A mixed-methods assessment of understanding (AoU) tool for AIDS vaccine trials in sub-Saharan Africa: results from a pilot study

Abstract Background The Human Immunodeficiency Virus (HIV) is the leading cause of death among adolescents in sub-Saharan Africa. Despite the long-term benefits of antiretroviral therapy (ART), adherence remains low among adolescents due to challenges related to cost, acquisition, and treatment regimen. Sub-optimal adherence to ART is associated with the development of viral resistance, treatment failure, and increased morbidity and mortality. Financial incentives and life skills training interventions have shown early promise in motivating protective behaviors, however, gaps still remain around effective and innovative ways to motivate adolescents to stay in HIV care. In partnership with youth, we developed an intervention to address their social and financial pressures in order to promote adherence. Methods A human-centered design approach was utilized to engage adolescents in the initial design of the intervention. Through random sampling, 72 adolescents ages 12–19 were then recruited from two clinics in Rwanda for the pilot study. Adolescents participated in three monthly peer-led life skills trainings at clinics and received financial incentives via mobile money upon clinic attendance and demonstration of suppressed viral load. Semi-structured interviews were then conducted with adolescents, healthcare workers, and caregivers to understand their experiences with the intervention. Results Participants responded favorably to the intervention because of the psychosocial, financial, and health benefits it provided. Caregivers felt that adolescents’ moods, attitudes, and overall well-being improved over time. Adolescents used funds to purchase school supplies and save for investments, thus mitigating their financial burdens. Additionally, we learned that logistical challenges such as SIM card registration and mobile phone access must be considered for scale-up of the intervention. Conclusions To our knowledge, this is the first intervention designed in partnership with youth in sub-Saharan Africa aimed at removing financial barriers to ART adherence. The findings suggest that involving youth in the design of programs, providing them with financial incentives, and training them to use and invest their money wisely has a positive effect on them and their families. Thus, to improve adherence to ART and retention in care among HIV-positive youth, it is critical to address their socioeconomic and psychosocial needs.

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Nurse-Led Education and Engagement for Diabetes Care in Sub-Saharan Africa: Protocol for a Mixed Methods Study (Preprint)

10.2196/preprints.15408 ◽

2019 ◽

Author(s):

Arti Singh ◽

Michelle Nichols

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Health Care ◽

Type 2 Diabetes Mellitus ◽

Mixed Methods ◽

Task Shifting ◽

Sub Saharan Africa ◽

Key Informant ◽

Sub Saharan

BACKGROUND As the impact of diabetes grows steeply in sub-Saharan Africa, improvement of the control and treatment of diabetes is a goal that health care systems in sub-Saharan Africa must achieve in the near future. Sub-Saharan Africa faces a number of challenges in addressing the increasing effects of diabetes. One important factor is the shortage of adequately trained health care workers. Diabetes management in sub-Saharan Africa would benefit from innovative approaches that are founded upon solid theoretical constructs, built upon existing human resources and infrastructure, and culturally tailored to the priorities and needs of the local population. Existing resources, such as mobile phones and task-shifting strategies, may be used to assist individuals with glycemic self-management and to facilitate management of additional day-to-day clinical responsibilities. OBJECTIVE The objective of the Nurse-Led Education and Engagement Study for Diabetes Care (NEEDS) mixed-methods protocol is to develop a practical, collaborative, effective, and sustainable program for diabetes prevention and management specifically for patients with type 2 diabetes mellitus in sub-Saharan Africa. The protocol aims to improve access to care through task-shifting strategies and the use of mobile health technology. METHODS This study was designed using a convergent parallel mixed-methods approach that consisted of surveys, key informant interviews, focus group discussions, and focused ethnography. Novel approaches, such as task-shifting strategies and the use of mobile technology, were implemented for type 2 diabetes mellitus health care in sub-Saharan Africa—currently an under-researched area. RESULTS Data collection began in February 2018, after ethics approval, at the Kwame Nkrumah University of Science and Technology. As of May 2020, participant surveys have been completed (N=100), key informant interviews (n=7) have been completed, and focus groups (5 focus groups; patients, n=18; caregivers, n=6; community leaders, n=2; and faith leaders, n=3) as well as focused ethnographic field observations have been completed. All audio recordings have been transcribed and transcripts of sessions recorded in Twi have been translated to English. Data analysis is currently underway and anticipated completion is in the spring of 2020. Following data analysis, investigators plan to publish study findings. CONCLUSIONS Insights from this study will inform the preliminary development of a feasible and effective nurse-led education and engagement mobile health intervention that has the potential to reduce diabetes-related morbidity, mortality, and burden in sub-Saharan Africa. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/15408

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Metadata Correction: Performance, Acceptability, and Usability of Respiratory Rate Timers and Pulse Oximeters When Used by Frontline Health Workers to Detect Symptoms of Pneumonia in Sub-Saharan Africa and Southeast Asia: Protocol for a Two-Phase, Multisite, Mixed-Methods Trial (Preprint)

10.2196/preprints.13755 ◽

2019 ◽

Author(s):

Kevin Baker ◽

Mucunguzi Akasiima ◽

Alexandra Wharton-Smith ◽

Tedila Habte ◽

Lena Matata ◽

...

Keyword(s):

Mixed Methods ◽

Southeast Asia ◽

Respiratory Rate ◽

Health Workers ◽

Sub Saharan Africa ◽

Two Phase ◽

Frontline Health Workers ◽

Sub Saharan ◽

Pulse Oximeters

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Evidence-based health security: The nexus of governance and pandemic preparedness

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.612 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

R Greenhill ◽

J Johnson ◽

P Malone ◽

A Westrum

Keyword(s):

Mixed Methods ◽

Expert Panel ◽

State Capacity ◽

Limit State ◽

Sub Saharan Africa ◽

Pandemic Preparedness ◽

African Region ◽

Health Security ◽

Preparedness Planning ◽

Sub Saharan

Abstract Background Pandemic preparedness continues to be an important focus of the global health security agenda. Many nations in the sub-Saharan African region remain at high risk for a major pandemic due to limited capacity and endemic co-morbid conditions in their populations. While the literature does suggest that state capacity influences health, no studies to date indicate an association between state capacity and pandemic disease distribution, particularly in the presence of other endemic diseases. Methods This mixed methods study will contribute to existing research by examining how economic and sociopolitical attributes of state capacity influence pandemic-prone disease distribution in sub-Saharan Africa. A convergent mixed methods design was used to collect and analyze quantitative state capacity attributes and prevention, and control using correlation in six sub-Saharan countries. Results of the quantitative study were triangulated through the use of an expert panel and results integrated for an overall interpretation and conclusion. Results Variables in the study showed statistically significant relationships between proxies of state capacity and the follow areas: control of pandemics and prevention of pandemics. The Expert Panel interviews illustrated convergence between the correlated results. Conclusions This study brought forward associations with expert confirmation suggestive of areas for national governments in sub-Saharan Africa to further review and improve. While many internal factors limit state capacity in these nations (e.g. human and fiscal resources), external funders may consider adding information from this study and other metrics to test progress. Key messages Evidence is valuable for pandemic preparedness planning. Nation state capacity is a factor in pandemic preparedness.

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