Uptake Of Services Research Articles

Service-Delivery Models to Increase the Uptake of Non-Communicable Disease Screening in South-Central Ethiopia: A Difference-In-Differences Analysis

Background: Screening for non-communicable diseases (NCDs) is a critical step for early detection and the prevention of consequent morbidity and mortality. To facilitate NCD screening, the Ethiopian Ministry of Health has developed screening guidelines. However, like other low- and middle-income countries, interventions to increase the uptake of NCD-screening services in Ethiopia remain ineffective. Thus, this study aimed to determine the effectiveness of service delivery models to increase NCD-screening service uptake in south-central Ethiopia. Method: A health-facility-based quasi-experimental study design was employed to determine the effectiveness of providing a multiple-NCD-screening service in addition to social- and behavioral-change communication (SBCC) intervention to increase the uptake of NCD-screening services. The interviewer-administered structured questionnaire was adapted from previously published research and used to collect data during the baseline and end-line survey periods. A difference-in-differences analysis was used to determine the effectiveness of the intervention. Results: Compared with routine care, the availability of a multiple-NCD-screening service, together with SBCC intervention, was found to significantly increase the uptake of cervical cancer screening, clinical breast examination, blood pressure measurement, and blood glucose-measurement services, by 18, 9, 44 and 23 percent points, respectively. However, the availability of a multiple-NCD-screening service without SBCC intervention increased clinical breast-examination service uptake by 9% point and blood glucose-measurement service uptake by 18% point without increasing the uptake of cervical cancer-screening or blood pressure-measurement services. Conclusion: The integration of multiple-NCD-screening services accompanied by SBCC intervention that promotes them is an important approach for improving the uptake of NCD-screening services.

Barriers and enablers to effective weight management for people living with overweight and obesity: A rapid scoping review.

A scoping review was conducted to identify barriers and enablers to effective weight management in healthcare settings for people living with overweight and obesity in English-speaking high-income countries. Peer-reviewed and gray literature were systematically searched in June 2024. Data were analyzed using inductive thematic analysis. Of the 15,684 unique articles identified and screened for relevance, 216 studies were included. Healthcare-related barriers and enablers to weight management were organized under three themes: a) healthcare provider-related factors, b) provision of care, and c) policy/funding. Prominent barriers included healthcare provider knowledge deficits and low prioritization of obesity management, mainly in the primary care setting. Weight management beyond the primary care setting was found to be especially challenging, with poor referral pathways, service fragmentation, lack of multidisciplinary practice, and restricted eligibility criteria, hindering the accessibility of services. Developing consistent policies and guidelines, improving the education of healthcare providers, and increasing funding to provide low-cost comprehensive care, were identified as enablers to access and uptake of weight management services. Considerable overlap in the identified barriers existed across healthcare providers and settings. A whole health system approach to minimize barriers and strengthen enablers to weight management services is needed, to address rising obesity rates.

Strengthening uptake of breast cancer screening services in Tanzania; re-visiting the breast cancer screening messages

BackgroundBreast Cancer remains among the top five cancers responsible for morbidity and mortality globally. For many years, infectious (communicable) diseases were a primary concern in low- and middle-income countries (LMICs) compared to higher-income countries, where non-communicable diseases (NCDs) were already a major concern. However, starting from the early 2000s, the LMICs including Tanzania has witnessed an epidemiological transition being equally affected by NCDs, and breast cancer, is among the prevalent NCDs. While the evidence is vast on the role of breast cancer screening messages in promoting screening, debunking myths, and addressing barriers to the uptake of breast cancer services, context-specific messages are limited. Amidst the changing technology, growth of social media and cultural dynamics, context-specific breast cancer screening messages are needed. We aimed to analyze the breast cancer screening messages from the experiences of women seeking care at Ocean Road Cancer Institute in Tanzania.MethodsAn exploratory qualitative case study adopting in-depth interviews (IDI) and focused group discussion (FGD) was carried out among purposefully selected women aged from 18 years to 65 years seeking care from Ocean Road Cancer Institute in Dar es Salaam, Tanzania. Eighteen women participated in the IDIs, and 16 women participated in FGD. Data analysis followed inductive qualitative content analysis.FindingsThree main categories emerged: the existence of multiple sources of breast cancer screening messages, the strengths and weaknesses of breast cancer screening messages, and clients’ mixed perceptions of breast cancer screening messages.ConclusionThe findings of this study depict that although breast cancer screening promotion messages are regarded as a source of information about cancers, they fall short of completeness and relevance to the otherwise at-risk population and trigger negative perceptions toward screening. Therefore, this study advocates revisiting the breast cancer screening messages, employing participatory approaches to tailor the screening messages and communication media to fit specific audiences. This calls for re-designing both the content of the messages and means of delivery; thus, collaborative efforts are needed.

Relationships Among COVID-19-Related Service Uptake, HIV Status, Drug Use, and COVID-19 Antibody Status Among HIV Testing Intervention Participants in KwaZulu-Natal, South Africa

People living with HIV (PLWH) and people who use drugs are vulnerable populations who may face barriers to accessing health services and may have irregularities in immune function. People with undiagnosed HIV infection may be particularly likely to have compromised immune function. However, research about whether/how HIV status is related to COVID-19-related health outcomes has been equivocal, and research on the predictors of COVID-19-related health service access/uptake has been limited in Sub-Saharan African settings. Among 470 participants of a peer-recruitment-based HIV-testing intervention in KwaZulu-Natal, we examined whether HIV status and/or hard drug use were associated with uptake of COVID-19 testing and vaccination, and whether they moderated the relationship between COVID-19 vaccination status and COVID-19 IgG antibody status. Women were significantly more likely than men to report testing for COVID-19 (OR = 1.84; p = 0.002) and being vaccinated (OR = 1.79; p = 0.002). Neither HIV status nor drug use was associated with likelihood of getting tested or vaccinated. Vaccinated participants (90% of whom obtained vaccines more than 6 months before the study) were significantly more likely to test positive for COVID-19 IgG antibodies (OR = 6.86; p < 0.0005). This relationship held true for subgroups of PLWH and participants with previously undiagnosed/uncontrolled HIV infection, and was not moderated by HIV status or hard drug use. These findings may suggest that both people who use drugs and PLWH were served as well as other people by KwaZulu-Natal’s COVID-19 response. However, gender-based disparities in COVID-19 service uptake suggest that special care should be taken during future COVID-19 outbreaks or other new epidemics to improve access to related healthcare services among men in this region.

"We're Not Gonna Aid You in Shooting Up": Stigma's Relationship to Harm Reduction in People Who Inject Drugs.

Harm reduction, when applied to drug use, prioritizes improving patient-centered health outcomes and reducing drug-related harm. In order for harm reduction strategies to be adopted by people who inject drugs (PWID), they need to be promoted, accessible, and accepted in that population and the community-at-large. While PWID face stigma at multiple levels, less is known about how stigma influences uptake and acceptance of harm reduction services and strategies among PWID. We aim to characterize the stigmatizing experiences PWID have had related to harm reduction and the role of stigma in influencing their acceptance and adoption of harm reduction services and strategies. A qualitative study using in-person, semi-structured interviews. We recruited hospitalized participants, age 18 and over, with a history of injection drug use. We developed an interview guide asking about various aspects of stigma and participants' experiences with naloxone, syringe service programs, fentanyl test strips, HIV and hepatitis C testing, and any other harm reduction strategies. Key themes were generated using a thematic analysis. We reached thematic saturation at 16 participants. PWID reported multi-level stigma related to harm reduction from themselves, the public, the healthcare system, and the legal and carceral systems. Themes were grouped into four main categories: internalized, interpersonal, intervention, and structural stigma. Stigma across all of these domains negatively impacted the ability of PWID to access harm reduction resources. Positive, non-stigmatizing experiences from others, such as syringe service programs and peer navigators, countered historically negative experiences and promoted greater education and comfort about using harm reduction resources among PWID. To expand the reach of harm reduction services, it is critical to develop interventions that can reduce the stigma against PWID and harm reduction.

Antenatal Care Services Uptake and Associated Factors in Somaliland: Further Analysis of the 2020 Somaliland Demographic Health Survey

Purpose Antenatal care (ANC) is vital to maintain the health of pregnant women and their unborn babies. It was linked to a positive pregnancy experience. However, ANC uptake remained low in Somaliland, and no study has been conducted to assess possible predictors. Hence, the current study aimed to determine the level of ANC utilization and to identify its associated factors in Somaliland. Materials and Methods Somaliland Demographic Health Survey (SLDHS) Data 2020 were used. A weighted sample of 3,192 women aged 15-49 years participated in the study. The survey used a two-stage cluster design for sample selection. Descriptive statistics in the form of frequency and percentage and multilevel multinomial logistic regression analysis were carried out to determine associated factors and statistical significance was declared by p< 0.05. Results The findings showed that 62.4% (95% CI: 60.7-64.1) of the women did not utilize ANC services, while 23.4% (95% CI: 21.9, 24.9) partially utilized and 14.2% (95% CI: 13.0, 15.4) adequately utilized ANC services. The odds of adequately utilizing ANC service decreased by a factor of 0.88 for women aged 35 and above compared to 15 - 24 year old women (AOR= 0.88, 95% CI: 0.61, 1.26). Women with higher educational levels had significantly higher odds (AOR=4.31, 95% CI: 1.54, 12.02) of adequately utilizing ANC compared to those with no formal education. The employment status, marital status, household wealth index, residence and region were also found to be associated with the utilization of Antenatal care. Conclusion The study showed low adequate utilization of ANC services in Somaliland. The variables, including age, education, wealth index, marital status, employment status, residence and region, were significantly associated with ANC utilization. Governmental and non-governmental organizations should enact a strategy with targeted intervention focusing on women from nomadic and rural communities, those from poor households, and low educational levels.

Trend and Determinants of Early Postnatal Care in Nepal with a Focus on Women’s Autonomy

Nepal has made significant strides in improving maternal and child health, notably reducing mortality rates over recent decades. However, challenges persist in meeting the maternal and newborn health targets outlined in the Sustainable Development Goals. Postnatal care is essential for the survival and well-being of both mothers and newborns, yet there is limited research on this topic in Nepal. This study aims to assess trends in early postnatal care coverage and analyze the factors influencing service uptake focusing on women’s autonomy. Using data from the Nepal Demographic and Health Surveys for 2011, 2016, and 2022, which included 10,991 mothers aged 15-49 with at least one live birth, the study revealed significant improvements in postnatal care coverage. The percentage of mothers receiving care within 48 hours increased from 43% in 2011 to 56% in 2016, reaching 72% in 2022. Despite this progress, 28% of mothers and newborns still lack timely postnatal care, which is crucial for their survival and well-being. Regression analysis indicated that women with greater decision-making autonomy are significantly more likely to receive postnatal care (adjusted OR 1.216, P < 0.01), even when accounting for socio-demographic factors. The study highlighted disparities in postnatal care coverage based on age, caste/ethnicity, education, occupation, province, urbanrural residence, wealth, and family size. These findings emphasize the need for targeted interventions to empower women and tailor maternal health programs to address the specific needs. Future research should focus on evaluating complete postnatal care coverage, assessing care quality, and exploring interventions to strengthen maternal health care.

Utilization Postnatal Care Services in Hyolmo Community

Postnatal care (PNC) utilization among the Hyolmo community highlights significant gaps in existing literature and underscores the critical need for targeted healthcare interventions in remote and ethnically distinct populations. This study reveals that, while considerable attention is given to urban and accessible rural populations, remote communities face unique challenges that can impede access to essential maternal health services. The results demonstrate that age, education, and socio-economic factors significantly influence PNC uptake, suggesting disparities that are compounded in remote areas like the Helambu Rural Municipality of Sindhupalchowk District. This study shows that younger mothers, often less aware or hindered by accessibility barriers, are less likely to utilize PNC services compared to their older counterparts. This disparity highlights the necessity for community-specific educational programs that can enhance understanding and encourage the use of PNC services among younger women. Additionally, the influence of education and socio-economic status on PNC utilization points to the broader implications of systemic inequities in healthcare access. Moreover, the study brings to light the role of cultural practices and beliefs in shaping healthseeking behaviors, which varies significantly across different communities. In the traditional beliefs may conflict with modern healthcare practices, there is a clear need for culturally sensitive health interventions that respect and integrate local customs and practices. This research not only contributes to a deeper understanding of the factors affecting PNC service uptake in a specific Nepalese community but also calls for comprehensive policy responses. By addressing the multifaceted challenges faced by the Hyolmo community ranging from geographic isolation to cultural and educational barriers the study advocates for a holistic approach to healthcare. This should include the development of policies that ensure equitable access to health services, enhance community health education, and promote cultural competence among healthcare providers. Ultimately, such efforts are essential for improving maternal and infant health outcomes in remote communities, ensuring that every individual, regardless of their socio-economic or cultural background, has access to the necessary postnatal care.

Applying the Health Belief Model to cervical cancer screening uptake among women in Ethiopia: a systematic reviewand meta-analysis.

Cervical cancer is a leading cause of cancer mortality globally, especially in Africa, including Ethiopia. This review assesses predictors of cervical cancer screening uptake among Ethiopian-eligible women using the Health Belief Model. Higher education levels, perceived susceptibility, severity, and fewer barriers are associated with increased screening. Effective HBM-based interventions could enhance screening rates, potentially reducing cervical cancer incidence and mortality. The review aimed to synthesize the existing literature on the prevalence of Cervical Cancer Screening Service Uptake and Associated Factors among Eligible Women using the Health belief model in Ethiopia, 2024. This systematic review and meta-analysis searched Google Scholar, PubMed, and the Cochrane Library engine. Key terms such as "Cervical cancer screening", "uptake", "utilization", "factors", "barriers", and "Ethiopia" were used to identify relevant articles. Data extraction utilized a detailed form, and the methodological quality of each study was assessed using the JBI quality appraisal checklist for cross-sectional studies. Statistical analysis was conducted using STATA version 17, and the meta-analysis findings were presented using forest plots and tables. The result of seven studies revealed that the overall prevalence of Cervical Cancer Screening Service Uptake among eligible women in Ethiopia was 21% (95% CI: 15%-27%). Factors independently associated with Cancer Screening Service Uptake included: Knowledge (OR = 4.563, 95% CI: 1.012-4.188), age 30 up to 49 (OR = 4.106, 95% CI: 1.562-6.650), history of STD (OR = 2.59, 95% CI: 1.694-4.486), high perceived susceptibility (OR = 3.814, 95% CI: 2.312-5.316), high perceived severity (OR = 2.603, 95% CI: 2.203-3.003), low perceived barrier (OR = 4.390, 95% CI: 1.331-8.449), high perceived self-efficacy (OR = 4.77, 95% CI: 4.102-5.431), high perceived benefit (OR = 3.67, 95% CI: 1.851-5.489), and education level greater than primary level (OR = 4.497, 95% CI: 3.619-5.375). Cervical cancer is a major public health challenge in Ethiopia. Consequently, there is a pressing need for the governments to formulate comprehensive, multi-sectorial policies and strategies. These initiatives should be designed to address the problem influenced by interconnected factors, to reduce the prevalence of cervical cancer in Ethiopia.

Feasibility of an environmental scan-based approach to collecting information about factors impacting cancer genetics services in Latin American countries.

Clinical cancer genetics services are expanding globally, but national policy and health care systems influence availability and implementation. Understanding the environmental factors within a country is required to appropriately implement, adapt, and evaluate cancer genetics service delivery models. An environmental scan (ES) is an approach used in business, public health, health care and other sectors to collect information about an environment or system for strategic decision making and program planning. An ES has been previously used to assess cancer genetics clinic-level factors to inform quality improvement efforts in the United States. We assessed the feasibility of using an ES to collect information about factors that may influence cancer genetics service delivery in the outer-most socio-ecological model environmental levels (policy, national agencies, healthcare systems, cultural considerations) in three Latin American countries. Oncology and Genetics care team members at three participating sites used publicly available sources and personal experiences to complete a data collection form (DCF) that included questions about subtopics: laws and policies, relevant agencies and regulations, health care systems and insurance, and cultural considerations. Time to complete the DCF and DCF completeness were used to measure ES feasibility. Participating sites completed the DCF in 3 months, and most questions (average, 87.0%) were answered. Questions in the cultural considerations subtopic had the fewest answers (average, 77.8%). Overall, the ES was feasible and identified a lack of published literature related to cultural considerations impacting health care and genetics services uptake in Latin America. Environmental factors impact cancer genetics services, and identification of these factors will facilitate future collaborative research and genetics service delivery dissemination efforts.

Compliance with the 2016 WHO’s antenatal care recommendation and its determinants among women in Sub-Saharan Africa: a multilevel-analysis of population survey data

BackgroundDespite the positive impact of adhering to the new antenatal care model on pregnancy outcomes and maternal health service uptake, women in resource-limited settings exhibit low levels of compliance with this recommendation. Previous studies on women’s adherence to the new antenatal care recommendation have been limited to individual countries, with no evidence available at Sub-Saharan Africa (SSA) level. Therefore, this study sought to investigate compliance with the 2016 WHO’s recommendation of at least eight antenatal care contacts among women in SSA countries and identify its determinants.MethodsThe study utilized a weighted sample of 101,983 women who had received antenatal care during their index pregnancy, drawn from recent DHS data of sixteen SSA countries. A multilevel mixed-effect analysis was conducted to identify factors that influence compliance with new antenatal care recommendations. Model comparison was performed using deviance and log-likelihood values, and statistical significance was determined at a P-value of less than 0.05.ResultsThe level of compliance with the recommended antenatal care contacts among women in SSA was 9.9% (95% CI: 9.7-10.1%), with the highest rate in Sierra Leone (26.1%) and lowest in Rwanda (< 1%). A multivariable logistic regression analysis showed that age, education, employment status, household wealth, healthcare decisions, the timing of antenatal contacts, consumption of nutritional supplements, residence, community-level women illiteracy, and media exposure were the significant determinants of compliance.ConclusionOnly one in ten pregnant women in SSA countries had attended the recommended number of antenatal contacts, with Sierra Leone having the highest compliance rate and Rwanda and Senegal having the lowest. Therefore, policymakers should focus on improving access to education, especially for women and their partners, and providing exempted services for pregnant women from low-income households. Interventions that target communities with low levels of literacy and media exposure could also be effective in improving the uptake of the services.

Uptake of early infant HIV diagnosis and its associated factors in Tanzania: an analytical cross-sectional study

The uptake of early infant HIV diagnosis services is crucial for preventing mother to child transmission of virus, and timely management. However, the uptake of the services remains a global challenge, despite major advances in HIV testing. This study investigated the uptake of early infant HIV diagnosis and its associated factors among mothersof exposed infants. The results showed that the uptake of early infant HIV diagnosis was 76%. Factors associated with the uptake are caregivers being married, have higher income level and having adequate knowledge on early infant HIV diagnosis.

Meeting Men Where they are: Motivators and Barriers to Accessing Health Services through a Men's Mobile Wellness Clinic, October 2019 to March 2020, Blantyre, Malawi.

In Malawi approximately, 88.3% people living with HIV are aware of their HIV status. Significant gaps are among men aged 15-34 years; only 72% know their HIV status. To reach men, Jhpiego, in collaboration with the Ministry of Health (MOH), implemented the Men's Mobile Wellness Clinic (MMWC) at workplace settings in Blantyre, Malawi between October 2019 and March 2020. We conducted a descriptive qualitative study to understand motivators and barriers to MMWC service uptake by employees and employers. Primary data was drawn from in-depth telephone interviews from four study populations: employers who accepted or declined to host the MMWC at their worksite, and employees who accessed or did not access the services. We performed a thematic analysis using Nvivo 12 software to identify patterns and themes across the dataset. Main reasons given for using the service among male employees were a desire to know their health status, availability of free health services at the workplace, and good quality services offered by MMWC staff, and support from their supervisor. Men who did not access services stated reasons such as work-clinic scheduling conflicts, lack of adequate promotion of the service, and miscommunication on the criteria about who should attend the MMWC. Employers who accepted to host the MMWC stated convenience and employee's rights to know their health status. Those who declined either stated that employees did not want the services or COVID-19 preventive measures by the MOH between October 2019 and March 2020 restricted participation. This study underscores the potential utility of MMWC services including HIV testing among men. The desire to know their health status, availability of free MMWC services at the workplace, good quality services offered by MMWC staff, and the endorsement of MMWC by supervisors were main motivators to access the MMWC services. Sensitizing supervisors and employees about the benefits of the MMWC services, strengthening demand creation, and clarifying eligibility are important to facilitate MMWC uptake among men in Malawi.

Identifying Geographic Inequities in Family Planning Service Uptake in Pakistan: A Comparative Study of PDHS 2006 and 2017 Using Cluster Hotspot Analysis

Identifying Geographic Inequities in Family Planning Service Uptake in Pakistan: A Comparative Study of PDHS 2006 and 2017 Using Cluster Hotspot Analysis

Validity of a visual analogue scale to measure and value the perceived level of sanitation - evidence from Ghana and Mozambique.

Two billion people globally lack access to a basic toilet, and sanitation is a critical determinant of health and wellbeing. Evaluations of sanitation programmes typically measure disease or behaviour, and visual analogue scales (VAS) have not been used to measure users' feelings about their level of sanitation. In this study, we assess the validity of a horizontal sanitation VAS numbered 0-10, with end-anchors "best imaginable" and "worst imaginable" sanitation. In Kumasi, Ghana, we surveyed 291 participants before and after uptake of a container-based sanitation service. In Maputo, Mozambique, we surveyed 424 participants from treatment groups of a prior trial. We assessed construct validity by testing hypothesised associations between VAS scores and toilet characteristics, and by respondents valuing three hypothetical sanitation states. We assessed responsiveness by comparing VAS with/without sanitation interventions. There was evidence (p<0.05) for 60% of hypothesised associations in Ghana, and 100% in Mozambique. For responsiveness, there was a 3.4 point increase (2.1 SD) in VAS 10 weeks post-intervention in Ghana, and a 2.9 point difference (1.3 SD) in Mozambique. In valuation exercises, the mean was higher (p<0.001) for the objectively better sanitation state. The sanitation VAS could be useful in economic evaluation to identify which improvements achieve quality of life gains most efficiently. For future studies we recommend a vertical sanitation VAS numbered 0-100 with emojis at end-anchors but retaining a 0-10 option for those who struggle with numeracy.

Marketing mental health services: a mixed-methods analysis of racially and ethnically diverse college students’ engagement with and perspectives on U.S. university mental health clinics’ websites

BackgroundThe United States (U.S.) faces a significant mental health crisis, with around 52.9 million adults experiencing mental health disorders, with young adults (18–25 years old), such as college students, having the highest prevalence and lowest service utilization rates. While efforts to expand mental health services through “push” strategies are in place (e.g., training therapists in evidence-based therapies), limited initial engagement suggests a need for “pull strategies” and targeted marketing that make services attractive to college students and increase demand. This mixed-methods study identifies U.S. university mental health clinic websites and website characteristics that are attractive and engaging to college students interested in seeking mental health services (i.e., students were considering or actively looking for mental health support).MethodsEleven U.S. university websites were chosen (10 randomly and one from the university where students were attending) from a pool of 44 Psychological Clinical Science Accreditation System training clinics websites. Fifty-seven college students (Mage = 20.95, SD = 2.97; 81% female; 68% racial/ethnic minority) were videorecorded engaging with two U.S. university mental health clinic websites, completed self-report engagement measures, and gave detailed feedback about websites through semi-structured interviews.ResultsLikert scale scores revealed moderate engagement with all websites (e.g., they were interesting and helpful). Qualitative results indicated that websites that provided important and easily understood information about key features of services (e.g., types, evidence-base, and cost), therapist backgrounds, psychoeducation, used lay language, and had an appealing website layout (e.g., color, font, images, organization, and interactive components) generated greater consumer interest and trust in their mental health services.ConclusionsThis study emphasizes the importance of using marketing strategies to enhance college students’ engagement through mental health service websites. Salient features, psychoeducation, and effective promotional strategies (e.g., how information is presented) were identified as crucial for website engagement and subsequent mental health service uptake. Using marketing strategies, such as tailoring language to consumer literacy levels, describing the evidence-base of services, and improving website design may address college students’ needs and enhance initial mental health service engagement.

Trends in the Uptake of Index Testing among Adolescents in USAID-Supported PEPFAR Programs, October 2017- September 2022.

Adolescents 10-19 years account for a growing proportion of people living with HIV (PLHIV). In 2023, 140,000 adolescents were diagnosed with HIV, yet knowledge of HIV status and uptake of testing services remain critically low. Index testing - offering testing to contacts of PLHIV - is an important case-finding strategy. In 2021, PEPFAR expanded guidance to explicitly include older adolescents 15 to 19 years. We reviewed index testing data to assess uptake and case-finding trends among biological adolescent-aged children and siblings of PLHIV 10-19 years. Routinely collected programmatic data from 27 USAID-supported PEPFAR country and regional programs were analyzed for fiscal years (FY) 2017 through FY2022 (October 2016 - September 2022). We compared the volume of index testing and subsequent new diagnoses across FYs and countries among biological adolescent-aged children and siblings of PLHIV, and disaggregated by age, 10-14 and 15-19 years, and sex. Index testing among adolescents 10-19 years increased from FY17 to FY22, nearly doubling from 147,088 to 291,534. Similarly, new diagnoses among adolescents increased between FY17 and FY22 (3,721 vs 10,730). Overall, across FYs, index testing uptake and case-finding were higher among females than males, and the gap in testing uptake between sexes was larger for older than younger adolescents. Index testing uptake has increased substantially among adolescents over time, with rebounded gains for adolescents 15-19 years noted beginning in FY21. However, uptake across age and sex remained uneven, highlighting an opportunity to ensure targeted testing strategies are employed to reach adolescents 15-19 years and males.

Genetic Testing Practices and Pathological Assessments in End Stage Heart Failure Patients Undergoing Heart Transplantation and Left Ventricular Assist Device

BackgroundGenetic cardiomyopathies (CM) are increasingly recognized as causes of end-stage heart failure (ESHF). Identification of a genetic etiology in ESHF has important prognostic and family implications. However, genetic testing practices are understudied in ESHF patients. MethodsThis single-center, retrospective study included consecutive ESHF patients who underwent heart transplantation (HT) or left ventricular assist device (LVAD) from 2018 to 2023. Data, including genetic testing and pathology reports, were collected from the electronic medical record. Analyses of demographic and clinical characteristics were stratified by genetic testing completion and presence of clinically actionable variant. Logistic regression was performed to evaluate for associations between histology findings and genetic variants. ResultsA total of 529 adult patients (mean age 57 years) were included in the study and were predominantly male (79%, 422/529) and non-white (61%, 322/529). Genetic testing was performed in 54% (196/360) of patients with either non-ischemic or mixed CM. A clinically actionable result was identified in 36% (70/196) of patients, of which, only 43% (30/70) had a genetic counselor referral. The most common genetic variants were TTN (32%, 24/75), MYBPC3 (13%, 10/75), and TTR (11%, 8/75). Clinically actionable variants were identified in patients with known heart failure precipitators, such as alcohol use. In multivariable analysis, presence of interstitial fibrosis, specifically diffuse, on pathology was significantly associated with a clinically actionable variant (aOR 2.29, 95% CI [1.08-4.86], p = 0.03). ConclusionESHF patients with non-ischemic or mixed CM undergoing advanced therapies had a low uptake of genetic services, including testing and counselors, despite a high burden of genetic disease. Pathology findings, such as interstitial fibrosis, may provide insight into genetic etiology. The underutilization of services suggests a need for implementation strategies to improve uptake.

Leveraging Fintech mobile money to expand banks’ financial services in developing countries

Mobile money consists of payments through mobile devices using Fintech platforms. Despite the accelerated mobile money adoption in developing countries, financial inclusion levels lag those in the developed world. We unveil how disruptive Fintech can foster financial inclusion, by examining a sample of nearly 70,000 observations from 70 emerging countries in 2021. Our results indicate that mobile money and its associated epidemic effects enhance the transition to deposit and credit-based financial services if institutional conditions and banks’ financial technologies are well aligned. This suggests that non-banks’ Fintechs can facilitate the uptake of financial services provided by conventional banks.

Social Risk Factor Domains and Preventive Care Services in US Adults

Growing evidence suggests that social determinants of health are associated with low uptake of preventive care services. To examine the independent associations of social risk factor domains with preventive care services among US adults. This cross-sectional study used National Health Interview Survey data on 82 432 unweighted individuals (239 055 950 weighted) from 2016 to 2018. Subpopulations were created for each of the primary outcomes: routine mammography (women aged 40-74 years), Papanicolaou test (women aged 21-65 years), colonoscopy (adults aged 45-75 years), influenza vaccine (adults aged ≥18 years), and pneumococcal vaccine (adults aged ≥65 years). Statistical analysis was performed from July to December 2023. Six social risk domains (economic instability, lack of community, education deficit, food insecurity, social isolation, and lack of access to care) and a count of domains. Logistic regression models were used to examine the independent association between each primary outcome (mammography, Papanicolaou test, colonoscopy, influenza vaccine, and pneumococcal vaccine) and social risk factor domains, while controlling for covariates (age, sex, race and ethnicity, health insurance, and comorbidities). A total of 82 432 unweighted US individuals (239 055 950 weighted individuals) were analyzed. A total of 54.3% were younger than 50 years, and 51.7% were female. All 5 screening outcomes were associated with educational deficit (mammography: odds ratio [OR], 0.73 [95% CI, 0.67-0.80]; Papanicolaou test: OR, 0.78 [95% CI, 0.72-0.85]; influenza vaccine: OR, 0.71 [95% CI, 0.67-0.74]; pneumococcal vaccine: OR, 0.68 [95% CI, 0.63-0.75]; colonoscopy: OR, 0.82 [95% CI, 0.77-0.87]) and a lack of access to care (mammography: OR, 0.32 [95% CI, 0.27-0.38]; Papanicolaou test: OR, 0.49 [95% CI, 0.44-0.54]; influenza vaccine: OR, 0.44 [95% CI, 0.41-0.47]; pneumococcal vaccine: OR, 0.30 [95% CI, 0.25-0.38]; colonoscopy: OR, 0.35 [95% CI, 0.30-0.41]). Fully adjusted models showed that every unit increase in social risk count was significantly associated with decreased odds of receiving a mammography (OR, 0.74 [95% CI, 0.71-0.77]), Papanicolaou test (OR, 0.84 [95% CI, 0.81-0.87]), influenza vaccine (OR, 0.81 [95% CI, 0.80-0.83]), pneumococcal vaccine (OR, 0.80 [95% CI, 0.77-0.83]), and colonoscopy (OR, 0.88 [95% CI, 0.86-0.90]). This cross-sectional study of US adults suggests that social risk factor domains were associated with decreased odds of receiving preventive services; this association was cumulative. There is a need to address social risk factors to optimize receipt of recommended preventive services.