Scalability of mobile technology interventions in the prevention and management of HIV among adolescents in low-income and middle-income countries: protocol for a systematic review.

INTRODUCTION: The rate of new infections with HIV remains high among adolescents globally. Adolescents in low-income and middle-income countries (LMICs), who are least likely to have access to quality healthcare, have the highest proportion of those living with HIV. Mobile technology has played an important role in providing access to information and services among adolescents in recent years. This review aims to synthesise and summarise information that will be useful in the planning, designing and implementing of future mHealth strategies. METHODS AND ANALYSIS: Interventional studies, reported in English, on the prevention and management of HIV among adolescents that used mobile technology in LMICs will be included. MEDLINE (via PubMed), Embase, Web of Science, CINAHL, Clinicaltrials.gov, WHO International Clinical Trials Registry Platform (ICTRP), and the Cochrane Library are the information sources that have been identified as relevant to the area of study. These sources will be searched from inception to March 2023. The risk of bias will be assessed using the Cochrane Risk of Bias tool. The scalability of each study will be assessed using the Intervention Scalability Assessment Tool. Two independent reviewers will conduct the selection of studies, data extraction, and assessment of the risk of bias and scalability. A narrative synthesis of all the included studies will be done. ETHICS AND DISSEMINATION: Ethical approval was not necessary for this study. This is a systematic review of publicly available information and therefore ethical approval was not deemed necessary. The results of this review will be published in a peer reviewed journal. TRIAL REGISTRATION: This protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42022362130.

Economic costs of terminal care for selected non-communicable diseases from a healthcare perspective: a review of mortality records from a tertiary hospital in Nigeria.

INTRODUCTION: WHO revealed that morbidity and mortality from non-communicable diseases (NCDs) are on the increase and NCDs accounted for approximately 29% of all deaths in Nigeria in 2016. This study was conducted to estimate the economic cost of selected NCDs-lung cancer, liver cancer and liver cirrhosis. These diseases are known to be associated with key modifiable health risk behaviours (smoking and alcohol use), which are prevalent in Nigeria and often commence during the adolescent years. METHODS: Data were obtained between 2016 and 2017, from mortality records of patients managed for the selected diseases in the University College Hospital, a major referral centre in Nigeria. Information on costs of treatment, clinic visits, admission and transportation was obtained. Average costs of terminal in-patient care and transportation costs (in 2020 prices) were computed per patient. Costs were converted to the US dollar equivalent using the current official rate of US$1: ₦360.50. RESULTS: Twenty-two (out of 90 cases recorded) could be retrieved and all the patients had been diagnosed in the terminal stages of the disease. The average direct costs were ₦510 152.62 (US$1415.13) for an average of 49.2 days of terminal care for lung cancer; ₦308 950.27 (US$857.00) and ₦238 121.83 (US$660.53) for an average of 16.6 and 21.7 days of terminal care for patients managed for liver cancer and liver cirrhosis, respectively. CONCLUSION: The economic costs of each of the diseases were very high. Findings emphasise the need for aggressive efforts to promote primary prevention, improve early diagnosis and provide affordable treatment in view of the fact that the monthly minimum wage is less than US$85.00 and treatment costs are borne out-of-pocket by the generality of the population in Nigeria.

Factors promoting sustainability of NURHI programme activities in Ilorin and Kaduna, Nigeria: findings from a qualitative study among health facility staff.

OBJECTIVES: The Nigerian Urban Reproductive Health Initiative (NURHI) was implemented in six urban sites in Nigeria from 2009 to early 2015. Under a second phase (NURHI-2), activities ceased operations in four of the original six sites in 2015 (Ilorin, Abuja, Benin City and Zaria), and continued in two sites (Kaduna and Ibadan). This paper examines the sustainability of facility-based intervention activities implemented under NURHI-1 in Ilorin and Kaduna. METHODS: A qualitative study that used in-depth interviews was conducted with 31 service providers purposively selected from 10 of the NURHI-1 intervention facilities in Ilorin and six in Kaduna. Interviews were digitally recorded and transcripts uploaded into ATLAS.ti for analysis. Structured observations to document renovations implemented during the NURHI-1 interventions were also conducted in the health facilities. RESULTS: Family planning (FP) awareness creation within the facilities and integration of FP into existing maternal and child health and HIV services, were sustained in both cities. The majority of the equipment supplied as part of the NURHI 72-hour clinic makeover were still functional in both cities. Respondents in both cities reported that FP awareness and demand were sustained. On the whole, challenges with sustaining activities were reported more among respondents in Ilorin than Kaduna. In Ilorin, NURHI outreach activities and trainings, had discontinued while in Kaduna, they were no longer being implemented to the same degree as occurred during NURHI-1. Inadequate funds was a major reason for discontinued activities in both cities while integration of FP into existing services enhanced sustainability. CONCLUSIONS: Many activities were not sustained in Ilorin compared with Kaduna although FP awareness and demand remained high in both cities. Integration of FP into existing services promoted sustainability in Ilorin and Kaduna. A gradual closeout of donor projects with concomitant input from government and indigenous institutions could be useful in sustaining donor activities.

The association between social support and mental health among vulnerable adolescents in five cities: findings from the study of the well-being of adolescents in vulnerable environments.

PURPOSE: Globally, adolescents are at risk of depression, traumatic stress, and suicide, especially those living in vulnerable environments. This article examines the mental health of 15- to 19-year-old youth in five cities and identifies the social support correlates of mental health. METHODS: A total of 2,393 adolescents aged 15-19 years in economically distressed neighborhoods in Baltimore, MD; New Delhi, India; Ibadan, Nigeria; Johannesburg, South Africa; and Shanghai, China were recruited in 2013 via respondent-driven sampling to participate in a survey using an audio computer-assisted self-interview. Weighted logistic regression and general linear models were used to explore the associations between mental health and social supports. RESULTS: The highest levels of depression and posttraumatic stress symptoms were displayed in Johannesburg among females (44.6% and 67.0%, respectively), whereas the lowest were among New Delhi females and males (13.0% and 16.3%, respectively). The prevalence of suicidal ideation ranged from 7.9% (New Delhi female adolescents) to 39.6% (Johannesburg female adolescents); the 12-month prevalence of suicide attempts ranged from 1.8% (New Delhi females) to 18.3% (Ibadan males). Elevated perceptions of having a caring female adult in the home and feeling connected to their neighborhoods were positively associated with adolescents' levels of hope across the sites while negatively associated with depression and posttraumatic stress symptoms with some variation across sites and gender. CONCLUSIONS: Adolescents living in the very economically distressed areas studied register high levels of depression and posttraumatic stress. Improving social supports in families and neighborhoods may alleviate distress and foster hope. In particular, strengthening supports from female caretakers to their adolescents at home may improve the outlooks of their daughters.