Existing Community Structures Research Articles

Reaching the unreached through building trust: a mixed-method study on COVID-19 vaccination in rural Lao PDR

IntroductionThe global COVID-19 vaccine rollout has been impacted by socioeconomic disparities and vaccine hesitancy, but few studies examine reasons for changed attitudes. In Lao People’s Democratic Republic (Lao PDR), a...

Process evaluation of the ‘Lafiyan Yara’ project on enhancing access to HIV testing services using existing community structures in Nigeria

BackgroundThe Lafiyan Yara Project aimed to increase demand for HIV counselling, testing, treatment, and prevention services among pregnant women and children in Taraba State, Nigeria. Implemented from 2019 to 2021, the project utilized existing community structures, including traditional birth attendants, village health workers, and patent and proprietary medicine vendors, for mobilization. This study assessed the project’s activities, contributors, relevance, effectiveness, and efficiency.MethodsThe process evaluation was conducted using focus group discussions and key informant interviews with beneficiaries, community leaders, project staff, health facility personnel, and government officials. Data analysis employed framework analysis.ResultsThe Lafiyan Yara project was reported to have achieved notable successes, including increased HIV testing rates among children and pregnant women, improved linkage to care services, reduced mother-to-child transmission of HIV, increased HIV/AIDS awareness and knowledge, and enhanced community engagement and support. Challenges identified included insufficient funding for community mobilizers, training needs for health workers, and inadequate availability of test kits at health facilities. Confidentiality and stigma issues arose during community mobilizations. A key lesson learned was the importance of a comprehensive HIV care approach, emphasizing testing and ensuring support for individuals testing positive.ConclusionsThe project’s approach of leveraging community structures to create demand for HIV services among women and children proved effective, provided proper linkage to care for those testing positive. Addressing stigma and involving husbands/fathers in the community approach are crucial for improving outcomes.Trial registrationIPHOAU/12/1384.

Engaging Community Health Workers (CHWs) in Africa: Lessons from the Canadian Red Cross supported programs.

Universal Health Coverage (UHC) will not be achieved if health care worker shortages, estimated to increase to 18 million by 2030, are not addressed rapidly. Community-based health systems, which pivot to effective engagement of community health workers (CHW), may have an essential role in linking communities with health care facilities and reducing unmet health services needs caused by these shortages. The Canadian Red Cross (CRC) has partnered with different National Red Cross/Red Crescent Societies and Ministries of Health in Africa in the implementation of programs where CHWs contributed to the provision of various health services. This study reports on key findings (i.e., beneficiaries reached, CHWs engaged, programs implemented, intervention outcomes) and lessons learned from CRC supported CHW programs in Africa over the last 15 years (2007-2022). Qualitative methodology was employed to conduct document analysis on 17 sets of reports from each CRC-supported community health worker project in Africa over the past 15 years. Focus was on identifying challenges, facilitators, and lessons learned. CRC supported projects have trained over 9000 CHWs, benefiting nearly 7.5 million people across Africa. Key success factors include adaptability and agility in programming and project management, and considering contextual factors (political, social, and cultural systems). Investing in essential training for CHWs, staff, and volunteers is crucial, alongside employing an evidence-based approach to inform all aspects of programming and implementation. Additionally, projects prioritizing protection, gender and inclusion (PGI) while leveraging existing community structures and partnerships important for successful implementation. Despite challenges (i.e., weak health systems, lack of political commitment, insufficient funding, inadequate training) CHWs are recognized as crucial in promoting community-based health, improving access to care, addressing disparities, and contributing to achieving (UHC). Their unique position within communities enables them to provide culturally appropriate and localized primary health care- particularly in remote, resource limited and poverty-stricken regions.

"This can certainly work…": stakeholder perspectives of the feasibility of a caregiver-led training program for caregivers of children with cerebral palsy in a rural setting in Malawi.

Caregiver training is a key component of rehabilitation for children with complex lifelong disabilities such as cerebral palsy. However critical shortages of therapists in low- and middle-income countries like Malawi, reduce access to therapy. Introducing expert caregivers to assist with the provision of basic training on the condition for fellow caregivers offers a potential solution. However, there is a paucity of evidence regarding the implementation of such strategies in low-resource settings. The aim of this study was to explore perspectives of stakeholders regarding the feasibility of implementing a caregiver-led and delivered training program for caregivers of children with cerebral palsy in Malawi. Over 5 days in January 2023, a caregiver-led training program, the "Malamulele Onward Carer-to-Carer Training Program," was conducted in Blantyre, Malawi. A South African master trainer traveled to Malawi and delivered the program to potential stakeholders including caregivers of children with cerebral palsy; physiotherapists; and community-based organization representatives. Stakeholder perspectives regarding the acceptability, demand, practicality and adaptation of the program were obtained through a combination of focus group discussions, in-depth interviews, and daily field notes. Data from the focus group discussions and in-depth interviews were analyzed using thematic analysis. The caregiver-led training program was deemed acceptable despite two areas identified as potential areas of concern; that the expert caregivers may cross practice boundaries and that their fellow caregivers may look down upon them. A demand for this program was expressed because of perceived relative advantages and relevance to caregiver needs. Participants indicated that the intervention could be easily delivered using local materials, absorbed and supported by existing community structures. A caregiver-led training program offers an innovative way of supporting caregivers of children with complex disabilities such as cerebral palsy in low-resource settings. The stakeholder engagement demonstrated the positive perspectives of all stakeholders. The areas for modification and adaptation highlighted by the stakeholders will be useful in strengthening the implementation of the program in Malawi.

Understanding multilevel barriers to childhood vaccination uptake among Internally Displaced Populations (IDPs) in Mogadishu, Somalia: a qualitative study

BackgroundDisparities in vaccination coverage exist in Somalia with Internally Displaced Persons (IDPs) being among the groups with the lowest coverage. We implemented an adapted Participatory Learning and Action (PLA) intervention, which focused on routine vaccinations among displaced populations living in Mogadishu IDP camps. The intervention was successful in improving maternal knowledge and vaccination coverage but unsuccessful in improving timely vaccination. We conducted a qualitative study to understand this result and analyze the multi-level barriers to routine childhood immunization uptake.MethodIn this qualitative study we used observation data from 40 PLA group discussions with female caregivers and purposively sampled nine vaccination service providers and six policy makers for interview. We also reviewed national-level vaccine policy documents and assessed the quality of health facilities in the study area. We used the socioecological framework to structure our analysis and analyzed the data in NVivo.ResultsThe barriers to childhood vaccination among IDPs at the individual level were fear due to lack of knowledge, mistrust of vaccines, concerns about side effects and misinformation; opportunity costs; and costs of transportation. At the interpersonal level, family members played an important role as did the extent of decision-making autonomy. Community factors such as cultural practices, gender roles, and household evictions influenced vaccination. Organizational issues at health facilities such as waiting times, vaccine stock-outs, distance to the facility, language differences, and hesitancy of health workers to open multi-dose vials affected vaccination. At the policy level, confusion about the eligible age for routine vaccination and age restrictions for catch-up vaccination and certain antigens such as BCG were important barriers.ConclusionComplex and interrelated factors affect childhood vaccination uptake among IDPs in Somalia. Interventions that address multiple barriers simultaneously will have the greatest impact given the complex nature of vulnerabilities in this population. There is a need to strengthen the health system and connect it with existing community structures to increase demand for services. Our research highlights the importance of formative research before implementing interventions. Further research on the integration of health service strengthening with PLA to improve childhood vaccination among IDPs is recommended.Trial registration numberISRCTN-83,172,390. Date of registration: 03/08/2021.

Applying a gender lens to biodiversity conservation in High Asia

Community-based conservation efforts represent an important approach to facilitate the coexistence of people and wildlife. A concern, however, is that these efforts build on existing community structures and social norms, which are commonly dominated by men. Some biodiversity conservation approaches may consequently neglect women’s voices and deepen existing inequalities and inequities. This paper presents two community case studies that draw upon the knowledge and experience gained in our snow leopard conservation practice in pastoral and agro-pastoral settings in Mongolia and India to better understand women’s roles and responsibilities. In these settings, roles and responsibilities in livestock management and agriculture are strongly differentiated along gender lines, and significant gaps remain in women’s decision-making power about natural resources at the community level. We argue that context-specific and gender-responsive approaches are needed to build community support for conservation actions and leverage women’s potential contributions to conservation outcomes.

An Ethnographic Study of Multiple Factors Influencing Perceptions, Attitudes, and Observance of COVID-19 Preventive Measures among Rural and Urban Slum Dwellers in Ghana.

The COVID-19 pandemic and government-led interventions to tackle it have had life-changing effects on vulnerable populations, especially rural and urban slum dwellers in developing countries. This ethnographic study explored how the Ghanaian government's management of COVID-19, socio-cultural factors, infrastructural challenges, and poverty influenced community perceptions, attitudes, and observance of COVID-19 prevention measures in Ghana. The study employed focused ethnography using in-depth interviews (IDIs), focus group discussions (FGDs), and nonparticipant observations to collect data from an urban slum and a rural community as well as from government officials, from October 2020 to January 2021. The data were triangulated and analyzed thematically with the support of qualitative software NVivo 12. All ethical procedures were followed. The Ghanaian government's strategy of communicating COVID-19-related information to the public, health-related factors such as health facilities failing to follow standard procedures in testing and tracing persons who came into contact with COVID-19-positive cases, poverty, and lack of social amenities contributed to the poor observance of COVID-19 preventive measures. In addition, the government's relaxation of COVID-19 restrictions, community and family values, beliefs, and misconceptions contributed to the poor observance of COVID-19 preventive measures. Nevertheless, some aspects of the government's intervention measures and support to communities with COVID-19 prevention items, support from nongovernmental organizations (NGOs), and high knowledge of COVID-19 and its devastating effects contributed to positive attitudes and observance of COVID-19 preventive measures. There is a need for the government to use the existing community structures to engage vulnerable communities so that their concerns are factored into interventions to ensure that appropriate interventions are designed to suit the context. Moreover, the government needs to invest in social amenities in deprived communities. Finally, the government has to be consistent with the information it shares with the public to enhance trust relations.

Community adaptation strategies in Nairobi informal settlements: Lessons from Korogocho, Nairobi-Kenya

Informal settlements are often the hotspots of vulnerability as evidenced by the recurrent environmental and climate-related shocks and stressors. Despite this exposure and susceptibility, their role in spearheading disaster risk preparedness and response is often overlooked. This exploratory research profiles four local community initiatives for climate mitigation and adaptation within Korogocho informal settlement in Kenya. Findings from 10 purposefully sampled key informants and 30 stratified sampled residents across nine villages within the informal settlement demonstrated the impact of locally led initiatives in creating awareness and developing the absorptive, adaptive and transformative capacity of communities for climate resilience. The research findings elaborate on the outstanding performance of community derived initiatives, whilst putting emphasis on the need for active dialogue and collaboration between communities, policy makers and practitioners. Additionally, the climate agenda ought to be able to simultaneously promote environmental benefits and the socio-economic wellbeing of the people. This study accentuates the role of smart approaches to climate literacy based on existing community structures that leverage on local experiential knowledge. These include digital storytelling, comics, art, music, local radio stations, community opinion leaders and chief barazas. A key takeaway is the significant role of children in transformative climate resilience. This is facilitated by the fact that they may comprehend climate change implications better than adults augmenting the possibility of human behavioral change toward pro-environmental deeds1.

'We do not talk about it': Engaging youth in Malawi to inform adaptation of a mental health literacy intervention.

There is limited knowledge on how to tackle mental health problems among youth in Africa. Literature describing community engagement (CE) approaches in low/middle-income countries (LMICs) health research is sparse. CE with youth from LMICS can help steer and shape culturally relevant interventions for stigmatised topics like mental health, resulting in better healthcare experiences. We share our experience of engaging youth in Malawi through advocacy organisations to inform cultural adaptation of a mental health literacy intervention. Young people were recruited using social media from universities and community youth organisations in Malawi to participate in focus group discussions to help culturally adapt content of an existing mental health literacy intervention. Nine online focus groups with 44 individuals were conducted. Discussions involved views and experiences of mental health, including impact of the coronavirus pandemic. Discussions were recorded, transcribed verbatim and analysed using content analysis. Transcript analyses revealed a vicious cycle of poverty and mental health problems for youth in Malawi. Four key themes were identified, 1) poverty-related socioeconomic and health challenges, 2) no one talks about mental health, 3) lacking mental health support and 4) relationship issues. These themes fed into one another within this vicious cycle which perpetually and negatively impacted their lives. The coronavirus pandemic worsened socioeconomic issues, health challenges, mental health and substance use issues, and burden on Malawi's already weak mental health system. Findings suggest increasing untreated mental health burden among Malawi's youth. It highlights great need to address mental health literacy using existing community structures like educational settings to minimise burden on a weak health system. Online focus groups are an effective way of acquiring views from various young people in Malawi on mental health. This CE approach has grown our stakeholder network, strengthening potential for future CE activities and broader research dissemination.

Preventive practices by households against Lassa fever transmission in Ondo State, Southwest, Nigeria

continued transmission of Lassa fever has been recorded in 6 Local Government Areas (LGAs) of Ondo State in Southwest, Nigeria annually with high case fatality rates. Genomic analysis of the Lassa virus has indicated ongoing transmission from local rodents´ population to humans despite several public health interventions during the outbreak including risk communication on preventive practices against the disease. We assessed adherence to preventive practices by household against the spread of Lassa fever in these affected LGAs. a descriptive cross-sectional study was conducted among community members in the six affected Local Government Area (LGAs). A semi structured questionnaire was administered to 2992 consenting respondents to assess their reported preventive practice against Lassa fever while their observed practices was assessed using observation checklist. Data analysis was done using frequency, proportions, Chi-Square test and logistic regression of predictors of outcome variable with statistical significance set at p<0.05. a higher proportion of the respondents were females (51.2%) compared to males (48.8%) with mean age of 43.04±13.97 years. Majority of the respondents (88.2%) were married with at least secondary education (76.7%). Majority of the respondents (80.2%) reported washing their hands with soap and water regularly, 84.6% washed their utensils before and after use likewise. However, 10.6% of the respondents reported not storing their food items in lid-covered containers while 61.9% practiced open air drying of food items by the roadside. Also, 34.3% of the respondents were observed to spread food items outside their home in the open air. Overall, 32.6% of the respondent were observed to have poor preventive practices against Lassa fever with their level of education as a significant determinant. the poor preventive practices observed among the respondents in this study could sustain the transmission of the virus hence there is also the need to further intensify enforcement of public health control measures for Lassa fever through existing community structures and institutions to stop the current and prevent future Lassa fever and other related outbreaks in the State.

Patient-public engagement strategies for health system improvement in sub-Saharan Africa: a systematic scoping review

BackgroundActively involving patients and communities in health decisions can improve both peoples’ health and the health system. One key strategy is Patient-Public Engagement (PPE). This scoping review aims to identify and describe PPE research in Sub-Saharan Africa; systematically map research to theories of PPE; and identify knowledge gaps to inform future research and PPE development.MethodsThe review followed guidelines for conducting and reporting scoping reviews. A systematic search of peer-reviewed English language literature published between January 1999 and December 2019 was conducted on Scopus, Medline (Ovid), CINAHL and Embase databases. Independent full text screening by three reviewers followed title and abstract screening. Using a thematic framework synthesis, eligible studies were mapped onto an engagement continuum and health system level matrix to assess the current focus of PPE in Sub-Saharan Africa.ResultsInitially 1948 articles were identified, but 18 from 10 Sub-Saharan African countries were eligible for the final synthesis. Five PPE strategies implemented were: 1) traditional leadership support, 2) community advisory boards, 3) community education and sensitisation, 4) community health volunteers/workers, and 5) embedding PPE within existing community structures. PPE initiatives were located at either the ‘involvement’ or ‘consultation’ stages of the engagement continuum, rather than higher-level engagement. Most PPE studies were at the ‘service design’ level of the health system or were focused on engagement in health research. No identified studies reported investigating PPE at the ‘individual treatment’ or ‘macro policy/strategic’ level.ConclusionThis review has successfully identified and evaluated key PPE strategies and their focus on improving health systems in Sub-Saharan Africa. PPE in Sub-Saharan Africa was characterised by tokenism rather than participation. PPE implementation activities are currently concentrated at the ‘service design’ or health research levels. Investigation of PPE at all the health system levels is required, including prioritising patient/community preferences for health system improvement.

Stakeholder perspectives to inform adaptation of a hypertension treatment program in primary healthcare centers in the Federal Capital Territory, Nigeria: a qualitative study

BackgroundImplementing an evidence-based hypertension program in primary healthcare centers (PHCs) in the Federal Capital Territory, Nigeria is an opportunity to improve hypertension diagnosis, treatment, and control and reduce deaths from cardiovascular diseases. This qualitative research study was conducted in Nigerian PHCs with patients, non-physician health workers, administrators and primary care physicians to inform contextual adaptations of Kaiser Permanente Northern California's hypertension model and the World Health Organization’s HEARTS technical package for the system-level, Hypertension Treatment in Nigeria (HTN) Program.MethodsPurposive sampling in 8 PHCs identified patients (n = 8), non-physician health workers (n = 12), administrators (n = 3), and primary care physicians (n = 6) for focus group discussions and interviews. The Primary Health Care Performance Initiative (PHCPI) conceptual framework and Consolidated Framework for Implementation Research (CFIR) domains were used to develop semi-structured interviews (Appendix 1, Supplemental Materials) and coding guides. Content analysis identified multilevel factors that would influence program implementation.ResultsParticipants perceived the need to strengthen four major health system inputs across CFIR domains for successful adaptation of the HTN Program components: (1) reliable drug supply and blood pressure measurement equipment, (2) enable and empower community healthcare workers to participate in team-based care through training and education, (3) information systems to track patients and medication supply chain, and (4) a primary healthcare system that could offer a broader package of health services to meet patient needs. Specific features of the PHCPI framework considered important included: accessible and person-centered care, provider availability and competence, coordination of care, and proactive community outreach. Participants also identified patient-level factors, such as knowledge and beliefs about hypertension, and financial and transportation barriers that could be addressed with better communication, home visits, and drug financing. Participants recommended using existing community structures, such as village health committees and popular opinion leaders, to improve knowledge and demand for the HTN Program.ConclusionsThese results provide information on specific primary care and community contextual factors that can support or hinder implementation and sustainability of an evidence-based, system-level hypertension program in the Federal Capital Territory, Nigeria, with the ultimate aim of scaling it to other parts of the country.

Elderly care in Nepal: Are existing health and community support systems enough.

In Nepal, a few governmental and community-based programmes for elderly care are in place; however, information about successful implementation and overall effectiveness of these programmes is not well understood. In this article, we introduced these programmes and discussed existing programmes’ gaps and implementation problems in light of existing grey and peer-reviewed evidence. A few notable governmental programmes, such as providing monthly allowances, pensions and free health care, have targeted specifically the elderly individuals. Yet, most health care institutions and providers are privately owned and profit-oriented, and there is a general lack of proper governmental health as well as social security systems for the elderly in the country. Generally, Nepalese communities consist of neighbourhood-based and religious-based groups that provide emotional and spiritual support to elderly individuals as well as provide support for health care access when needed. However, the influence that these groups can have on health and social well-being of elderly remains not well understood. Traditional family-based support systems may be feasible only for some families, while for others it could impose financial and psychological burdens. The role of the state is important in the effective implementation of existing programmes as well as in the development and implementation of additional programmes to ensure health and social well-being of elderly individuals. Furthermore, there is a need to establish partnerships with existing community structures and to mobilize them in the implementation of community-based programmes.

Implementer and recipient perspectives of community-wide mass drug administration for soil-transmitted helminths in Kwale County, Kenya.

Soil-transmitted helminthiases (STH) are one of 17 neglected tropical diseases (NTDs) earmarked for control or elimination by 2020 in the WHO's Roadmap on NTDs. Deworming programs for STH have thus far been focused on treating pre-school and school-aged children; however, there is a growing consensus that to achieve elimination of STH transmission, programs must also target adults, potentially through community-wide mass drug administration (MDA). There is currently a gap in the literature on what components are required to deliver community-wide MDA for STH in order to achieve high intervention reach and uptake. Nested within the TUMIKIA Project, a cluster randomized trial in Kenya evaluating the effectiveness of school-based deworming versus community-wide MDA, we collected qualitative data from program implementers and recipients in eight clusters where community-wide MDA was delivered. Data collection included semi-structured in-depth interviews (n = 72) and focus group discussions (n = 32). A conceptual framework for drug distribution was constructed to help build an analysis codebook. Case memos were developed for each top-level theme. Community-wide MDA for STH was perceived as a complex intervention with key administrative and social mobilization domains. Key actionable themes included: (1) developing an efficient strategy to allocate reasonable workload for implementers to cover all targeted households; (2) maximizing community drug distributors' motivation through promoting belief in the effectiveness of the intervention and providing sufficient financial incentives; (3) developing effective capacity building strategies for implementers; and (4) implementing a context-adapted community engagement strategy that leverages existing community structures and takes into consideration past community experiences of MDAs. Transitioning from STH control to elimination goals requires significant planning and action to ensure community-wide MDA is delivered with sufficient reach and uptake. We present findings that can inform national deworming programs to increase intervention delivery capacity.

Cohort Profile: The Kaloleni/Rabai Community Health and Demographic Surveillance System.

Why was the cohort set up?In many resource-constrained settings, availability of reli-able vital statistics and health information is limited bylack of proper system for civil registration and health infor-mation. This is further limited by the fact that the majorityof population health events, such as births, morbidity andmortality, occur outside the reach of these systems. In par-ticular, obtaining credible data from rural and remote ge-ographies can be even more constrained. The developmentof population-based surveillance systems in resource-constrained countries to monitor demographic and healthevents in these countries has as its basis the limited capac-ity of civil registration and health information systems.Locally rooted surveillance systems that are embedded inthe nexus of existing community structures and localhealth systems can serve to address this gap.

A process evaluation of the Communication for Healthy Communities adolescent health program in Uganda.

This study is a process evaluation of an adolescent-focused intervention of the USAID Communication for Healthy Communities program, in Uganda. We used mixed methods including observation, consultations and review of program documents to collect data on program coverage, reach and factors influencing implementation. Findings show that program activities were successfully implemented through collaborative partnerships with service partners and the community. Interpersonal communication complemented by mass-media messaging was effective in reaching and empowering adolescents with health information to make informed choices for behavior change. The program used theoretical frameworks to guide targeted interventions through audience segmentation and community empowerment. Targeted mass-media messaging and placement was found to be pertinent for program reach. Working through existing community structures is important for an effective reach of health promotion programs. Lessons identified for scaling-up adolescent health programs include the need to harmonize training and deployment of community champions by development partners, recruit audience-specific influential champions and link income-generating activities to health education interventions. There is thus need to collaboratively develop and institutionalize effective monitoring and evaluation strategies during program inception and design phases for appropriate accountability, ownership and a continuation of gains.

Outsiders, insiders, and intermediaries: village health teams\u2019 negotiation of roles to provide high quality sexual, reproductive and HIV care in Nakaseke, Uganda

BackgroundCommunity health workers, known as Village Health Teams (VHTs) in Uganda, play a central role in increasing access to community-based health services. The objective of this research is to explore tensions that may emerge as VHTs navigate multiple roles as community members and care providers particularly when providing sensitive reproductive health and HIV care.MethodsTwenty-five VHTs from a rural clinic in Uganda completed semi-structured interviews focused on experiences providing services. Interview questions focused on challenges VHTs face providing services and strategies for improving quality care. After translation from Luganda and transcription, interviews were analyzed using content analysis to identify emergent themes.ResultsMost VHTs were female (n = 16). The average age was 46, and average length of VHT work, 11 years. Analyses revealed that all VHTs capitalized upon the duality of their position, shifting roles depending upon context. Three themes emerged around VHTs’ perceptions of their roles: community insiders, professional outsiders, and intermediaries. A caregiver “insider” role facilitated rapport and discussion of sensitive issues. As community members, VHTs leveraged existing community structures to educate clients in familiar settings such as “drinking places”. However, this role posed challenges as some VHTs felt compelled to share their own resources including food and transport money. Occupying a professional outsider role offered VHTs respect. Their specialized knowledge gave them authority to counsel others on effective forms of family planning. However, some VHTs faced opposition, suspicions about their motives, and violence in this role. In balancing these two roles, the VHTs adopted a third as intermediaries, connecting the community to services in the formalized health care system. Participants suggested that additional training, ongoing supervision, and the opportunity to collaborate with other VHTs would help them better navigate their different roles and, ultimately, improve the quality of service.ConclusionsAs countries scale up family planning and HIV services using VHTs, supportive supervision and ethical dilemma training are recommended so VHTs are prepared for the challenges of assuming multiple roles within communities.

Use and Acceptability of HIV Self-Testing Among First-Time Testers at Risk for HIV in Senegal

HIV Self-Testing (HIVST) aims to increase HIV testing coverage and can facilitate reaching the UNAIDS 90-90-90 targets. In Senegal, key populations bear a disproportionate burden of HIV and report limited uptake of HIV testing given pervasive stigma and criminalization. In these contexts, HIVST may represent a complementary approach to reach populations reporting barriers to engagement with existing and routine HIV testing services. In this study, 1839 HIVST kits were distributed in Senegal, with 1149 individuals participating in a pre-test questionnaire and 817 participating in a post-test questionnaire. Overall, 46.9% (536/1144) were first-time testers and 26.2% (300/1144) had tested within the last year; 94.3% (768/814) reported using the HIVST, and 2.9% (19/651) reported a reactive result which was associated with first-time testers (p = 0.024). HIVST represents an approach that reached first-time testers and those who had not tested recently. Implementation indicators suggest the importance of leveraging existing community structures and programs for distribution.

“The Environment Was Like They Were in the Pub But With No Alcohol” –

Men’s health and life expectancy, particularly for those men from lower socioeconomic groups, remains an issue of concern in Ireland. This concern is reflected in the recent National Men’s Health Action Plan where important priority has been placed on finding appropriate ways to garner sustained involvement in health promotion interventions for men. Physical activity (PA) has been shown to be a useful ‘hook’ to assist with such engagement. ‘Men on the Move’ (MOM) is a 12-week, community based, gender-sensitized, PA program established as a pragmatic controlled trial and aimed at improving the health and wellbeing of inactive men. The program was co-created with Local Sports Partnerships (LSP), delivered by experienced PA co-ordinators (PACs), and often supported by local community champions. This paper reports on the process evaluation of the MOM program using data collected from focus groups with the LSPs and those involved in delivering MOM from all 8 counties that took part. It aims to describe how MOM program activities were delivered, how closely it was implemented as planned, and how well it reached the target population. Findings highlight the importance of negotiated partnerships at and between national and local levels in terms of providing support, consistent guidance and appropriately branded materials to the LSPs. The underpinning inclusive ethos of MOM, embodied by the PACs, led to the creation of a fun, inclusive and comfortable atmosphere that helped sustain men’s involvement. This was aided by the use of male-familiar settings through which to deliver the program. While PA focused, findings here suggest a much wider impact on mental wellbeing and social connection and that this was achieved in a very cost-effective way. Importantly, men’s health training (ENGAGE) was a key factor in program design and implementation assisting in building capacity among service providers to work with men. Joined up service provision and drawing on existing, trusted, local community networks were vital to recruiting men into the program. Finally, the potential for MOM to signpost and offer an aftercare plan to community support for the men beyond the 12-week program was noted as important particularly where there is increased need of these among more marginalized groups of men. This process evaluation provides a good example of how health promotion interventions need to recognize and exploit the fact that health and wellbeing are integrally linked to the communities where people live out and experience their daily lives. Ensuring that MOM was embedded within existing community structures, and supported by community champions with the requisite skills and local knowledge, underpinned program success and sustainability.

Tracing Community Genealogy: How New Communities Emerge from the Old

The process by which new communities emerge is a central research issue in the social sciences. While a growing body of research analyzes the formation of a single community by examining social networks between individuals, we introduce a novel community-centered perspective. We highlight the fact that the context in which a new community emerges contains numerous existing communities. We reveal the emerging process of communities by tracing their early members' previous community memberships. Our testbed is Reddit, a website that consists of tens of thousands of user-created communities. We analyze a dataset that spans over a decade and includes the posting history of users on Reddit from its inception to April 2017. We first propose a computational framework for building genealogy graphs between communities. We present the first large-scale characterization of such genealogy graphs. Surprisingly, basic graph properties, such as the number of parents and max parent weight, converge quickly despite the fact that the number of communities increases rapidly over time. Furthermore, we investigate the connection between a community's origin and its future growth. Our results show that strong parent connections are associated with future community growth, confirming the importance of existing community structures in which a new community emerges. Finally, we turn to the individual level and examine the characteristics of early members. We find that a diverse portfolio across existing communities is the most important predictor for becoming an early member in a new community.