Preventive Services Research Articles

The Factors Influencing the Depression, Anxiety, and Stress of Grassroots Healthcare Workers in the Context of the Covid-19 Pandemic in the Vietnamese Mekong Delta: A Cross-Sectional Study in An Giang Province

Introduction: Grassroots health workers are crucial in Vietnam's healthcare system. As the frontline of healthcare, closest to the community, they are considered the backbone for disease prevention, control efforts, and initial healthcare for the population. The Ministry of Health in Vietnam has endeavored to improve infrastructure, equipment, and workforce quality, along with providing mental health care for grassroots healthcare workers to effectively carry out health education, disease prevention, and well-organized healthcare services. This paper aims to investigate factors affecting depression, anxiety, and stress among grassroots health workers in An Giang Province located in the Vietnamese Mekong Delta region. Methods: A population-based cross-sectional study was conducted using data from the 2023 Grassroots health workers in An Giang Province. A total of 466 grassroots health workers were selected. The Research method to collect quantitative data from the questionnaire tools was applied and data analysis was conducted using the SPSS 22.0. Results: The research findings showed that 18.3%, 28.8%, and 16.8% of participants exhibited symptoms of depression, anxiety, and stress, respectively, predominantly at mild, moderate, severe, and extremely severe levels. Risk factors impacting mental health included income and benefits, COVID-19 infection, and prolonged symptoms affecting physical health, as well as workplace infrastructure. Conclusions: Improving salary policies, physical health care, and upgrading workplace infrastructure will reduce the risk of mental health issues among grassroots health workers, both during the pandemic and in the future.

Agile implementation of alcohol screening in primary care

BackgroundDespite the United States Preventive Services Task Force recommendation to screen adults for unhealthy alcohol use, the implementation of alcohol screening in primary care remains suboptimal.MethodsA pre and post-implementation study design that used Agile implementation process to increase screening for unhealthy alcohol use in adult patients from October 2021 to June 2022 at a large primary care clinic serving minority and underprivileged adults in Indianapolis.ResultsIn comparison to a baseline screening rate of 0%, the agile implementation process increased and sustained screening rates above 80% for alcohol use using the Alcohol Use Disorders Identification Test – Consumption tool (AUDIT-C).ConclusionsUsing the agile implementation process, we were able to successfully implement evidence-based recommendations to screen for unhealthy alcohol use in primary care.

Penyuluhan Fisioterapi K3 Dalam Upaya Melakukan Preventif Dan Promotive Low Back Pain Di Penjahit Sartika Express Samarinda, Kalimantan Timur

Introduction: Jobs in long static positions, such as tailors, can cause musculoskeletal disorders (MSDs). MSDs are caused by unergonomic work postures, long work durations, and monotonous movements, resulting in loss of productivity and health problems. In Indonesia, the prevalence of musculoskeletal diseases is around 7.30%. Tailors often experience stiff posture and static muscle loads, causing muscle pain and stiffness in the waist and lower back. Objective: To provide preventive and promotional services and understanding of low back pain to tailors at Sartika Express, Samarinda, East Kalimantan. Method: This counseling is carried out by a health promotion method about low back pain which is carried out with presentations and using flyer media to facilitate education, this aims to understand the tailors, after that conduct a question and answer session to find out the condition and complaints of the tailors and then, educate with exercises and management that can be done independently. Conclusion: The counseling process went well, the tailors were able to follow and understand the exercises that had been taught, this activity got results in the form of understanding related to the exercises that had been taught from 0% to 100% after the counseling was carried out so that it could help the tailors prevent low back pain

Primary health care response to noncommunicable diseases: an assessment of Wellness Clinics in Ghana

BackgroundGlobally, there is a significant unmet need for the rapidly growing burden of Non-Communicable Diseases (NCDs). Ghana has adopted and implemented Wellness Clinics (WC) nationwide to respond to the rising burden of NCDs. Regrettably, very little is known about WCs, including their structure and the services they offer. This study explores the concept of WC, their structure, position within the hospital environment, and services from the perspectives of healthcare providers and clients.MethodsAn exploratory qualitative study was conducted with health professionals (n = 12) and clients (n = 26) of Wellness Clinics in two district hospitals and one regional hospital in a deprived region of Ghana where NCDs are rising. Using the WHO-PEN approach, an interview guide was purposely designed for this study. The data were analysed thematically using Atlas.ti.ResultsAll three Wellness Clinics were sub-units under the outpatient department. The WC was created by the facilities to respond to the increase in NCDs and to meet annual performance review requirements. The Wellness Clinics provided NCD diagnosis, counselling, and treatment services to approximately 300 clients per week at the facility level. Only one of the WCs provided NCD prevention services at the community level. Integrated NCD care was also provided at the WC, despite the health system and individual-level challenges reported by the health workers and clients.ConclusionThe implementation of the Wellness Clinic demonstrates the government’s commitment to addressing the increasing burden of NCDs in Ghana through the primary health system. To maximise the impact of the wellness clinics, we recommend developing best practices, providing logistics, and addressing health insurance challenges.

Suicide prevention providers' perspectives on addressing social determinants of health for at-risk Veterans

ObjectiveSuicide prevention is a top clinical priority within the Department of Veterans Affairs (VA). While research consistently shows that suicide risk is associated with adverse social determinants of health (SDH, e.g., housing instability, unemployment, justice involvement), less is known about the extent to which suicide prevention staff are aware of and able to address these risk factors. This study aimed to understand the experiences of VA Suicide Prevention Coordinators (SPCs) with referring Veterans at risk of suicide to services that address SDH. MethodIn January–February 2022, 171 VA SPCs completed a questionnaire about their experiences connecting Veterans with SDH-focused services. Descriptive statistics summarized closed-response items and a thematic analysis was conducted for open-ended responses. ResultsThe majority of SPCs agreed that adverse SDH contribute to suicide risk and that services to address SDH could reduce suicide risk for Veterans. While most SPCs were aware of on-site SDH services, many reported barriers to connecting Veterans with those services including insufficient resources, lack of staff time, and eligibility criteria. ConclusionChanges at the organizational and policy levels are needed to provide comprehensive suicide prevention services that connect at-risk Veteran with services to address adverse SDH.

Impact of the Implementation of the Affordability Care Act on Gastric Cancer Survival Rates.

Introduction Gastric cancer, a significant public health concern, remains one of the most challenging malignancies to treat effectively. In the United States, survival rates for gastric cancer have historically been low, partly due to late-stage diagnosis and disparities in access to care. The Affordable Care Act (ACA)sought to address such disparities by expanding healthcare coverage and improving access to preventive and early treatment services. Objective This study aims to determine the causal effects of the ACA's implementation on gastric cancer survival rates, focusing on a comparative analysis between two distinct U.S. states: New Jersey, which fully embraced ACA provisions, and Georgia, which has not adopted the policy, as of 2023. Methods In this retrospective analysis, we utilized data from the Surveillance, Epidemiology, and End Results Program (SEER) registry to assess the impact of the ACA on cancer-specific survival (CSS) among gastric cancer patients. The study spanned the period from 2000 to 2020, divided into pre-ACA (2000-2013) and post-ACA (2016-2020) periods, with a two-year washout (2013-2015). We compared Georgia (a non-expansion state) to New Jersey (an expansion state since 2014) using a Difference-in-Differences (DiD) approach. We adjusted for patient demographics, income, metropolitan status, disease stage, and treatment modalities. Results Among 25,061 patients, 58.7% were in New Jersey (14,711), while 41.3% were in Georgia (10,350). The pre-ACA period included 18,878 patients (40.0% in Georgia and 60.0% in New Jersey), and 6,183 patients were in the post-ACA period (45.2% in Georgia and 54.8% in New Jersey). The post-ACA period was associated with a 20% reduction in mortality hazard among gastric cancer patients, irrespective of the state of residence (HR = 0.80, 95% CI: 0.73-0.88). Patients who were residents of New Jersey experienced a 12% reduction in mortality hazard compared to those who resided in Georgia in the post-ACA period (HR = 0.88, 95% CI: 0.78-0.99). Other factors linked to improved survival outcomes included surgery (OR = 0.30, 95% CI: 0.28-0.34) and female gender (OR=0.83, 95% CI: 0.76-0.91). Conclusion The study underscores the ACA's potential positive impact on CSS among gastric cancer patients, emphasizing the importance of healthcare policy interventions in improving patient outcomes.

Service navigation and concrete supports from a family Perspective: A preventative and community-based approach to child welfare

The child welfare system in the United States has historically focused funding on intervening after child maltreatment has occurred, with fewer resources allocated to prevention. However, research has found that families benefit from concrete supports, like financial payments, and when families are provided with these supports, child welfare involvement significantly declines. Less is known about the impact of preventative approaches, such as service navigation, which could act as a bridge between families and essential concrete supports and resources. Additionally, it is vital to incorporate family voice into decisions being made regarding the development and evaluation of prevention programming. This qualitative study explores family experiences and outcomes with community-based service navigation. The sample included 12 family members working with a community navigator at the time of data collection. Data were obtained through focus groups and interviews held in English, Spanish, and Arabic. A thematic analysis guided the researchers in better understanding participants’ perspectives on service navigation. Results indicate that participants found preventative service navigation to be a supportive and collaborative experience through which they were connected with concrete supports and other essential resources. Five themes were identified: (1) normalizing the need for support; (2) time as a limited resource for families; (3) service navigation as empowering and humanizing for families; (4) service navigation poses new challenges for families; and (5) service navigation creates new opportunities for families. Results from this study suggest that service navigation may represent a more socially just intervention to ensure child safety, permanency, and well-being.

Caseload factors predictive of family abuse and neglect treatment outcomes

BackgroundIn child welfare, caseloads are frequently far higher than optimal. Not all cases are created equal; however, little is known about which combination and interaction of factors make caseloads more challenging and impact child and family outcomes. ObjectiveThis study aims to identify which case, provider, and organizational factors most strongly differentiate between families with favorable and less-than-positive treatment outcomes. Participants and settingParticipants were 25 family advocacy program providers and 17 supervisors at 11 Department of the Air Force installations. MethodsFollowing informed consent, participants completed demographic and caseload questionnaires, and we collected information about organizational factors. Providers were sent a weekly case update and burnout questionnaire for seven months. We used linear mixed-effects model tree (LMM tree) algorithms to determine the provider, client, and organizational characteristics that best distinguish between favorable vs. unfavorable outcomes. ResultsThe LMM tree predicting provider-rated treatment success yielded three significant partitioning variables: (a) commander involvement, (b) case complexity, and (c) % of clients in a high-risk field. The LMM predicting client-rated treatment progress yielded seven significant partitioning variables: (a) command involvement; (b) ease of reaching tenant unit command; (c) # of high-risk cases; (d) % of clients receiving Alcohol and Drug Abuse Prevention and Treatment services; (e) ease of reaching command; (f) % of clients with legal involvement; (g) provider age. ConclusionsThis study is a first step toward developing a dynamic caseload management tool. An intelligent, algorithm-informed approach to case assignment could help child welfare agencies operate in their typically resource-scarce contexts in a manner that improves outcomes.

Characteristics associated with early vs. late adoption of lung cancer screening

BackgroundAlthough lung cancer screening (LCS) reduces lung cancer mortality among high-risk individuals, uptake overall remains low. With all cancer screening modalities, a period of diffusion among medical providers and the public is expected, with screening uptake exhibiting a distribution among early vs. late adoption. We aimed to characterize individuals undergoing LCS based upon the timeframe of screening adoption. MethodsThis retrospective study examined patients who underwent LCS between January 2015 – December 2022 in a centralized LCS program. Based on United States Preventive Services Task Force (USPSTF) criteria for LCS, early and late adopters of LCS – defined by time from eligibility to screening completion – were compared. A multivariable regression model was constructed to identify factors associated with early adoption of LCS. ResultsAmong patients screened during the study period, 90.4% were eligible based on USPSTF 2013 criteria, and 9.6% were eligible based on USPSTF 2021 criteria. Of the USPSTF 2013 eligible persons, multivariable analysis demonstrated Black/African-American individuals and current smokers had significantly greater odds of early adoption (aOR 1.428 and 1.514, respectively). Those without a family history of lung cancer or without a personal history of cancer had significantly lower odds of early adoption of LCS. ConclusionsEarly adopters were more likely to report Black/African-American race or current smoking status after adjustment for covariates. Future research should examine how screening diffuses across the overall LCS-eligible population, as well as identify factors that drive and inhibit diffusion to create programs and policies with the ultimate goal of increasing timely LCS uptake.

The Cuyahoga youth count: one county’s prevalence of and experience data from LGBTQ+ youth in out-of-home placements

ABSTRACT This study aimed to better understand the experiences of LGBTQ+ youth in foster care in the Midwest. Of the youth who participated in the study, 32.2% indicated they were LGBTQ+. LGBTQ+ youth were more likely to have been hospitalized for physical illness and emotional reasons and experience a great number of discriminatory experiences. LGBTQ+ youth were less likely to report being treated well in foster care and that they could be themselves in their placement. Findings suggest the need for increased LGBTQ+ tailored prevention services for families and policy and practice shifts within the child welfare system.

Understanding health literacy in men: a cross-sectional survey

BackgroundMales have a shorter life expectancy than females. Men are less likely to seek the advice of a health professional or utilise preventive health services and programs. This study seeks to explore health literacy and the characteristics affecting this among Australian men.MethodsFour hundred and thirty-one adult males engaged with the New South Wales Rural Fire Service, completed an online cross-sectional survey, undertaken from September – November 2022. The survey tool captured demographic data, health status and lifestyle risk characteristics. Health literacy was measured using the 44-item Health Literacy Questionnaire (HLQ). Descriptive statistics, frequencies, percentages, means and standard deviations, were used to describe the sample. Interferential statistics, including the Mann-Whitney U Test and the Kruskal-Wallis Test, were used to explore differences between demographics and HLQ scales.ResultsFor the first 5 scales (4-point Likert scale), the lowest score was seen for ‘Appraisal of health information’ (Mean 2.81; SD 0.52) and the highest score was seen for ‘Feeling understood and supported by healthcare providers ’ (Mean 3.08; SD 0.64). For the other 4 scales (5-point Likert scale), the lowest score was seen for ‘Navigating the healthcare system’ (Mean 3.74; SD 0.69). The highest score was seen for ‘Understand health information well enough to know what to do’ (Mean 4.10; SD 0.53). Age, income level and living in an urban/rural location were significantly related to health literacy scales.ConclusionsThis study provides new insight into men’s health literacy and the factors impacting it. This knowledge can inform future strategies to promote men’s engagement with health services and preventive care.

Real-world impacts from a decade of Quality Enhancement Research Initiative-partnered projects to translate the Diabetes Prevention Program in the Veterans Health Administration.

To describe the impacts of four Veterans Health Administration (VA) Quality Enhancement Research Initiative (QUERI) projects implementing an evidence-based lifestyle intervention known as the Diabetes Prevention Program (DPP). 2012-2024 VA administrative and survey data. This is a summary of findings and impacts from four effectiveness-implementation projects focused on in-person and/or online DPP across VA sites. Patient demographics, participation data, and key findings and impacts were summarized across reports from the VA Diabetes-Mellitus Quality Enhancement Research Initiative (QUERI-DM) Diabetes Prevention Program (VA DPP) Trial, QUERI-DM Online DPP Trial, the Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER) QUERI DPP Project, and EMPOWER 2.0 QUERI Program. Between 2012 and 2024, four VA QUERI studies enrolled 963 Veterans in DPP across 16 VA sites. All participants had overweight/obesity with one additional risk factor for type 2 diabetes (i.e., prediabetes, elevated risk score, or history of gestational diabetes) and 56% (N = 536) were women. In addition to enhancing the reach of and engagement in diabetes prevention services among Veterans, these projects resulted in three key impacts as follows: (1) informing the national redesign of VA MOVE! including recommendations to increase the number of MOVE! sessions and revise guidelines across 150+ VA sites, (2) enhancing the national evidence base to support online DPP delivery options with citations in national care guidelines outside VA, and (3) demonstrating the importance of gender-tailoring of preventive care services by and for women Veterans to enhance engagement in preventive services. Over the past decade, the evolution of VA QUERI DPP projects increased the reach of and engagement in diabetes prevention services among Veterans, including women Veterans who have been harder to engage in lifestyle change programs in VA, and resulted in three key impacts informing type 2 diabetes and obesity prevention efforts within and outside of VA.

Confronting Alzheimer's Disease Risk in Women: A Feasibility Study of Memory Screening as Part of the Annual Gynecological Well-Woman Visit.

Objective: Routine health care visits offer the opportunity to screen older adults for symptoms of Alzheimer's disease (AD). Many women see their gynecologist as their primary health care provider. Given this unique relationship, the Women's Preventive Services Initiative and the American College of Obstetrics and Gynecology advocate for integrated care of women at all ages. It is well-established that women are at increased risk for AD, and memory screening of older women should be paramount in this effort. Research is needed to determine the feasibility and value of memory screening among older women at the well-woman visit. Materials and Methods: Women aged 60 and above completed a 5-item subjective memory screener at their well-woman visit at the Columbia University Integrated Women's Health Program. Women who endorsed any item were considered to have a positive screen and were given the option to pursue clinical evaluation. Rates of positive screens, item endorsement, and referral preferences were examined. Results: Of the 530 women approached, 521 agreed to complete the screener. Of those, 17.5% (n = 91) were classified as positive. The most frequently endorsed item was difficulty with memory or thinking compared with others the same age. Among women with positive screens, 57.5% were interested in pursuing clinical referrals to a memory specialist. Conclusion: Results support the feasibility and potential value of including subjective memory screening as part of a comprehensive well-woman program. Early identification of memory loss will enable investigation into the cause of memory symptoms and longitudinal monitoring of cognitive change.

Describing the effect of COVID-19 on sexual and healthcare-seeking behaviours of men who have sex with men in three counties in Kenya: a cross-sectional study

BackgroundWhile the COVID-19 pandemic disrupted HIV preventative services in sub-Saharan Africa, little is known about the specific impacts the pandemic has had on men who have sex with men (MSM)...

Suicidal Ideation and Attempts Among Youth With Physical-Mental Comorbidity in Canada: Proposal for an Epidemiological Study.

Evidence suggests that having a chronic physical illness (CPI; eg, asthma, diabetes, and epilepsy) is an independent risk factor for suicidality (ie, suicidal ideation or attempts) among youth. Less is known about the mechanisms linking CPI and suicidality. Some evidence suggests that mental illness (eg, depression and anxiety) or neurodevelopmental disorder (eg, attention-deficit/hyperactivity disorder) mediates or moderates the CPI-suicidality association. Missing from the knowledge base is information on the association between having co-occurring CPI and mental illness or neurodevelopmental disorder (MIND) on youth suicidality. This study uses epidemiological data from the 2019 Canadian Health Survey of Children and Youth (CHSCY) to study the intersection of CPI, MIND, and suicidality in youth. We will estimate prevalence, identify predictors, and investigate psychosocial and service use outcomes for youth with CPI-MIND comorbidity versus other morbidity groups (ie, healthy, CPI only, and MIND only). Conducted by Statistics Canada, the CHSCY collected data from 47,850 children (aged 1-17 years) and their primary caregiving parent. Measures of youth CPI, MIND, family environment, and sociodemographics are available using youth and parent informants. Information on psychiatric services use is available via parent report and linkage to national administrative health data found in the National Ambulatory Care Reporting System and the Discharge Abstract Database, which allow the investigation of hospital-based mental health services (eg, emergency department visits, hospitalizations, and length of stay in hospital). Questions about suicidality were restricted to youths aged 15-17 years (n=6950), which form our analytic sample. Weighted regression-based analyses will account for the complex survey design. Our study began in November 2023, funded by the American Foundation for Suicide Prevention (SRG-0-008-22). Access to the linked CHSCY microdata file was granted in May 2024. Initial examination of CHSCY data shows that approximately 20% (1390/6950) of youth have CPI, 7% (490/6950) have MIND, 7% (490/6950) seriously considered suicide in the past year, and 3% (210/6950) had attempted suicide anytime during their life. Findings will provide estimates of suicidality among youth with CPI-MIND comorbidity, which will inform intervention planning to prevent loss of life in this vulnerable population. Modeling correlates of suicidality will advance understanding of the relative and joint effects of factors at multiple levels-information needed to target prevention efforts and services. Understanding patterns of psychiatric service use is vital to understanding access and barriers to services. This will inform whether use matches need, identifying opportunities to advise policy makers about upstream resources to prevent suicidality. Importantly, findings will provide robust baseline of information on the link between CPI-MIND comorbidity and suicidality in youth, which can be used by future studies to address questions related to the impact of the COVID-19 pandemic and associated countermeasures in this vulnerable population of youth. DERR1-10.2196/57103.

Preventive Service Usage and New Chronic Disease Diagnoses: Using PCORnet Data to Identify Emerging Trends, United States, 2018-2022.

Data modernization efforts to strengthen surveillance capacity could help assess trends in use of preventive services and diagnoses of new chronic disease during the COVID-19 pandemic, which broadly disrupted health care access. This cross-sectional study examined electronic health record data from US adults aged 21 to 79 years in a large national research network (PCORnet), to describe use of 8 preventive health services (N = 30,783,825 patients) and new diagnoses of 9 chronic diseases (N = 31,588,222 patients) during 2018 through 2022. Joinpoint regression assessed significant trends, and health debt was calculated comparing 2020 through 2022 volume to prepandemic (2018 and 2019) levels. From 2018 to 2022, use of some preventive services increased (hemoglobin A1c and lung computed tomography, both P < .05), others remained consistent (lipid testing, wellness visits, mammograms, Papanicolaou tests or human papillomavirus tests, stool-based screening), and colonoscopies or sigmoidoscopies declined (P < .01). Annual new chronic disease diagnoses were mostly stable (6% hypertension; 4% to 5% cholesterol; 4% diabetes; 1% colonic adenoma; 0.1% colorectal cancer; among women, 0.5% breast cancer), although some declined (lung cancer, cervical intraepithelial neoplasia or carcinoma in situ, cervical cancer, all P < .05). The pandemic resulted in health debt, because use of most preventive services and new diagnoses of chronic disease were less than expected during 2020; these partially rebounded in subsequent years. Colorectal screening and colonic adenoma detection by age group aligned with screening recommendation age changes during this period. Among over 30 million patients receiving care during 2018 through 2022, use of preventive services and new diagnoses of chronic disease declined in 2020 and then rebounded, with some remaining health debt. These data highlight opportunities to augment traditional surveillance with EHR-based data.

Factors Influencing Community Decisions in Choosing Community Health Centers for Promotive and Preventive Health Services: Literature Review

Introduction: Minister of Health Regulation Number 43 of 2019 stated that Community Health Centers (Puskesmas) were health service facilities that provided community health efforts (UKM) and individual health efforts (UKP) at the first level, prioritizing promotive and preventive efforts in their working areas. The reason for composing this article was crucial, as Community Health Centers, as both general health services and providers of promotive and preventive services, were expected to attract public interest.. Objective: Analyzed factors influencing community choices of health centers for promotive and preventive services. Method: A qualitative research study was conducted, employing a literature review via electronic databases, particularly utilizing Scopus journal sources. Keywords like "Primary health care," "consumer attraction," and "decision to visit the health center" guided the search, Inclusion criteria set for articles published in English, freely accessible, and between 2019 and 2023. Result: Based on the literature search process through electronic databases, 7 articles were obtained. The selected articles met the predetermined criteria. These articles were related to the use of price transparency tools, community satisfaction and dissatisfaction, the Health Extension Program, the crucial role of good healthcare services, as well as the influence of income and grants. Conclusion: Factors influencing the community's choice of Community Health Centers as a health service included offering lower service costs through insurance or BPJS Kesehatan, the presence of the Health Extension Program (HEP), patient satisfaction with services, gender factors, income, access to grants, and contact with health education.

The Urban-Rural Divide in Neurocritical Care in Low-Income and Middle-Income Countries.

The term "urban-rural divide" encompasses several dimensions and has remained an important concern for any country. The economic disparity; lack of infrastructure; dearth of medical specialists; limited opportunities to education, training, and health care; lower level of sanitation; and isolating effect of geographical location deepens this gap, especially in low-income and middle-income countries (LMICs). This article gives an overview of the rural-urban differences in terms of facilities related to neurocritical care (NCC) in LMICs. Issues related to common clinical conditions such as stroke, traumatic brain injury, myasthenia gravis, epilepsy, tubercular meningitis, and tracheostomy are also discussed. To facilitate delivery of NCC in resource-limited settings, proposed strategies include strengthening preventive measures, focusing on basics, having a multidisciplinary approach, promoting training and education, and conducting cost-effective research and collaborative efforts. The rural areas of LMICs bear the maximum impact because of their limited access to preventive health services, high incidence of acquired brain injury, inability to have timely management of neurological emergencies, and scarcity of specialist services in a resource-deprived health center. An increase in the health budget allocation for rural areas, NCC education and training of the workforce, and provision of telemedicine services for rapid diagnosis, management, and neurorehabilitation are some of the steps that can be quite helpful.

A mixed methods process evaluation: understanding the implementation and delivery of HIV prevention services integrated within sexual reproductive health (SRH) with or without peer support amongst adolescents and young adults in rural KwaZulu-Natal, South Africa

BackgroundCombination prevention interventions, when integrated with community-based support, have been shown to be particularly beneficial to adolescent and young peoples’ sexual and reproductive health. Between 2020 and 2022, the Africa Health Research Institute in rural South Africa conducted a 2 × 2 randomised factorial trial among young people aged 16–29 years old (Isisekelo Sempilo) to evaluate whether integrated HIV and sexual and reproductive health (HIV/SRH) with or without peer support will optimise delivery of HIV prevention and care. Using mixed methods, we conducted a process evaluation to provide insights to and describe the implementation of a community-based peer-led HIV care and prevention intervention targeting adolescents and young people.MethodsThe process evaluation was conducted in accordance with the Medical Research Council guidelines using quantitative and qualitative approaches. Self-completed surveys and clinic and programmatic data were used to quantify the uptake of each component of the intervention and to understand intervention fidelity and reach. In-depth individual interviews were used to understand intervention experiences. Baseline sociodemographic factors were summarised for each trial arm, and proportions of participants who accepted and actively engaged in various components of the intervention as well as those who successfully linked to care were calculated. Qualitative data were thematically analysed.ResultsThe intervention was feasible and acceptable to young people and intervention implementing teams. In particular, the STI testing and SRH components of the intervention were popular. The main challenges with the peer support implementation were due to fidelity, mainly because of the COVID-19 pandemic. The study found that it was important to incorporate familial support into interventions for young people’s sexual health. Moreover, it was found that psychological and social support was an essential component to combination HIV prevention packages for young people.ConclusionThe results demonstrated that peer-led community-based care that integrates SRH services with HIV is a versatile model to decentralise health and social care. The family could be a platform to target restrictive gender and sexual norms, by challenging not only attitudes and behaviours related to gender among young people but also the gendered structures that surround them.

Optimizing the cascade of prevention to protect people from tuberculosis: A potential game changer for reducing global tuberculosis incidence.

The provision of tuberculosis preventive treatment is one of the critical interventions to reduce tuberculosis incidence and ultimately eliminate the disease, yet we still miss appropriate tools for an impactful intervention and treatment coverage remains low. We used recent data, epidemiological estimates, and research findings to analyze the challenges of each step of the cascade of tuberculosis prevention that currently delay the strategy implementation. We addressed research gaps and implementation bottlenecks that withhold key actions in tuberculosis case finding, testing for tuberculosis infection, provision of preventive treatment with safer, shorter regimens and supporting people to complete their treatment. Empowering communities to generate demand for preventive therapy and other prevention services in a holistic manner and providing adequate financial support to sustain implementation are essential requirements. The adoption of an effective, universal monitoring and evaluation system is a prerequisite to provide general and granular insight, and to steer progress of the tuberculosis infection strategy at global and local level.