Potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria in low-income and middle-income countries: a modelling study.

BACKGROUND: COVID-19 has the potential to cause substantial disruptions to health services, due to cases overburdening the health system or response measures limiting usual programmatic activities. We aimed to quantify the extent to which disruptions to services for HIV, tuberculosis, and malaria in low-income and middle-income countries with high burdens of these diseases could lead to additional loss of life over the next 5 years. METHODS: Assuming a basic reproduction number of 3·0, we constructed four scenarios for possible responses to the COVID-19 pandemic: no action, mitigation for 6 months, suppression for 2 months, or suppression for 1 year. We used established transmission models of HIV, tuberculosis, and malaria to estimate the additional impact on health that could be caused in selected settings, either due to COVID-19 interventions limiting activities, or due to the high demand on the health system due to the COVID-19 pandemic. FINDINGS: In high-burden settings, deaths due to HIV, tuberculosis, and malaria over 5 years could increase by up to 10%, 20%, and 36%, respectively, compared with if there was no COVID-19 pandemic. The greatest impact on HIV was estimated to be from interruption to antiretroviral therapy, which could occur during a period of high health system demand. For tuberculosis, the greatest impact would be from reductions in timely diagnosis and treatment of new cases, which could result from any prolonged period of COVID-19 suppression interventions. The greatest impact on malaria burden could be as a result of interruption of planned net campaigns. These disruptions could lead to a loss of life-years over 5 years that is of the same order of magnitude as the direct impact from COVID-19 in places with a high burden of malaria and large HIV and tuberculosis epidemics. INTERPRETATION: Maintaining the most critical prevention activities and health-care services for HIV, tuberculosis, and malaria could substantially reduce the overall impact of the COVID-19 pandemic. FUNDING: Bill & Melinda Gates Foundation, Wellcome Trust, UK Department for International Development, and Medical Research Council.

Preparing student midwives for professional practice: Evaluation of a student e-portfolio assessment item.

Capstone experiences facilitate consolidation and application of previous learning, strengthening professional identity and competency. This study evaluates the effectiveness and acceptability of a capstone assessment item, in the form of an e-portfolio, designed to identify and demonstrate preparedness for professional midwifery practice. A sequential explanatory strategy occurred within a mixed method research design. Final year Bachelor of Midwifery students at an Australian university, having completed the e-portfolio assessment, participated in two phases of data collection; an initial online-survey, followed by in-depth exploration of emergent concepts within a focus group. Analysis of the quantitative data identified completing the e-portfolio assessment increased students' skills, knowledge and confidence and promoted reflection and critical thinking. Three themes emerged from the qualitative data; acknowledging growth and development; transitioning to practice, and knowing 'who I am and where I am going'. The e-portfolio assessment meets the aims of a capstone assessment and provides an appropriate framework and authentic opportunity for students to identify and demonstrate their level of preparedness for professional practice, determine their ongoing learning needs and develop strategies for achieving them. The assessment item provides an opportunity to develop and articulate a personal practice philosophy and embeds the principles of lifelong learning.

The impact of culturally responsive self-management interventions on health outcomes for minority populations: A systematic review.

OBJECTIVES: The health of people from Indigenous and ethnic minorities is poorer than the remainder of the population. Frequently, Westernized health systems respond by introducing self-management interventions to improve chronic illness health outcomes. The aim of this study was to answer the research question: "Can self-management programs that have been adapted or modified still be effective for ethnic minority and Indigenous populations?" METHODS: A systematic review across four databases was conducted. RESULTS: Twenty-three publications met the inclusion criteria. As the studies were heterogeneous, meta-analysis was not possible. Overall, interventions resulted in more positive health outcomes than usual care, but findings were inconsistent. DISCUSSION: We argue that rather than focusing on individual skills, knowledge, self-efficacy, and attitudes toward self-management, it may be more important to explore the structures and processes that underpin the sharing of information and skills within clinical or education encounters. Given that self-management is a Western cultural construct, creating empathic and responsive systems might be more effective for improving health of Indigenous and ethnic minority groups rather than relying predominantly on individual skill development.