Ethical Oversight of Implementation Research in Rural Settings of a Developing Country During the COVID-19 Outbreak.

Abstract Background: Transgender people face numerous barriers to accessing care, particularly in rural settings. Transportation, travel time, a lack of providers offering transgender care, and discrimination all contribute to these barriers. The Gender Wellness Center was established to fill a gap in rural transgender care, and was subsequently awarded a Robert Wood Johnson Foundation grant to establish a Center of Excellence. This study examines the implementation of the Center of Excellence, a complex intervention, over the course of 18 months. Methods: The Consolidated Framework for Implementation Research was used to develop baseline and follow-up surveys. These were distributed to members of the core implementation team at the Gender Wellness Center at the midpoint and conclusion of the Robert Wood Johnson Foundation grant. Responses were largely open-ended and analyzed qualitatively. Results: Results are presented in terms of Consolidated Framework domains and constructs, as well as the relative outlook (positive or negative) of implementation. Overall, there were improvements over time, with more encouraging feedback and examples of success at follow-up. Though true, organizational culture and individual beliefs about the provision of transgender care challenged implementation of the Center of Excellence throughout the project. Conclusions: This study highlights the importance of organizational culture on implementation efforts, as well as the need for complex, multi-faceted interventions to overcome such challenges in order to improve care for marginalized populations. Trial registration: Not applicable

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A Low-Cost, Low-Skill Model for Efficient Breast Cancer Screening in Low Resource Rural Settings of a Developing Country

Cureus ◽

10.7759/cureus.1571 ◽

2017 ◽

Author(s):

Sachin Khanduri ◽

Mriganki Chaudhary ◽

Tushar Sabharwal ◽

Tarim Usmani ◽

Aakshit Goyal ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Developing Country ◽

Low Cost ◽

Low Resource ◽

Rural Settings

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Longitudinal Use of the Consolidated Framework for Implementation Research to Evaluate the Creation of a Rural Center of Excellence in Transgender Health

10.21203/rs.3.rs-78730/v1 ◽

2020 ◽

Author(s):

Pamela Jane Tinc ◽

Christopher Wolf-Gould ◽

Carolyn Wolf-Gould ◽

Anne Gadomski

Keyword(s):

Organizational Culture ◽

Implementation Research ◽

Robert Wood Johnson Foundation ◽

Implementation Team ◽

The Core ◽

Center Of Excellence ◽

Rural Settings ◽

Wellness Center ◽

Over Time

Abstract BackgroundTransgender people face numerous barriers to accessing care, particularly in rural settings. Transportation, travel time, a lack of providers offering transgender care, and discrimination all contribute to these barriers. The Gender Wellness Center was established to fill a gap in rural transgender care, and was subsequently awarded a Robert Wood Johnson Foundation grant to establish a Center of Excellence. This study examines the implementation of the Center of Excellence, a complex intervention, over the course of 18 months.MethodsThe Consolidated Framework for Implementation Research was used to develop baseline and follow-up surveys. These were distributed to members of the core implementation team at the Gender Wellness Center at the midpoint and conclusion of the Robert Wood Johnson Foundation grant. Responses were largely open-ended and analyzed qualitatively.ResultsResults are presented in terms of Consolidated Framework domains and constructs, as well as the relative outlook (positive or negative) of implementation. Overall, there were improvements over time, with more encouraging feedback and examples of success at follow-up. Though true, organizational culture and individual beliefs about the provision of transgender care challenged implementation of the Center of Excellence throughout the project.ConclusionsThis study highlights the importance of organizational culture on implementation efforts, as well as the need for complex, multi-faceted interventions to overcome such challenges in order to improve care for marginalized populations.Trial registrationNot applicable

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Tuberculosis: Diagnostic Challenges in Rural Africa

Praxis ◽

10.1024/1661-8157/a003355 ◽

2019 ◽

Vol 108 (15) ◽

pp. 991-996

Author(s):

Ngisi Masawa ◽

Farida Bani ◽

Robert Ndege

Keyword(s):

Extrapulmonary Tuberculosis ◽

X Ray ◽

Molecular Tests ◽

Rural Settings ◽

Chest X Ray ◽

Screening Questions ◽

Rural Africa ◽

Tb Diagnostics ◽

Strip Test ◽

Urine Strip

Abstract. Tuberculosis (TB) remains among the top 10 infectious diseases with highest mortality globally since the 1990s despite effective chemotherapy. Among 10 million patients that fell ill with tuberculosis in the year 2017, 36 % were undiagnosed or detected and not reported; the number goes as high as 55 % in Tanzania, showing that the diagnosis of TB is a big challenge in the developing countries. There have been great advancements in TB diagnostics with introduction of the molecular tests such as Xpert MTB/RIF, loop-mediated isothermal amplification, lipoarabinomannan urine strip test, and molecular line-probe assays. However, most of the hospitals in Tanzania still rely on the TB score chart in children, the WHO screening questions in adults, acid-fast bacilli and chest x-ray for the diagnosis of TB. Xpert MTB/RIF has been rolled-out but remains a challenge in settings where the samples for testing must be transported over many kilometers. Imaging by sonography – nowadays widely available even in rural settings of Tanzania – has been shown to be a useful tool in the diagnosis of extrapulmonary tuberculosis. Despite all the efforts and new diagnostics, 30–50 % of patients in high-burden TB countries are still empirically treated for tuberculosis. More efforts need to be placed if we are to reduce the death toll by 90 % until 2030.

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