Worker Program Research Articles

P-181. Limited oxygen therapy capacity against COVID-19 and the public health response in Zambia 2021

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic revealed the limited capacity of intensive oxygen therapy in Zambia, especially in provincial medical facilities. Zambia COVID-19 treatment centers with newly installed HFNC and NPPV devices in 2021 Methods The Ministry of Health (MoH) conducted a clinical chart review of COVID-19 cases admitted to 11 COVID-19 treatment centers across Zambia to evaluate oxygen therapy practices and clinical outcomes. Then, MoH launched a multidisciplinary capacity-building project targeting four national COVID-19 treatment centers in the provinces aiming to deploy high-flow nasal cannula (HFNC) and non-invasive positive pressure ventilation (NPPV) coupled with training for healthcare workers. The chart review and the reporting of the project were approved by National Health Research Authority, Zambia (NHRA000006/15/10/2021, NHRA00003/25/04/2022), and Tohoku University, Japan (2021-1-983, 2022-1-287). Results Among 1,687 cases of severe/critical COVID-19, 84 cases (5%) were treated without oxygen, 687 (41%) were administered with oxygen only via nasal cannula, 759 (45%) via conventional masks, and 157 cases (9%) received intensive oxygen therapy, including HFNC, NPPV, and invasive mechanical ventilation. Compared to the capital Lusaka, COVID-19 cases treated in the provinces were more likely to receive oxygen administration only via nasal cannula and less likely to receive intensive oxygen therapy. To strengthen the intensive oxygen therapy capacity in the provinces, MoH installed HFNC and NPPV devices in four provincial medical facilities equipped with oxygen plants and piping in October and November 2021. MoH also provided a five-day training program for healthcare workers focusing on clinical knowledge/skills of HFNC and NPPV in COVID-19 and infection prevention and control in aerosol-generating procedures. Conclusion Our study identified the inequity of intensive oxygen therapy capacity between Lusaka and the provinces in Zambia and the need for further strengthening. A multidisciplinary approach coordinating national experts was practical in rapidly deploying HFNC and NPPV amid the COVID-19 pandemic. Disclosures All Authors: No reported disclosures

A Digital Tool (Technology-Assisted Problem Management Plus) for Lay Health Workers to Address Common Mental Health Disorders: Co-production and Usability Study in Pakistan.

Mental health remains among the top 10 leading causes of disease burden globally, and there is a significant treatment gap due to limited resources, stigma, limited accessibility, and low perceived need for treatment. Problem Management Plus, a World Health Organization-endorsed brief psychological intervention for mental health disorders, has been shown to be effective and cost-effective in various countries globally but faces implementation challenges, such as quality control in training, supervision, and delivery. While digital technologies to foster mental health care have the potential to close treatment gaps and address the issues of quality control, their development requires context-specific, interdisciplinary, and participatory approaches to enhance impact and acceptance. We aimed to co-produce Technology-Assisted Problem Management Plus (TA-PM+) for "lady health workers" (LHWs; this is the terminology used by the Lady Health Worker Programme for lay health workers) to efficiently deliver sessions to women with symptoms of common mental health disorders within the community settings of Pakistan and conducted usability testing in community settings. A 3-stage framework was used for co-producing and prototyping the intervention. Stage 1 (evidence review and stakeholder consultation) included 3 focus group discussions with 32 LHWs and 7 in-depth interviews with key stakeholders working in the health system or at the health policy level. Thematic analyses using the Capability, Opportunity, and Motivation for Behavioral Change (COM-B) model were conducted. Stage 2 included over eight online workshops, and a multidisciplinary intervention development group co-produced TA-PM+. Stage 3 (prototyping) involved 2 usability testing rounds. In round 1 conducted in laboratory settings, 6 LHWs participated in role plays and completed the 15-item mHealth Usability App Questionnaire (MUAQ) (score range 0-7). In round 2 conducted in community settings, trained LHWs delivered the intervention to 6 participants screened for depression and anxiety. Data were collected using the MUAQ completed by LHWs and the Patient Satisfaction Questionnaire (PSQ) (score range 0-46) completed by participants. Qualitative analysis indicated that a lack of digital skills among LHWs, high workload, resource scarcity for digitization (specifically internet bandwidth in the community), and need for comprehensive training were barriers for TA-PM+ implementation in the community through LHWs. Training, professional support, user guidance, an easy and automated interface, offline functionalities, incentives, and strong credibility among communities were perceived to enhance the capability, opportunity, and motivation of LHWs to implement TA-PM+. TA-PM+ was co-produced with features like an automated interface, a personal dashboard, guidance videos, and a connected supervisory panel. The mean MUAQ score was 5.62 in round 1 of usability testing and improved to 5.96 after incorporating LHW feedback in round 2. The mean PSQ score for TA-PM+ was 40 in round 2. Co-production of TA-PM+ for LHWs balanced context and evidence. The 3-stage iterative development approach resulted in high usability and acceptability of TA-PM+ for LHWs and participants.

The SDG 3 Enhancement Through Health-Service Management in Post-Conflict Afghanistan: Resource Allocation, Training, Community Engagement, and Data Use

Purpose: This study aims to identify critical factors that enhance health service delivery in post-conflict Afghanistan, focusing on effective resource allocation, comprehensive training programs for healthcare workers, community engagement, and the utilization of Health Management Information Systems (HMIS) data. The novelty of this research lies in its integrative approach to addressing health service delivery in post-conflict settings. Unlike previous studies that have often examined these factors in isolation, this research uniquely combines them to provide a comprehensive framework for improving healthcare outcomes. Method: Using a narrative literature review methodology, this study synthesizes findings from peer-reviewed journals, government reports, and international health organization publications. Results and Discussion: The findings reveal that targeted resource allocation is essential for reducing health inequalities and improving service delivery. Comprehensive training programs enhance the skills and knowledge of healthcare providers, leading to better service quality and management efficiency. Community engagement fosters a sense of ownership and accountability, improving health practices and outcomes. Effective utilization of HMIS data enhances decision-making, monitoring, and resource allocation. The study concludes that a holistic approach, integrating these elements, is necessary to build resilient health systems in post-conflict settings. Research Implications: The implications for policymakers and health managers include prioritizing resource allocation, training, community engagement, and data utilization to improve health outcomes. Future research should focus on developing and implementing strategies that incorporate these factors to strengthen health systems in similar environments. Originality/Value: The novelty or urgency of this study is underscored by the profound disruptions in Afghanistan's healthcare system following the Taliban's takeover in August 2021. Decades of conflict have severely impacted healthcare delivery, exacerbating existing challenges and creating new barriers to accessing essential services. The withdrawal of international aid and restrictive policies have further strained the healthcare infrastructure, particularly affecting vulnerable populations such as women and children. This urgent backdrop justifies the need for a comprehensive analysis to identify strategies that can effectively address these challenges.

The impact of the Lesotho health reform in the re-structuring of the village health workers program

BackgroundCommunity Health Workers locally known as Village Health Workers (VHW) in Lesotho are key members of the primary health workforce, and has been playing a significant role in building primary health systems in many countries and they can fill significant gaps in human resources as low and middle income countries work towards universal health coverage in the era of Sustainable Development Goals (SDGs). The 2014 Lesotho health reform restructured the VHW program to compensate, professionalize, and integrate VHWs into primary care services. We sought to document the ways in which the VHW program changed as a result of the health reform and the perceived impact of those changes.MethodsIn 2018, we conducted a qualitative research study with an inductive content analysis approach in the four pilot health reform districts of Lesotho. We conducted 26 in-depth interviews with health workers practicing in the community and in primary health facilities, as well as district health authorities, and Ministry of Health officials.ResultsWe found that the Lesotho health reform program was observed that it helped to professionalize the VHW program by introducing clear roles and responsibilities, regular monitoring, and supervision. The initiation of performance-based payment of VHWs and regular monitoring and reporting was thought contribute to overall improvement; in performance, strengthened links between communities and facilities, and promoted uptake of services.ConclusionThe Lesotho Health Reform program was felt to be highly effective in re-structuring the VHW program in Lesotho, suggesting that when VHWs are well-incentivized, monitored, and supervised they can better fulfil their essential role as the backbone of the primary health workforce.

From Worker Victory to Policy Reform: Injured Migrant Workers Fight for Return to Work Justice in Workers' Compensation in Ontario, Canada.

This article explores the challenges facing injured migrant farm workers in the workers' compensation system in Canada's province of Ontario, with a focus on their fight for return to work justice. Told from the perspective of one of the lawyers who represented the workers, it highlights a recent victory achieved by 4 workers in the Seasonal Agricultural Worker Program in defending their rights to workers' compensation support. The workers' compensation tribunal decided that the workers' compensation board must evaluate these workers' ability to return to work, access retraining, and receive compensation based on their labor markets in Jamaica-instead of based on fictional job prospects in Ontario. The tribunal also called out the need to consider systemic anti-Black racism in workers' compensation law and policy. The article analyzes how this legal victory could reshape workers' compensation policy in Ontario for injured migrant farm workers. It also discusses the implications of the win for injured workers in other temporary work programs and precarious employment sectors.

Addressing Health-Related Social Needs During COVID-19 Through a Hospital-Based, Community Health Worker Program: A Case Study.

Background. Despite accounting for 34% of the population in Austin, Texas, Latinx individuals made up 50% of those who tested positive for coronavirus, 54% of COVID-related hospitalizations, and 51% of COVID-related deaths between March and June 2020. Of hospitalized Latinx patients, 40% had never seen a primary care provider and many had undiagnosed health conditions. A community health worker (CHW) pilot program was implemented based on these disparities. Method. This mixed-method implementation study describes a hospital-based, CHW program for Latinx patients hospitalized with COVID-19 at an academic medical center in Austin, Texas. The program included a social needs assessment, care coordination, and post-discharge follow-up. Patient data include demographics from the full sample (N = 57), social determinants of health (n = 24), and qualitative interviews (n = 6). Focus group data from health care professionals (n = 26) is also presented to describe the benefits of the CHW program. Results. Latinx patients in this study, two-thirds of who primarily spoke Spanish, reported high levels of satisfaction with the CHW program with fewer reported social needs after the CHW program. Health care providers underscored CHW expertise in addressing complex social needs, providing continuity of care within the hospital, and closing the loop through community resource navigation. Conclusion. This study demonstrated the capacity of CHWs to provide holistic care in hospital settings through trust building and increased capacity to address health-related social needs. Investment in hospital-based, CHW programs for vulnerable populations such as uninsured, Spanish-speaking patients is necessary to reduce health disparities beyond COVID-19.

The Rapid Rise of Silicosis in Victoria, Australia Associated With Artificial Stone Countertop Industry Work.

The fabrication and installation of artificial (engineered) stone countertops is a relatively new cause of silicosis. Our aim was to investigate silicosis rates in Victoria, Australia, and the association with stone countertop industry work. Workers' compensation claims for silicosis from January 1, 1991 to December 31, 2022 were analyzed across 8-year time periods. Incidence rates per 100,000 persons were calculated by time period, age, and sex. Additionally, incident silicosis cases were reported to a clinical registry by respiratory physicians from May 1, 2019 to December 31, 2022, and analyzed by referral source and occupational history. Over 32 years, there were 536 workers' compensation claims for silicosis (98.9% male, median age 40 years). In total, 482 (89.9%) were received between 2015 and 2022, a 27-fold increase from the previous 8-year period. The incidence rate for silicosis claims in the adult population increased from 0.12 per 100,000 in 1991-1998 to 2.38 per 100,000 in 2015-2022. In the clinical registry there were 210 incident cases between 2019 and 2022; 97% worked in the countertop industry, 95% with artificial stone. Almost all (89%) cases had been referred following participation in a government screening program for stone countertop industry workers. There has been a major rise in compensation claims for silicosis in Victoria. Active screening of stone countertop workers led to the diagnosis of almost all registered incident silicosis cases. This underscores the risk to stone countertop workers and highlights the potential for under-recognition of silicosis without screening at-risk workers, especially in countries where artificial stone has become popular.

Improving health outcomes by strengthening public sector capacity in social and behaviour change programming in Nigeria: a qualitative study

ObjectiveThis paper examines the outcomes of the public sector capacity strengthening (PSCS) approach and how they contribute to the promotion of maternal, newborn, and child health, and nutrition (MNCH+N), family...

Challenges to Achieving Surgical Equity in Slums.

There is a critical lack of surgical data on individuals who live in urban slums, which hampers the allocation of healthcare resources and the provision of preventative measures. The complex interplay of factors affecting surgical care in slums, such as trust deficits, mental health concerns, and socioeconomic barriers, necessitates a distinct academic approach. We propose that researchers should consider "slum surgical health" as an area of study separate from urban health or slum health. From this perspective, we make a case for defining "slum surgical health" while presenting evidence from multiple countries that shows the unique challenges of providing surgical care in slum settings. We discuss a successful model that has deployed community health worker programs as intermediaries between slum dwellers and healthcare providers. This model, which achieved a 60% conversion rate from unmet to met surgical needs, demonstrates the potential of culturally sensitive, community-based approaches to address surgical inequities in urban slums.

Enhancing Well-being at Work: Qualitative Insights into Challenges and Benefits of Long-term Yoga Programs for Desk-based Workers

Enhancing Well-being at Work: Qualitative Insights into Challenges and Benefits of Long-term Yoga Programs for Desk-based Workers

Knowledge and occupational practices of beauticians and barbers in the transmission of viral hepatitis: A mixed-methods study in Volta Region of Ghana.

Hepatitis B and C viral (HBV and HCV) infections are endemic in Ghana. Also, the National Policy on Viral Hepatitis stipulates that there is unreliable data, limited knowledge, and a deficiency in research on viral hepatitis, especially among some high-risk workers in the eastern part of the country. This study therefore assessed the knowledge level and occupational practices of street beauticians and barbers in the transmission of HBV and HCV in the Volta Region of Ghana. A cross-sectional mixed methods study was conducted in Volta Ghana from April to June 2021. An in-depth interview was used to collect data from five environmental health officers who were selected as key informants in the qualitative stage. Structured questionnaires/checklists and direct observations were employed to collect data from 340 street beauticians and barbers in the quantitative stage. During the qualitative stage, the process of coding, and mind mapping via thematic analysis was carried out. Furthermore, descriptive and inferential analyses were performed using Stata version 17.0 at a 95% significance level in the quantitative stage. Most street beauticians and barbers reported poor knowledge levels about HBV and HCV (67.0%), although the awareness of this viral hepatitis was high (88.2%). While almost one-third of the participants observed safe occupational practices (31.5%), about 29.0%, 49.4%, and 55.3% of them also followed hand hygiene protocols, wore protective clothes/gloves, and sterilized or disinfected tools after use respectively. Street beauticians and barbers with higher (tertiary) education (AOR = 6.15; 95%CI = 1.26-29.9; p = 0.024), those who had heavy workload of more than 20 customers per day (AOR = 3.93; 95%CI = 1.26-12.3; p = 0.019), and those who had work experience of at least four years (AOR = 1.65; 95%CI = 1.02-2.69; p = 0.040) were more likely to have good knowledge level about viral hepatitis. Additionally, beauticians were more likely to adhere to safe occupational practices as compared to barbers (AOR = 11.2; 95%CI = 3.46-36.3; p<0.001). The key informant interviews revealed that there was a lack of licensing, monitoring, and planned training for street beauticians and barbers, although their services are rampant in the Volta Region. Participants showed high awareness but limited knowledge about HBV and HCV infections. The general safety practices among the participants were poor. Our study results suggest possible viral transmission through the activities of street beauticians and barbers which could be attributed to the lack of regulatory systems and training of these cosmetologists. Policy-makers and regulatory bodies should institute and enforce rigorous policies and guidelines on job-related safety measures and health practices including regular training, monitoring, screening, and vaccination programs for these high-risk community workers in Ghana.

Quality Assessment of a Medical Prescription for Antibiotic Therapy

Objective: Our study aimed to assess the quality of antibiotic prescriptions and identify potential opportunities for improvement in antibiotic use in our setting. Methodology: This is how we conducted a prospective cross-sectional descriptive study which concerned 404 prescriptions collected in the pharmacy of the HGR mwangeji Results: The most prescribed antibiotic families were beta lactams with 60.15%, followed by imidazoles with 11.88% and fluoroquinolones or 8.1%; they were more prescribed in INN with 70% in the following galenic forms: tablets 46.8% followed by bottles 17.1% and finally suspensions with 12.6% with an unspecified route of administration in 80.9%. The dosage, dose, total quantity and duration of treatment were specified respectively as follows: 86.9%; 62.4%; 98.3% and 80.4%. Most of the prescriptions bore the name and first name of the patients 82.9%; The age of the patient was indicated at 75.2%; Almost all of the prescriptions did not have the weight of the patient indicated (97%); Almost all of them bore the sex of the patient (97.6%); Not all prescribers wore the patient's size (100%). In 84.4% of cases, prescribers had indicated their name on the prescriptions; A large number of prescription slips did not bear the prescriber status 86.6%; Almost all prescribers had indicated their place of practice 99.5%; 97% of prescribers had not indicated their contact details on the prescriptions; The minority 18.6% of prescribers had not signed on the prescriptions; The order number is shown on the majority of prescription slips 83.7%. Conclusion: The results of this study remain relevant. They will help improve training programs for health workers by establishing interactive information for practitioners, through visits and intensive supervision by more experienced managers in the hierarchy, this would be likely to optimize the quality of practitioners' prescriptions ; so that they better master the principles of prescribing antibiotics . Keywords: Prescription, Antibiotics, evaluation, quality, medical, antibiotic therapy

E Employment Inequality and Poverty Dynamics in NTT: An Analysis of Causal Factors and Policy Implications

Employment inequality and poverty in East Nusa Tenggara (NTT) are important issues that are interrelated and are the main concerns in this study. Limited access to education, dominance of the informal sector, and inequality in employment opportunities are the backgrounds that worsen employment conditions and poverty in NTT. This research was conducted through a qualitative-descriptive approach with a literature review method that relied on secondary data from various previous studies. The results of the study show that low labor quality, insufficient wages, and dependence on the informal sector are the main factors causing poverty in NTT. The proposed policy recommendations include increasing access to vocational education, certification programs for informal workers, and the development of an informal sector that is able to provide decent wage jobs.

Антистресс-обучение медицинских работников скорой помощи: возможности, направления, оценка эффективности

&lt;p&gt;The work is &lt;strong&gt;aimed&lt;/strong&gt; at finding technologies to protect professionals from the ever-increasing negative stressors of their life and professional environment. The objective of the study was to evaluate the effectiveness of a short-term anti-stress training program for emergency medical workers. The study &lt;strong&gt;participants&lt;/strong&gt; included employees of several emergency medical teams (n = 30, 73% women, 27% men; age 27&amp;ndash;42 years (M = 32.2)) divided into an experimental (n = 15, 80% women, 20% men) and a control (n = 15, 67% women, 33% men) group. The study included two diagnostic measurements of the current state, stress level, and burnout of specialists before and after (10 days later) the &lt;em&gt;anti-stress training program&lt;/em&gt;, which included 7 1.5-hour sessions over 14 days. The &lt;strong&gt;methods&lt;/strong&gt; used were: &amp;ldquo;The scale-thermometer of self-assessment of the current state&amp;rdquo; (A.O. Prokhorov), Methodology for assessing the dominant state (DS-6 by L.V. Kulikova), Differential diagnostics of states of reduced performance (DORS by A.B. Leonova and S.B. Velichkovskaya), burnout test by K. Maslach (adaptation by Vodopyanova), stress level test by V.Yu. Shcherbatykh (2022 version). The &lt;strong&gt;results&lt;/strong&gt; obtained indicate an improvement in the activity and performance indicators of the participants in anti-stress training, an increase in the subjective value of the activity and their contribution to the profession, a decrease in the level of fatigue, emotional and physiological manifestations of stress. &lt;strong&gt;Conclusion&lt;/strong&gt;: the effectiveness of not only long-term but also short-term anti-stress training has been demonstrated, with a systematic organization of mastering the skills of self-regulation and personal resource growth.&lt;/p&gt;

Profilaxia pós-exposição ocupacional contra o vírus da imunodeficiência humana para trabalhadores da área de saúde vítimas de acidentes com material biológico

Introduction: Postexposure prophylaxis (PEP) reduces the risk of human immunodeficiencyvirus (HIV) transmission after workplace exposure of health care workers. Objectives: Toevaluate adherence to postexposure prophylaxis for HIV, incident characteristics, post-incidentinitiation of therapy, and reported adverse effects among treated health care workers. Methods: Epidemiologic, descriptive, retrospective study based on analysis of workplace incident reports involving exposure to biological materials from 2011 to 2020 at a university hospital. Data were analyzed using descriptive statistics, odds ratio using simple logistic regression, and comparison of variables using Fisher’s exact test (p&lt;0.05). Results: A total of 516 cases eligible for prophylaxis were analyzed and divided into three risk groups: 168 (32.6%) involving HIV-positive source patients, 263 (50.9%) involving source patients with unknown infection status, and 85 (16.4%) involving source patients in the window period. Most cases involved females (74.80%), injuries from percutaneous exposure (80.42%), contact with blood (56.59%), and nursing technicians (30.46%). Full compliance and adherence with drug therapy (28 days) was reported in 77.45% of the workers, and the time between the incident and the start of prophylaxis was within 24 hours of the incident in 94.27% of the workers. In total, 205 (39.73%) of the workers discontinued outpatient follow-up, which was associated with education, risk group, and occupation. Conclusions: Incidents involving contaminated sharp instruments pose an increased risk of infection by pathogens transmitted primarily by blood. Workplace HIV infection can be prevented by providing mandatory training programs for workers on proper work practices, use of devices with retractable needles and needle protection systems, safe and proper disposal of materials,use of personal protective equipment, and appropriate workplace postexposure interventions, including PEP. None of the workers who completed outpatient follow-up seroconverted to HIV, thus demonstrating the protective effect of PEP. Regular training is recommended, with an emphasis on incident prevention, infection control, and health education, combined with case reporting strategies.

Needs and presence of temporary migrant workers in the regions of Quebec (Canada): From public data to a unified database

Background During the recent years of labour shortage, many employers and employer associations have been calling for the recruitment of more temporary migrant workers (TMW) in the province of Quebec. The various programs, the needs expressed by employers, and the problems encountered by TMWs remain largely unknown to the structures that receive these workers (municipalities, Regional County Municipalities or RCM …) or help them (associations …). The real number of TMWs in each local territorial division (Administrative regions, RCM and municipalities) remains unknown. It is therefore difficult to develop welcoming policies or an inclusive framework that meets the needs of these populations. Objective To develop a more detailed knowledge of the presence of TMWs in Quebec and the needs expressed by employers. Methods Design of a unified database to elaborate a statistical portrait of the needs expressed by employers and the presence of TMWs in the province of Quebec by stream of the Temporary Foreign Worker Program (TFWP), by skill level, and by territory from 2017 to 2022. An exploratory data analysis to summarize the main characteristics of this longitudinal sample using statistical graphics and maps was conducted. Results There are substantial differences between regions and their territories regarding the streams of the TFWP, occupations and skills needed. The data also illustrate the prominence of some companies who hire a large number of TMWs in the province of Quebec and the effect of the COVID-19 lockdowns. Conclusion Our analysis shows an increase of various types of TMWs in specific administrative regions and a gap in statistical data about workers from the TFWP for the organizing efforts of local environments (RCM, municipalities and their community sector) to respond to the needs of a growing number of these workers.

Looking beyond efficacy: The implementation science exploration of the Australian PITCH study, a national stepped‐wedge cluster RCT evaluating a dementia training program for home care workers

Looking beyond efficacy: The implementation science exploration of the Australian PITCH study, a national stepped‐wedge cluster RCT evaluating a dementia training program for home care workers

Study Protocol for a Randomized Health and Social Literacy Intervention to Improve Maternal Health in Pakistan

Many poor and illiterate women in reproductive years in Pakistan live in underdeveloped areas and are solely dependent on free primary health services provided by the state through the Lady Health Worker (LHW) Programme. These women need higher health and social literacy to make informed health decisions and receive inferior services from overburdened LHWs. This project aims to deliver a health and social literacy intervention by integrating Community Social Workers (CSWs) at the primary level to promote maternal health in the country. A 24-month intervention with six health and social literacy modules will be delivered by trained CSWs. Multistage randomized sampling will be used to sample 6 BHUs across six cities from six districts of Punjab, Pakistan. A total of 360 women will be sampled and assigned randomly to the experiment and control groups. Pakistan needs to catch up on its sustainable development goals for maternal health, not just due to the limitations of the existing services, but also due to the low health and social literacy of women, which prevents effective uptake. Each LHW is expected to have an estimated 1,500 women clients for multiple services, which makes support for women’s literacy and awareness difficult. Integrating a partner workforce or CSWs to support disadvantaged women for improved maternal health outcomes is critically needed. The results of this intervention will advise policymakers and stakeholders about long-term plans for literacy support of women and the integration of CSWs in the primary healthcare setup.

Measuring the impact of a pastoral care intervention to increase referrals and improve the quality of chaplain documentation in patient records

The complexity of patient care demands that health care teams collaborate effectively. This means that when pastoral care staff engage with patients, they need to communicate their findings to other members of the multidisciplinary team to maximize patient benefits. In 2016, an Australian hospital found that pastoral care staff were able to visit only 30% of admitted patients, and that documentation of pastoral care visits was minimal. This paper describes and measures the impact of a quality improvement education program for pastoral care workers by auditing patient medical records pre- and post-intervention. The intervention did not significantly increase the number of pastoral care visits or referrals. Documentation of pastoral care visits was significantly improved in terms of the detail provided. More work is required to standardize indications for pastoral care referral and templates for pastoral documentation in patient medical records.

Recent infection testing to inform HIV prevention responses and surveillance in a programme context: lessons from implementation within a nationally scaled female sex worker programme in Zimbabwe.

In the context of key population HIV testing programmes, identifying new HIV acquisitions, tracking incidence, and responding with prevention and treatment interventions will be critical for achieving HIV epidemic control. Laboratory tests for recently acquired HIV used as part of a "recent infection testing algorithm" (RITA), offer a potential tool to support this work. We implemented a RITA for female sex workers (FSWs) in Zimbabwe to explore opportunities and programmatic benefits. Between October 2021 and January 2023, recency testing was offered to FSWs attending the Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe's key populations programme. Dried blood spot (DBS) samples were taken at 86 clinic sites across 10 provinces and Laboratory LAg Avidity and viral load testing conducted. RITA results were analysed and linked to programme data to explore geographical differences and calculate HIV incidence. We describe concurrent efforts in HIV testing for social (social network testing [SNT]) and sexual (index case testing [ICT]) contacts of those testing HIV positive. Among 24,976 FSWs tested at programme sites, 9.5% (2363/24,976) were confirmed HIV positive. We enrolled 55.5% (1311/2363) of eligible HIV-positive FSWs to our study, of whom 11.7% (153/1311) were identified as having recently acquired HIV. It took a median of 37 days (IQR 20-67) for samples to be processed. Enrolment rates varied between provinces but the proportion of recently acquired HIV was similar (range: 18.4% to 4.0%). Overall HIV incidence was 3.4 (95% CI 2.7-4.0) per 100py. Where results could be linked to routinely collected data, we found no evidence of a difference in test-positivity between the ICT and SNT contacts of those with recently acquired compared to those with long-term HIV. Implementation of a RITA was possible within a nationally scaled sex worker programme, and while challenging to implement, can provide an understanding of transmission dynamics and HIV incidence in this context. Sub-optimal recruitment and data linkage limited the interpretation of our findings and opportunities for strategic gains though focusing on HIV prevention efforts.