Systematic review of barriers and facilitators to voluntary medical male circumcision in priority countries and programmatic implications for service uptake.

Voluntary medical male circumcision (VMMC) is an effective biomedical HIV prevention strategy. There is a need to identify key barriers and facilitators to VMMC uptake in priority countries to improve uptake. In this paper, we report findings from a systematic review of the barriers and facilitators of VMMC uptake, comparing them across countries in order to provide programmers critical information to design effective VMMC uptake interventions. Our review followed PRISMA protocol. Twenty three articles from 10 of the 14 priority countries were included. The top three barriers cited were: MC negatively perceived as being practiced by other or foreign cultures and religions, fear of pain caused by the procedure, and perceptions of VMMC as not helpful/needed. The top four facilitators cited in most countries were: Belief that VMMC reduces health risks and improves hygiene, family and peer support of MC, and enhanced sexual performance and satisfaction. The barriers and facilitators highlighted in this paper can help inform programmatic strategies in these countries. More research is needed to ensure that all sub-populations are being adequately reached. By applying this information to new research and programming, these countries can achieve greater VMMC uptake - and thus reductions in HIV transmission and prevalence.

Global partnerships to support noncommunicable disease care in low and middle-income countries: lessons from HIV/AIDS.

OBJECTIVE: The aim of this study was to identify lessons learned from partnerships addressing the HIV/AIDS epidemic that can inform those needed to mitigate the noncommunicable diseases (NCDs) epidemic in low and middle-income countries (LMICs). DESIGN: We selected and analysed a convenience sample of organizational partnerships developed to address the HIV/AIDS epidemic in LMICs, focusing on their specific strategies and contributions. METHODS: A review of published literature and website information pertaining to a convenience sample of five global organizations and/or types of partnerships that provide support to fight the HIV/AIDS epidemic was qualitatively analysed to assess key areas of support provided to scale-up services in response to the HIV/AIDS epidemic. RESULTS: Six topical areas of support were identified: HIV/AIDS service delivery; enhancing comprehensive health systems capacity; operational and implementation science research to improve care delivery; introducing and improving the availability of new products; political advocacy; and early-stage planning for sustainability and transition to more independent implementing-country delivery programmes. These six areas of support were qualitatively assessed for identify a focus, contributory or minimal contribution on the part of each of the organizations and/or types of partnerships reviewed. CONCLUSION: No single global partnership addresses the range of support needed to respond to the HIV/AIDS epidemic, and this will likely be true for an effective response to the emerging NCD epidemic. A range of coordinated financial and/or technical support as well as lessons learned from global HIV/AIDS partnerships will be key to achieving an effective response to the global NCD epidemic.

Systematic review of the effect of economic compensation and incentives on uptake of voluntary medical male circumcision among men in sub-Saharan Africa.

Voluntary medical male circumcision (VMMC) prevalence in priority countries in sub-Saharan Africa, particularly among men aged ≥20 years, has not yet reached the goal of 80% coverage recommended by the World Health Organization. Determining novel strategies to increase VMMC uptake among men ≥20 years is critical to reach HIV epidemic control. We conducted a systematic review to analyze the effectiveness of economic compensation and incentives to increase VMMC uptake among older men in order to inform VMMC demand creation programs. The review included five qualitative, quantitative, and mixed methods studies published in peer reviewed journals. Data was extracted into a study summary table, and tables synthesizing study characteristics and results. Results indicate that cash reimbursements for transportation and food vouchers of small nominal amounts to partially compensate for wage loss were effective, while enrollment into lotteries offering prizes were not. Economic compensation provided a final push toward VMMC uptake for men who had already been considering undergoing circumcision. This was in settings with high circumcision prevalence brought by various VMMC demand creation strategies. Lottery prizes offered in the studies did not appear to help overcome barriers to access VMMC and qualitative evidence suggests this may partially explain why they were not effective. Economic compensation may help to increase VMMC uptake in priority countries with high circumcision prevalence when it addresses barriers to uptake. Ethical considerations, sustainability, and possible externalities should be carefully analyzed in countries considering economic compensation as an additional strategy to increase VMMC uptake.

Preeclampsia knowledge among women in Utah.

BACKGROUND: Despite the benefits of preeclampsia (PE) education in improving health outcomes, little is known about how often healthcare providers in Utah include PE in prenatal education or how much information women retain. As such, the purpose of this study was to explore PE awareness among mothers in Utah and inquire how often PE is included in prenatal education. Factors associated with PE knowledge were also investigated. METHODS: A cross-sectional survey was conducted. Questions were created from two Preeclampsia Awareness Surveys developed by the Preeclampsia Foundation. PE knowledge was measured with 29 items from the 2014 Preeclampsia Awareness Survey, and a knowledge score was calculated. RESULTS: A total of 340 women completed the survey. Over half (56.7%) of women reported their healthcare provider described the signs and symptoms of PE to them. The mean PE knowledge score was 17.07. Hearing of PE from a healthcare provider, having the signs and symptoms of PE described by a healthcare provider and having a history of PE were significantly associated with a higher PE knowledge score. CONCLUSIONS: Patient awareness is essential to the successful management of PE. The need for improved PE education in Utah was evident in this survey. As not all healthcare providers are diligent in instructing patients regarding PE, more research is needed to fully assess the knowledge of mothers and examine the practices of providers. An explanation of PE signs and symptoms should be given to all women at prenatal care visits to improve health outcomes.

The application of systems thinking concepts, methods, and tools to global health practices: An analysis of case studies.

OBJECTIVES: This review of systems thinking (ST) case studies seeks to compile and analyse cases from ST literature and provide practitioners with a reference for ST in health practice. Particular attention was given to (1) reviewing the frequency and use of key ST terms, methods, and tools in the context of health, and (2) extracting and analysing longitudinal themes across cases. METHODS: A systematic search of databases was conducted, and a total of 36 case studies were identified. A combination of integrative and inductive qualitative approaches to analysis was used. RESULTS: Most cases identified took place in high-income countries and applied ST retrospectively. The most commonly used ST terms were agent/stakeholder/actor (n = 29), interdependent/interconnected (n = 28), emergence (n = 26), and adaptability/adaptation (n = 26). Common ST methods and tools were largely underutilized. Social network analysis was the most commonly used method (n = 4), and innovation or change management history was the most frequently used tool (n = 11). Four overarching themes were identified; the importance of the interdependent and interconnected nature of a health system, characteristics of leaders in a complex adaptive system, the benefits of using ST, and barriers to implementing ST. CONCLUSIONS: This review revealed that while much has been written about the potential benefits of applying ST to health, it has yet to completely transition from theory to practice. There is however evidence of the practical use of an ST lens as well as specific methods and tools. With clear examples of ST applications, the global health community will be better equipped to understand and address key health challenges.

Evaluation of Diet-Related Infographics on Pinterest for Use of Behavior Change Theories: A Content Analysis.

BACKGROUND: There is increasing interest in Pinterest as a method of disseminating health information. However, it is unclear whether the health information promoted on Pinterest is evidence-based or incorporates behavior change theory. OBJECTIVES: The objective of the study was to determine the presence of health behavior theory (HBT) constructs in pins found on Pinterest and assess the relationship between various pin characteristics and the likelihood of inclusion of HBT. METHODS: A content analysis was conducted on pins collected from Pinterest identified with the search terms "nutrition infographic" and "healthy eating infographic." The coding rubric included HBT constructs, pin characteristics, and visual communication tools. Each HBT construct was coded as present or not present (yes=1, no=0). A total theory score was calculated by summing the values for each of the 9 constructs (range 0-9). Adjusted regression analysis was used to identify factors associated with the inclusion of health behavior change theory in pins (P<.05). RESULTS: The mean total theory score was 2.03 (SD 1.2). Perceived benefits were present most often (170/236, 72%), followed by behavioral capability (123/238, 51.7%) and perceived severity (79/236, 33.5%). The construct that appeared the least was self-regulation/self-control (2/237, 0.8%). Pin characteristics associated with the inclusion of HBT included a large amount of text (P=.01), photographs of real people (P=.001), cartoon pictures of food (P=.01), and the presence of references (P=.001). The number of repins (P=.04), likes (P=.01), and comments (P=.01) were positively associated with the inclusion of HBT. CONCLUSIONS: These findings suggest that current Pinterest infographics targeting healthy eating contain few HBT elements. Health professionals and organizations should create and disseminate infographics that contain more elements of HBT to better influence healthy eating behavior. This may be accomplished by creating pins that use both text and images of people and food in order to portray elements of HBT and convey nutritional information.

A content analysis of precede-proceed constructs in stress management mobile apps.

BACKGROUND: The emergence of Apple's iPhone provides a platform for freelance developers to design third party apps, which greatly expands the functionality and utility of mobile devices for stress management. This study provides a basic overview of the stress management apps under the health and fitness category of the Apple App store and appraises each app's potential for influencing behavior change. METHODS: Data for this study came from a content analysis of health and fitness app descriptions available in the App Store on iTunes. Trained research assistants used the Precede-Proceed Model (PPM) as a framework to guide the coding of paid stress management apps and to evaluate each app's potential for effecting health behavior change. RESULTS: Most apps were rated as being plausible (96.9%) and intending to address stress management (98.5%), but only 63.3% were rated as recommendable to others for their use. Reinforcing apps were less common than predisposing and enabling apps. Less than one percent (0.39%) of apps included all three factors (predisposing, enabling and reinforcing). CONCLUSIONS: Practitioners should be cautious when promoting the use of stress management apps, as most provide only health-related information (predisposing) or suggestions for enabling behavior, but almost none include all three theoretical factors recommended for behavior change.

Visualizing the autophagy pathway in avian cells and its application to studying infectious bronchitis virus.

Autophagy is a highly conserved cellular response to starvation that leads to the degradation of organelles and long-lived proteins in lysosomes and is important for cellular homeostasis, tissue development and as a defense against aggregated proteins, damaged organelles and infectious agents. Although autophagy has been studied in many animal species, reagents to study autophagy in avian systems are lacking. Microtubule-associated protein 1 light chain 3 (MAP1LC3/LC3) is an important marker for autophagy and is used to follow autophagosome formation. Here we report the cloning of avian LC3 paralogs A, B and C from the domestic chicken, Gallus gallus domesticus, and the production of replication-deficient, recombinant adenovirus vectors expressing these avian LC3s tagged with EGFP and FLAG-mCherry. An additional recombinant adenovirus expressing EGFP-tagged LC3B containing a G120A mutation was also generated. These vectors can be used as tools to visualize autophagosome formation and fusion with endosomes/lysosomes in avian cells and provide a valuable resource for studying autophagy in avian cells. We have used them to study autophagy during replication of infectious bronchitis virus (IBV). IBV induced autophagic signaling in mammalian Vero cells but not primary avian chick kidney cells or the avian DF1 cell line. Furthermore, induction or inhibition of autophagy did not affect IBV replication, suggesting that classical autophagy may not be important for virus replication. However, expression of IBV nonstructural protein 6 alone did induce autophagic signaling in avian cells, as seen previously in mammalian cells. This may suggest that IBV can inhibit or control autophagy in avian cells, although IBV did not appear to inhibit autophagy induced by starvation or rapamycin treatment.