A foci cohort analysis to monitor successful and persistent foci under Thailand's Malaria Elimination Strategy.

BACKGROUND: Thailand's success in reducing malaria burden is built on the efficient "1-3-7" strategy applied to the surveillance system. The strategy is based on rapid case notification within 1 day, case investigation within 3 days, and targeted foci response to reduce the spread of Plasmodium spp. within 7 days. Autochthonous transmission is still occurring in the country, threatening the goal of reaching malaria-free status by 2024. This study aimed to assess the effectiveness of the 1-3-7 strategy and identify factors associated with presence of active foci. METHODS: Data from the national malaria information system were extracted from fiscal years 2013 to 2019; after data cleaning, the final dataset included 81,012 foci. A Cox's proportional hazards model was built to investigate factors linked with the probability of becoming an active focus from 2015 to 2019 among foci that changed status from non-active to active focus during the study period. We performed a model selection technique based on the Akaike Information Criteria (AIC). RESULTS: The number of yearly active foci decreased from 2227 to 2013 to 700 in 2019 (68.5 %), and the number of autochthonous cases declined from 17,553 to 3,787 (78.4 %). The best Cox's hazard model showed that foci in which vector control interventions were required were 18 % more likely to become an active focus. Increasing compliance with the 1-3-7 strategy had a protective effect, with a 22 % risk reduction among foci with over 80 % adherence to 1-3-7 timeliness protocols. Other factors associated with likelihood to become or remain an active focus include previous classification as an active focus, presence of Plasmodium falciparum infections, level of forest disturbance, and location in border provinces. CONCLUSIONS: These results identified factors that favored regression of non-active foci to active foci during the study period. The model and relative risk map align with the national malaria program's district stratification and shows strong spatial heterogeneity, with high probability to record active foci in border provinces. The results of the study may be useful for honing Thailand's program to eliminate malaria and for other countries aiming to accelerate malaria elimination.

Implementation and success factors from Thailand's 1-3-7 surveillance strategy for malaria elimination.

Thailand's National Malaria Elimination Strategy 2017-2026 introduced the 1-3-7 strategy as a robust surveillance and response approach for elimination that would prioritize timely, evidence-based action. Under this strategy, cases are reported within 1 day, cases are investigated within 3 days, and foci are investigated and responded to within 7 days, building on Thailand's long history of conducting case investigation since the 1980s. However, the hallmark of the 1-3-7 strategy is timeliness, with strict deadlines for reporting and response to accelerate elimination. This paper outlines Thailand's experience adapting and implementing the 1-3-7 strategy, including success factors such as a cross-sectoral Steering Committee, participation in a collaborative regional partnership, and flexible local budgets. The programme continues to evolve to ensure prompt and high-quality case management, capacity maintenance, and adequate supply of lifesaving commodities based on surveillance data. Results from implementation suggest the 1-3-7 strategy has contributed to Thailand's decline in malaria burden; this experience may be useful for other countries aiming to eliminate malaria.

Training Australian general practitioners to counsel women experiencing intimate partner abuse (WEAVE): a pre-post training analysis.

BACKGROUND: Evaluations of Intimate Partner Abuse training for general practitioners is limited. The Women's Evaluation of Abuse and Violence Care study trialled in Australia was a primary care intervention that included delivering the Health Relationships training, a program that educates practitioners on how to provide supportive counselling and assistance to women afraid of an intimate partner. We report on effectiveness of the Healthy Relationships training program within a cluster-randomised controlled trial. METHODS: General practitioners filled out a baseline survey and surveys before and after training, including quantitative and open-text questions on barriers and enablers to supporting victim-survivors. The Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) tool, a validated measure, was included to assess practitioner knowledge, skills, confidence, and attitudes. General linear model repeated analysis of variance tested the difference between trial groups over time. RESULTS: Fifty-two general practitioners completed the baseline demographic survey, with 65% (19 intervention, 18 comparison) completing both pre-and-post-training surveys. There were no between-group differences in baseline characteristics. Post-training, the intervention group had significantly higher average scores than the comparison on perceived preparation to address abuse (p = .000), perceived knowledge (p = .000), actual knowledge (p = .03), and greater awareness of practice-related issues (p = .000). There were no between-group differences in PREMIS opinion domain scores on workplace issues, self-efficacy and understanding of victims. Post-training, the qualitative data indicated that the intervention practitioners (n = 24) reported increased knowledge, awareness, and confidence, while time pressures and lack of referral options impeded addressing abuse. CONCLUSION: The Healthy Relationships Training program for general practitioners increased aspects of practitioner knowledge, skills, and confidence. However, more support is needed to change opinions and support victim-survivors sustainably. TRIAL REGISTRATION: The WEAVE trial was registered on 21/01/2008 with the Australian New Zealand Clinical Trial Registry, number ACTRN12608000032358.

Healthcare Responses to Gender-Based Violence in Timor-Leste: Women Want Empathy, Information and Safety From an Integrated Support System.

Healthcare providers are one of the first professionals women are likely to come into contact with after experiencing violence as they seek care for injuries and associated health problems or in routine care such as reproductive health services. Systematic reviews of women's experiences and expectations when disclosing abuse in health settings reveal a dearth of research with women in low-income countries and from rural areas. The aim of this study was to understand the information and interventions women who have experienced domestic violence or sexual assault want from their health providers in Timor-Leste, a country with a largely rural population and very high rates of violence against women. The mixed-methods study consisted of in-depth qualitative interviews with 28 women survivors of violence, followed by a 'pile-sort' activity in which they rated their preference for different types of interventions they wanted from their healthcare provider. The pile-sort activity showed the highest-ranked interventions centred around emotional support, information and safety, the middle-ranked interventions centred around empowering women and playing an advocacy role, and the lowestranked interventions were around intervening at the relationship level and mandatory reporting to the police. The qualitative interviews provided rich insights that affirmed women value empathy and kindness from service providers, they want to be supported to make their own decisions and the importance of formal as well as informal sources of support such as community leaders and family. There are significant implications for the content of existing training programmes on gender-based violence in Timor-Leste and similar contexts, particularly the need to build capacity on how to respond in an empathic and empowering way and how to balance mandatory reporting obligations, while also practising woman-centred care and providing the kind of support women value.Abstratu TetunFornesedór kuidadu saúde nuudar profisionál dahuluk ida ne'ebé iha posibilidade atu halo kontaktu ho feto sira depoiz de hetan violénsia tanba sira buka tratamentu ba kanek no problema saúde ne'ebe iha ligasaun ka iha kuidadu rutina sira hanesan servisu saúde reprodutiva nian. Estudu sistemátiku kona-ba feto sira nia esperiénsia no espetativa bainhira fósai abuzu iha kontestu saúde nian dehan katak ladun barak peskiza ho feto sira iha nasaun ho rendimentu kiik no husi área rurál sira. Estudu ida nee ezamina informasaun no intervensaun feto sira neebé hetan violénsia doméstika ka asaltu seksuál sira nia hakarak hosi fornesedor saúde iha Timor-Leste, nasaun ida neebé ho populasaun rurál barak no númeru ne'ebe mak aas tebes hosi violénsia hasoru feto. Métodu estudu mistura ne'ebé kompostu hosi entrevista kualitativa profundu ho sobrevivente feto na'in 28 ne'ebé sofre violénsia, tuir fali ho atividade 'pile sort' iha ne'ebé sira klasifika sira nia preferénsia ba tipu intervensaun ne'ebé diferente. Atividade pile sort hatudu intervensaun sira ne'ebé hetan klasifikasaun boot liu mak iha apoiu emosionál, informasaun no seguransa, intervensaun ho klasifikasaun médiu foka liu ba empoderamentu feto no hala'o papél advokasia, no intervensaun ho klasifikasaun kik liu mak iha intervensaun iha nivel relasaun, no keixa obrigatóriu (mandatory reporting) ba iha polisia. Entrevista kualitativu fórnese persepsaun barak ne'ebe feto sira koalia sai kona-ba sira nia valor empatia no laran-di'ak hosi prestadór servisu, sira hakarak atu hetan apoia atu halo desizaun rasik, no importánsia husi fonte formal no mos informál sira nia apoiu, hanesan lider komunitáriu no família. Iha implikasaun signifikativu ba konteúdu programa formasaun ne'ebé eziste kona-ba violénsia bazeia ba jéneru iha Timor-Leste no kontextu ne'ebe mak hanesan, liu-liu presiza atu hasa'e kapasidade kona-ba oinsá atu responde ho maneira empatia no empodera feto sira no oinsa halo balansu obrigasaun relatóriu mandatóriu (mandatory reporting) enkuantu mós prátika kuidadu feto sira no fornese apoiu ne'ebe mak iha valor ba feto sira.DisclaimerReaders should be aware that this article contains stories of trauma and abuse that some people may find difficult to read. If you experience any distress or something similar has happened or is happening to you, there are support services available in most countries. If you are in Timor-Leste, where this research was conducted, the following website has a list of services and contact details to get further assistance www.hamahon.tl.Nota: Le nain sira tenke hatene katak artigu ida ne'e kontein istória trauma no abuzu ne'ebé ema balun dalaruma sente defisil atu lee. Karik ita boot esperiensia difikuldade ruma ka iha esperiensia ruma neebé hanesan akontese ona ka akontese hela ba ita boot, iha servisu apoiu neebé mka disponivel iha nasaun barak. Karik ita boot hela iha Timor-Leste, iha nasaun ne'ebé hala'o peskiza ida ne'e, website tuir mai ne'e iha lista servisu no kontaktu detallu hodi hetan liu tan asisténsia www.hamahon.tl.

Financial burdens of HIV and chronic disease on people living with HIV in Côte d'Ivoire: A cross-sectional out-of-pocket expenditure study.

BACKGROUND: Although people living with HIV in Côte d'Ivoire receive antiretroviral therapy (ART) at no cost, other out-of-pocket (OOP) spending related to health can still create a barrier to care. METHODS: A convenience sample of 400 adults living with HIV for at least 1 year in Côte d'Ivoire completed a survey on their health spending for HIV and chronic non-communicable diseases (NCDs). In addition to descriptive statistics, we performed simple linear regression analyses with bootstrapped 95% confidence intervals. FINDINGS: 365 participants (91%) reported OOP spending for HIV care, with a median of $16/year (IQR 5-48). 34% of participants reported direct costs with a median of $2/year (IQR 1-41). No participants reported user fees for HIV services. 87% of participants reported indirect costs, with a median of $17/year (IQR 7-41). 102 participants (26%) reported at least 1 NCD. Of these, 80 (78%) reported OOP spending for NCD care, with a median of $50/year (IQR 6-107). 76 participants (95%) with both HIV and NCDs reported direct costs, and 48% reported paying user fees for NCD services. Participants had missed a median of 2 HIV appointments in the past year (IQR 2-3). Higher OOP costs were not associated with the number of HIV appointments missed. 21% of participants reported spending over 10% of household income on HIV and/or NCD care. DISCUSSION AND CONCLUSIONS: Despite the availability of free ART, most participants reported OOP spending. OOP costs were much higher for participants with co-morbid NCDs.

HARMONY: a pragmatic cluster randomised controlled trial of a culturally competent systems intervention to prevent and reduce domestic violence among migrant and refugee families in general practice: study protocol.

INTRODUCTION: Domestic violence and abuse (DVA) is prevalent, harmful and more dangerous among diaspora communities because of the difficulty accessing DVA services, language and migration issues. Consequently, migrant/refugee women are common among primary care populations, but evidence for culturally competent DVA primary care practice is negligible. This pragmatic cluster randomised controlled trial aims to increase DVA identification and referral (primary outcomes) threefold and safety planning (secondary outcome) among diverse women attending intervention vs comparison primary care clinics. Additionally, the study plans to improve recording of DVA, ethnicity, and conduct process and economic evaluations. METHODS AND ANALYSIS: Recruitment of ≤28 primary care clinics in Melbourne, Australia with high migrant/refugee communities. Eligible clinics need ≥1 South Asian general practitioner (GP) and one of two common software programmes to enable aggregated routine data extraction by GrHanite. Intervention staff undertake three DVA training sessions from a GP educator and bilingual DVA advocate/educator. Following training, clinic staff and DVA affected women 18+ will be supported for 12 months by the advocate/educator. Comparison clinics are trained in ethnicity and DVA data entry and offer routine DVA care. Data extraction of DV identification, safety planning and referral from routine GP data in both arms. Adjusted regression analysis by intention-to-treat by staff blinded to arm. Economic evaluation will estimate cost-effectiveness and cost-utility. Process evaluation interviews and analysis with primary care staff and women will be framed by Normalisation Process Theory to maximise understanding of sustainability. Harmony will be the first primary care trial to test a culturally competent model for the care of diverse women experiencing DVA. ETHICS AND DISSEMINATION: Ethical approval from La Trobe University Human Ethics Committee (HEC18413) and dissemination by policy briefs, journal articles and conference and community presentations. TRIAL REGISTRATION NUMBER: ANZCTR- ACTRN12618001845224; Pre-results.

Moving sexual health into primary care.

The rise in sexually transmitted infections (STIs) and the high rate of teenage pregnancies mean that sexual health services need to be increasingly provided in primary care settings by primary care professionals. Guidance from the National Institute of Clinical Excellence (NICE) in 2007 recommends proactive intervention sessions with individuals whose sexual history identifies them as at risk. Midwives and health visitors should make regular visits to under-18s who are pregnant or already mothers to provide advice on sexual health and contraception. Primary care professionals should be proactive in partner notification of STIs. The implications of implementing the NICE guidance are discussed, including the need for Primary Care Trusts to ensure that systems and funding are available to move more sexual health activity to primary care.

Sexually transmitted infections in men.

Under the National Sexual Health Strategy, some sexual health services are sited in primary care. Men are increasingly approaching primary care services about sexual health and professionals should be able to give accurate advice and refer them to the appropriate services. This article offers the non-specialist nurse an overview of the topic, including references to current clinical management and treatment guidelines. It discusses how and when to refer patients for a specialist opinion.

Dealing with trichomoniasis.

Trichomoniasis is a common but less well known sexually transmitted infection affecting men and women. In men it is often asymptomatic and goes undetected. In women it can produce a profuse, frothy, unpleasant-smelling vaginal discharge with pruritus and soreness which is sometimes confused with vulvo-vaginal candidiasis (thrush) and bacterial vaginosis. Women often mistakenly treat themselves for thrush with no result. Diagnosis is by laboratory culture and treatment is with metronidazole. Partner notification and treatment should be undertaken. Trichomoniasis often coexists with chlamydia and gonorrhoea. It can have consequences for reproduction, including low birth weight and preterm labour, and has been found to be a co-factor in the transmission of HIV. It is therefore mandatory to ensure prompt and appropriate treatment for all patients diagnosed with trichomoniasis.

Syphilis: still with us, so watch out!

The number of syphilis cases has been increasing in the UK, partly because of localised outbreaks. The sharpest rises have been among men having sex with men, but the incidence among heterosexuals has also risen. Blood-test screening for syphilis is an important part of sexual health, and includes routine screening of pregnant women at the first antenatal visit. Prompt treatment with penicillin in the earlier stages can stop the progression of the disease. Unfortunately, public awareness of syphilis and its potentially serious consequences is low. It is important for health professionals to be alert for signs of the disease and to initiate tests if there is a likelihood that a patient has or is at risk for the disease.

How to take a sexual history.

Under the National Strategy for Sexual Health and HIV, most patients seeking or requiring routine sexual health care are now offered the option of being treated by the primary health care team, rather than a specialised genito-urinary medicine clinic. Taking a sexual history and making a risk assessment is a key skill for making a diagnosis and care plan. This article offers a structured approach to this task, particularly for nurses, midwives and other community health professionals. It also describes the often sensitive core questions that the professional may need to ask in order to obtain an effective sexual history and determine the risks for a particular patient.

Sexually transmitted infections. Genital chlamydia: practical management in primary care.

As the number of infected people increases, more nurses outside the specialist sexual health services are being called upon to provide advice and clinical care for genital chlamydial infection. This article provides non-specialist nurses with practical information on the diagnosis, treatment, management and follow-up of clients with genital chlamydial infections.

Identifying and managing bacterial vaginosis.

The diagnosis and management of bacterial vaginosis are discussed, including the role of the nurse and midwife in testing and treatment.