scholarly journals Acceptability and Preferences of Two Different Community Models of ART Delivery in a High Prevalence Urban Setting in Zambia: Cluster-Randomized Trial, Nested in the HPTN 071 (PopART) Study

2021 ◽  
Author(s):  
Mohammed Limbada ◽  
Chiti Bwalya ◽  
David Macleod ◽  
Osborn Shibwela ◽  
Sian Floyd ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Stated Preference ◽  
Revealed Preference ◽  
Cluster Randomized Trial ◽  
Urban Setting ◽  
People Living With Hiv ◽  
Home Based ◽  
Delivery Options ◽  
Cluster Randomized ◽  
Art Delivery

AbstractCommunity delivery of Antiretroviral therapy (ART) is a novel innovation to increase sustainable ART coverage for People living with HIV (PLHIV) in resource limited settings. Within a nested cluster-randomised sub-study in two urban communities that participated in the HPTN 071 (PopART) trial in Zambia we investigated individual acceptability and preferences for ART delivery models. Stable PLHIV were enrolled in a cluster-randomized trial of three different models of ART: Facility-based delivery (SoC), Home-based delivery (HBD) and Adherence clubs (AC). Consenting individuals were asked to express their stated preference for ART delivery options. Those assigned to the community models of ART delivery arms could choose (“revealed preference”) between the assigned arm and facility-based delivery. In total 2489 (99.6%) eligible individuals consented to the study and 95.6% chose community models of ART delivery rather than facility-based delivery when offered a choice. When asked to state their preference of model of ART delivery, 67.6% did not state a preference of one model over another, 22.8% stated a preference for HBD, 5.0% and 4.6% stated a preference for AC and SoC, respectively. Offering PLHIV choices of community models of ART delivery is feasible and acceptable with majority expressing HBD as their stated preferred option.

scholarly journals Delivery of home-based postpartum contraception in rural Guatemalan women: a cluster-randomized trial protocol

2019 ◽  
Author(s):  
Margo Harrison ◽  
Saskia Bunge-Montes ◽  
Claudia Rivera ◽  
Andrea Jimenez-Zambrano ◽  
Gretchen Heinrichs ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Clinical Care ◽  
Cluster Randomized Trial ◽  
Trial Registration ◽  
Postpartum Visit ◽  
Postpartum Contraception ◽  
Home Setting ◽  
Home Based ◽  
Cluster Randomized ◽  
Long Acting

Abstract Background Postpartum contraception is important to prevent unintended and closely spaced pregnancies following childbirth. Methods This study is a cluster-randomized trial of communities in rural Guatemala where women receive ante- and postnatal care through a community-based nursing program. When nurses visit women for their postpartum visit in the intervention clusters, instead of providing only routine care that includes postpartum contraceptive education and counseling, the nurses will also bring a range of barrier, short-acting, and long-acting contraceptives that will be offered and administered in the home setting, after routine clinical care is provided. Discussion A barrier to postpartum contraception is access to medications and devices. Our study removes some access barriers (distance, time, cost) by providing contraception in the home. We also trained community nurses to place implants, which are a type of long-acting reversible contraceptive method that was previously only available in the closest town, which is about an hour away by vehicle. Therefore, our study examines how home-based delivery of routinely available contraceptives and the less routinely available implant may be associated with increased uptake of postpartum contraception within three months of childbirth. The potential implications of this study include: nurses may be able to be trained to safely provide contraceptives, including place implants, in the home setting, and provision of home-based contraception may be an effective way of delivering an evidence-based intervention for preventing unintended and closely spaced pregnancies in the postpartum period. Retrospective Trial Registration clinicaltrials.gov Trial Identifying Number NCT04005391 Date of Registration in Primary Registry: July 1, 2019 Trial Registration: https://clinicaltrials.gov/ct2/show/NCT04005391?term=NCT04005391&rank=1 Keywords: postpartum contraception, long-acting reversible contraceptives, implant, nursing, community programming, cluster-randomized trial

scholarly journals Delivery of home-based postpartum contraception in rural Guatemalan women: a cluster-randomized trial protocol

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Margo S. Harrison ◽  
Saskia Bunge-Montes ◽  
Claudia Rivera ◽  
Andrea Jimenez-Zambrano ◽  
Gretchen Heinrichs ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Clinical Care ◽  
Cluster Randomized Trial ◽  
Routine Care ◽  
Postpartum Visit ◽  
Postpartum Contraception ◽  
Home Setting ◽  
Home Based ◽  
Cluster Randomized ◽  
Long Acting

Abstract Background Postpartum contraception is important to prevent unintended and closely spaced pregnancies following childbirth. Methods This study is a cluster-randomized trial of communities in rural Guatemala where women receive ante- and postnatal care through a community-based nursing program. When nurses visit women for their postpartum visit in the intervention clusters, instead of providing only routine care that includes postpartum contraceptive education and counseling, the nurses will also bring a range of barrier, short-acting, and long-acting contraceptives that will be offered and administered in the home setting, after routine clinical care is provided. Discussion A barrier to postpartum contraception is access to medications and devices. Our study removes some access barriers (distance, time, cost) by providing contraception in the home. We also trained community nurses to place implants, which are a type of long-acting reversible contraceptive method that was previously only available in the closest town which is about an hour away by vehicular travel. Therefore, our study examines how home-based delivery of routinely available contraceptives and the less routinely available implant may be associated with increased uptake of postpartum contraception within 3 months of childbirth. The potential implications of this study include that nurses may be able to be trained to safely provide contraceptives, including placing implants, in the home setting, and provision of home-based contraception may be an effective way of delivering an evidence-based intervention for preventing unintended and closely spaced pregnancies in the postpartum period. Trial registration Clinicaltrials.gov, NCT04005391. Retrospectively registered on 1 July 2019.

scholarly journals Delivery of home-based postpartum contraception in rural Guatemalan women: a cluster-randomized trial protocol

2019 ◽  
Author(s):  
Margo Harrison ◽  
Saskia Bunge-Montes ◽  
Claudia Rivera ◽  
Andrea Jimenez-Zambrano ◽  
Gretchen Heinrichs ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Clinical Care ◽  
Cluster Randomized Trial ◽  
Routine Care ◽  
Postpartum Visit ◽  
Postpartum Contraception ◽  
Home Setting ◽  
Home Based ◽  
Cluster Randomized ◽  
Long Acting

Abstract Abstract Background: Postpartum contraception is important to prevent unintended and closely spaced pregnancies following childbirth. Methods: This study is a cluster-randomized trial of communities in rural Guatemala where women receive ante- and postnatal care through a community-based nursing program. When nurses visit women for their postpartum visit in the intervention clusters, instead of providing only routine care that includes postpartum contraceptive education and counseling, the nurses will also bring a range of barrier, short-acting, and long-acting contraceptives that will be offered and administered in the home setting, after routine clinical care is provided. Discussion: A barrier to postpartum contraception is access to medications and devices. Our study removes some access barriers (distance, time, cost) by providing contraception in the home. We also trained community nurses to place implants, which are a type of long-acting reversible contraceptive method that was previously only available in the closest town, which is about an hour away by vehicle. Therefore, our study examines how home-based delivery of routinely available contraceptives and the less routinely available implant may be associated with increased uptake of postpartum contraception within three months of childbirth. The potential implications of this study include: nurses may be able to be trained to safely provide contraceptives, including place implants, in the home setting, and provision of home-based contraception may be an effective way of delivering an evidence-based intervention for preventing unintended and closely spaced pregnancies in the postpartum period.

scholarly journals Cost Analysis of Community-Based Smoking Cessation Services in Vietnam: A Cluster-Randomized Trial

2021 ◽  
Vol 14 ◽  
pp. 117863292110309
Author(s):  
Vu Quynh Mai ◽  
Hoang Van Minh ◽  
Nguyen Truong Nam ◽  
Hoang Thao Anh ◽  
Nguyen Minh Van ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Randomized Trial ◽  
Cluster Randomized Trial ◽  
Counseling Session ◽  
Smoking Cessation Service ◽  
Community Based ◽  
Implementation Phase ◽  
Home Based ◽  
Cluster Randomized ◽  
The Cost

The study aimed to estimate the cost for developing and implementing 2 smoking cessation service delivery models that were evaluated in a 2-arm cluster randomized trial in Commune Health Centers (CHCs) in Vietnam. In the first model (4As) CHC providers were trained to ask about tobacco use, advise smokers to quit, assess readiness to quit, and assist with brief counseling. The second model included the 4As plus a referral to Village Health Workers (VHWs) who were trained to provide multisession home-based counseling (4As + R). An activity-based ingredients (ABC-I) costing approach with a healthcare provider perspective was applied to collect the costs for each intervention model. Opportunity costs were excluded. Costs during preparation and implementation phase were estimated. Sensitivity analysis of the cost per smoker with the included intervention’ activities were conducted. The cost per facility-based counseling session ranged from USD 9 to USD 11. Cost per home-based counseling session at 4As + R model was USD 4. The non-delivery cost attributed to supportive activities (eg, Monitoring, Logistic, Research, General training) was USD 107 per counseling session. Cost per smoker ranged from USD 6 to USD 451. The study analyzed and compared cost of implementing and scaling community-based smoking cessation service models in Vietnam.

scholarly journals Twelve-Month outcomes of a Cluster-Randomized Trial of Home-Based Postpartum Contraceptive Delivery in Southwest Trifinio, Guatemala

2021 ◽  
Vol 04 (02) ◽  
Author(s):  
Margo S Harrison ◽  
Saskia Bunge-Montes ◽  
Claudia Rivera ◽  
Andrea Jimenez-Zambrano ◽  
Gretchen Heinrichs ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Cluster Randomized Trial ◽  
Home Based ◽  
Cluster Randomized
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