ABSTRACT
Background Xylazine is an increasingly common adulterant in the North American unregulated drug supply that is associated with adverse health outcomes (e.g., skin infections, overdose). However, there are significant knowledge gaps regarding how xylazine was initially identified and how syringe services program (SSP) staff and clients (people who use drugs) responded to its emergence. Methods From June-July 2023, we conducted qualitative interviews with medical (e.g., clinicians) and frontline SSP staff (e.g., outreach workers) and adult clients with a history of injection drug use at a Miami-based SSP. Inductive memos identified emergent codes; thematic analysis involving team consensus established final themes. Results From interviews with SSP staff (n = 8) and clients (n = 17), xylazine emergence was identified at different times, in various ways. Initially, during summer 2022, clients identified a "tranquilizer-like substance" that worsened sedation and withdrawal and caused wounds. SSP medical staff later identified this adulterant as xylazine by treating new medical cases and through diverse information-sharing networks that included professional societies and news sources; however, frontline SSP staff and clients needed additional educational resources about xylazine and its side effects. With limited guidance on how to reduce harm from xylazine, SSP clients altered their drug consumption routes, reduced drug use, and relied on peers' experiences with the drug supply to protect themselves. Some individuals also reported preferring xylazine-adulterated opioids and increasing their drug use, including the use of stimulants to avoid over sedation. Conclusions Xylazine's emergence characterizes the current era of unprecedented shifts in the unregulated drug supply. We found that xylazine spurred important behavioral changes among people who use drugs (e.g., transitioning from injecting to smoking). Incorporating these experiences into early drug warning surveillance systems and scaling up drug-checking services and safer smoking supply distribution could help mitigate significant health harms caused by xylazine and other emergent adulterants.
ABSTRACT
Young people's sexual and reproductive health (SRH) continues to be a major challenge in low and middle-income countries, with implications for public health now and in the future. Fortunately there is a growing array of evidence-based interventions, and commitments from governments, development partners and donors, to support programmes that aim to improve young people's SRH.However, in some situations, the technical assistance that governments feel that they need to strengthen and implement national policies and strategies, to move from words to action, is not available. The WHO Adolescent and Youth Sexual and Reproductive Health and Rights (AYSRHR) Technical Assistance (TA) Coordination Mechanism was initiated to help fill this technical assistance gap; to respond to TA requests from ministries of health in ways that are timely, efficient, effective and contribute to strengthening capacity.This paper describes the process of developing the Technical Assistance Coordination Mechanism (TA Mechanism) and the outcomes, experiences and lessons learned after three years of working. It triangulates the findings from a preliminary review of the literature and discussions with selected key informants; the outcomes from a series of structured review meetings; and the documented processes and results of the technical assistance provided to countries.The lessons learned focus on three aspects of the TA Mechanism. How it was conceptualized and designed: through listening to people who provide and receive AYSRHR TA and by reviewing and synthesizing past experiences of TA provision. What the TA Mechanism has achieved: a standardized process for TA provision, at different stages for a range of AYSRHR issues in ten countries in three geographic regions. And what worked well and what did not: which common challenges was the TA Mechanism able to address and which ones persisted despite efforts to avoid or resolve them. The paper ends with the implications of the lessons learned for future action.
Subject(s)
Reproductive Health , Sexual Health , Humans , Adolescent , World Health Organization , Reproductive Rights , Female , Reproductive Health Services/organization & administration , Male , Developing Countries , Young AdultABSTRACT
BACKGROUND: People who inject drugs (PWID) remain a high priority population under the federal Ending the HIV Epidemic initiative with 11% of new HIV infections attributable to injection drug use. There is a critical need for innovative, efficacious, scalable, and community-driven models of healthcare in non-stigmatizing settings for PWID. We seek to test a Comprehensive-TeleHarm Reduction (C-THR) intervention for HIV prevention services delivered via a syringe services program (SSP). METHODS: The CHARIOT trial is a hybrid type I effectiveness-implementation study using a parallel two-arm randomized controlled trial design. Participants (i.e., PWID; n = 350) will be recruited from a syringe services program (SSP) in Miami, Florida. Participants will be randomized to receive either C-THR or non-SSP clinic referral and patient navigation. The objectives are: (1) to determine if the C-THR intervention increases engagement in HIV prevention (i.e., HIV pre-exposure prophylaxis; PrEP or medications for opioid use disorder; MOUD) compared to non-SSP clinic referral and patient navigation, (2) to examine the long-term effectiveness and cost-effectiveness of the C-THR intervention, and (3) to assess the barriers and facilitators to implementation and sustainment of the C-THR intervention. The co-primary outcomes are PrEP or MOUD engagement across follow-up at 3, 6, 9 and 12 months. For PrEP, engagement is confirmed by tenofovir on dried blood spot or cabotegravir injection within the previous 8 weeks. For MOUD, engagement is defined as screening positive for norbuprenorphine or methadone on urine drug screen; or naltrexone or buprenorphine injection within the previous 4 weeks. Secondary outcomes include PrEP adherence, engagement in HCV treatment and sustained virologic response, and treatment of sexually transmitted infections. The short and long term cost-effectiveness analyses and mixed-methods implementation evaluation will provide compelling data on the sustainability and possible impact of C-THR on comprehensive HIV prevention delivered via SSPs. DISCUSSION: The CHARIOT trial will be the first to our knowledge to test the efficacy of an innovative, peer-led telehealth intervention with PWID at risk for HIV delivered via an SSP. This innovative healthcare model seeks to transform the way PWID access care by bypassing the traditional healthcare system, reducing multi-level barriers to care, and meeting PWID where they are. TRIAL REGISTRATION: ClinicalTrials.gov NCT05897099. Trial registry name: Comprehensive HIV and Harm Prevention Via Telehealth (CHARIOT). Registration date: 06/12/2023.
Subject(s)
Drug Users , HIV Infections , Substance Abuse, Intravenous , Humans , Harm Reduction , HIV Infections/epidemiology , HIV Infections/prevention & control , Methadone/urine , Randomized Controlled Trials as Topic , Substance Abuse, Intravenous/complicationsABSTRACT
BACKGROUND: As injection drug use has increased in the US, so too has the prevalence of receptive syringe sharing. Since the 1980s, Needle and Syringe Programs (NSPs) have been an important source of clean injection equipment and disposal of used syringes. This study reports national syringe coverage and examines the impact of program attributes on organizational-level service uptake, defined as number of syringes distributed per participant contact per year. METHODS: In 2019 and 2020, we administered an annual cross-sectional survey to NSPs operating in the US (n = 260). A national estimate of coverage was calculated by dividing the total number of syringes distributed by the 2019 and 2020 population estimate of people who inject drugs (PWID). Frequency distributions and percentages were calculated for categorical variables (e.g., funding, census region, distribution policy/modality), and median and interquartile ranges (IQR) were calculated for continuous variables (e.g., participant contacts, syringes distributed). Bivariate and multivariable mixed effects logistic regression models were used to estimate the odds ratio associated with organizational characteristics on increasing service uptake at the NSP level. RESULTS: From 2019 to 2020, the total number of participant contacts by NSPs increased from 871,976 to 898,891, and the number of syringes distributed increased from 92,648,529 to 113,071,748. The national coverage estimate increased from 29.5 (95 % CI = 15.0, 58.2) to 35.8 (95 % CI = 18.2, 70.6) syringes per PWID. Fifty-eight percent of NSPs increased service uptake in 2020 as compared to the previous year. NSPs that received government funding and NSPs that changed to a less restrictive syringe distribution policy were more likely to increase service uptake (aOR 1.80, 95 % CI = 1.01, 3.22 and aOR 3.33, 95 % CI = 1.11, 9.94, respectively). Syringe distribution modalities also diversified, with more NSPs reaching participants via backpacking/outreach, fixed site pop-ups, mobile delivery, mail-based delivery, leaving supplies out, and secondary distribution. CONCLUSION: Both governmental investment in harm reduction programming and needs-based distribution of syringes increased service uptake and thus should be expanded and sustained to reduce harms associated with injection drug use.
Subject(s)
HIV Infections , Substance Abuse, Intravenous , Humans , United States , Substance Abuse, Intravenous/epidemiology , Substance Abuse, Intravenous/complications , Needle-Exchange Programs , Cross-Sectional Studies , Needles , Needle Sharing , HIV Infections/complicationsABSTRACT
BACKGROUND: Research on menstrual health is required to understand menstrual needs and generate solutions to improve health, wellbeing, and productivity. The identification of research priorities will help inform where to invest efforts and resources. OBJECTIVES: To identify research priorities for menstrual health across the life-course, in consultation with a range of stakeholder groups from a variety of geographic regions, and to identify if menstrual health research priorities varied by expertise. METHODS: A modified version of the Child Health and Nutrition Research Initiative approach was utilized to reach consensus on a set of research priorities. Multisector stakeholders with menstrual health expertise, identified through networks and the literature, were invited to submit research questions through an online survey. Responses were consolidated, and individuals were invited to rank these questions based on novelty, potential for intervention, and importance/impact. Research priority scores were calculated and evaluated by participants' characteristics. RESULTS: Eighty-two participants proposed 1135 research questions, which were consolidated into 94 unique research questions. The mean number of questions did not differ between low- and middle-income country (LMIC) and high-income country (HIC) participants, but significantly more questions were raised by participants with expertise in mental health and WASH. Sixty-six participants then ranked these questions. The top ten-ranked research questions included four on 'understanding the problem', four on 'designing and implementing interventions', one on 'integrating and scaling up', and one on 'measurement'. Indicators for the measurement of adequate menstrual health over time was ranked the highest priority by all stakeholders. Top ten-ranked research questions differed between academics and non-academics, and between participants from HICs and LMICs, reflecting differences in needs and knowledge gaps. CONCLUSIONS: A list of ranked research priorities was generated through a consultative process with stakeholders across LMICs and HICs which can inform where to invest efforts and resources.
Subject(s)
Developing Countries , Research Design , Child , Humans , Surveys and Questionnaires , Health Priorities , Child HealthABSTRACT
Comprehensive sexuality education (CSE) is a well-established component of the package of interventions required to improve adolescent sexual and reproductive health and rights. As the international community has increased its emphasis on equity and leaving no-one behind with the Agenda for Sustainable Development, attention has been drawn to the need for complementary CSE programmes to reach young people who are not in school, or whose needs are not met by in-school CSE programmes. CSE in out-of-school contexts presents unique considerations, especially those related to facilitation. In this manuscript, we present the protocol for a multi-country implementation research study in Colombia, Ethiopia, Ghana, and Malawi to assess the feasibility, acceptability, and effectiveness of context-specific actions to prepare and support facilitators to deliver CSE in out-of-school settings to defined groups of young people with varying needs and circumstances. This study will be led by the World Health Organization and the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, in partnership with local research institutions. It will be nested within a multi-country programme led by UNFPA, in partnership with local implementing partners and with financial support from the Government of Norway. This study will shed new insight into what it takes to effectively deliver CSE in out-of-school contexts, to enhance progress towards the achievement of SDG 3 "Ensure healthy lives and promote wellbeing for all at all ages" and SDG 5 "Achieve gender equality and empower all women and girls".
Subject(s)
Sex Education , Sexual Health , Adolescent , Humans , Female , Feasibility Studies , Sexual Behavior , ReproductionABSTRACT
Background: At the start of the pandemic, relaxation of buprenorphine prescribing regulations created an opportunity to create new models of medications for opioid use disorder (MOUD) delivery and care. To expand and improve access to MOUD, we adapted and implemented the Tele-Harm Reduction (THR) intervention; a multicomponent, telehealth-based and peer-driven intervention to promote HIV viral suppression among people who inject drugs (PWID) accessing a syringe services program (SSP). This study examined buprenorphine initiation and retention among PWID with opioid use disorder who received the adapted THR intervention at the IDEA Miami SSP.Methods: A retrospective chart review of participants who received the THR intervention for MOUD was performed to examine the impact of telehealth on buprenorphine retention. Our primary outcome was three-month retention, defined as three consecutive months of buprenorphine dispensed from the pharmacy.Results: A total of 109 participants received the adapted THR intervention. Three-month retention rate on buprenorphine was 58.7%. Seeing a provider via telehealth at baseline or any follow up visit (aOR = 7.53, 95% CI: [2.36, 23.98]) and participants who had received an escalating dose of buprenorphine after baseline visit (aOR = 8.09, 95% CI: [1.83, 35.87]) had a higher adjusted odds of retention at three months. Participants who self-reported or tested positive for a stimulant (methamphetamine, amphetamine, or cocaine) at baseline had a lower adjusted odds of retention on buprenorphine at three months (aOR = 0.29, 95% CI: [0.09, 0.93]).Conclusions: Harm reduction settings can adapt dynamically to the needs of PWID in provision of critical lifesaving buprenorphine in a truly destigmatising approach. Our pilot suggests that an SSP may be an acceptable and feasible venue for delivery of THR to increase uptake of buprenorphine by PWID and promote retention in care.KEY MESSAGESThe Tele-Harm Reduction intervention can be adapted for initiating and retaining people who inject drugs with opioid use disorder on buprenorphine within a syringe services program settingUsing telehealth was associated with increased three-month buprenorphine retentionBaseline stimulant use was negatively associated with three-month buprenorphine retention.
Subject(s)
Buprenorphine , Drug Users , Opioid-Related Disorders , Substance Abuse, Intravenous , Humans , Harm Reduction , Retrospective Studies , Pharmaceutical PreparationsABSTRACT
Over the last two decades, improvements in Ethiopia's socio-economic context, the prioritization of health and development in the national agenda, and ambitious national health and development policies and programmes have contributed to improvements in the living standards and well-being of the population as a whole including adolescents. Improvements have occurred in a number of health outcomes, for example reduction in levels of harmful practices i.e., in child marriage and female genital mutilation/cutting (FGM/C), reduction in adolescent childbearing, increase in positive health behaviours, for example adolescent contraceptive use, and maternal health care service use. However, this progress has been uneven. As we look to the next 10 years, Ethiopia must build on the progress made, and move ahead understanding and overcoming challenges and making full use of opportunities by (i) recommitting to strong political support for ASRHR policies and programmes and to sustaining this support in the next stage of policy and strategy development (ii) strengthening investment in and financing of interventions to meet the SRH needs of adolescents (iii) ensuring laws and policies are appropriately communicated, applied and monitored (iv) ensuring strategies are evidence-based and extend the availability of age-disaggregated data on SRHR, and that implementation of these strategies is managed well (v) enabling meaningful youth engagement by institutionalizing adolescent participation as an essential element of all programmes intended to benefit adolescents, and (vi) consolidating gains in the area of SRH while strategically broadening other areas without diluting the ASRHR focus.
Subject(s)
Health Policy/trends , Health Priorities/trends , Social Class , Socioeconomic Factors , Adolescent , Adolescent Health Services/standards , Adolescent Health Services/trends , Child , Circumcision, Female/statistics & numerical data , Circumcision, Female/trends , Ethiopia , Female , Humans , Marriage/statistics & numerical data , Marriage/trends , Maternal Health Services/standards , Maternal Health Services/trendsABSTRACT
INTRODUCTION: Pregnancy and childbearing among adolescents-especially younger adolescents-is associated with health complications and lost opportunities for education and personal development. In addition to established challenges adolescents and young women face in sexual and reproductive healthcare, evidence suggests that they also face mistreatment during childbirth. METHODS: This is a secondary analysis of the WHO study 'How women are treated during facility-based childbirth' cross-sectional community survey in Ghana, Guinea, Myanmar and Nigeria. We used descriptive analysis to assess experiences of mistreatment among adolescents (15-19 years) and young women (20-24 years) and multivariable logistic regression models to assess the association between experiences of mistreatment and satisfaction with care during childbirth. RESULTS: 862 participants are included (15-19 years: 287, 33.3%; 20-24 years: 575, 66.7%). The most common mistreatment was verbal abuse (15-19 years: 104/287, 36.2%; 20-24 years: 181/575, 31.5%). There were high levels of poor communication (15-19 years: 92/287, 32.1%; 20-24 years: 171/575, 29.7%), lack of supportive care (15-19 years: 22/287, 42.5%; 20-24 years: 195/575, 33.9%) and lack of privacy (15-19 years: 180/287, 62.7%; 20-24 years: 395/575, 68.7%). Women who were verbally abused were less likely to report satisfaction with care (adjusted OR (AOR): 0.19, 95% CI: 0.12 to 0.31) and less likely to recommend the facility (AOR: 0.24, 95% CI: 0.15 to 0.38). There were similar reports among those who were physically abused, had long waiting time, did not mobilise and did not give consent for vaginal examinations. CONCLUSION: Our study shows that adolescents and young women mistreatment during childbirth, contributing to low satisfaction with care. It is critical to recognise adolescents and young women's unique needs in maternal healthcare and how their needs may intersect with social stigma around sex and pregnancy.
Subject(s)
Parturition , Quality of Health Care , Adolescent , Cross-Sectional Studies , Female , Health Facilities , Humans , Pregnancy , Surveys and QuestionnairesABSTRACT
During its last funding cycle from 2018-2020, the Global Fund in collaboration with the Ministry of Health, World Health Organization, and implementing partners Cordaid and Santé Rural (SANRU), implemented a multi-sectoral, contextualized approach to improve the sexual and reproductive health of adolescent girls and young women in two regions in the Democratic Republic of the Congo, which included community-based, school-based and health facility-based actions. This implementation research focuses on the health-facility component. The objective of this research is to evaluate the feasibility, acceptability, and effectiveness of a package of interventions to improve health workers' knowledge, skills, and attitudes in providing sexual and reproductive health services to adolescents, whilst concomitantly creating an enabling work environment for building health workers' motivation. The package includes a combination of job descriptions, training and refresher training, desk reference tools, and collaborative learning. The package did not focus on improving amenities, providing or repairing equipment, or providing medicines and supplies. The underlying theoretical framework informing the project and the implementation research draws from Social Network Theory, Diffusion of Innovations and Normalization Process Theory. Qualitative and quantitative process and outcome data from in-depth interviews and focus group discussions with health workers and health managers, field notes, monitoring reports, costing sheets, and health worker surveys, adolescent mystery client assessments, and exit interviews with adolescents will be collected as part of a time-series study. The findings from this implementation research will be utilized to inform future adaptations and/or scale-up of the package of interventions to improve health worker motivation and performance in the Democratic Republic of the Congo and elsewhere. The findings will also contribute to advancing the use of theoretical approaches within the field of implementation research.
Subject(s)
Adolescent Health Services , Reproductive Health Services , Adolescent , Democratic Republic of the Congo , Feasibility Studies , Female , Humans , Motivation , Reproductive HealthABSTRACT
Poor performance among health service providers is a key barrier to high quality, adolescent-responsive health services. Collaborative learning has been shown to strengthen health service provider performance, but few studies have examined its implementation in adolescent health services. In this paper, we describe a collaborative learning approach for adolescent health service providers implemented as part of a project aiming to prevent HIV in adolescent girls and young women in the Democratic Republic of the Congo (DRC) and explore its feasibility, acceptability, benefits and challenges. To do so, we reviewed plans, budgets and progress reports, as well as nested implementation research related to the project. We also carried out a quantitative analysis of the number, location, participants and topics of collaborative learning sessions conducted as part of this initiative, and thematic analysis to synthesise findings on perceived benefits and challenges. Under the project, 32 collaborative learning sessions of approximately two-hour duration were held with up to 15 participants, most of whom were nurses, between June 2018 and May 2019. The project cost was approximately USD 135,000 over three years. Reported benefits included improving health service provider attitudes, knowledge and skills; ensuring delivery of non-judgemental, empathic and confidential health services; and improving communication and collaboration between health services and adolescents together with their parents. While the novelty of the approach in this context presented challenges, our results suggest that collaborative learning in adolescent health services is feasible, acceptable, and inexpensive. It may help strengthen the knowledge and skills of health service providers, build positive attitudes and motivation, and improve their performance and thereby the adolescent-responsiveness of health services. Further research is needed to confirm these results in other settings and to examine the impact of collaborative learning on the acceptability and uptake of health services.
Subject(s)
Adolescent Health Services , Interdisciplinary Placement , Reproductive Health Services , Adolescent , Democratic Republic of the Congo , Feasibility Studies , Female , Humans , Reproductive HealthABSTRACT
Over the past 25 years, tremendous progress has been made in increasing the evidence on child marriage and putting it to good use to reduce the prevalence of child marriage and provide support to married girls. However, there is still much to be done to achieve the Sustainable Development Goal target 5.3 of ending child marriage by 2030, and to meet the needs of the 12 million girls who are still married before age 18 each year. To guide and stimulate future efforts, the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, the World Health Organization, the UNICEF-UNFPA Global Programme to End Child Marriage, and Girls Not Brides: The Global Partnership to End Child Marriage convened an expert group meeting in 2019 to: (1) review the progress made in building the evidence base on child marriage since the publication of research priorities in this area in 2015, (2) identify an updated set of research priorities for the next ten years, and (3) discuss how best to support research coordination, translation, and uptake. This article provides a summary of the progress made in this area since 2015 and lists an updated set of research gaps and their rationale in four key areas: (1) prevalence, trends, determinants, and correlates of child marriage; (2) consequences of child marriage; (3) intervention effectiveness studies to prevent child marriage and support married girls; and (4) implementation research studies to prevent child marriage and support married girls. It also highlights a number of calls-to-action around research coordination and knowledge translation to support the emerging and evolving needs of the field.
RéSUMé: Au cours des 25 dernières années, d'énormes progrès ont été réalisés pour mettre à jour les données concernant le mariage des enfants et les mettre à profit pour réduire la prévalence du mariage des enfants et apporter un soutien aux filles mariées. Cependant, il reste encore beaucoup à faire pour atteindre la cible 5.3 de l'Objectif de Développement Durable consistant à mettre fin au mariage des enfants d'ici 2030 et pour répondre aux besoins des 12 millions de filles qui sont encore mariées avant l'âge de 18 ans chaque année. Guider et stimuler les efforts futurs, tel est le Programme Spécial de Recherche de la Banque Mondiale PNUD-FNUAP-UNICEF-OMS, du Développement et la Formation à la Recherche en Reproduction Humaine, de l'Organisation Mondiale de la Santé, du Programme Mondial UNICEF-FNUAP pour mettre fin au mariage des enfants et « Des filles pas des Mariées ¼ : le Partenariat Mondial pour mettre fin au mariage des enfants a convoqué une réunion de groupe d'experts en 2019 pour : 1. passer en revue les progrès accomplis dans la constitution de la base de données factuelles sur le mariage des enfants depuis la publication des priorités de la recherche dans ce domaine en 2015, 2. identifier un ensemble actualisé de priorités de recherche pour les dix prochaines années, et 3. discuter de la meilleure façon de soutenir la coordination, la traduction et la compréhension de la recherche. Cet article résume les progrès réalisés dans ce domaine depuis 2015 et répertorie sous forme de mise à jour un ensemble de lacunes dans la recherche et leur justification dans quatre domaines clés: 1) prévalence, tendances, déterminants et corrélatifs du mariage des enfants; 2) conséquences du mariage des enfants; 3) études ayant trait à l'efficacité des interventions pour prévenir le mariage des enfants et soutenir les filles mariées; et 4) études de recherche sur la mise en Åuvre pour prévenir le mariage des enfants et soutenir les filles mariées. Il met également en évidence un certain nombre d'appels à l'action autour de la coordination de la recherche et de l'application des connaissances pour répondre aux besoins émergents et à l'évolution de ce domaine.
RESUMEN: En los últimos 25 años se ha avanzado enormemente y existe ahora más evidencia sobre el matrimonio infantil, y sobre como se debe poner la evidencia en práctica para reducir la prevalencia del matrimonio infantil y proporcionar apoyo a las niñas casadas. Sin embargo, aún queda mucho por hacer para alcanzar la meta 5.3 de los Objetivos de Desarrollo Sostenible de poner fin al matrimonio infantil para 2030, y para satisfacer las necesidades de los 12 millones de niñas que cada año se casan antes de los 18 años. Para orientar y estimular los esfuerzos futuros, el Programa Especial de Investigación, Desarrollo y Formación de Investigadores en Reproducción Humana del PNUD-FNUAP-UNICEF-OMS-Banco Mundial, la Organización Mundial de la Salud, el Programa Mundial para la Eliminación del Matrimonio Infantil de UNICEF-FNUAP y Girls Not Brides: La Alianza Mundial para Acabar con el Matrimonio Infantil convocó una reunión de un grupo de expertos en 2019 para: 1. Revisar los progresos realizados en la construcción de la base de evidencias sobre el matrimonio infantil desde la publicación de las prioridades de investigación en este ámbito en 2015, 2. Identificar un conjunto actualizado de prioridades de investigación para los próximos diez años, y 3. Debatir la mejor manera de apoyar la coordinación, la traducción y la aceptación de la investigación.Este artículo ofrece un resumen de los progresos realizados en este ámbito desde 2015 y enumera un conjunto actualizado de lagunas de investigación y su justificación en cuatro áreas clave: 1) prevalencia, tendencias, determinantes y correlaciones del matrimonio infantil; 2) consecuencias del matrimonio infantil; 3) estudios de eficacia de las intervenciones para prevenir el matrimonio infantil y apoyar a las niñas casadas; y 4) estudios de implementación para prevenir el matrimonio infantil y apoyar a las niñas casadas. También destaca una serie de llamados a la acción en torno a la coordinación de la investigación y la traducción de conocimientos para apoyar las necesidades emergentes y en evolución del campo.
Subject(s)
Family , Marriage , Adolescent , Child , Female , Humans , World Health OrganizationABSTRACT
The term "menstrual health" has seen increased use across advocacy, programming, policy, and research, but has lacked a consistent, self-contained definition. As a rapidly growing field of research and practice a comprehensive definition is needed to (1) ensure menstrual health is prioritised as a unified objective in global health, development, national policy, and funding frameworks, (2) elucidate the breadth of menstrual health, even where different needs may be prioritised in different sectors, and (3) facilitate a shared vocabulary through which stakeholders can communicate across silos to share learning. To achieve these aims, we present a definition of menstrual health developed by the Terminology Action Group of the Global Menstrual Collective. We describe the definition development process, drawing on existing research and terminology, related definitions of health, and consultation with a broad set of stakeholders. Further, we provide elaboration, based on current evidence, to support interpretation of the definition.
Subject(s)
Global Health , Menstruation , Humans , PolicyABSTRACT
Over the past 25 years, there has been significant progress in increasing the recognition of, resources for, and action on adolescent health, and adolescent sexual and reproductive health (ASRH) in particular. As with numerous other health areas, however, many of the projects that aim to improve ASRH are implemented without well-thought-out plans for evaluation. As a result, the lessons that projects learn as they encounter and address policy and programmatic challenges are often not extracted and placed in the public arena. In such cases, post-project evaluation (PPE) offers the possibility to generate learnings about what works (and does not work), to complement prospective studies of new or follow-on projects. To fill the gap in the literature and guidance on PPE, the World Health Organization developed The project has ended, but we can still learn from it! Practical guidance for conducting post-project evaluations of adolescent sexual and reproductive health projects. This article provides an overview of the guidance by outlining key methodological and contextual challenges in conducting PPE, as well as illustrative solutions for responding to them.
Subject(s)
Adolescent Health , Sexual Health , Adolescent , Humans , Prospective Studies , Reproductive Health , World Health OrganizationABSTRACT
In recognition of the opportunity created by the increasing attention to menstrual health at global, regional, and national levels, the World Health Organization's Department of Sexual and Reproductive Health and Research and the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction convened a global research collaborative meeting on menstrual health in adolescents in August 2018. Experts considered nine domains of menstrual health (awareness and understanding; stigma, norms, and socio-cultural practices; menstrual products; water and sanitation; disposal; empathy and support; clinical care; integration with other programmes; and financing) and answered the following five questions: (1) What is the current situation? (2) What are the factors contributing to this situation? (3) What should the status of this domain of adolescent menstrual health be in 10 years? (4) What actions are needed to achieve these goals? (5) What research is needed to achieve these goals? This commentary summarizes the consensus reached in relation to these questions during the expert consultation. In doing so, it describes the state of adolescent menstrual health in low- and middle-income countries and sets out suggestions for action and research that could contribute to meeting the holistic menstrual health needs of adolescent girls and others who menstruate worldwide.
Subject(s)
Health Knowledge, Attitudes, Practice , Hygiene , Menstrual Hygiene Products , Menstruation , Adolescent , Adolescent Health , Developing Countries , Female , HumansABSTRACT
BACKGROUND: Despite the substantial need for sexuality education and evidence on its effectiveness, implementing organisations continue to grapple with numerous challenges, especially related to community support and resistance. This article aims to analyse the experience of Udaan, a programme that has achieved remarkable success in Jharkhand, India, to answer the following questions: (1) What strategies did Udaan use to create a supportive environment? and (2) What processes did Udaan use to respond to resistance during its implementation? METHODS: We reviewed programme documents and publications, synthesized key themes, identified questions of interest, and conducted interviews with key informants from the Centre for Catalyzing Change's leadership. RESULTS: Community support for Udaan was built by ensuring that the curriculum was responsive to the context, capitalizing on an enabling policy environment, institutionalizing Udaan through government-led implementation, prioritizing careful selection and training of teachers, emphasizing monitoring and evaluation, and engaging with community gatekeepers. Udaan effectively responded to resistance by organizing a formal curriculum review, orienting editors of local newspapers on the programme; responding to questions and concerns; and proactively creating positive visibility. CONCLUSION: The lessons from Udaan provide insight into approaches that can be used to design and sustain sexuality education programmes in complex settings.
Subject(s)
Curriculum , Reproductive Health/education , Sex Education , Social Support , Government , Humans , India , Program Evaluation , SexualityABSTRACT
BACKGROUND: Despite recognition of the important role of health workers in providing adolescent-friendly sexual and reproductive health services (AFSRHS), evidence on strategies for improving performance is limited. This review sought to address: (1) which interventions are used to improve health worker performance in delivering AFSRHS? and (2) how effective are these interventions in improving AFSRHS health worker performance and client outcomes? METHODS: Building on a 2015 review, a search for literature on 18 previously identified programs was conducted to identify updated literature and data relevant to this review. Data was systematically extracted and analyzed. RESULTS: Due to the parent review's eligibility criteria, all programs included health worker training. Otherwise, supervision was the most frequently reported intervention used (n=10). Components and methods related to quality of trainings and supervision varied considerably in program reports. Nearly half of programs described employing processes to ensure availability of basic medicines and supplies (n=7). Other interventions (policies, standards, and job descriptions [n=5]; refresher trainings [n=5]; job aids or other reference material [n=3]) were less commonly reported to have been employed. No discernible patterns emerged in the relationship between interventions and outcomes of interest. CONCLUSIONS: Multi-faceted complementary strategies are recommended to improve health worker performance to deliver AFSRHS; however, this was uncommonly reported in the programs that we reviewed. Effectiveness and cost-effectiveness evaluations of interventions and intervention packages are needed to guide efficient use of limited resources to enhance health worker capacity to deliver AFSRHS. In the interim, programs should be developed and implemented based on available existing evidence on improving health worker performance within and outside adolescent health. IMPLICATIONS AND CONTRIBUTION: This review is the first to examine the interventions commonly used to improve health worker performance in delivering AFSRHS. The findings indicate a need for additional effectiveness and cost-effectiveness evaluations of such interventions. In the meantime, existing evidence on improving health worker performance within and outside adolescent health must be integrated more thoughtfully into program planning and implementation.