Effectiveness of Linkage to Care and Prevention Interventions Following HIV Self-Testing: A Global Systematic Review and Meta-analysis.

Over 38.4 million people were living with HIV globally in 2021. The HIV continuum includes HIV testing, diagnosis, linkage to combined antiretroviral therapy (cART), and retention in care. An important innovation in the HIV care continuum is HIV self-testing. There is a paucity of evidence regarding the effectiveness of interventions aimed at linking self-testers to care and prevention, including pre-exposure prophylaxis (PrEP). To bridge this gap, we carried out a global systematic review and meta-analysis to ascertain the effectiveness of interventions post-HIV self-testing regarding: (1) linkage to care or ART, (2) linkage to PrEP, and (3) the impact of HIV self-test (HIVST) interventions on sexual behaviors. We searched PubMed, Web of Science, SCOPUS, Cochrane Library, CINAHL Plus (EBSCO), MEDLINE (Ovid), Google Scholar, and ResearchGate. We included only published randomized controlled trials (RCTs) and quasi-experiment that compared HIVST to the standard of care (SoC). Studies with sufficient data were aggregated using meta-analysis on RevMan 5.4 at a 95% confidence interval. Cochrane's Q test was used to assess heterogeneity between the studies, while Higgins and Thompson's I2 was used to quantify heterogeneity. Subgroup analyses were conducted to identify the source of heterogeneity. Of the 2669 articles obtained from the databases, only 15 studies were eligible for this review, and eight were included in the final meta-analysis. Overall, linkage to care was similar between the HIVST arm and SoC (effect size: 0.92 [0.45-1.86]; I2: 51%; p: 0.04). In the population subgroup analysis, female sex workers (FSWs) in the HIVST arm were significantly linked to care compared to the SoC arm (effect size: 0.53 [0.30-0.94]; I2: 0%; p: 0.41). HIVST interventions did not significantly improve ART initiation in the HIVST arm compared to the SoC arm (effect size: 0.90 [0.45-1.79]; I2: 74%; p: < 0.001). We found that more male partners of women living with HIV in the SoC arm initiated PrEP compared to partners in the HIVST arm. The meta-analysis showed no difference between the HIVST and SoC arm regarding the number of clients (effect size: - 0.66 [1.35-0.02]; I2: 64%; p: 0.09) and non-clients FSWs see per night (effect size: - 1.45 [- 1.45 to 1.38]; I2: 93%; p: < 0.001). HIVST did not reduce the use of condoms during insertive or receptive condomless anal intercourse among MSM. HIVST does not improve linkage to care in the general population but does among FSWs. HIVST intervention does not improve linkage to ART nor significantly stimulate healthy sexual behaviors among priority groups. The only RCT that linked HIVST to PrEP found that PrEP uptake was higher among partners of women living with HIV in the SoC arm than in the HIVST arm. More RCTs among priority groups are needed, and the influence of HIVST on PrEP uptake should be further investigated.

Health-related quality of life among adults living with chronic non-communicable diseases in the Ho Municipality of Ghana: a health facility-based cross-sectional study.

BACKGROUND: Morbidity and mortality rates from chronic non-communicable diseases (CNCDs) are increasing globally. In Ghana, CNCDs account for 43% of all deaths. We examined the Health-Related Quality of Life (HRQoL) and associated factors among adults living with CNCDs in the Ho Municipality. METHODS: This was a health facility-based descriptive cross-sectional study among 432 adults living with cancer, diabetes, chronic kidney disease (CKD), stroke, and hypertension in the Ho Municipality of Ghana. The study adopted the EQ-5D-5L instrument and the Ugandan value set to compute respondents' HRQoL index. Quantile regression models were used in analysing the data with STATA v17.0 at 95% Confidence Intervals, and statistical significance set at p < 0.05. RESULTS: 63.7% of our respondents reported having a problem across the five dimensions of the EQ-5D-5L. The most problems were reported in the dimensions "Anxiety/Depression" (94.4%) and "Pain/Discomfort" (91.4%). Divorced/separated respondents (aOR=-0.52, 95% CI=-0.71, -0.33) and those living with comorbidities (aOR=-0.95, 95% CI=-0.15, -0.04,) were less likely to report high index for HRQoL. However, respondents diagnosed with CKD (aOR = 0.26, 95% CI = 0.10, 0.42), diabetes (aOR = 0.28, 95% CI = 0.11, 0.45), hypertension (aOR = 0.35, 95% CI = 0.19, 0.50) and stroke (aOR = 0.26, 95% CI = 0.11, 0.40) were more likely to report higher index than those diagnosed with cancer. CONCLUSION: Our study revealed elevated proportions of reported problems in the "Anxiety/Depression" and "Pain/Discomfort" dimensions, indicating noteworthy concerns in these areas of HRQoL. The prevalent issues reported across HRQoL dimensions are cause for concern, posing potential exacerbation of health conditions. We advocate for collaborative efforts from the Ministry of Health, Ghana Health Service, and relevant stakeholders to scrutinize and implement interventions targeting social and psychological factors. These efforts should specifically address contributors to diminished health-related quality of life, particularly among less educated, divorced, and comorbid individuals.

Shared correlates of maternal and childhood overweight in Cameroon: a cross-sectional analysis of demographic and health survey data.

BACKGROUND: Overweight parents are likelier to bear overweight babies, who are likelier to grow into overweight adults. Understanding the shared risks of being overweight between the mother-child dyad is essential for targeted life course interventions. In this study, we aimed to identify such risk factors in Cameroon. METHODS: We conducted secondary data analysis using Cameroon's 2018 Demographic and Health Surveys. We used weighted multilevel binary logistic regressions to examine individual, household, and community correlates of maternal (15-49 years) and child (under five years) overweight. RESULTS: We retained 4511 complete records for childhood and 4644 for maternal analysis. We found that 37% [95%CI:36-38%] of mothers and 12% [95%CI:11-13%] of children were overweight or obese. Many environmental and sociodemographic factors were positively associated with maternal overweight, namely urban residence, wealthier households, higher education, parity and being a Christian. Childhood overweight was positively associated with a child being older and a mother being overweight, a worker, or a Christian. Therefore, only religion affected both mothers overweight (aOR: 0.71[95%CI:0.56-0.91]) and childhood overweight (aOR 0.67[95%CI: 0.5-0.91]). Most of the potentially shared factors only indirectly affected childhood overweight through maternal overweight. CONCLUSION: Besides religion, which affects both mothers and childhood overweight (with the Muslim faith being protective), much of childhood overweight is not directly explained by many of the observed determinants of maternal overweight. These determinants are likely to influence childhood overweight indirectly through maternal overweight. Extending this analysis to include unobserved correlates such as physical activity, dietary, and genetic characteristics would produce a more comprehensive picture of shared mother-child overweight correlates.

Management of chronic non-communicable diseases in Ghana: a qualitative study of patients' coping strategies and the role of caregivers.

BACKGROUND: Chronic Non-Communicable Diseases (CNCDs) has become a major cause of mortality and disability globally. We explored the coping strategies adopted by CNCD patients and the roles of caregivers in the management of CNCDs in Ghana. METHODS: This was a qualitative study that adopted an exploratory design. The study was carried out at the Volta Regional Hospital. Purposive convenience sampling procedures were used to sample patients and caregivers. Data for the study were collected using in-depth interview guides. Data were collected among 25 CNCDs patients and 8 caregivers and analysed thematically using ATLAS.ti. RESULTS: Patients adopted a variety of strategies to cope with their condition. These strategies were emotion-oriented coping, task-oriented coping, and avoidance-oriented coping. Family members were the main caregivers, who provided social and financial support for patients. Financial challenges, inadequate family support, poor attitudes of health workers, delays at the health facility, unavailability of drugs at the facility, and patients' non-adherence to the medical advice were major challenges that militated against caregivers' efforts in supporting patients in the management of their CNCDs. CONCLUSION: We found that patients adopted various strategies to cope with their conditions. The roles of the caregivers in supporting patients in the management practices were identified as very important as they contribute immensely to the financial and social support for the patients in their management of CNCDs. It is crucial that health professionals actively involve caregivers in every aspect of the day-to-day management of CNCDs as these caregivers spend more time with these patients and understand them better.

Ethical considerations in using a smartphone-based GPS app to understand linkages between mobility patterns and health outcomes: The example of HIV risk among mobile youth in rural South Africa.

Smartphones with Global Positioning System (GPS) apps offer simple and accurate tools to collect data on human mobility. However, their associated ethical challenges remain to be assessed. We used the Emanuel framework to assess the ethical concerns of using smartphone GPS to record mobility patterns of young adults in rural South Africa for a larger study on mobility and HIV risk (Sesikhona). We conducted four focus groups (FGDs) with individuals eligible for the Sesikhona study. FGD data were coded using the Emanuel framework. Participants perceived use of smartphone GPS to study human mobility and HIV risk as valuable. They raised concerns about invasion of privacy and confidentiality. Also mentioned were risk/benefit ratio, informed consent and ongoing respect. Concerns expressed provided a useful evidence-base for the development of a guide to inform future participants about ethical issues arising in the use of GPS technology to track mobility and health-related issues.

Provision of injectable contraceptives by community health workers in sub-Saharan Africa: a systematic review of safety, acceptability and effectiveness.

BACKGROUND: Injectable contraceptives are the most popular method of contraception in sub-Saharan Africa (SSA), but their availability in clinical settings has been severely limited, despite the scarcity of health care providers and limited access to health facilities. WHO and USAID have endorsed the community-based distribution of injectable contraceptives as a promising option for improving access to family planning services and expanding the method mix for women who want to limit the number of births. Studies have shown that community health workers (CHWs) can provide women with injectable contraceptives that meet acceptable quality standards. The goal of this study is to identify, evaluate and synthesize evidence supporting the use of community-based administration of injectable contraceptives in SSA. METHODS: This review's guidance was based on a previously developed protocol. Nine international electronic databases and the websites of organizations known to support community-based reproductive health initiatives in SSA were searched systemically. Experts in this area were also contacted for the identification of unpublished literature and ongoing studies. The reference lists of eligible studies were reviewed. The Effective Public Practice Project tool was used to assess the quality and risk of bias in eligible studies. Data were extracted and analysed using a custom data extraction form and a narrative synthesis. RESULTS: The search strategy identified a total of 1358 studies with 12 studies meeting the inclusion criteria. One unpublished study was provided by an expert making a total of 13 studies. The results showed that irrespective of the study designs, well-trained CHWs can competently administer injectable contraceptives safely and community-based delivery of injectable contraceptives is acceptable in SSA. Also, the use of community health workers in the provision of depot-medroxyprogesterone acetate expanded access to inhabitants of hard-to-reach areas and led to an overall uptake of injectable contraceptives as well as family planning. Studies that compared CHWs to clinic-based providers revealed equivalent or higher levels of performance in favour of CHWs. CONCLUSIONS: The CHWs can competently provide injectable contraceptives within SSA communities if appropriately trained and supervised. Hence, SSA policymakers should give this initiative due consideration as a way of improving access to family planning services.

Prevalence and determinants of maternal healthcare utilisation among young women in sub-Saharan Africa: cross-sectional analyses of demographic and health survey data.

BACKGROUND: Maternal health constitutes high priority agenda for governments across the world. Despite efforts by various governments in sub-Saharan Africa (SSA), the sub-region still records very high maternal mortality cases. Meanwhile, adequate utilization of maternal healthcare (antenatal care [ANC], skilled birth attendance [SBA], and Postnatal care [PNC]) plays a vital role in achieving improved maternal health outcomes. We examined the prevalence and determinants of maternal healthcare utilization among young women in 28 sub-Saharan African countries using data from demographic and health surveys. METHODS: This was a cross-sectional study of 43,786 young women aged 15-24 years from the most recent demographic and health surveys of 28 sub-Saharan African countries. We adopted a multilevel logistic regression analysis in examining the determinats of ANC, SBA, and PNC respectively. The results are presented as adjusted Odds Ratios (aOR) for the logistic regression analysis. Statistical significance was set at p < 0.05. RESULTS: The prevalence of maternal healthcare utilisation among young women in SSA was 55.2%, 78.8%, and 40% for ANC, SBA, and PNC respectively with inter-country variations. The probability of utilising maternal healthcare increased with wealth status. Young women who were in the richest wealth quintile were, for instance, 2.03, 5.80, and 1.24 times respectively more likely to utilise ANC (95% CI = 1.80-2.29), SBA (95% CI = 4.67-7.20), and PNC (95% CI = 1.08-1.43) than young women in the poorest wealth quintile. Young women who indicated having a barrier to healthcare utilisation were, however, less likely to utilise maternal healthcare (ANC: aOR = 0.83, 95% CI = 0.78-0.88; SBA: aOR = 0.82, 95% CI = 0.75-0.88; PNC: aOR = 0.88, 95% CI = 0.83-0.94). CONCLUSION: While SBA utilisation was high, we found ANC and PNC utilisation to be quite low among young women in SSA with inter-country variations. To accelerate progress towards the attainment of the Sustainable Development Goal (SDG) targets on reducing maternal mortality and achieving universal health coverage, our study recommends the adoption of interventions which have proven effective in some countries, by countries which recorded low maternal healthcare utilisation. The interventions include the implementation of free delivery services, training and integration of TBAs into orthodox maternal healthcare, improved accessibility of facilities, and consistent public health education. These interventions could particularly focus on young women in the lowest wealth quintile, those who experience barriers to maternal healthcare utilisation, uneducated women, and young women from rural areas.

Decision-making preferences and risk factors regarding early adolescent pregnancy in Ghana: stakeholders' and adolescents' perspectives from a vignette-based qualitative study.

BACKGROUND: Worldwide, over half of the adolescent pregnancies recorded are unintended. The decision to continue the pregnancy to term or to opt for an abortion is a constant dilemma that is directly or indirectly influenced by stakeholders and also by the wider social environment. This study aimed at understanding the perceived decision-making preferences and determinants of early adolescent pregnancy in the Jamestown area of Accra in Ghana. METHODS: A vignette-based qualitative study design was used. Eight focus group discussions were carried among various purposively selected groups of participants: parents, teachers, adolescent students who had not been pregnant before, and adolescents who had had at least one pregnancy in the past. The vignette was a hypothetical case of a 15-year-old high school student who had not experienced her menses for the past 6 weeks. The data were analyzed using a thematic analysis approach. RESULTS: Lack of parent-daughter communication, the taboo on discussing sex-related issues in households and weak financial autonomy were considered to be the main contributing factors to the high early adolescent pregnancy rates in the community. Partner readiness to assume responsibility for the girl and the baby was a key consideration in either continuing the pregnancy to term or opting for an abortion. The father was overwhelmingly considered to be the one to take the final decision regarding the pregnancy outcome. Irrespective of the fact that the respondents were very religious, opting for an abortion was considered acceptable under special circumstances, especially if the pregnant adolescent was doing well in school. CONCLUSION: Inadequate and inappropriate communication practices around sexuality issues, as well as weak financial autonomy are the major predictors of early adolescent pregnancy in this community. The father is perceived to be the main decision maker regarding a young adolescent's pregnancy outcome. Policy-makers should carefully evaluate the implications of this overwhelming perceived desire for the father to be the final decision-maker regarding adolescent pregnancy outcomes in this community.

Prevalence and Determinants of Unintended Pregnancy in Sub -Saharan Africa: A Systematic Review.

Over forty percent of pregnancies worldwide are unintended, with a quarter of these from Africa. There is a growing body of evidence regarding the adverse health, economic, societal, and developmental consequences of unintended pregnancies. The main aim of this systematic review is to report on the current prevalence and determinants of unintended pregnancies in sub-Saharan Africa. A literature search (in PubMed, Embase, PsycINFO and Scopus) was performed up to 29 May 2019. The Joanna Briggs Institute Reviewers' Manual guidelines to assess the quality of peer-reviewed quantitative articles were used to select articles that met our inclusion criteria. A total of 29 articles from 9 countries were included in the final review. The mean unintended pregnancy rate was 33.9%. The mean unwanted pregnancy rate was 11.2%, while the mean mistimed pregnancy rate was 22.1%. Mistimed pregnancies were more frequent across the 13 studies that classified unintended pregnancies into the unwanted and mistimed pregnancy sub-groups. Being an adolescent (19 years old or less), single, and having 5 children or more were consistent risk factors for unintended pregnancy. Awareness and use of modern contraception, level of education, socio-economic status, religion, and area of residence as independent variables were either protective or associated with an increased risk of reporting a pregnancy as being unintended. The unintended pregnancy rate in sub-Saharan Africa remains high, especially among singles, adolescents, and women with 5 or more children. There was no uniform tool used across studies to capture pregnancy intention. The studies did not capture pregnancy intention among women whose pregnancies ended up as stillbirths or abortions. More research is required to ascertain when it is best to capture pregnancy intention, and how exclusion or inclusion of pregnancies ending up as stillbirths or abortions impact reported unintended pregnancy rates.

Eliminating the high abortion related complications and deaths in Cameroon: the restrictive legal atmosphere on abortions is no acceptable excuse.

BACKGROUND: The abortion law in Cameroon is highly restrictive. The law permits induced abortions only when the woman's life is at risk, to preserve her physical and mental health, and on grounds of rape or incest. Unsafe abortions remain rampant with however rare reported cases of persecution, even when these abortions are proven to have been carried out illegally. DISCUSSION: Available public health interventions are cheap and feasible (Misoprostol and Manual Vacuum Aspiration in post abortion care, modern contraception, post-abortion counseling), and must be implemented to reduce unacceptably high maternal mortality rates in the country which still stand at as high as 596/100.000. Changes in the legal status of abortions might take a long time to come by. Albeit, advocacy efforts must be reinforced to render the law more liberal to permit women to seek safe abortion services. The frequency of abortions, generally clandestine, in this restrictive legal atmosphere has adverse economic, health and social justice implications. CONCLUSION: We argue that a non-optimal or restrictive legal atmosphere is not an acceptable excuse to justify these high maternal deaths resulting from unsafe abortions, especially in Cameroon where unsafe abortions remain rampant. Implementing currently available, cheap and effective evidence based practice guidelines are possible in the country. Expansion and use of Manual Vacuum Aspiration kits in health care facilities, post-abortion misoprostol and carefully considering the content of post abortion counseling packages deserve keen attention. More large scale qualitative and quantitative studies nationwide to identify and act on context specific barriers to contraception use and abortion related stigma are urgently needed.

Legal and Ethical Considerations during Maternal Death Surveillance and Response.

Maternal death surveillance and response (MDSR) is a promising strategy, to identify record and track key drivers of maternal deaths. Despite its potential in reducing maternal mortality, ethical and legal challenges need to be properly ascertained and acted upon, to guarantee its acceptability, sustainability, and effectiveness. This paper proposes a legal and ethical framework to guide practitioners and researchers through the MDSR process. Three (03) categories of both legal and ethical issues are discussed: namely the issues related to data, people and use of findings. Most challenges of the MDSR strategy have ethical and legal underappraisal origins, the most outstanding being the low maternal death notification rates. Efforts should be made for respondents to properly understand the rationale for the process, and how the data obtained will be put into use. Dispelling fears of possible litigation remains fundamental in obtaining quality data. Health care providers involved in the process need to understand their ethical and legal responsibilities, as well as privileges (legal protection). It is hoped that this framework will offer a structure to guide professionals in improving MDSR implementation and research.

Ethical issues surrounding the provider initiated opt--Out prenatal HIV screening practice in Sub-Saharan Africa: a literature review.

BACKGROUND: Prevention of mother to child transmission of HIV remains a key public health priority in most developing countries. The provider Initiated Opt - Out Prenatal HIV Screening Approach, recommended by the World Health Organization (WHO) lately has been adopted and translated into policy in most Sub - Saharan African countries. To better ascertain the ethical reasons for or against the use of this approach, we carried out a literature review of the ethics literature. METHODS: Papers published in English and French Languages between 1990 and 2015 from the following data bases were searched: Pubmed, Cochrane literature, Embase, Cinhal, Web of Science and Google Scholar. After screening from 302 identified relevant articles, 21 articles were retained for the critical review. DISCUSSION: Most authors considered this approach ethically justifiable due to its potential benefits to the mother, foetus and society (Beneficence). The breaching of respect for autonomy was considered acceptable on the grounds of libertarian paternalism. Most authors considered the Opt - Out approach to be less stigmatizing than the Opt - In. The main arguments against the Opt - Out approach were: non respect of patient autonomy, informed consent becoming a meaningless concept and the HIV test becoming compulsory, risk of losing trust in health care providers, neglect of social and psychological implications of doing an HIV test, risk of aggravation of stigma if all tested patients are not properly cared for and neglect of sociocultural peculiarities. CONCLUSIONS: The Opt - Out approach could be counterproductive in case gender sensitive issues within the various sociocultural representations are neglected, and actions to offer holistic care to all women who shall potentially test positive for HIV were not effectively ascertained. The Provider Initiated Opt - Out Prenatal HIV Screening option remains ethically acceptable, but deserves caution, active monitoring and evaluation within the translation of this approach into to practice.

Exploring therapeutic communication in managing chronic non-communicable diseases: a mixed-method study in Ghana.

BACKGROUND: Globally, the burden of chronic non-communicable diseases is increasing rapidly and approximately one in three of all adults suffer from multiple chronic conditions. Therapeutic communication plays a crucial role in achieving curative, preventive, and promotive goals regarding chronic disease management. We examined therapeutic communication between health professionals and patients with chronic non-communicable diseases at the Ho Teaching Hospital. METHODS: We adopted a concurrent mixed-methods approach. The quantitative aspect of the study was descriptive while the qualitative was explanatory. The quantitative study was conducted among 250 patients. The qualitative data was collected among eight health professionals. A stratified sampling and simple random sampling methods were used to recruit patients for the quantitative survey while purposive and convenient sampling was used for the qualitative aspect of the study. The quantitative data was collected using a semi-structured questionnaire while the qualitative data was collected using an in-depth interview guide. The quantitative data were analyzed using STATA v17 and the qualitative data were analyzed thematically using Atlas ti. The major themes that emerged were, therapeutic communication practices, barriers to therapeutic communication and possible solutions to good therapeutic communication. RESULTS: We found that 37% patients were 60 years and above with 53.2% being females. It was noted that 36.4% of patients have had tertiary-level education. We found that 59.2% of patients reported having good therapeutic communication with health professionals. We, however, noted that male participants were 92% less likely to practice good therapeutic communication compared with females (aOR = 0.92,95% Cl = 0.46-1.84). Health professionals' activities to ensure good therapeutic practices included their capacity to listen, build rapport with their patients, and clarify information. We found that the major facilitators of good therapeutic communication included trust in the health professionals (90.4%), conducive environment (93.2%), using simple and plain language by health professionals (92.0%) We found that there are myriad of barriers that impede communication process. This included language, health professionals' inability to break terminologies, and the unconscious state of patients. CONCLUSIONS: The study revealed that there was good therapeutic communication between health professionals and patients with CNCDs. Nevertheless, it was also identified that ineffective therapeutic communication between health professionals and their patients due to barriers like language could lead to dissatisfaction with care, misdiagnosis, and noncompliance to treatment regimen. For Ghana as a country to achieve SDG target 3.4 by reducing mortality due to NCDs and improve wellbeing of patients by 2030, it will be imperative on Ghana Health Service to design communication strategy training for health professionals that could help improve therapeutic communication between patients and health professionals.

Influence of perceived social support and other factors on treatment adherence among adults living with chronic non-communicable diseases in the Ho Municipality of Ghana: A health facility-based cross-sectional study.

BACKGROUND: In Sub-Saharan Africa (SSA), there is a noticeable shift from infectious diseases to chronic non-communicable diseases (CNCDs) based on recent studies. However, other studies suggest that social support can significantly improve self-care, increase knowledge of disease symptoms, and ultimately increase overall well-being in patients with CNCDs. In this study, we investigated the influence of perceived social support on treatment adherence among adults living with CNCDs in the Ho Municipality. METHODS: This was a health facility-based cross-sectional study among 432 adults living with cancer, diabetes, chronic kidney disease (CKD), stroke, and hypertension in the Ho Municipality of the Volta Region, Ghana. We adopted the Multi-dimensional Scale of Perceived Social Support (MSPSS), Medication Adherence Rating Scale and independent items to collect data. Logistic regression models were used to analyze the data with STATA v17.0 at 95% Confidence Intervals with statistical significance set at p<0.05. RESULTS: Majority of the participants (62%) reported high levels of perceived social support. While friends were the main source of support (69.4%), significant others provided the least support (45.4%). Among the dimensions of treatment adherence, participants demonstrated the highest adherence to reviews/check-ups (98.8%), while medication adherence had the highest level of non-adherence (38%). We did not find a significant association between perceived social support and overall treatment adherence, except for individuals with low perceived social support from friends (aOR = 8.58, 95% CI = 4.21,17.52), who were more likely to exhibit high adherence to behavioural and lifestyle recommendations. CONCLUSION: While the majority of respondents reported high perceived social support, there was no significant link between social support and overall treatment adherence. However, individuals with low support from friends showed a notably increased adherence to behavioural and lifestyle recommendations. This underscores the nuanced impact of social support on specific aspects of adherence, highlighting the need for targeted interventions tailored to individual support networks.

Increasing HIV testing and linkage to care among men in rural South Africa using conditional financial incentives and a decision support app: A process evaluation.

Men in sub-Saharan Africa are less likely to accept HIV testing and link to HIV care than women. We conducted a trial to investigate the impact of conditional financial incentives and a decision support application, called EPIC-HIV, on HIV testing and linkage to care. We report the findings of the trial process evaluation to explore whether the interventions were delivered as intended, identify mechanisms of impact and any contextual factors that may have impacted the trial outcomes. Between August 2018 and March 2019, we conducted in-depth interviews and focus group discussions with trial participants (n = 31) and staff (n = 14) to examine views on the implementation process, participant responses to the interventions and the external factors that may have impacted the implementation and outcomes of the study. Interviews were audio-recorded, transcribed, and translated where necessary, and thematically analyzed using ATLAS-ti and NVivo. Both interventions were perceived to be acceptable and useful by participants and implementers. EPIC-HIV proved challenging to implement as intended because it was difficult to ensure consistent use of earphones, and maintenance of privacy. Some participants struggled to navigate the EPIC-HIV app independently and select stories that appealed to them without support. Some participants stopped exploring the app before the end, resulting in an incomplete use of EPIC-HIV. While the financial incentive was implemented as intended, there were challenges with eligibility. The convenience and privacy of home testing influenced the uptake of HIV testing. Contextual barriers including fear of HIV stigma and disclosure if diagnosed with HIV, and expectations of poor treatment in clinics may have inhibited linkage to care. Financial incentives were relatively straightforward to implement and increased uptake of home-based rapid HIV testing but were not sufficient as a 'stand-alone' intervention. Barriers like fear of stigma should be addressed to facilitate linkage to care.

The SPIN framework to control and prevent the Marburg virus disease outbreak in Equatorial Guinea.

A full grasp of the epidemiological factors promoting transmission is necessary for responding to highly infectious diseases, which involves their control and prevention. With the recent outbreak of Marburg Virus Disease (MVD) in Equatorial Guinea, we saw the need to re-shed some technical light based on our field experiences and published literature. We reviewed 15 previous MVD outbreaks globally. Coupled with core One-Health approaches, we highlighted the SPIN (socio-environmental context, possible transmission routes, informing and guiding public health action, needs in terms of control measures) framework as a guiding tool for response teams to appropriately approach this highly contagious infectious disease outbreak for collective and stronger global health security. The Central African Regional Collaborating Centre (RCC) of the Africa Centres for Disease Control and Prevention (Africa CDC) has a big lead role to play, most especially in coordinating the community engagement and risk communication packages of the response, which is highly needed at this point. We reiterate that this framework remains relevant, if not timely, in rethinking pandemic preparedness and response in resource-limited settings.

Does adherence to antiretroviral therapy differ by place of residence in Nigeria? A systematic review and meta-analysis protocol.

INTRODUCTION: Retention in care is still a significant challenge in the HIV treatment cascade and varies extensively across regions, leading to poor adherence to antiretroviral therapy (ART). Several factors across different socioecological levels, such as health and community-level factors, inhibit ART adherence among people living with HIV (PLWH) in Nigeria. This review seeks to ask whether adherence to ART differs by place of residence in Nigeria. METHOD AND ANALYSIS: This systematic review and meta-analysis will follow the updated Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. We will search PubMed, SCOPUS, CINAHL, Web of Science, MEDLINE (Ovid) and Google Scholar from onset to 30 April 2023. We will include only quantitative observational studies or mixed-method studies that measured the association between place of residence (urban and rural) and adherence to ART among PLWH aged ≥15 years. Title and abstract screening, full-text screening, data extraction and quality assessment will be done by two reviewers independently. A third reviewer will resolve disagreements. We will extract the author's name and year of publication, study aim(s), participant's characteristics, sample size, sampling method, region and state, adherence definition and adherence level in urban and rural areas. Data will be analysed with Review Manager V.5.4. The Q statistical test will be used to assess between-study heterogeneity, while Higgins and Thompson's I2 will be used to quantify the heterogeneity level. Several subgroups and sensitivity analyses will be conducted. ETHICS AND DISSEMINATION: Ethical approval is not warranted for this study since primary published data will be utilised. The findings of this review will be published in a high-impact peer-reviewed journal and presented at a conference. PROSPERO REGISTRATION NUMBER: CRD42022371965.

Prevalence and factors associated with adolescent pregnancies in Zambia: a systematic review from 2000-2022.

BACKGROUND: Adolescent pregnancy increases risk of short- and long-term adverse social and health outcomes for the adolescent mother and child. Zambia has high prevalence rates of adolescent pregnancy. However, the risk factors are varied and in need of further review and research. The study accordingly reviewed the prevalence and factors associated with adolescent pregnancy in Zambia. METHODS: This systematic review was conducted following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The review included original peer-reviewed research articles published from 2000 onwards in English, retrieved from Medline, EMBASE, CINAHL, and African Journals Online databases. Thematic synthesis was used in the analysis of the data extracted from the included studies. RESULTS: Six research studies carried out in Zambia (two quantitative, two qualitative, and two mixed methods) were reviewed and included. Prevalence of adolescent pregnancy in Zambia ranged from 29 to 48%. Additionally, it was found that 29.1% of the country's adolescents, nationally, had given birth as of 2018. Factors at an individual's level such as early or child marriage, exposure to media, knowledge about sexual and reproductive health (SRH) and contraception, contraceptive use, as well as risky sexual behaviours were found to be significantly associated with adolescent pregnancy. Peer pressure, educational attainment, household wealth, and the power dynamics of the household head were identified as the major socio-economic factors alongside socio-cultural, gender and sexual norms amongst other environmental and contextual factors. Policy level factors identified were lack and limited access to SRH information and services by adolescents, including an enabling legal environment. CONCLUSION: From the review, it was abundantly clear that a combination of individual, interpersonal, environmental, and an enabling legal/policy level factors significantly contribute to the high levels of adolescent pregnancy. There is a paucity of empirical research on the prevalence and determinants of adolescent pregnancy, which suggests an imperative need for large multi-site mixed methods studies to properly explore these and other determinants on a national scale, as well as the long-term implications of these pregnancies on adolescent mothers and babies. Multifaceted and multisectoral interventions which include improved access to education, economic empowerment, addressing gender and socio-cultural norms, should be implemented having due regard to the socio-cultural context which should ride on strong political will, failing which adolescent girls in Zambia will definitely be left behind.

Pregnancy increases risk of adverse short- and long-term outcomes for adolescent mothers and their babies. Adolescent pregnancy is significantly high in Zambia. However, the risk factors are varied and in need of further review and research. Using a systematic review process, we identify the trends and factors that influence adolescent pregnancy in Zambia from research articles published since 2000. We found that prevalence of adolescent pregnancy in Zambia was between 29%-48% and that nationally, 29.1% of the country's adolescents had given birth as of 2018. Factors identified as influencing adolescent pregnancy in Zambia were analysed at four levels: 1) individual factors such as early or child marriage, exposure to media, knowledge about sexual and reproductive health and contraception, contraceptive use, as well as risky sexual behaviours; 2) interpersonal level factors such as peer pressure, educational attainment, household wealth, influence of male or female headed households, and family members; 3) community/environmental factors such as socio-cultural, gender and sexual norms; and 4) an enabling policy/legal environment covering mostly access to SRH information and services. It was emphasized that various stakeholders should deliberately collaborate to address these issues at all four levels using interventions that are socio-culturally suitable and should be supported by strong political will at policy and implementation levels to facilitate better access to education, improve economic empowerment of girls, review of gender and dysfunctional cultural norms and practices, amongst other considerations.

Improving investment in chronic disease care in Sub-Saharan Africa is crucial for the achievement of SDG 3.4: application of the chronic care model.

Over 41 million people die of chronic non-communicable diseases (CNCDs) each year, accounting for 71% of all global deaths. The burden of CNCD is specifically a problem in sub-Saharan Africa (SSA) since CNCDs are largely a leading major cause of mortality in the sub-region. While the disease burden and mortality from chronic non-communicable diseases (CNCDs) have reached an epidemic threshold in sub-Saharan Africa (SSA), health systems, policy-makers and individuals still consider CNCDs to be uncommon and, therefore, do not give its management the required attention. In sub-Saharan Africa (SSA), effectively addressing the growing burden of CNCDs will require comprehensive measures that incorporate both curative and preventive interventions, towards achieving the Sustainable Development Goal (SDG) 3.4 target of reducing by one-third premature mortality from CNCDs through prevention and treatment and the promotion of mental health and well-being by the year 2030. In this commentary, we adopt the Chronic Care Model (CCM) to discuss how improved investment in Chronic Disease Care is crucial in achieving the SDG target in SSA. At the health systems level of the CCM, we propose that countries in SSA should increase the proportion of their annual budgets allocated to health in line with the Abuja Declaration of 2001. Social health insurance should also be adopted by all countries and effectively implemented. At the community level, we propose intensified community-based health education, the formation of peer support groups and the implementation of community-based policies that promote healthy eating and physical activity.

Increased investment in Universal Health Coverage in Sub-Saharan Africa is crucial to attain the Sustainable Development Goal 3 targets on maternal and child health.

Universal Health Coverage (UHC) is considered a strategic component of the Sustainable Development Goals specifically for goal 3 which seeks to ensure healthy lives and promote well-being for all, where all individuals and communities have equal access to key promotive, preventive, curative, and rehabilitative health interventions without financial constraints. Despite Sub-Saharan Africa (SSA) accelerated gains on the UHC effective coverage of 2.6% between 2010 to 2019, many countries in the sub-region show lagging performance. The major challenges faced in attaining the UHC in many countries include inadequate capital investment for health and their equitable distribution, fiscal space to finance UHC policies and programs. This paper discusses how increased investment in Universal Health Coverage in SSA is crucial to attain the Sustainable Development Goal 3 targets on maternal and child health. The Universal Health Monitoring Framework (UHMF) is adopted in this paper as the underpinning framework. The delivery of essential maternal and child health services to achieve UHC in SSA requires strategic actions such as policies, plans and programs with focus on maternal and child health. We report findings from recently published papers that clearly highlighted the strong connection between health insurance coverage and maternal health care utilization. Strategic actions such as implementing national health insurance scheme (NHIS) that directly incorporates free maternal and child health care could strengthen maternal health services and transform health systems in order to achieve UHC in SSA. We argue that achieving the SDG 3 on maternal and child health will only be possible if significant progress in made in increasing UHC. This is key to ensure optimal maternal health care utilization, and consequently reducing maternal and child deaths.