sub-Saharan Africa Experience Research Articles

Reflecting on Democratic and Economic Experiences in sub-Saharan Africa: A Comparative Analysis of the First 3 Decades vs. the Second 3 Decades under Ghana’s Republics

This study sought to juxtapose Ghana’s first three decades [1960s-1980s] of democratic and military regimes with its second three decades [the 1990s-2010s] of only democratic regimes to understand its political and economic trajectories and dynamics. Drawing on the Mandate Theory and leveraging on the interpretivist paradigm, the study adopted a qualitative content analysis and in-depth interviews to collect and analyze the views and opinions of respondents in Accra. The findings show that (a) The 1992 constitution has effectively halted Ghana’s 1960s and 80s cyclical political turmoil, ushering in ‘Pax Ghanaianica’, (b) There is a correlation between campaign promises and real GDP growth under the Fourth Republic, and (c) There is no correlation between a stable democracy and a stable real GDP growth under the Fourth Republic [i.e., The political campaign promises relative to power/electrification/energy have been unable to sustain production in Industry, Agriculture, Commerce, and Services]. The study concludes that Ghana’s roller coaster economic development may re-trigger ‘alien’ incursions into contemporary Ghanaian politics. It recommends that the political economy of Ghana should be structured to propel sustainable production in Industry, Agriculture, Commerce, and Services.

Trust as moral currency: Perspectives of health researchers in sub-Saharan Africa on strategies to promote equitable data sharing.

Groundbreaking data-sharing techniques and quick access to stored research data from the African continent are highly beneficial to create diverse unbiased datasets to inform digital health technologies and artificial intelligence in healthcare. Yet health researchers in sub-Saharan Africa (SSA) experience individual and collective challenges that render them cautious and even hesitant to share data despite acknowledging the public health benefits of sharing. This qualitative study reports on the perspectives of health researchers regarding strategies to mitigate these challenges. In-depth interviews were conducted via Microsoft Teams with 16 researchers from 16 different countries across SSA between July 2022 and April 2023. Purposive and snowball sampling techniques were used to invite participants via email. Recorded interviews were transcribed, cleaned, coded and managed through Atlas.ti.22. Thematic Analysis was used to analyse the data. Three recurrent themes and several subthemes emerged around strategies to improve governance of data sharing. The main themes identified were (1) Strategies for change at a policy level: guideline development, (2) Strengthening data governance to improve data quality and (3) Reciprocity: towards equitable data sharing. Building trust is central to the promotion of data sharing amongst researchers on the African continent and with global partners. This can be achieved by enhancing research integrity and strengthening micro and macro level governance. Substantial resources are required from funders and governments to enhance data governance practices, to improve data literacy and to enhance data quality. High quality data from Africa will afford diversity to global data sets, reducing bias in algorithms built for artificial intelligence technologies in healthcare. Engagement with multiple stakeholders including researchers and research communities is necessary to establish an equitable data sharing approach based on reciprocity and mutual benefit.

Population size, HIV prevalence, and antiretroviral therapy coverage among key populations in sub-Saharan Africa: collation and synthesis of survey data, 2010–23

Key population HIV programmes in sub-Saharan Africa require epidemiological information to ensure equitable and universal access to effective services. We aimed to consolidate and harmonise survey data among female sex workers, men who have sex with men, people who inject drugs, and transgender people to estimate key population size, HIV prevalence, and antiretroviral therapy (ART) coverage for countries in mainland sub-Saharan Africa. Key population size estimates, HIV prevalence, and ART coverage data from 39 sub-Saharan Africa countries between 2010 and 2023 were collated from existing databases and verified against source documents. We used Bayesian mixed-effects spatial regression to model urban key population size estimates as a proportion of the gender-matched, year-matched, and area-matched population aged 15-49 years. We modelled subnational key population HIV prevalence and ART coverage with age-matched, gender-matched, year-matched, and province-matched total population estimates as predictors. We extracted 2065 key population size data points, 1183 HIV prevalence data points, and 259 ART coverage data points. Across national urban populations, a median of 1·65% (IQR 1·35-1·91) of adult cisgender women were female sex workers, 0·89% (0·77-0·95) were men who have sex with men, 0·32% (0·31-0·34) were men who injected drugs, and 0·10% (0·06-0·12) were women who were transgender. HIV prevalence among key populations was, on average, four to six times higher than matched total population prevalence, and ART coverage was correlated with, but lower than, the total population ART coverage with wide heterogeneity in relative ART coverage across studies. Across sub-Saharan Africa, key populations were estimated as comprising 1·2% (95% credible interval 0·9-1·6) of the total population aged 15-49 years but 6·1% (4·5-8·2) of people living with HIV. Key populations in sub-Saharan Africa experience higher HIV prevalence and lower ART coverage, underscoring the need for focused prevention and treatment services. In 2024, limited data availability and heterogeneity constrain precise estimates for programming and monitoring trends. Strengthening key population surveys and routine data within national HIV strategic information systems would support more precise estimates. UNAIDS, Bill & Melinda Gates Foundation, and US National Institutes of Health.

Can Support Groups Improve Treatment Adherence and Reduce Sexual Risk Behavior among Young People Living with HIV? Results from a Cohort Study in South Africa.

Adolescents and young adults living with HIV (AYLHIV) in sub-Saharan Africa experience poorer HIV outcomes than adults, including lower ART adherence and virologic suppression. They also have high rates of unprotected sex, increasing the risk of adverse sexual health outcomes and onward transmission. This one-arm, pre-post study investigates a structured 14-session support group aiming to boost treatment adherence and sexual protective behavior for AYLHIV in South Africa. Logistic and Poisson regression analyses were performed on self-reported pre- and post-intervention survey data collected approximately 7.5 months apart from a cohort of 548 AYLHIV. Participants were significantly more likely to report at least 95% adherence at follow-up and rate their health as "good;" they also demonstrated greater treatment knowledge and had fewer absences from school overall and due to illness. Among sexually active AYLHIV, contraception use at last sex increased significantly, while condom use did not. Effects were small, and greater programmatic emphasis on adherence and multifaceted service packages is likely necessary to promote viral suppression. Nonetheless, the intervention addresses an important gap in service provision for AYLHIV in South Africa. Findings denote the potential for incorporating care and treatment components into sexual and reproductive health interventions tailored for AYLHIV.

A systematic review and meta-analysis of compassion fatigue among healthcare professionals before and during COVID-19 in Sub-Saharan Africa.

Compassion fatigue is a significant concern globally, particularly in Sub-Saharan Africa, where the COVID-19 pandemic exacerbated existing challenges, placing unprecedented strain on healthcare professionals. This study systematically estimated the prevalence of compassion fatigue among healthcare professionals before and during COVID-19 in Sub-Saharan Africa. A systematic review was conducted using keywords in PubMed, ScienceDirect, Google Scholar, and grey literature, covering all literature published between 2012 and December 30, 2023. The search team independently conducted study selection, quality assessments, data extractions, and analysis of all included studies. The systematic review, reported following PRISMA guidelines, included 11 studies. The results show that the pooled overall prevalence of compassion fatigue in Sub-Saharan Africa was 70% (95% CI: 57-82, I2 = 88.37%). The highest prevalence was found in Eastern Africa at 74% (95% CI: 55-93, I2 = 94.40%), compared to 64% in Southern Africa (95% CI: 49-79, I2 = 59.01%). Nurses reported the highest rates of compassion fatigue at 80% (95% CI: 57-100, I2 = 34.77%), followed by general healthcare professionals at 59% (95% CI: 22-97, I2 = 94.11%) and nursing students at 50% (95% CI: 35-64, I2 = 0.00%). Before COVID-19, the overall prevalence of compassion fatigue was 66% (95% CI: 41-91, I2 = 27%). During COVID-19, this increased to 74% (95% CI: 63-85, I2 = 88.73%). Our results indicate that nearly 3 in 4 healthcare professionals in Sub-Saharan Africa experience compassion fatigue, and this prevalence increased due to the pandemic. The high prevalence underscores the importance of addressing and mitigating compassion fatigue to support the mental health and emotional well-being of healthcare professionals dedicated to helping others in challenging circumstances. Systematic registration: PROSPERO. REG No: CRD42023449462.

Understanding the Stigma Experience of Men Living with HIV in Sub-Saharan Africa: A Qualitative Meta-synthesis.

Men living with HIV (MLWH) in sub-Saharan Africa experience poor health outcomes and increased AIDS-related deaths due to stigma influencing testing and treatment uptake and adherence. PRISMA 2020 was used to report a meta-synthesis of the stigma experiences of MLWH in SSA. With the help of an expert librarian, a search of six databases was formulated and performed to examine the available qualitative and mixed method studies with qualitative results relevant to the research question. Studies focused on adult men living with HIV, with five studies specifically examining the HIV experience of men who have sex with men. Study themes were synthesized to describe MLWH's perceived, internalized, anticipated, enacted, and intersectional stigma experiences. Most studies included masculinity as a key theme that affected both testing and treatment adherence upon diagnosis. Future research is needed to better understand subpopulations, such as men who have sex with men living with HIV, and what interventions may be beneficial to mitigate the disparities among MLWH in SSA.

Flip the Script: Rebranding ART and enhancing the U=U message in Malawi and Zimbabwe

Background Since 2009, global efforts have made significant strides in identifying and treating People Living with HIV (PLHIV), with the number on Antiretroviral Therapy (ART) surpassing 25 million by 2020. However, challenges persist as a substantial number of individuals enrolled in ART, particularly in countries like Zimbabwe and Malawi, are lost to follow-up, impeding the success of HIV response initiatives. Stigma and limited awareness continue to pose barriers to effective HIV management. Methods The methodology centres on identifying compelling messengers to bridge the gap between medical information and lived experiences in sub-Saharan Africa. Grounded in human-centered and co-design approaches, the initiative engages host country governments, stakeholders, influencers, and the target audience to create a globally resonant brand with country-specific adaptations. Results The "Undetectable = Untransmittable" (U=U) movement, founded in 2016, emphasizes that PLHIV with undetectable viral loads cannot transmit the virus, playing a crucial role in dismantling stigma and enhancing HIV prevention efforts. To address the low awareness of U=U in Malawi and Zimbabwe, the collaborative "Flip the Script" project was launched, involving public and various private sectors. This initiative aims to reshape perceptions around ART, presenting it as a key to a normalized, healthy life rather than a symbol of infection. "Flip the Script" seeks to boost ART initiation and re-initiation, promote effective ART use, and encourage viral load testing and result sharing among PLHIV. It also strives for consistent counseling on the prevention benefits of ART by health providers. Conclusions Ultimately, the initiative aims to increase the percentage of PLHIV achieving and sustaining viral suppression, leading to a reduction in HIV incidence. Its success hinges on effectively communicating the U=U message, challenging stigma, and empowering both PLHIV and health providers in the targeted regions.

Interest of Chest CT to Assess the Prognosis of SARS-CoV-2 Pneumonia: An In-Hospital-Based Experience in Sub-Saharan Africa.

We included all patients with respiratory symptoms (dyspnea, fever, and cough) and/or respiratory failure admitted to the SOS Médecins de nuit SARL hospital, DR Congo, during the 2nd and 3rd waves of the COVID-19 pandemic. The diagnosis of COVID-19 was established based on RT-PCR anti-SARS-CoV-2 tests (G1 (RT-PCR positive) vs. G2 (RT-PCR negative)), and all patients had a chest CT on the day of admission. We retrieved the digital files of patients, precisely the clinical, biological, and chest CT parameters of the day of admission as well as the vital outcome (survival or death). Chest CT were read by a very high-definition console using Advantage Windows software and exported to the hospital network using the RadiAnt DICOM viewer. To determine the threshold for the percentage of lung lesions associated with all-cause mortality, we used ROC curves. Factors associated with death, including chest CT parameters, were investigated using logistic regression analysis. The study included 200 patients (average age 56.2 ± 15.2 years; 19% diabetics and 4.5% obese), and COVID-19 was confirmed among 56% of them (G1). Chest CT showed that ground glass (72.3 vs. 39.8%), crazy paving (69.6 vs. 17.0%), and consolidation (83.9 vs. 22.7%), with bilateral and peripheral locations (68.8 vs. 30.7%), were more frequent in G1 vs. G2 (p < 0.001). No case of pulmonary embolism and fibrosis had been documented. The lung lesions affecting 30% of the parenchyma were informative in predicting death (area under the ROC curve at 0.705, p = 0.017). In multivariate analysis, a percentage of lesions affecting 50% of the lung parenchyma increased the risk of dying by 7.194 (1.656-31.250). The chest CT demonstrated certain characteristic lesions more frequently in patients in whom the diagnosis of COVID-19 was confirmed. The extent of lesions affecting at least half of the lung parenchyma from the first day of admission to hospital increases the risk of death by a factor of 7.

Assessment of the Barriers and Enablers of the Use of mHealth Systems in Sub-Saharan Africa According to the Perceptions of Patients, Physicians, and Health Care Executives in Ethiopia: Qualitative Study.

Digital technologies are increasingly being used to deliver health care services and promote public health. Mobile wireless technologies or mobile health (mHealth) technologies are particularly relevant owing to their ease of use, broad reach, and wide acceptance. Unlike developed countries, Sub-Saharan Africa experiences more challenges and obstacles when it comes to deploying, using, and expanding mHealth systems. In addition to barriers, there are enabling factors that could be exploited for the design, implementation, and scaling up of mHealth systems. Sub-Saharan Africa may require tailored solutions that address the specific challenges facing the region. The overall aim of this study was to identify the barriers and enablers for using mHealth systems in Sub-Saharan Africa from the perspectives of patients, physicians, and health care executives. Multi-level and multi-actor in-depth semistructured interviews were employed to qualitatively explore the barriers and enablers of the use of mHealth systems. Data were collected from patients, physicians, and health care executives. The interviews were audio recorded, transcribed verbatim, translated, and coded. Thematic analysis methodology was adopted, and NVivo software was used for the data analysis. Through this rigorous study, a total of 137 determinants were identified. Of these determinants, 68 were identified as barriers and 69 were identified as enablers. Perceived barriers in patients included lack of awareness about mHealth systems and language barriers. Perceived enablers in patients included need for automated tools for health monitoring and an increasing literacy level of the society. According to physicians, barriers included lack of available digital health systems in the local context and concern about patients' mHealth capabilities, while enablers included the perceived usefulness in reducing workload and improving health care service quality, as well as the availability of mobile devices and the internet. As perceived by health care executives, barriers included competing priorities alongside digitalization in the health sector and lack of interoperability and complete digitalization of implemented digital health systems, while enablers included the perceived usefulness of digitalization for the survival of the highly overloaded health care system and the abundance of educated manpower specializing in technology. mHealth systems in Sub-Saharan Africa are hindered and facilitated by various factors. Common barriers and enablers were identified by patients, physicians, and health care executives. To promote uptake, all relevant stakeholders must actively mitigate the barriers. This study identified a promising outlook for mHealth in Sub-Saharan Africa, despite the present barriers. Opportunities exist for successful integration into health care systems, and a user-centered design is crucial for maximum uptake.

Glomus Tumors: A Systematic Review of the Sub-Saharan Africa Experience.

Glomus tumors are rare benign tumors that were first described in 1812 by Wood. They arise from normal glomus apparatus, usually located in the reticular dermis of the body. Although glomus tumors are universal in occurrence, the sub-Saharan Africa experience has not been well documented. The authors performed a systematic literature review of eligible studies between 1960 and August 2023, using the terms "glomus," "tumor," "glomangioma," "glomangiomyoma," and "Africa." We also performed a search of the AIC Kijabe Hospital pathology department database of about 140,000 records, covering 30 years, for the terms "glomus tumor," "glomangioma" and "glomangiomyoma." The systematic literature search and institutional database search produced a total of 74 patients who had glomus tumors. These patients had a lag of between 3 months and 20 years from symptom development to definitive treatment. There are very few reports of glomus tumors from sub-Saharan Africa in the current literature: the authors' histopathology database of 140,000 specimens had 46 glomus tumors (0.03%), and only 28 additional patients were found in literature from sub-Saharan Africa. The low numbers of African patients may indicate racial differences in the occurrence of glomus tumors, although this may also be due to failure of clinicians to recognize glomus tumors. The prolonged lag period between symptom development and definitive treatment for glomus tumors indicates the need for diligence in the diagnosis and treatment of a simple problem that is otherwise the cause of incapacitating pain and misery.

Systems issues limiting acute fracture care delivery at a tertiary care hospital in Northern Tanzania.

sub-Saharan Africa experiences a significant musculoskeletal trauma burden. Among patients who receive surgical treatment, there have been no reports as to how often surgical care is determined to be "adequate" or, if "inadequate", then what hospital and orthopaedic specialty-specific systems limitations might be prohibitive. data from patients presenting to the orthopaedic trauma service at a tertiary care center in sub-Saharan Africa were prospectively collected over a 6-week period and then retrospectively reviewed to determine whether the surgical treatment was "adequate" (or otherwise, "inadequate") according to the principle of restoring length, alignment, and rotation. Exclusion criteria included insufficient clinical information; isolated spinal injury; infection; cases involving only removal of hardware; soft-tissue procedures; tumor cases; and medical (non-surgical) conditions. 112 cases were included for analysis. Surgery was indicated in 106 of 112 cases (94.6%), and of those, surgery was performed in 62 cases (58.4%). Among patients who underwent surgery with available post-operative imaging (n=56), surgical treatment was "inadequate" in 24 cases (42.9%). The most common reasons treatment was deemed "inadequate" included unavailability of appropriate implants (n=16), unavailability of intraoperative fluoroscopy (n=10) and incomplete intraoperative evaluation of injury (n=5). several systems limitations prevent the delivery of adequate surgical treatment in patients with acute orthopaedic traumatic injuries, including lack of intraoperative fluoroscopy and lack of implant availability. This study will serve as a useful baseline for ongoing efforts seeking to improve orthopaedic specialty resource availability and facilitate more effective fracture care in this region.

1.C. Workshop: COVID-19 and strategies to improve pandemic preparedness in Africa: Results of 4 systematic reviews

Abstract Background The COVID-19 pandemic has had a massive impact on mortality and health service utilisation globally. However, its impact in low- and lower middle-income countries (LLMIC), in particular in sub-Saharan Africa, remains poorly understood. The German West-African Centre (G-WAC) for Global Health and Pandemic Prevention aims to contribute to a better understanding of the pandemic and to strengthen pandemic preparedness in the region. Objectives The workshop aims to provide an overview of available research on four aspects that are key for understanding the COVID-19 pandemic in sub-Saharan Africa and to support improved pandemic preparedness in the region: (1) the impact of the pandemic on excess mortality, (2) the changes in health services utilisation, (3) the different strategies that support community engagement, and (4) the role of mHealth tools for community-based disease surveillance. Together with workshop participants, we intend to discuss challenges and opportunities for research on the COVID-19 pandemic in sub-Saharan Africa and the potential for research to contribute to better pandemic preparedness. We also wish to receive input for the further research agenda of G-WAC. Added value The workshop will bring together the findings of four systematic reviews that provide complementary evidence contributing to a better understanding of the COVID-19 pandemic in sub-Saharan Africa. It will provide a platform for researchers engaged in related work in Africa or Europe to share their experiences and to contribute to shaping the future research agenda of G-WAC. Coherence of workshop Following a brief introduction explaining the underlying research concept that links the four systematic reviews, results will be presented for: (1) a systematic review and meta-analysis of excess mortality, reporting pooled excess mortality estimates; (2) a scoping review illustrating the range of approaches and settings where research has been conducted on health service utilisation during the pandemic; (3) a scoping review of the various strategies that have been used to foster community engagement to strengthen infection control activities; and (4) a scoping review of different mobile phone-based tools that support Community Health Workers engaged in infectious disease surveillance. Format This is a regular workshop consisting of four brief (7 mins) presentations. Each presentation will be followed by 5 mins discussions, giving room to the audience for questions and comments that relate findings to previous research experiences. Another 10 mins are reserved at the end to discuss further research needs. Several polling rounds will engage the audience and collect input on (a) research experiences in sub-Saharan Africa, (b) reflections about the relevance of presented results, and (c) suggestions for further research. Key messages • The workshop will summarise existing evidence on the impact of the COVID-19 pandemic on mortality and health service utilisation in sub-Saharan Africa. • Community participation may support improved pandemic preparedness and response by contributing to early detection of outbreaks and the successful implementation of infection control activities.

Exploratory Factor Analysis of Congolese Information Technology Graduates’ Employability: Towards Sustainable Employment

High unemployment rates in many developing countries have prompted research to focus on sustainability and inclusiveness of employment in line with the sustainable development goal target 8.6. The democratic republic of Congo (DRC) in sub-Saharan Africa experiences one of the highest youth unemployment rates owing to its long-term socio-political and economic instability. Qualitative and quantitative research studies have linked low employability of university-educated youth in the DRC to tribalism, corruption, and insecurity. The current study sought to identify contextual factors that predict employability of information technology (IT) graduates in the DRC. The study surveyed 355 graduates (274 male, 81 female) using 43 questionnaire. Bartlett test was 3,930.05 for Chi2 ( p-value = .000) and KMO test scored 0.68. McDonald’s Omega test of reliability of the instrument scored 0.77 with a total cumulative variance of 72.02%. Results of this study advance the conflict theory by pinpointing the true factors which influence the employability of IT graduates in unstable developing countries. This study has discovered that socio-political background of graduates, graduate academic competencies, graduate-employer relationship, and university employability strategies are the contextual factors that predict the employability of IT graduates in the DRC. The Cronbach’s Alpha test of reliability for the retained contextual factors scored .78, .75, .63, and .53, respectively.

“I decided to participate….because I saw it as benefiting our community and families”: a qualitative study of lay providers’ experiences with delivering an evidence-based mental health intervention for families in Uganda

BackgroundChildren and adolescents who live in resource-limited communities in sub-Saharan Africa (SSA) experience significant mental health problems, including behavioral problems. In SSA, one of the most significant impediments to expanding services is a scarcity of mental health specialists. Task-shifting can effectively solve the mental health care gap in low-resource settings, yet it is underutilized in child and adolescent mental health. Moreover, the experiences of lay providers are understudied in global mental health, despite their potential impact on intervention effectiveness. In this study, we examined the experiences of community health workers and parent peers with the task-shifting of an evidence-based family strengthening intervention in Uganda.MethodsAs part of a larger randomized clinical trial, semi-structured in-depth interviews were conducted with 24 facilitators selected using stratified purposive sampling. Interviews explored their decision to participate in the program; experiences with the training; and experiences with intervention delivery. All interviews were conducted in Luganda (local language) and audio recorded. They were transcribed verbatim and translated into English. Thematic analysis was used to analyze the data.ResultsDespite concerns around lack of previous experience and time commitment, facilitators reported high relevance of the intervention to the families in their communities as well as their own as a motivation to participate. They also identified financial incentives as a motivating factor. These two factors also ensured their attendance at the training. They were satisfied with the content and skills provided during the training and felt prepared to deliver the intervention. During intervention delivery, they enjoyed seeing the families engaged and participating actively in the sessions as well as observing positive changes in the families. Some challenges with family attendance and engagement were noted. The facilitators reported an increased sense of self-efficacy and competence over time; and expressed high satisfaction with supervision.ConclusionFacilitators’ positive experiences point to the high acceptability and appropriateness of task-shifting this intervention in low-resource settings. As the global mental health field continues to be interested in task-shifting interventions to lay providers, successful examples should be studied so that evidence-based models can be put in place to support them through the process.

Driving Sustainable Development: The Power of Vehicle-Based Services in Rural Sub-Saharan Africa

Vehicle-based services such as mobile health clinics can increase spatial accessibility in rural areas. In contrast to stationary infrastructure, vehicle-based services are flexible and can be less capital-intensive to initiate service supply. In particular, rural communities across sub-Saharan Africa experience insufficient access to essential public services necessary for sustainable human development. We consider vehicles as mobile service platforms capable of temporarily transporting service staff, goods, and functions necessary for service delivery spatially closer to rural demand locations. Despite these advantages, public authorities must perform a cost–benefit analysis before allocating resources to a vehicle-based service fleet. This paper analyzes which vehicle-based services beneficially influence the Sustainable Development Goals and quantify their potential for the sub-Saharah African region. Based on a criteria-based selection method, we parse 169 target formulations and extract a set of directly influential Sustainable Development Goals. The remaining goals are the starting point for a literature review to identify existing vehicle-based service concepts addressing the targets. Our evaluation reveals that vehicle-based services can enhance about 128 (76%) of all targets and 16 of the 17 Sustainable Development Goals. Half of these targets require the delivery of consumable goods, whereas 59 (35%) of the Sustainable Development Goal targets relate to the transportation of people, and 24 (14%) require access to a broader spectrum of functionality mounted on top of the vehicle, such as water pumps or refrigerators. In combination with publicly available data, we can identify the SDG for each African country with the greatest potential for a vehicle-based service intervention. Our approach enriches public project appraisals for systematical decision support between stationary and mobile infrastructure.

Prevalence of Adverse Childhood Experiences in sub-Saharan Africa: A multicountry analysis of the Violence Against Children and Youth Surveys (VACS)

BackgroundAdverse Childhood Experiences are traumatic events early in life and have been associated with significant negative health outcomes. ObjectiveTo estimate the prevalence of ACEs in five low- and middle-income sub-Saharan African countries. Participants and settingNationally representative data from the Cote d'Ivoire (2018), Kenya (2019), Lesotho (2018), Mozambique (2019), and Namibia (2019) Violence Against Children and Youth Surveys (VACS) were used. Analyses were restricted to youth ages 18–24 years (n = 8766 females and 2732 males). MethodsVACS data were analyzed to generate sex-stratified weighted prevalence of individual ACEs (including sexual, physical, and emotional violence; witnessing interparental violence and violence in the community; and orphanhood) and aggregate ACEs (total ACEs; 0, 1–2, and 3 or more), for each country and combined. ResultsThe most common type of ACEs among both females and males was witnessing physical violence (males: 55.0 % [95 % CI: 51.1–58.8] and females: 37.2 % [95 % CI = 34.3–40.1]) followed by experiencing physical violence (males: 49.7 % [95 % CI = 45.5–53.9] and in females: 36.5 % [95 % CI = 33.8–39.2]). Prevalence of sexual violence was significantly higher in females than in males (16.0 % [95 % CI = 13.9–18.2] vs 8.3 % [95 % CI = 7.0–9.8]; p < 0.001). About 72 % of females and 82 % of males have experienced at least one form of ACE with 20 % of females and 24.2 % of males experiencing 3 or more ACEs. ConclusionThis study demonstrated that majority of the children in countries in sub-Saharan Africa have experienced multiple ACEs in their lifetime. Understanding the extent of the problem will help design early interventions to reduce childhood exposure to ACEs or mitigate against the harmful impact of ACEs.

Perceptions of multiple chronic conditions and coping strategies among migrants from Sub-Saharan Africa living in France with diabetes mellitus and HIV: An interview-based qualitative study.

Although diabetes is common among people living with HIV/AIDS (PLWHA), few data exists on how migrants from Sub-Saharan Africa (SSA) experience living with these two coexisting conditions in France. The objective of this study was to analyze perception of polypathology among PLWHA from SSA with type 2 diabetes and identify barriers and facilitators to their self-management. A qualitative study was conducted using semi-structured interviews from November 2019 to April 2020 with participants selected from a cohort of PLWHA and diabetes at Avicenne University Hospital. A total of 12 semi-structured interviews were conducted and analyzed using thematic analysis with inductive approach. Stigma remained a major issue in self-managing HIV, and some participants did not consider themselves as having a polypathology, as HIV has always been considered as a distinct condition. In general, emotion-based resources (e.g spirituality, trust in the medical discourse) and social support were mobilized more than problem-solving resources (e.g perception of medication as life-saving). Participants used the same main resource in self-management of HIV and diabetes, and resources used differed from participant to participant. This study highlighted challenges in self-management of diabetes and HIV in this population and complexity related to the socioeconomic and cultural specificities. Self-management could be more successful if patients and carers move in the same direction, having identified the individual coping resources to reach objectives.

Synthesis of end-user research to inform future multipurpose prevention technologies in sub-Saharan Africa: a scoping review.

Women in sub-Saharan Africa (SSA) experience disproportionately high rates of HIV infection and unintended pregnancy compared to their age-matched counterparts in other regions of the world. Multipurpose prevention technologies (MPTs) that offer protection against HIV and unintended pregnancy in a single product stand to address these dual sexual and reproductive health needs simultaneously. The aim of this scoping review is to identify factors that are important for optimizing the likelihood of MPT adoption by end users in SSA. Study inclusion criteria included MPT research (HIV and pregnancy prevention dual indication) published or presented in English from 2000 to 2022 and conducted in SSA amongst end-users (women aged 15-44), male partners, health care providers, and community stakeholders. References were identified by searching peer reviewed literature, grey literature, conference presentations (2015-2022), grant databases, and outreach to MPT subject matter experts. Of 115 references identified, 37 references met inclusion criteria and were extracted for analysis. A narrative synthesis approach was used to summarize findings within and across MPT products. Studies were identified from six countries in SSA and a substantial proportion included a South African (n = 27) and/or Kenyan (n = 16) study site. Most studies utilized a qualitative study design (n = 22) and evaluated MPT acceptability and preferences by presenting hypothetical products through images or a list of product attributes (n = 21). The vaginal ring (n = 20), oral tablet (n = 20), and injection (n = 15) were examined most frequently. Across studies, there was high acceptability and demand for an HIV and pregnancy prevention MPT. End users valued choice in prevention product type as well as discreetness and long-acting options. Provider counseling and community sensitization were reported as essential for future introduction of novel MPT delivery forms. Recognizing the heterogeneity of women's preferences and changing reproductive and sexual health needs over the life course, choice is important in the delivery of pregnancy and HIV prevention products as well as amongst MPT products with distinct product profiles. End user research with active MPTs, vs. hypothetical or placebo MPTs, is necessary to advance understanding of end-user preferences and acceptability of future products.

Bridges-Round 2: A study protocol to examine the longitudinal HIV risk prevention and care continuum outcomes among orphaned youth transitioning to young adulthood.

Youth orphaned by HIV in sub-Saharan Africa experience immense hardships including social disadvantage, adverse childhood events and limited economic prospects. These adversities disrupt the normative developmental milestones and can gravely compromise their health and emotional wellbeing. The Bridges to the Future study (2012-2018) prospectively followed 1,383 adolescents, between 10-16 years, to evaluate the efficacy and cost-effectiveness of a family-based economic empowerment intervention comprising of child development accounts, financial literacy training, family income generating activities and peer mentorship. Study findings show efficacy of this contextually-driven intervention significantly improving mental health, school retention and performance and sexual health. However, critical questions, such as those related to the longitudinal impact of economic empowerment on HIV prevention and engagement in care remain. This paper presents a protocol for the follow-up phase titled, Bridges Round 2. The Original Bridges study participants will be tracked for an additional four years (2022-2026) to examine the longitudinal developmental and behavioral health outcomes and potential mechanisms of the effect of protective health behaviors of the Bridges cohort. The study will include a new qualitative component to examine participants' experiences with the intervention, the use of biomedical data to provide the most precise results of the highly relevant, but currently unknown sexual health outcomes among study participants, as well as a cost-benefit analysis to inform policy and scale-up. Study findings may contribute to the scientific knowledge for low-resource communities on the potential value of providing modest economic resources to vulnerable boys and girls during childhood and early adolescence and how these resources may offer long-term protection against known HIV risks, poor mental health functioning and improve treatment among the HIV treatment care continuum.

Barriers to linkage and retention in HIV care still persist among adolescent girls and young women in western Kenya

Adolescent girls and young women (AGYW) in sub-Saharan Africa experience delayed linkage to and poor retention in HIV care. Identifying and addressing specific barriers in HIV care programming is important to achieving the upgraded UNAIDS 95-95-95 targets and epidemic control. We examined these challenges among 103 HIV-positive AGYW in and out of HIV care in communities around Lake Victoria in western Kenya as part of a larger qualitative study to identify drivers of HIV testing and HIV care utilisation in key populations. We used the social-ecological model to guide development of interview guides. Individual-level barriers included denial and forgetfulness and gendered household responsibilities, medication side effects, especially if taken without food, pills being too big and difficult to swallow and the burden of a daily medication-taking regimen. Interpersonal barriers included troubled family relationships and pervasive fears of stigma and discrimination by friends and family. Communitylevel barriers were stigmatising attitudes toward people living with HIV. Health-system barriers included negative provider attitudes and confidentiality breaches. At the structural level, participants noted high costs due to long travel times to facilities, long clinic waiting times, household food insecurity and school and work commitments. AGYW’s limited decision-making autonomy due to age and gender norms, including their reliance on the authority of older adults, makes these barriers especially troubling. Innovative treatment approaches that take into account the unique vulnerabilities of AGYW are urgently needed.