitative outcome and qualitative process data collected. Effectiveness was examined using a quasi-experimental single blind study design comparing Happy Talk with 'usual care' across four preschools. Qualitative process data were also gathered to examine the acceptability and feasibility of the Happy Talk approach in practice, and to identify factors to improve the probability of successful wider implementation. Child language (PLS-5) and quality-of-life measures were administered pre- and immediately post- the 11-week intervention. Responsiveness was assessed as the parental outcome, and the oral language environment of preschools was measured using the Communication Supporting Classroom Observation Tool (CSCOT). Retrospective acceptability was analysed with reference to the theoretical framework of acceptability (v 2). Pre-/post-expressive and composite language scores were collected for 58 children, and receptive scores for 54 children. Multiple linear regression revealed significant intervention effects for comprehension and total language with large and moderate effect sizes, respectively (0.60 and 0.46 SD). No significant effect was shown for parental responsiveness. No effects were found for the preschool environment or children's quality of life. Preschool staff deemed the programme to be an acceptable method of enhancing children's speech and language skills and rated the intervention positively. The Happy Talk pilot effectiveness trial shows that comprehension can be improved (with a large effect) in preschool children from areas of social disadvantage, following an 11-week intervention, in which parents and preschool staff are simultaneously engaged. The ecological validity of the programme, as well as feasibility and acceptability to staff, make it a suitable programme to be delivered at scale. What is already known on the subject Up to 50% of children from socially disadvantaged areas enter preschool with speech and language difficulties. The majority of intervention studies are (1) researcher led; (2) efficacy trials carried out in ideal conditions; and (3) focus on working with parents or early childhood educators rather than engaging with both groups simultaneously. Many studies omit child language outcomes, and those that include them tend to show relatively modest effects for expressive language and negligible effects for receptive language. What this paper adds to existing knowledge This pilot study shows that the Happy Talk programme, which is embedded in the community and which simultaneously engages with parents and early childhood educators, is highly effective in improving children's receptive language skills. These findings are particularly important in the context of (1) the study taking place in real world conditions; and (2) the programme being designed and refined by speech and language therapy services, rather than one which is researcher led. What are the potential or actual clinical implications of this work? Implementing an 11-week targeted selective community-based language intervention can result in a large positive effect on receptive language for children from areas of social disadvantage. The study findings highlight the importance of embedding intervention programmes in the community and of simultaneously engaging with parents and preschool staff.

The German Alliance Against Depression and suicide rates: A retrospective analysis.

Supported by the German Alliance Against Depression, 82 regions in Germany launched their own community-based multi-level intervention programs targeting both depression and suicidal behavior prior to January 2016. Sixteen of these regions have implemented the full 4-level intervention program comprising 1) training of General Practitioners, 2) a public awareness campaign, 3) training of community facilitators and 4) support for depressed patients and their relatives for at least three years. The aim of the study was to examine possible suicide prevention effects in these sixteen 4-level intervention regions (comprising a population of 6,976,309) by 1) comparing the annual suicide rates during the 3-year intervention period to a 10-year baseline and 2) comparing these differences to corresponding trends in Germany after excluding all intervention regions (Germany-IR). Primary outcome was the annual rate of suicides. Analyses included negative binomial regression models. When examining differences between suicide rates during the intervention period compared to the baseline period, only a trend towards a significant reduction was found. This reduction of suicides in the sixteen 4-level intervention regions did not differ from that in Germany-IR as control. The interpretation of these findings has to take into account that the training of General Practitioners, police and other community facilitators might have improved the recognition of suicides, thus increasing detection rates. Furthermore, destigmatizing effects of the public awareness campaigns might have increased the number of suicides by lowering suicide threshold (“normalization”) for those at risk and by decreasing the rate of suicides deliberately hidden by suicide victims or their relatives.

CreatingWith, NotForPeople: Theory of Change and Logic Models for Culturally Responsive Community-Based Intervention

Intervention scientists have used program theory-driven evaluation to design, implement, and assess the success of intervention programs for decades. However, interventions often are designed without the input of the community for which they are intended. The lack of incorporation of community members’ voices that participate in various intervention programs and the de-emphasis of systemic influences on program outcomes may decrease the extent to which participants experience intended positive outcomes. This often leads to interventions that are irrelevant at best and harmful at worst. Theory of change and logic models are two forms of theory-driven evaluation that can be used in tandem to incorporate community voices into program design and implementation while attending to systemic influences on the program. The following paper presents a stage model process for creating and utilizing both a theory of change and logic model for community-based intervention programs aiming to work with ethnically and racially diverse and immigrant populations.

Liver health events: an indigenous community-led model to enhance HCV screening and linkage to care.

Despite high prevalence of hepatitis C virus (HCV), linkage to care and treatment for Indigenous people is low. In an Indigenous community in Saskatchewan, Canada a retrospective review identified 200 individuals (∼12% prevalence) had HCV antibodies though majority lacked ribonucleic acid (RNA) testing, and few received treatment despite availability of an effective cure. Following Indigenous oral traditions, focus group discussions were held with key community members and leadership. Participants emphasized the need for a community-based screening and treatment programme. A team of community members, peers and healthcare professionals developed a streamlined screening pathway termed 'liver health event' (LHE) to reduce stigma, reach undiagnosed, re-engage previously diagnosed, and ensure rapid linkage to care/treatment. LHEs began December 2016. Statistics were tracked for each event. As of July 2019, there were 10 LHEs with 540 participants, 227 hepatitis C tests and 346 FibroScans completed. This represented 294 unique individuals, of which 64.3% were tested, and of those, 40.8% were Ab positive. Among those positive for antibodies, 41.7% had active hepatitis C infections, and among these, 90% were linked to care, and 14 new positive individuals were identified. Following the success of LHEs, these were adapted and implemented in 10 other communities in this region, resulting in 17 additional LHEs. This intervention is reaching the undiagnosed and linking clients to care through a low-barrier and de-stigmatizing approach. It has facilitated collaboration, knowledge exchange and mentorship between Indigenous communities, significantly impacting health outcomes of Indigenous people in this region.

African American men who become mental health advocates.

Using a narrative approach, this study explored how African American men became mental health advocates. This ancillary study is part of a formative within an ongoing community based intervention program that was designed to promote mental health of African Americans (AMEN) project within an ongoing community based intervention program that was designed to promote mental health of African Americans (AMEN) project. Narrative research techniques were used to analyze and synthesize the data. Analysis generated one major theme (interdependence) with four supporting sub-themes (credibility, social depression, stigma, and calling). These findings and insights through this qualitative study guided the AMEN project team to formulate effective communication strategies in establishing working relationships with community partners and wider stakeholders as well as crafting culturally tailored messages for African American participants.

Implementation support for contingency management: preferences of opioid treatment program leaders and staff

BackgroundContingency management (CM), a behavioral intervention that provides incentives for achieving treatment goals, is an evidence-based adjunct to medication to treat opioid use disorder. Unfortunately, many front-line treatment providers do not utilize CM, likely due to contextual barriers that limit effective training and ongoing support for evidence-based practices. This study applied user-informed approaches to adapt a multi-level implementation strategy called the Science to Service Laboratory (SSL) to support CM implementation.MethodsLeaders and treatment providers working in community-based opioid treatment programs (OTPs; N = 43) completed qualitative interviews inquiring about their preferences for training and support implementation strategies (didactic training, performance feedback, and external facilitation). Our team coded interviews using a reflexive team approach to identify common a priori and emergent themes.ResultsLeaders and providers expressed a preference for brief training that included case examples and research data, along with experiential learning strategies. They reported a desire for performance feedback from internal supervisors, patients, and clinical experts. Providers and leaders had mixed feelings about audio-recording sessions but were open to the use of rating sheets to evaluate CM performance. Finally, participants desired both on-call and regularly scheduled external facilitation to support their continued use of CM.ConclusionsThis study provides an exemplar of a user-informed approach to adapt the SSL implementation support strategies for CM scale-up in community OTPs. Study findings highlight the need for user-informed approaches to training, performance feedback, and facilitation to support sustained CM use in this setting.

David Katzenstein and James Hakim-In Memoriam.

The world lost two wonderful doctors who devoted their lives to the fight against HIV/AIDS in Africa. Ironically, they both died of COVID-19 within hours of each other in late January in Zimbabwe. David Katzenstein, MD, began his career in the early 1980 s working with underserved populations at a Native Tribal clinic in New Mexico and with persons suffering from AIDS at the Haight Ashbury Clinic in San Francisco, conducted CMV research at the University of Minnesota, and then took a position working as a microbiologist at the University of Zimbabwe in Harare between 1985 and 1987. In 1989, David joined the faculty at Stanford University where he remained until his retirement in 2017. Dr Katzenstein, led many important clinical and translational research studies related to HIV. With his colleagues in the AIDS Clinical Trials Group (ACTG), he led studies that resulted in the approval of life-saving antiretroviral medications. David dedicated a major portion of his academic endeavors to study HIV drug resistance, serving as director of one of the Virology Specialty Laboratories for the ACTG for many years. He was a protocol team member and leader on several ACTG studies and served on numerous ACTG committees, including the Performance Evaluation Committee and the original Virology Committee. He was co-chair of ACTG 384 that dealt with protease and/or non-nucleoside reverse transcriptase inhibitors, and was one of the first investigators to call attention to the issues of drug resistance in Africa. Recognizing the disparate impact of HIV in resource limited settings, David was a pioneer in Global HIV Research, in the fields of perinatal HIV transmission prevention, and studying different approaches to optimize antiretroviral treatment and laboratory monitoring in various settings around the world. He worked diligently to bring laboratory technology to Zimbabwe. Following his retirement from Stanford in 2017, David became the director of the Biomedical Research Training Institute in Zimbabwe where he led the molecular diagnostics laboratory to support laboratory monitoring of community-based treatment programs. In all his work, David engaged researchers and trainees from different parts of the world. Generous with his time, effort and ideas, David was a cherished mentor for many young and mid-career physicians and scientists, now scattered throughout different academic institutions and agencies in the U.S. He nurtured careers of clinicians, basic and social scientists, while encouraging multidisciplinary efforts to tackle the global HIV pandemic. He worked tirelessly and with great joy, giving of himself without reserve. James Gita Hakim, MRCP-UK, Professor of Medicine, University of Zimbabwe College of Health Sciences, to COVID-19. Dr Hakim was an accomplished investigator who made seminal contributions in HIV treatment and prevention research. He was known internationally for his accomplishments as a research leader, a builder of African research capacity, a leader of modernizing medical education in Africa, and as a mentor of young African investigators. Dr Hakim was at the forefront of clinical research on HIV/AIDS in Africa for over 20 years. He founded the University of Zimbabwe Clinical Research Centre (UZ-CRC) in 2001 as a site for international clinical trials on HIV treatment and prevention. He was a leader in pivotal international clinical trials including the landmark HIV ‘treatment as prevention’ trial HPTN 052, the MRC-funded “Development of Anti-Retroviral Therapy in Africa” (DART) trial, and the ACTG “Prospective Evaluation of Antiretroviral Therapy in Resource Limited Settings” (PEARLS) study. These studies contributed to the knowledge needed for successful implementation of antiretroviral therapy in southern Africa. Dr Hakim was as Principal Investigator of the University of Zimbabwe's program, the Medical Education Partnership Initiative (MEPI) which serves as a model for medical education in Africa. He was as a representative on the International AIDS Society (IAS) Governing Council from 2016 to 2020 and on the World Health Organization Guidelines Review Committee, the UNAIDS Advisory Committee, and on program committees for IAS Conference on HIV Science, the Conference on Retroviruses and Opportunistic Infections (CROI). Dr Hakim was Co-chair of the World AIDS Conference, Amsterdam, Netherlands in 2018. James Hakim's life demonstrated how investment in biomedical research and modern medical education can pay large dividends and be transformative for Africa. The world is better for the lives you lived, David and James. May light perpetual shine upon you.

A Pilot Evaluation of the STOP Intimate Partner Violence Intervention Program

This pilot study examines the impacts of a 12-week community-based intimate partner violence intervention program delivered in British Columbia, Canada. The Stop Taking it Out on your Partner (STOP) program targets males who have engaged in abusive behaviors toward their intimate partners; most are voluntary participants. The STOP program was evaluated in three sites across the province (once program per cycle), with a total of 39 enrollees. Thirty-seven men completed the pretest survey; analyses focus on the 22 participants who completed pretest and posttest questions regarding knowledge and skills learned, and the 15 participants who completed the Abusive Behavior Inventory (Shepard & Campbell, 1992) regarding psychologically and physically abusive behaviors. Results suggest that participation in STOP contributed to significant decreases in both physical and psychological abuse. Further, program participants increased in their use of cognitive behavioral strategies to avoid violence. Implications for intimate partner violence intervention and future research are discussed.

Impact of COVID-19-Related Social Distancing on Delivery of Intensive Case Management.

Social distancing due to COVID-19 may adversely impact treatment of adults with serious mental illness, especially those receiving intensive forms of community-based care, in part through weakening of the therapeutic alliance. Veterans and staff at a Veterans Affair (VA) medical center were surveyed 3 months after social distancing disrupted usual service delivery in intensive community-based treatment programs. Veterans (n = 105) and staff (n = 112) gave similar multi-item ratings of service delivery after social distancing, which involved far less face-to-face contact and more telephone contact than usual and rated their therapeutic alliances and clinical status similarly as "not as good" on average than before social distancing. Self-reported decline in therapeutic alliance was associated with parallel decline in clinical status indicators. Both veterans and staff indicated clear preference for return to face-to-face service delivery after the pandemic with some telehealth included.

Skin Carotenoid Scores Assessed with Reflection Spectroscopy Are Associated with Self-Reported Fruit and Vegetable Intake Among Latino Early Adolescents

BackgroundLatino early adolescents have a high prevalence of overweight and obesity. Interventions to address healthy eating among Latino youth frequently focus on fruit and vegetable (FV) intake. Reflection spectroscopy assessed skin carotenoid (SC) levels has been proposed as an easy, noninvasive method to evaluate FV intake, but validation studies involving ethnically diverse youth are lacking. ObjectiveThis study aimed to assess the association between reflection spectroscopy-measured SC scores and self-reported FV intake among low-income, urban, Latino early adolescents, controlling for potential confounding factors. DesignThis study was a cross-sectional secondary analysis of baseline data from a community-based intervention program (Padres Preparados, Jóvenes Saludables) involving Latino fathers and adolescents to improve paternal parenting practices and youth energy balance-related behaviors. Participants/settingParticipants were 195 low-income, Latino early adolescents (aged 10 to 14 years). Data were collected in the Minneapolis/St Paul metropolitan area from 2017 to 2020 during fall or winter months. Main outcome measuresSC scores were measured using reflection spectroscopy, usual intakes of FV and carotenoid compounds were estimated based on the assessment using 24-hour dietary recalls. Statistical analysisMultivariable linear regression analyses were used to estimate associations of SC scores and each dietary component and potential confounding factors after assessing variables for inclusion in the analyses. ResultsThe mean SC score was 225 ± 95. The mean FV and total carotenoid intakes were 3.3 ± 0.5 servings/day and 8,360 ± 786 μg/day, respectively. Higher SC scores were observed among youth who had higher FV (β = .37 and P < 0.01) or total carotenoid intakes (β = .31 and P < 0.01). SC scores measured during fall were higher than scores measured during winter. Study participants with higher home FV availability and accessibility had higher SC scores. ConclusionsFindings supported using SC score as a potential easy-to-use indicator of FV intake among Latino youth with consideration of seasonal variation and home FV availability and accessibility.

58096 A community-academic partnership to implement DASH diet and social/behavioral interventions in congregate meal settings to reduce hypertension among seniors aging in place

ABSTRACT IMPACT: Our implementation model translates two evidence-based nutritional and behavioral interventions to lower blood pressure, into a community-based intervention program for seniors receiving congregate meals. OBJECTIVES/GOALS: The Rockefeller University, Clinical Directors Network, and Carter Burden Network received an Administration for Community Living Nutrition Innovation grant to test whether implementation of DASH-concordant meals and health education programs together lower blood pressure among seniors aging in place. METHODS/STUDY POPULATION: n=200, &gt;60 yr, &gt;4 meals/week at CBN; engagement of seniors/stakeholders in planning and conduct; Advisory Committee to facilitate dissemination; menus aligned with Dietary Approaches to Stop Hypertension (DASH) and NYC Department for the Aging nutritional guidelines; interactive sessions for education in nutrition, BP management, medication adherence. Training in use of automated daily home BP monitors (Omron 20). Validated surveys at M0, M1, M3, M6. Taste preference and cost assessed through Meal Satisfaction (Likert scale) and Plate Waste measures. Primary Outcome: Change in Systolic BP (SBP) at Month 1; change in %BP controlled. Secondary: validated cognitive, behavioral, nutritional measures (SF-12, PQH-2), economics; staff/client satisfaction, trends and significant associations. RESULTS/ANTICIPATED RESULTS: n=94, x2 age =73 +/- 8 years, 65% female, 50% White, 32% Black/African American, 4% Asian, 1% American Indian, Alaskan Native, 13% Other, 32% Latino/a, 43% with income &lt;$20,000. Mean SBP at Baseline was 137.87 +18.8 mmHg (range 98-191). Menus were adapted to provide 20% daily DASH requirements at breakfast, 50% at lunch. Participants attended classes in nutrition and medication management and were provided with and trained to use an automated home BP monitor. Meal satisfaction scores dipped briefly then met or exceed pre-DASH levels. Home BP data was downloaded every 2-4 weeks with social/behavioral support. The COVID-19 closures interfered with BP outcome data collection and meal service ceased. Primary outcome: x2 change in SBP at Month 1 = -4.41 mmHg + 18 (n=61) (p=0.713). Significant associations will be reported. DISCUSSION/SIGNIFICANCE OF FINDINGS: Our community-academic research partnership implemented the DASH diet in congregate-meal settings to address uncontrolled hypertension in seniors. COVID-19 interrupted the study, but encouraging trends were observed that may inform refinement to this community-based health intervention for seniors.

Impact of Health Interventions on the Knowledge, Perception, Attitude, and Misconception of HIV Infection in an African Rural Community

ABSTRACT Background: Adequate knowledge of human immunodeficiency virus (HIV), its modes of transmission, and methods of prevention can facilitate its prevention and control among any people. This study evaluates the impact of health interventions on the knowledge, perception, attitude, and misconception of HIV infection in Bonny Kingdom of Rivers State, Nigeria. Materials and Methods: This is a quantitative survey that used a structured questionnaire to determine the impact of community-based interventions (awareness education, free counseling and testing, etc.) on the prevention of HIV/acquired immune deficiency syndrome (AIDs) among a representative sample of the general population aged 15 to 49 years in Bonny Island, Nigeria. The data obtained include the demographics; age, sex, education, occupation, marital status, and sexual-related information. Data were analyzed by using SPSS, version 25.0. Result: The study comprised 1215 participants in each of the pre- and postintervention surveys. Before intervention, only 47.2% could correctly identify three transmission routes of HIV, as compared with 82.8% after the interventions (P &lt; 0.0001). The intervention participants were 5.37 (95% CI. 4.46–6.48) more likely to have good knowledge of HIV transmission routes than respondents without interventions. The odds of misconception about HIV transmission routes before intervention were 3.52 (95% CI 2.48–5.01; P &lt; 0.0001). About 80.7% and 45.9% believed that they were not at risk of contracting HIV at the baseline and postinterventions, respectively. Postintervention respondents were 4.04 (95% CI 3.41–4.79; P &lt; 0.0001) willing to share meals, 4.84 (95% CI 3.94–5.94) willing to care for, 3.73 (95% CI 3.14–4.44) willing to allow teachers infected with HIV in school, and 3.14 (95% CI 2.60–7.80) willing to buy food from an infected person as compared with the preinterventions survey (P &lt; 0.0001). Conclusion: This study has demonstrated the positive impacts of community-based intervention programs on the knowledge, prevention methods, and levels of misconception of HIV in Bonny Kingdom. Similar interventions are needed in other rural communities to promote the quest to end HIV/ AIDS by the year 2030.

Community perceptions and attitudes regarding epilepsy and disease cost after implementation of a community-based epilepsy treatment program in onchocerciasis-endemic communities in the Democratic Republic of Congo

BackgroundIn October 2017, a community-based epilepsy treatment program (CBETP) was initiated in the Logo health zone (Ituri province, Democratic Republic of Congo), consisting mainly of community epilepsy education, provision of free antiepileptic drugs (AEDs), and monthly follow-up of persons with epilepsy (PWE). Prior to the implementation of the CBETP, qualitative research had revealed several misconceptions about the cause of epilepsy, major epilepsy-related stigma, and high economic cost for families of PWE mainly because of costly treatment by traditional healers. One year after the implementation of the CBETP, we assessed the perceived effect of this program on the community’s perceptions and attitudes regarding epilepsy and on disease costs. MethodsFocus group discussions (FGD) and semi-structured in-depth interviews (SSI) were conducted with different target groups. Additionally, the cost associated with epilepsy was evaluated using questionnaires administered to 74 PWE and/or their families. ResultsNine FGDs and 16 SSIs were conducted. There was a notable shift in perceptions and attitudes, as most community members no longer believed that epilepsy is contagious, while acknowledging that this condition can be treated in local health centers. Persons with epilepsy and their family experienced less epilepsy-related stigma and consulted less frequently traditional healers; the latter showed a growing willingness to collaborate with health professionals in the management of PWE. The direct and indirect costs for families caring for a PWE decreased by 95.2% and 95.7%, respectively. ConclusionThe main perceived benefits of the CBETP were the decrease in misconceptions about epilepsy and epilepsy-related stigma. Families with PWE understood the benefit of seeking health care from trained health professionals rather than with traditional healers. The direct and indirect costs for families to take care of a PWE reduced considerably after the program. However, the cost-effectiveness and long-term sustainability of this approach remain to be assessed.

The Association of Moms2B, a Community-Based Interdisciplinary Intervention Program, and Pregnancy and Infant Outcomes among Women Residing in Neighborhoods with a High Rate of Infant Mortality.

We evaluated the effectiveness of Moms2B, a community-based group pregnancy and parenting program, in an effort to assess whether the program improvedpregnancy and infant outcomes. We conducted a retrospective matched exposure cohort study comparing women exposed to the Moms2B program during pregnancy (two or more prenatal visits) who delivered a singleton live birth or stillbirth (≥ 20weeks gestation) from 2011-2017 to a closely matched group of women not exposed to the program. Primary outcomes were preterm birth and low birth weight. Propensity score methods were used to provide strong control for confounders. The final analytic file comprised 675 exposed pregnancies and a propensity score-matched group of 1336 unexposed pregnancies. Most of the women were non-Hispanic Black. We found evidence of better outcomes among pregnancies exposed to Moms2B versus unexposed pregnancies, particularly for the primary outcome of low birth weight [9.45% versus 12.00%, respectively, risk difference (RD) = -2.55, 95% confidence interval (CI) = (-5.44, 0.34)]. Point estimates for all adverse pregnancy outcomes uniformly favored exposure to Moms2B. Our findings suggest that participation in the Moms2B program improves pregnancy and infant outcomes. The program offers an innovative group model of pregnancy and parenting support for women, especially in non-Hispanic Black women with high-risk pregnancies.

Increasing HIV/AIDS knowledge among urban ethnic minority youth: Findings from a community-based prevention intervention program

HIV (Human Immunodeficiency Virus)/AIDs (Acquired immunodeficiency syndrome) prevention and research are imperative. Prevention-intervention programming is minimal in low-income communities of color. Additional research is needed that uncovers points of support and prevention to increase HIV knowledge and awareness and limit new HIV infections among adolescents of color. This study presents preliminary findings from a community-based HIV/AIDS, substance abuse, and viral hepatitis (VH) prevention education intervention for ethnic minority youth in a northeastern urban community. We evaluated HIV/AIDS knowledge and factors associated with knowledge. Participants (N = 599) completed a baseline survey followed by an exit survey measuring HIV/AIDS knowledge. Exit survey findings indicated that there was an increase in HIV/AIDs knowledge. Multivariate regression analyses showed that change scores in VH knowledge accuracy, sexual negotiation skills, risk perception, and ethnic identity were positively associated with change in HIV/AIDs knowledge score. The development and implementation of HIV/AIDS knowledge interventions can be crucial in alleviating new infections in the U.S.

Prevalence of intestinal parasites in Deula community, Kirtipur Municipality, Kathmandu, Nepal.

Infections with intestinal protozoans, helminths, and other parasites are major, but overlocked problems in developing countries. Accurate surveys of intestinal parasites in Deula community inform empirical treatment regimens and can assess the impact of community-based drug treatment programs. There is limited information on this topic in Nepal. In a prospective study of intestinal parasites in symptomatic people of the Deula community, January-July 2018, samples were examined by microscopy of a direct and concentrated faecal sample. We studied 150 samples. The median (inter-quartile range) age of the people was 34.5 (16-50.5) years, 52% were female and 48% were male. The proportion of people with abdominal pain was 30.39%, diarrhea 42.16%, anemia 14.71% and malnutrition 3.92%. Altogether 102 (68%) parasitic infections were detected. The most common parasites using all methods of detection were Entamoeba histolytica (35.30%), Giardia lamblia (21.57%), Trichuris trichiura (14.71%), hookworm (13.73%), Ascaris lumbricoides (7.84%) and Strongyloides stercoralis (6.85%). E. histolytica was most common, followed by G. lamblia in all age groups, T. trichiura and A. lumbricoides. Hookworm and S. stercoralis were more common with increasing age. This study substantiate the significance of intestinal parasitic infections in indicative Deula community and the need for adequate facilities for laboratory diagnosis together with education to improve personal hygiene and sanitation.

Assessment of outcomes of a hospital-based tobacco cessation intervention program: A retrospective study

Background: Tobacco use among adult Indian population is 34.6% by Global adult tobacco survey (2016–2017) reported 6.8 crores urban, 19.9 crores rural Indians are tobacco consumers. M. P state fact file declares highest tobacco consumers residing in Madhya Pradesh. Methodology: The current study is an individual as well as community-based tobacco intervention program, to evaluate the trends of tobacco use, awareness related to tobacco hazard, quit tobacco regime, withdrawal, relapse in post intervention follow-up. Results: In the total regime of 3 months starting from detox groundwork of body for cessation to behavior modification, phase of nicotine replacement therapy (NRT) to pharmacological intervention at spaced out follow-up the graph gradually declined down of individuals positively motivated for quitting. Conclusion: Tobacco cessation (quitting) with behavior modification, NRT, and Pharmacological mode is a relatively novel approach of tobacco control in India. It is considered to be the most cost-effective intervention as compared to other tobacco control programs and other approaches of reducing tobacco menace.