Capacities and needs of health care facilities for schistosomiasis diagnosis and management in elimination settings.

BACKGROUND: Schistosomiasis is a debilitating neglected tropical disease endemic in sub-Saharan Africa. The role of health facilities in the prevention, diagnosis, control, and elimination of schistosomiasis is poorly documented. In a setting targeted for schistosomiasis elimination in Zanzibar, we assessed the prevalence of Schistosoma haematobium among patients seeking care in a health facility and investigated schistosomiasis-related knowledge of staff, and health facilities' capacities and needs for schistosomiasis diagnosis and management. METHODS: We conducted a health facility-based mixed-method study on Pemba Island from June to August 2023. Patients aged ≥ 4 years seeking care in four health facilities were screened for S. haematobium infection using urine filtration and reagent strips. Those patients aged ≥ 10 years were additionally interviewed about signs and symptoms. Staff from 23 health facilities responded to a questionnaire assessing knowledge and practices. Ten staff participated in a focus group discussion (FGD) about capacities and needs for schistosomiasis diagnosis and management. RESULTS: The prevalence of S. haematobium infection in patients attending the health facilities, as determined by the presence of eggs in urine, was 1.1% (8/712). Microhaematuria was detected in 13.3% (95/712) of the patients using reagent strips. Among patients responding to the questionnaire, pelvic pain, pain during sex, and painful urination were reported by 38.0% (237/623), 6.3% (39/623), and 3.2% (20/623), respectively. Among the health facility staff, 90.0% (44/49) and 87.8% (43/49) identified blood in urine and pelvic pain, respectively, as symptoms of urogenital schistosomiasis, 81.6% (40/49) and 93.9% (46/49) reported collecting a urine sample and pursuing a reagent strip test, respectively, for diagnosis, and 87.8% (43/49) administered praziquantel for treatment. The most reoccurring themes in the FGD were the need for more staff training about schistosomiasis, requests for diagnostic equipment, and the need to improve community response to schistosomiasis services in health facilities. CONCLUSIONS: The prevalence of S. haematobium infection in patients seeking care in health facilities in Pemba is very low and similar to what has been reported from recent community-based cross-sectional surveys. The health facility staff had good schistosomiasis-related knowledge and practices. However, to integrate schistosomiasis patient management more durably into routine health facility activities, scalable screening pathways need to be identified and capacities need to be improved by regular staff training, and an unbroken supply of accurate point-of-care diagnostics and praziquantel for the treatment of cases.

Cross-sector collaboration in Project Catalyst: Creating state partnerships to address the health impact of intimate partner violence.

Intimate Partner Violence and Human Trafficking are major public health problems with myriad health and social consequences. This paper describes a federal initiative in the United States to formalize cross-sector collaborations at the state-level and encourage practice and policy changes intended to promote prevention and improve health and safety outcomes for Intimate Partner Violence/Human Trafficking (IPV/HT) survivors. Project Catalyst Phases I and II (2017-2019) engaged six state leadership teams, consisting of leaders from each state's Primary Care Association, Department of Health, and Domestic Violence Coalition. Leadership teams received training and funding to disseminate information on trauma-informed practices to health centers and integrate IPV/HT considerations into state-level initiatives. At the beginning and end of Project Catalyst, participants completed surveys assessing the status of their collaboration and project goals (e.g., number of state initiatives involving IPV/HT, number of people trained). All domains of collaboration increased from baseline to project end. Largest improvements were seen in 'Communication' and 'Process & Structure,' both of which increased by more than 20% over the course of the project. 'Purpose' and 'Membership Characteristics' increased by 10% and 13%, respectively. Total collaboration scores increased 17% overall. Each state made substantial efforts to integrate and improve responses to IPV/HT in community health centers and domestic violence programs, and integrated IPV/HT response into state-level initiatives. Project Catalyst was successful in facilitating formalized collaborations within state leadership teams, contributing to practice and policy changes intended to improve health and safety for IPV/HT survivors.

Policy and Systems Change in Intimate Partner Violence and Human Trafficking: Evaluation of a Federal Cross-Sector Initiative.

Objectives: This study evaluates Project Catalyst's impact on policies related to Intimate Partner Violence (IV) and Human Trafficking (HT), which contribute to negative health outcomes for survivors. Methods: We utilized continuous evaluation using data from policy assessment tools and interviews with participating state leadership team (SLT) members. Results: Five SLTs reported integration of IPV into state-level initiatives. All implemented clinical practice and organizational policy recommendations. SLTs reported that Project Catalyst increased awareness of IPV/HT and health impacts and established ongoing partnerships between the three organizations. Conclusions: Funding, training, and technical assistance to encourage cross-sector collaboration at the state level can promote policy changes that support comprehensive health center responses to IPV/HT.

Promoting Cross-Sector Collaborations to Address Intimate Partner Violence in Health Care Delivery Systems Using a Quality Assessment Tool.

Background: As part of a Domestic Violence and Health care Partnership (DVHCP) project in California, 19 leadership teams consisting of representatives from domestic violence agencies and health care delivery systems in California came together to improve care related to intimate partner violence (IPV). We evaluated the impact of a Quality Assessment/Quality Improvement (QA/QI) tool on health care delivery systems' ability to collaborate with victim service agencies to address IPV. Methods: Each leadership team completed the QA/QI tool every 6 months between 2014 and 2017. Fifteen clinics that completed the tool at least twice are included in this analysis. Results: The largest changes noted in the QA/QI tool were having written protocols for assessing for IPV, providers distributing educational safety cards about IPV to patients, scripts for providers on how to assess and support survivors of IPV, trainings led by IPV agency advocates, and support for staff to discuss difficult cases. Conclusions: Implementation of a QA/QI tool can guide health care delivery systems to make changes in provider practices and clinic protocols to improve care and support for survivors of IPV. Such clinic-level changes may support providers to more readily or consistently integrate addressing IPV in clinical encounters while facilitating and promoting cross-sector collaborations with victim service advocacy and related social service agencies.

Barriers to the identification of frailty in hospital: a survey of UK clinicians.

Despite numerous national campaigns, frailty remains under-recognised in the hospital setting. We performed a survey of hospital-based clinicians across the UK to identify barriers to the identification and best practice management of frailty in hospital. A total of 402 clinicians were surveyed across a range of grades, specialties and hospitals. Responses highlighted variable awareness and personal understanding of frailty, particularly among junior doctors and clinicians in non-medical specialties. Although 74% of responders agreed frailty assessments should be undertaken for all older people admitted to hospital, only 36% felt this was currently feasible with available resources. Free-text responses highlighted limited education, the perceived subjectivity of frailty assessments, scepticism as to their utility in the hospital setting, and deficiencies in service provision. This was the first survey of UK hospital clinicians regarding frailty assessments. Results highlight multiple areas for improvement and engagement.