Evaluating Implementation of the Behavioral Recovery Outreach (BRO) Team: One Year of Implementation

We present evaluation results after one year of implementation by nine BRO Teams. Monthly checklists documented consistent composition across teams: a psychologist, social worker and nurse. Social workers were recognized as having a critical role in implementation, serving as a referral source and liaison between the CLC, Veteran/family, and community facility. Early implementation focused on team and program development with barriers including unprotected time for Team members. In the first year, the nine teams enrolled 70 Veterans, discharging 86% to community facilities. Characteristics of the Veterans suggest Teams are reaching the complex Veteran targeted by the model. Barriers to successful discharge include community facility inexperience/training and confidence to manage complex residents. COVID emerged as the leading barrier to outreach to internal and external partners and providing transitional support to the Veteran after discharge. We discuss the impact of these preliminary findings on future implementation and dissemination of the model.

Bus terminal planning with the TOD approach for Jakarta, case study Kampung Rambutan bus terminal

Travel convenience needs to be supported by the existence of cheap, fast and comfortable public transportation. Jakarta as a Metropolitan City pays close attention to this and plans to improve all existing bus terminals and make them well and planned connected to all existing transportation networks. The transportation network integration system with community facility centers is known as “Transit Oriented Development” or TOD. One of the bus terminals included in this program is the Kampung Rambutan Bus Terminal, which is deemed unsuitable for use. The irregularity of the flow of passengers, the flow of private vehicles gives the impression of chaos and slum in this bus terminal. The position of this bus terminal is considered very strategic and important, because this bus terminal is a transit for passengers near and far. In principle, the TOD approach is a technique of connecting the transportation mode from the station or terminal to the surrounding buildings or areas. For example, commercial areas, offices and residences, are also connected via outdoor and indoor pedestrian paths that are open to the public and direct through to stations or terminals available in the area. Smooth travel and good network connectivity, this will also support the terminal environment maintenance issues. These two approach topics will be the theme of the new Kampung Rambutan bus terminal design.

Community-facility linkage models and maternal and infant health outcomes in Malawi’s PMTCT/ART program: A cohort study

Background In sub-Saharan Africa, 3 community-facility linkage (CFL) models—Expert Clients, Community Health Workers (CHWs), and Mentor Mothers—have been widely implemented to support pregnant and breastfeeding women (PBFW) living with HIV and their infants to access and sustain care for prevention of mother-to-child transmission of HIV (PMTCT), yet their comparative impact under real-world conditions is poorly understood. Methods and findings We sought to estimate the effects of CFL models on a primary outcome of maternal loss to follow-up (LTFU), and secondary outcomes of maternal longitudinal viral suppression and infant “poor outcome” (encompassing documented HIV-positive test result, LTFU, or death), in Malawi’s PMTCT/ART program. We sampled 30 of 42 high-volume health facilities (“sites”) in 5 Malawi districts for study inclusion. At each site, we reviewed medical records for all newly HIV-diagnosed PBFW entering the PMTCT program between July 1, 2016 and June 30, 2017, and, for pregnancies resulting in live births, their HIV-exposed infants, yielding 2,589 potentially eligible mother–infant pairs. Of these, 2,049 (79.1%) had an available HIV treatment record and formed the study cohort. A randomly selected subset of 817 (40.0%) cohort members underwent a field survey, consisting of a questionnaire and HIV biomarker assessment. Survey responses and biomarker results were used to impute CFL model exposure, maternal viral load, and early infant diagnosis (EID) outcomes for those missing these measures to enrich data in the larger cohort. We applied sampling weights in all statistical analyses to account for the differing proportions of facilities sampled by district. Of the 2,049 mother–infant pairs analyzed, 62.2% enrolled in PMTCT at a primary health center, at which time 43.7% of PBFW were ≤24 years old, and 778 (38.0%) received the Expert Client model, 640 (31.2%) the CHW model, 345 (16.8%) the Mentor Mother model, 192 (9.4%) ≥2 models, and 94 (4.6%) no model. Maternal LTFU varied by model, with LTFU being more likely among Mentor Mother model recipients (adjusted hazard ratio [aHR]: 1.45; 95% confidence interval [CI]: 1.14, 1.84; p = 0.003) than Expert Client recipients. Over 2 years from HIV diagnosis, PBFW supported by CHWs spent 14.3% (95% CI: 2.6%, 26.1%; p = 0.02) more days in an optimal state of antiretroviral therapy (ART) retention with viral suppression than women supported by Expert Clients. Infants receiving the Mentor Mother model (aHR: 1.24, 95% CI: 1.01, 1.52; p = 0.04) and ≥2 models (aHR: 1.44, 95% CI: 1.20, 1.74; p < 0.001) were more likely to undergo EID testing by age 6 months than infants supported by Expert Clients. Infants receiving the CHW and Mentor Mother models were 1.15 (95% CI: 0.80, 1.67; p = 0.44) and 0.84 (95% CI: 0.50, 1.42; p = 0.51) times as likely, respectively, to experience a poor outcome by 1 year than those supported by Expert Clients, but not significantly so. Study limitations include possible residual confounding, which may lead to inaccurate conclusions about the impacts of CFL models, uncertain generalizability of findings to other settings, and missing infant medical record data that limited the precision of infant outcome measurement. Conclusions In this descriptive study, we observed widespread reach of CFL models in Malawi, with favorable maternal outcomes in the CHW model and greater infant EID testing uptake in the Mentor Mother model. Our findings point to important differences in maternal and infant HIV outcomes by CFL model along the PMTCT continuum and suggest future opportunities to identify key features of CFL models driving these outcome differences.

FASILITAS OLAHRAGA INTERAKTIF DI RAWA BUNGA

Rawa Bunga population is constantly increased as time goes by. The increasing population in Rawa Bunga is leading to a change in land-use planning. The initial planning which create a balance between commercial and housing is forced to change into domination of housing. Although the housing community is constantly increased, but the government didn’t increased the community facility or third place in Rawa Bunga. This condition is causing a huge problem for the community to satisfy their daily basic needs. Even more, they started to occupy every vacant place for their activity and making problems for other people. The objective of this design is making a third place for the community of Rawa Bunga that can help them to socialize and interact with each other. The design method is divided into two parts, the first part is collecting data from observation, urban study, and analysis. The second part is start from the program and follow the theory of activity tipology. The design idea is a community facility or third place for interactive sport, sport and interactive technology is chosen because the community in Rawa Bunga loves sports. In addition, the third place will inserted by Betawi culture to introduce the genius loci of Rawa Bunga. Keywords: interactive sports; Rawa Bunga; Third Place AbstrakKelurahan Rawa Bunga memiliki jumlah penduduk yang selalu meningkat seiring berjalannya waktu. Peningkatan jumlah penduduk yang terjadi berdampak kepada perubahan fungsi lahan yang tidak semestinya seperti Rancangan zonasi awal yang mempunyai komposisi yang seimbang antara komersial dan hunian. Tetapi pada kenyataannya, fungsi lahan yang ada didominasi oleh hunian. Walaupun fungsi hunian bertambah, tetapi tidak diiringi pertambahan third place yang memadai. Akibatnya adalah masalah beruntun berupa kebutuhan dasar manusia yang tidak terpenuhi. Dampak yang dihasilkan adalah pelaksanaan aktivitas masyarakat di tempat – tempat yang tidak semestinya sebagai ganti fasilitas lingkungan yang tidak memadai. Tujuan dari perancangan ini adalah berusaha memenuhi kebutuhan dasar masyarakat di Kelurahan Rawa Bunga akan aktivitas penunjang seperti sosialisasi dan interaksi baik antar manusia maupun dengan lingkungannya melalui third place. Metode Perancangan yang dipakai dibagi menjadi dua tahap, pertama tahap pencarian data dengan metode empiris yaitu observasi, studi kota dan analisis. Tahap kedua, Tahap perancangan dimulai dari hasil yang didapat dari analisis berupa program. Program akan diolah dengan pendekatan metode desain tipologi kegiatan. Ide dari perancangan ini adalah fasilitas lingkungan atau third place dengan aktivitas olahraga yang memakai teknologi interaktif untuk membantu proses sosialisasi dan interaksi baik antar manusia maupun dengan lingkungannya. Olahraga dipilih karena masyarakat di Rawa Bunga senang dengan aktivitas yang bersifat olahraga dan tidak lupa juga disisipi elemen kebudayaan Betawi untuk memperkenalkan genius loci kawasan Rawa Bunga.

Maternal Death Surveillance and Response in Tanzania: Comprehensiveness of Maternal Deaths Narrative Summaries and Action Points from Death Reviews

BackgroundReview of maternal deaths relies on comprehensive documentation of medical records that can reveal sequence of events that led to death. Maternal Death and Surveillance (MDSR) system recommends the use of narrative summaries during maternal death reviews to discuss the case and categorize medical causes of death, identify gaps in care and recommend action plans to prevent deaths. Suggested action plans are recommended to be Specific, Measurable, Attainable, Relevant and Time bound (SMART). To identify gaps in documenting information and planning recommendations, comprehensiveness of written narrative summaries and adequacy of action plans according the MDSR guideline were assessed. MethodsA total of 76 facility maternal deaths that occurred in two regions in Southern Tanzania in 2018 were included for analysis. We assessed the comprehensiveness of narrative summaries and action plans using a prepared checklist from MDSR guideline of 2015. Presence or absence of items in four domains each with several attributes was recorded on the checklist. The domains were socio-demographic characteristics, antenatal care, referral information and events that occurred after admission. Less than 75% completeness of attributes in all domains was considered poor while >94% was good/comprehensive. Action plans were assessed by application of SMART criteria and according to place of planned implementation (community, facility or higher level of health system). Results Two-thirds of summaries (66%) scored poor, and none were scored as good/comprehensive. Summaries missed key information such as demographic characteristics, information of events that occurred in community (16%), time between diagnosis of complication and commencing treatment (65%), investigation results (47%), summary of case evolution (51%) and referral information (47%). A total of 285 action plans were analysed. Most action plans 242(85%) were allocated to health facilities for implementation and they were mostly 42(42%) on service delivery. Only 42% (32/76) of the action plans were deemed to be SMART.ConclusionsAbstraction of information to prepare narrative summaries used in MDSR system is inadequately done. Action plans and recommendations in MDSR system are mostly for facility sub standards of care and are not specific on the issues to be addressed.