Challenges and Opportunities for Paving the Road to Global Health Equity Through Implementation Science.

Implementation science focuses on enhancing the widespread uptake of evidence-based interventions into routine practice to improve population health. However, optimizing implementation science to promote health equity in domestic and global resource-limited settings requires considering historical and sociopolitical processes (e.g., colonization, structural racism) and centering in local sociocultural and indigenous cultures and values. This review weaves together principles of decolonization and antiracism to inform critical and reflexive perspectives on partnerships that incorporate a focus on implementation science, with the goal of making progress toward global health equity. From an implementation science perspective, wesynthesize examples of public health evidence-based interventions, strategies, and outcomes applied in global settings that are promising for health equity, alongside a critical examination of partnerships, context, and frameworks operationalized in these studies. We conclude with key future directions to optimize the application of implementation science with a justice orientation to promote global health equity.

The HI V O pen Call on I nformed C onsent and E thics in Research (VOICE) for Adolescents and Young Adults: A Digital Crowdsourcing Open Call in Low- and Middle-Income Countries.

BACKGROUND: Many adolescents and young adults (AYAs; 10-24 years old) are excluded from HIV research because of social, ethical, and legal challenges with informed consent, resulting in limited AYA-focused data. We use a participatory approach to identify strategies for improving AYA consent processes in HIV research in low- and middle-income countries (LMICs). METHODS: We conducted a digital crowdsourcing open call for ideas to improve AYA consent to HIV research in LMICs. Crowdsourcing involves engaging a group of people in problem-solving, then sharing emergent solutions. Submissions were evaluated by 3 independent judges using predefined criteria, with exceptional strategies receiving prizes. Demographic data were collected, and textual data were qualitatively analyzed for emergent themes in barriers and facilitators for improving AYA consent in HIV research, guided by a socioecological model. RESULTS: We received 110 strategies total; 65 were eligible for evaluation, 25 of which were identified as finalists. Fifty-eight participants from 10 LMICs submitted the 65 eligible submissions, of which 30 (52%) were 18 to 24 years old. Thematic analysis identified 10 barriers to AYA consent, including HIV stigma, limited education, and legal/regulatory barriers. Strategies for improving AYA consent processes revealed 7 potential facilitators: enhancing AYA engagement in research, involving parents/guardians, improving education/awareness, improving institutional practices/policy, making research participation more AYA-friendly, enhancing engagement of other key communities of interest, and empowering AYA. CONCLUSIONS: Diverse communities of interest in LMICs developed compelling strategies to enhance informed consent that may improve AYA inclusion in HIV research. These data will be used to develop practical guidance on improving AYA consent processes.

A designathon to co-create HPV screening and vaccination approaches for mothers and daughters in Nigeria: findings from a community-led participatory event.

BACKGROUND: Oncogenic types of human Papillomavirus (HPV) infection cause substantial morbidity and mortality in Nigeria. Nigeria has low cervical cancer screening and vaccination rates, suggesting the need for community engagement to enhance reach and uptake. We organised a designathon to identify community-led, innovative approaches to promote HPV screening and vaccination for women and girls, respectively, in Nigeria. A designathon is a three-phase participatory process informed by design thinking that includes the preparation phase that includes soliciting innovative ideas from end-users, an intensive collaborative event to co-create intervention components, and follow-up activities. METHODS: We organised a three-phase designathon for women (30-65yrs) and girls (11-26yrs) in Nigeria. First, we launched a national crowdsourcing open call for ideas on community-driven strategies to support HPV screening among women and vaccination among girls. The open call was promoted widely on social media and at in-person gatherings. All eligible entries were graded by judges and 16 exceptional teams (with 4-6members each). All six geo-political zones of Nigeria were invited to join an in-person event held over three days in Lagos to refine their ideas and present them to a panel of expert judges. The ideas from teams were reviewed and scored based on relevance, feasibility, innovation, potential impact, and mother-daughter team dynamics. We present quantitative data on people who submitted and themes from the textual submissions. RESULTS: We received a total of 612 submissions to the open call from mother-daughter dyads. Participants submitted ideas via a website designated for the contest (n = 392), in-person (n = 99), email (n = 31), or via an instant messaging application (n = 92). Overall, 470 were eligible for judging after initial screening. The average age of participants for daughters was 19 years and 39 years for mothers. Themes from the top 16 proposals included leveraging local leaders (5/16), faith-based networks (4/16), educational systems (4/16), and other community networks (7/16) to promote awareness of cervical cancer prevention services. After an in-person collaborative event, eight teams were selected to join an innovation training boot camp, for capacity building to implement ideas. CONCLUSIONS: Innovative strategies are needed to promote HPV screening for mothers and vaccination for girls in Nigeria. Our designathon was able to facilitate Nigerian mother-daughter teams to develop cervical cancer prevention strategies. Implementation research is needed to assess the effectiveness of these strategies.

Sustaining sexual health programs: practical considerations and lessons from the President's Emergency Plan for AIDS Relief.

Enhancing the sustainability of sexual health programs is important, but there are few practical tools to facilitate this process. Drawing on a sustainability conceptual framework, this Editorial proposes four ideas to increase the sustainability of sexual health programs - early planning, equitable community engagement, return on investment, and partnerships to address social determinants. Early planning during the design of a sexual health program is important for sustainability because it provides an opportunity for the team to build factors relevant to sustainability into the program itself. Equitable community engagement can expand multi-sectoral partnerships for institutionalisation, identify allies for implementation, and strengthen relationships between beneficiaries and researchers. From a financial perspective, considering the return on investment could increase the likelihood of sustainability. Finally, partnerships to address social determinants can help to identify organisations with a similar vision. Existing sustainability frameworks can be used to measure each of these key elements. Several approaches can be used to enhance the sustainability of sexual health programs. The President's Emergency Plan for AIDS Relief provides potential lessons for increasing the sustainability of sexual health programs in diverse global settings.

Sustaining HIV Research in Resource-Limited Settings Using PLAN (People, Learning, Adapting, Nurturing): Evidence from the 4 Youth by Youth Project in Nigeria.

PURPOSE OF REVIEW: Sustaining evidence-based interventions in resource-limited settings is a perennial challenge. Despite growing research on the significance of sustainability, few frameworks describe why and how to plan for sustainability in settings limited with resources. Drawing on a synthesis of the literature on sustainability, including the Dynamic Sustainability Framework, we review lessons learned from research to date, to point out a path forward for sustaining evidence-based interventions in resource-limited settings. RECENT FINDINGS: We describe PLAN or why people learning, adapting, and nurturing the core values of an intervention can enhance its sustainability over time. PLAN is a dynamic framework that simplifies the process of planning for sustainability of evidence-based interventions throughout the lifecyle of an intervention, taking into consideration the people that matter as well as the learning, adaptation, and nurturing involved with understanding and studying the interactions between interventions/innovations, practice settings, intervention fit, and the broader ecological contexts in which implementation occurs. We use case-study data from our ongoing pragmatic HIV implementation trial, the 4 Youth by Youth project, to detail the value and implications of why people learning, adapting, and nurturing HIV interventions implemented in resource-limited settings matter. PLAN is designed to further the dialogue on ways research and practice teams can critically work to ensure the sustainability of their evidence-based interventions from the onset, particularly in settings and with populations limited with resources. It also illustrates how attention to sustainability from the beginning may foster actions necessary for sustained program → sustained benefits → sustained capacity → sustained value, but in the absence of early and active planning, none of this will occur. Ultimately, we hope to accelerate the sustainability of evidence-based HIV interventions, and making a PLAN at the bare minimum may ensure that the goals of continuing and maintaining desirable features of any evidence-based interventions can be realized.

Assessing Engagement of Adolescents and Young Adults (AYA) in HIV Research: A Multi-method Analysis of a Crowdsourcing Open Call and Typology of AYA Engagement in Sub-Saharan Africa.

Engagement of adolescents and young adults (AYA) in HIV research is increasing in many settings. We organized a crowdsourcing open call to solicit examples of how AYA have been engaged in HIV research in Africa and to develop an engagement typology. We formed a steering committee, promoted the open call, organized judging and recognized finalists. We used a multi-methods approach to identify emerging themes and measure engagement. We received 95 entries from individuals in 15 countries; 74 met the eligibility criteria. More than three-quarters of entries were from AYA (55/74, 74%). Four themes characterized AYA engagement: (1) AYA were co-creators in the HIV research process. (2) AYA were involved in community-level capacity building. (3) AYA were co-leaders in minor risk research. (4) AYA used digital methods to enhance engagement. Our open call identified diverse methods of AYA engagement, which can enhance strategies used to reach AYA in African HIV studies.

Acceptability and user experiences of a patient-held smart card for antenatal services in Nigeria: a qualitative study.

BACKGROUND: Poor maternal, newborn and child health outcomes remain a major public health challenge in Nigeria. Mobile health (mHealth) interventions such as patient-held smart cards have been proposed as effective solutions to improve maternal health outcomes. Our objectives were to assess the acceptability and experiences of pregnant women with the use of a patient-held smartcard for antenatal services in Nigeria. METHODS: Using focus group discussions, qualitative data were obtained from 35 pregnant women attending antenatal services in four Local Government Areas (LGAs) in Benue State, Nigeria. The audio-recorded data were transcribed and analyzed using framework analysis techniques such as the PEN-3 cultural model as a guide. RESULTS: The participants were 18-44 years of age (median age: 24 years), all were married and the majority were farmers. Most of the participants had accepted and used the smartcards for antenatal services. The most common positive perceptions about the smartcards were their ability to be used across multiple health facilities, the preference for storage of the women's medical information on the smartcards compared to the usual paper-based system, and shorter waiting times at the clinics. Notable facilitators to using the smartcards were its provision at the "Baby showers" which were already acceptable to the women, access to free medical screenings, and ease of storage and retrieval of health records from the cards. Costs associated with health services was reported as a major barrier to using the smartcards. Support from health workers, program staff and family members, particularly spouses, encouraged the participants to use the smartcards. CONCLUSION: These findings revealed that patient-held smart card for maternal health care services is acceptable by women utilizing antenatal services in Nigeria. Understanding perceptions, barriers, facilitators, and supportive systems that enhance the use of these smart cards may facilitate the development of lifesaving mobile health platforms that have the potential to achieve antenatal, delivery, and postnatal targets in a resource-limited setting.

Training primary healthcare workers on a task-strengthening strategy for integrating hypertension management into HIV care in Nigeria: implementation strategies, knowledge uptake, and lessons learned.

BACKGROUND: With improved access to anti-retroviral drugs, persons living with HIV/AIDS (PLWHA) are living longer but with attendant increased risks of non-communicable diseases (NCDs). The increasing burden of NCDs, especially hypertension, could reverse gains attributed to HIV care. Nurses and Community Health Officers (CHO) in Nigeria are cardinal in delivering primary health care. A task-strengthening strategy could enable them to manage hypertension in HIV care settings. This study aimed to assess their knowledge and practice of hypertension management among Healthcare workers (HCWs) and to explore the challenges involved in conducting onsite training during pandemics. METHODS: Nurses and CHOs in the employment of the Lagos State Primary Health Care Board (LSPHCB), Lagos State, Nigeria, were recruited. They were trained through hybrid (virtual and onsite) modules before study implementation and a series of refresher trainings. A pre-and post-training test survey was administered, followed by qualitative interviews to assess skills and knowledge uptake, the potential barriers and facilitators of task-sharing in hypertension management in HIV clinics, and the lessons learned. RESULTS: Sixty HCWs participated in the two-day training at baseline. There was a significant improvement in the trainees' knowledge of hypertension management and control. The average score during the pre-test and post-test was 59% and 67.6%, respectively. While about 75% of the participants had a good knowledge of hypertension, its cause, symptoms, and management, 20% had moderate knowledge, and 5% had poor knowledge at baseline. There was also an increase in the mean score between the pre-test and post-test of the refresher training using paired t-tests (P < 0.05). Role-playing and multimedia video use improved the participants' uptake of the training. The primary barrier and facilitator of task sharing strategy in hypertension management reported were poor delineation of duties among HCWs and the existing task shifting at the Primary Healthcare Centres (PHC) level, respectively. CONCLUSIONS: The task strengthening strategy is relevant in managing hypertension in HIV clinics in Nigeria. The capacity development training for the nurses and CHOs involved in the Integration of Hypertension Management into HIV Care in Nigeria: A Task Strengthening Strategy (TASSH-Nigeria) study yielded the requisite improvement in knowledge uptake, which is a reassurance of the delivery of the project outcomes at the PHCs.

Dear Health Promotion Scholar: Letters of Life From, for, and About Black Women in Academia.

Black women are change agents actively working within their power to combat systemic racism in academia, while constantly battling injustices. Understanding lived realities and experiences of racial ethnic minority women as "outsiders within" is crucial for confronting long-standing racism embedded within academic spaces. Institutions may be outwardly addressing racial injustice, and perpetuating injustices internally, whether known or unknown. Using a relational dialectics framework and letter writing style, the purpose of this commentary is to describe the complexities present in experiences of Black women as they navigate academia as change agents, from the perspectives of tenure track and tenured faculty members in predominately White institutions. Black women academics contend with the push and pull of being in relationship with students, colleagues, and predominately White institutions; these tensions illuminate the experience of both/and-ness creating a constant presence of uncertainty/certainty, pushing/pivoting, and conforming/disrupting among others. Black women faculty are actively working to overcome barriers in research and practice and actively recognizing how racism is acting in academic settings. Black women are dealing with their own personal/professional situations, while also advocating interpersonally through mentorship, institutionally through incorporating underrepresented voices in research/practice, and strategically through addressing policies prompting action. This commentary shares the breadth, scope, and uniqueness of Black women experiences in higher education. This article concludes with implications for practice, including utilizing dialectic introspection to illuminate Black women, disrupting the norm by utilizing letters to center Black women, and building collectives to foster connections.

HIV testing and ethnicity among adolescent girls and young women aged 15-24 years in Ghana: what really matters?

Despite the high prevalence of HIV among adolescent girls and young women (AGYW) aged 15-24 years in Ghana, HIV testing remains low among this population. The objective of this study was to examine the relationship between ethnicity and HIV testing among AGYW in Ghana. The 2014 Ghana Demographic and Health Survey data were used and analyses were restricted to 3325 female participants aged 15-24 years. Chi-squared tests and a logistic regression model were used to assess the association between ethnicity and HIV testing. Furthermore, the PEN-3 cultural model informed the conceptual framework that explained the relationship between ethnicity and HIV testing behaviour. Results from the bivariate analysis showed an association between ethnicity and HIV testing among AGYW (p<0.05). However, when controlling for other behavioural and socioeconomic determinants of HIV testing in the logistic regression, there was no association between ethnicity and HIV testing. The significant predictors of HIV testing were marital status, having multiple sexual partners, and condom use. The AGYW who were married (adjusted odds ratio [aOR] = 4.56, CI: 3.46-6.08) or previously married (aOR = 4.30, CI: 2.00-9.23) were more likely to test for HIV compared with those who were never married. Having multiple sexual partners (aOR = 0.41, CI: 0.20-0.85) and condom use (aOR = 0.56, CI: 0.38-0.84) were associated with lower odds of HIV testing. The results provide evidence that ethnicity is not associated with HIV testing among AGYW in Ghana, as the bivariate association was attenuated when other behavioural and socioeconomic determinants of HIV testing were accounted for. These findings highlight the importance of considering individual-level factors, community-level factors, and other socio-cultural factors as they really matter in the development of HIV prevention programmes for adolescent girls and young women in Ghana.

Socioeconomic empowerment and HIV testing among Ethiopian women: results from the 2016 Ethiopian Demographic and Health Survey.

HIV testing is a cornerstone for early HIV diagnoses which can improve quality of life, survival, and reduce forward transmission. This study examined socioeconomic determinants of HIV testing among women in Ethiopia using the 2016 Ethiopian Demographic and Health Survey. The sample was collected using stratified cluster sampling design and was selected in two stages. A total of 15,683 women aged 15-49 completed the survey. For this study, only 8681 participants were included. Kabeer's theoretical framework on women's empowerment was used for variable selection and analysis. Chi-square test and multiple logistic regression modeling were performed. Overall, 52% of the women reported testing for HIV. In the multivariable-adjusted model, education, residence, wealth index, occupation, living arrangement, and healthcare decision making were significantly (P < 0.05) associated with ever being tested for HIV. For instance, women who don't participate in the decision making of their own health care were less likely to have ever been tested (AOR: 0.77 (0.63-0.94) than those who do. This implies that HIV prevention among Ethiopian women presupposes national policies that promote their overall socioeconomic empowerment. Providing more resources to women, especially to those living in rural areas, might increase HIV testing.

A designathon to co-create community-driven HIV self-testing services for Nigerian youth: findings from a participatory event.

BACKGROUND: Youth are at high risk for HIV, but are often left out of designing interventions, including those focused on adolescents. We organized a designathon for Nigerian youth to develop HIV self-testing (HIVST) strategies for potential implementation in their local communities. A designathon is a problem-focused event where participants work together over a short period to create and present solutions to a judging panel. METHODS: We organized a 72-h designathon for youth (14-24 years old) in Nigeria to design strategies to increase youth HIVST uptake. Proposals included details about HIVST kit service delivery, method of distribution, promotional strategy, and youth audience. Teams pitched their proposals to a diverse seven-member judging panel who scored proposals based on desirability, feasibility, potential impact and teamwork. We examined participants' socio-demographic characteristics and summarized themes from their HIVST proposals. RESULTS: Forty-two youth on 13 teams participated in the designathon. The median team size was 3 participants (IQR: 2-4). The median age was 22.5 years (IQR: 21-24), 66.7% were male, 47.4% completed tertiary education, and 50% lived in Lagos State. Themes from proposals included HIVST integration with other health services, digital marketing and distribution approaches, and engaging students. Judges identified seven teams with exceptional HIVST proposals and five teams were supported for further training. CONCLUSIONS: The designathon provided a structured method for incorporating youth ideas into HIV service delivery. This approach could differentiate HIV services to be more youth-friendly in Nigeria and other settings.

Implementation science research for the scale-up of evidence-based interventions for sickle cell disease in africa: a commentary.

BACKGROUND: The burden of sickle cell disease (SCD) is greatest among African nations. Effective scalability of evidence-based interventions (e.g., newborn screening, health education, prophylaxis for infection, optimal nutrition and hydration, hydroxyurea therapy, blood transfusions, and transcranial Doppler (TCD) screening) is urgently needed particularly in these settings for disease management. However, Africa is constrained by limited resources and the lack of capacity to conduct implementation science research for proper understanding of context, and assessment of barriers and facilitators to the uptake and scalability of evidence-based interventions (EBI) for SCD management. MAIN BODY: We outline implementation science approaches to embed EBI for SCD within the African context and highlight key implementation research programs for SCD management. Building implementation research capacity will meet the major need of developing effective life-long and accessible locally-tailored interventions for patients with SCD in Africa. CONCLUSION: This commentary communicates the importance of the application of implementation science methodology to scale-up evidence-based interventions for the management of SCD in order to reduce pain, prevent other morbidities and premature death experienced by people with SCD in Africa, and improve their overall quality of life.

Young people's preferences for HIV self-testing services in Nigeria: a qualitative analysis.

BACKGROUND: HIV self-testing (HIVST) provides young people with a convenient, discreet, and empowering way to know their HIV status. However, there is limited knowledge of young people's preferences for HIVST services and potential factors that may influence the uptake of HIVST among this population. The purpose of this research was to use qualitative methods to examine HIVST preferences among Nigerian youth. METHODS: Semi-structured in-depth interviews with a purposive sample of young people 14-24 years old were conducted in Lagos, Nigeria. Data were analyzed thematically to identify themes and domains related to preferences and factors influencing the use of HIV self-testing. RESULTS: A total of 65 youth with mean age of 21 years, were interviewed, and the majority were females (56%). Four themes emerged as the most important characteristics that may influence young people's preferences for HIV self-testing: 1) Cost (i.e. majority of participants noted that they would pay between NGN500 to NGN1,500 naira (USD1.38-USD4.16) for oral HIV self-testing kits); 2) Testing method (i.e. although blood-based sample kits were more popular than oral-based self-testing kits, most preferred the oral-based option due to its perceived benefits and for some, phobia of needles); 3) Access location (i.e. participants suggested they preferred to obtain the HIVST kits from youth-friendly centers, pharmacies, private health facilities, and online stores); and 4) Continuing care and support (i.e. participants highlighted the importance of linkage to care with trained youth health workers for positive or negative test results or toll-free helpline). CONCLUSION: HIV self-testing preferences among Nigerian youth appear to be influenced by several factors including lower cost, less invasive testing method, location of testing, and linkage to care and support post testing. Findings underscore the need to address young people's HIV self-testing preferences as a foundation for implementing programs and research to increase the uptake of HIVST.

Partner violence and HIV testing uptake among Ethiopian women.

Guided by the Anderson Behavioral Model, the researchers in this study examined the association between emotional violence and HIV testing uptake among women, using the 2016 Ethiopian Demographic and Health Survey. Only 3,637 women between the ages of 15 and 49 years were included. In the bivariate analysis, emotional violence, reported by 42.6% of respondents, was associated with prior HIV testing. In the multiple logistic regression model, emotional violence was not associated with HIV testing uptake among women (p > 0.05). Our findings suggest that efforts to improve women's socio-economic status and decision-making autonomy may be more relevant to increasing HIV testing uptake.

'When she rises, we all rise': a crowdsourcing challenge to increase women's participation in an infectious diseases research fellowship.

BACKGROUND: Women are under-represented in many mid-career infectious diseases research fellowships, including a TDR fellowship for low- and middle-income country (LMIC) researchers. TDR solicited creative ideas as part of a challenge contest to increase the number of women fellowship applicants. The purpose of this study is to examine themes from submitted ideas and the impact of implementing the top three ideas on the number of women applicants. METHODS: We solicited ideas for modifying the TDR fellowship using a crowdsourcing challenge. Then we used a mixed methods approach to evaluate texts submitted in response to the challenge. The qualitative analysis identified themes from eligible submissions. The quantitative analysis examined the mean score (1-10 scale) assigned to submitted ideas and also the number of eligible women applicants before (2014-7) and after (2018) implementing the top three ideas. RESULTS: We received 311 ideas on improving women's participation in this fellowship from 63 countries. Among all ideas, 282 (91%) were from women and 286 (92%) were from low- and middle-income countries (LMICs). Thirty-three (17%) ideas received an overall mean score of 7.0 or greater. The top three ideas included enhanced social media communication targeting women, improving career mentorship, and creating a nomination system to nudge women applicants. These ideas were implemented as part of the 2018 fellowship application cycle. The number of eligible women applicants increased from 11 in 2016 to 48 in 2018. The number of eligible men applicants increased from 55 in 2016 to 114 in 2018. Women represent 44% (8/18) of the 2018 cohort. CONCLUSION: This suggests that the challenge contest resulted in strong participation from women in LMICs. The three top ideas likely contributed to a greater number of women applicants to this mid-career fellowship. Further ways of enhancing women's participation in global health training are needed.

Application of the Consolidated Framework for Implementation Research to examine nurses' perception of the task shifting strategy for hypertension control trial in Ghana.

BACKGROUND: The burden of hypertension in many low-and middle-income countries is alarming and requires effective evidence-based preventative strategies that is carefully appraised and accepted by key stakeholders to ensure successful implementation and sustainability. We assessed nurses' perceptions of a recently completed Task Shifting Strategy for Hypertension control (TASSH) trial in Ghana, and facilitators and challenges to TASSH implementation. METHODS: Focus group sessions and in-depth interviews were conducted with 27 community health nurses from participating health centers and district hospitals involved in the TASSH trial implemented in the Ashanti Region, Ghana, West Africa from 2012 to 2017. TASSH evaluated the comparative effectiveness of the WHO-PEN program versus provision of health insurance for blood pressure reduction in hypertensive adults. Qualitative data were analyzed using open and axial coding techniques with emerging themes mapped onto the Consolidated Framework for Implementation Research (CFIR). RESULTS: Three themes emerged following deductive analysis using CFIR, including: (1) Patient health goal setting- relative priority and positive feedback from nurses, which motivated patients to make healthy behavior changes as a result of their health being a priority; (2) Leadership engagement (i.e., medical directors) which influenced the extent to which nurses were able to successfully implement TASSH in their various facilities, with most directors being very supportive; and (3) Availability of resources making it possible to implement the TASSH protocol, with limited space and personnel time to carry out TASSH duties, limited blood pressure (BP) monitoring equipment, and transportation, listed as barriers to effective implementation. CONCLUSION: Assessing stakeholders' perception of the TASSH implementation process guided by CFIR is crucial as it provides a platform for the nurses to thoroughly evaluate the task shifting program, while considering the local context in which the program is implemented. The feedback from the nurses informed barriers and facilitators to implementation of TASSH within the current healthcare system, and suggested system level changes needed prior to scale-up of TASSH to other regions in Ghana with potential for long-term sustainment of the task shifting intervention. TRIAL REGISTRATION: Trial registration for parent TASSH study: NCT01802372. Registered February 27, 2013.

Addressing Stroke Literacy in Nigeria Through Music: A Qualitative Study of Community Perspectives.

BACKGROUND: The incidence of stroke in Nigeria is unknown, but stroke literacy, defined here as awareness of stroke warning symptoms and risk factors may be poor in high-risk communities. Although there is growing recognition of the use of music as a conduit to promote health literacy, African music is often overlooked as a source of health information. We sought to understand community-level perspectives on using African music to promote acute stroke literacy. METHODS: A purposive sample of education, health and music professionals, high school and university students were recruited to participate in the qualitative study. Study participants completed a brainstorming exercise that elicited their perceptions of potential barriers and facilitators to the use of music to promote acute stroke literacy in Nigeria. Content analysis was used to identify key themes emerging from the brainstorming exercise. RESULTS: A total of 44 individuals, comprising of 25 students with a mean age of 15.9 ± 1.6 years (52% females) and 19 professionals with a mean age of 39 ± 7.7 years (57.9% males) participated in the brainstorming exercise. Facilitators to the use of music to promote acute stroke literacy in Nigeria include the cultural relevance of music, the ubiquity of music, and government involvement. Key barriers include religious beliefs that discourage the use of "secular" music, cost-related barriers, and limited government support. CONCLUSIONS: Findings from this study provide guidance aimed at improving acute stroke literacy in Nigeria, particularly the importance of government involvement in the development and implementation of stroke literacy interventions guided by African music. Future work should consider implementing interventions that leverage the cultural elements of African music and further assess the extent to which these identified facilitators and/or barriers may influence stroke literacy.

Crowdsourcing to Improve HIV and Sexual Health Outcomes: a Scoping Review.

PURPOSE OF REVIEW: This review synthesizes evidence on the use of crowdsourcing to improve HIV/sexual health outcomes. RECENT FINDINGS: We identified 15 studies, including four completed randomized controlled trials (RCTs), one planned RCT, nine completed observational studies, and one planned observational study. Three of the four RCTs suggested that crowdsourcing is an effective, low-cost approach for improving HIV testing and condom use among key populations. Results from the observational studies revealed diverse applications of crowdsourcing to inform policy, research, and intervention development related to HIV/sexual health services. Crowdsourcing can be an effective tool for informing the design and implementation of HIV/sexual health interventions, spurring innovation in sexual health research, and increasing community engagement in sexual health campaigns. More research is needed to examine the feasibility, acceptability, and effectiveness of crowdsourcing interventions, particularly in low- and middle-income countries.

Preferences for HIV testing services among young people in Nigeria.

BACKGROUND: Despite high HIV incidence rates among young people in Nigeria, less than 24% of this population have ever tested for HIV. These low HIV testing rates suggest that current testing services may not align with their testing preferences. To address this gap, the objective of this study was to assess preferences for HIV testing options among young people in Nigeria. METHODS: We conducted a cross-sectional study using survey to assess preferences for HIV testing options among 113 youth aged 14-24 years residing in Nigeria. The survey included a series of hypothetical HIV testing options, comprised of six characteristics centered around HIV testing service (i.e. location of testing, test administrator, mode of pre-test, mode of post-test counseling, type of HIV test, and cost of HIV test). For each characteristic, participants were asked to select one of the options that they prefer or indicate none of the above. A descriptive analysis of the preferences made by participants was conducted, summarizing proportions of participants who selected different options for HIV testing. RESULTS: The mean age of study participants was 19.5 years old (SD = 2.7). Most youth (73, 64.6%) had at least a secondary school degree. There was pronounced heterogeneity in HIV testing preferences among young people. Although most youth preferred free HIV testing, 14 (16.7%) reported preferring paying a small amount compared to free testing. More youth preferred blood-based HIV self-testing 39(48.8%) compared to facility-based HIV testing and oral HIV self-testing. CONCLUSIONS: Our finding suggest that young people have a range of HIV testing preferences in Nigeria. This suggests that a "one-size-fits-all" approach to delivering services to youth may be challenging in this context. HIV testing services can be optimized to reach young people if a variety options are provided to meet their unique preferences.