Six Moments of Infection Prevention in Injection Drug Use: An Educational Toolkit for Clinicians

Background Injection drug use-associated bacterial and viral infections are increasing. Expanding access to harm reduction services, such as safe injection education, are effective prevention strategies. However, these strategies have had limited uptake. New tools are needed to improve provider capacity to facilitate dissemination of these evidence-based interventions. Methods The “Six Moments of Harm Reduction” provider educational tool was developed using a global, rather than pathogen-specific, infection prevention framework, highlighting the prevention of invasive bacterial and fungal infections in additional to viral pathogens. The tool’s effectiveness was tested using a short, paired pre/post survey that assessed provider knowledge and attitudes about harm reduction. Results N=75 respondents completed the paired surveys. At baseline, 17 respondents (22.6%) indicated that they had received no prior training in harm reduction and 28 (37.3%) reported discomfort counseling patients who inject drugs (PWID). 60 respondents (80.0%) reported they had never referred a patient to a syringe service program (SSP) and, of those, 73.3% cited lack of knowledge regarding locations of SSPs and 40.0% reported not knowing where to access information regarding SSPs. After the training, 66 (88.0%) reported that they felt more comfortable educating PWID (p<0.0001), 65 respondents (86.6%) reported they planned to use the “Six Moments” model in their own practice, and 100% said they would consider referring patients to a SSP in the future. Conclusions The “Six Moments” model emphasizes the importance of a global approach to infection prevention and harm reduction. This educational intervention can be used as part of a bundle of implementation strategies to reduce morbidity and mortality in PWID.

Characterizing health care provider knowledge: Evidence from HIV services in Kenya, Rwanda, South Africa, and Zambia

Background Identifying approaches to improve levels of health care provider knowledge in resource-poor settings is critical. We assessed level of provider knowledge for HIV testing and counseling (HTC), prevention of mother-to-child transmission (PMTCT), and voluntary medical male circumcision (VMMC). We also explored the association between HTC, PMTCT, and VMMC provider knowledge and provider and facility characteristics. Methods We used data collected in 2012 and 2013. Vignettes were administered to physicians, nurses, and counselors in facilities in Kenya (66), Rwanda (67), South Africa (57), and Zambia (58). The analytic sample consisted of providers of HTC (755), PMTCT (709), and VMMC (332). HTC, PMTCT, and VMMC provider knowledge scores were constructed using item response theory (IRT). We used GLM regressions to examine associations between provider knowledge and provider and facility characteristics focusing on average patient load, provider years in position, provider working in another facility, senior staff in facility, program age, proportion of intervention exclusive staff, person-days of training in facility, and management score. We estimated three models: Model 1 estimated standard errors without clustering, Model 2 estimated robust standard errors, and Model 3 estimated standard errors clustering by facility. Results The mean knowledge score was 36 for all three interventions. In Model 1, we found that provider knowledge scores were higher among providers in facilities with senior staff and among providers in facilities with higher proportions of intervention exclusive staff. We also found negative relationships between the outcome and provider years in position, average program age, provider working in another facility, person-days of training, and management score. In Model 3, only the coefficients for provider years in position, average program age, and management score remained statistically significant at conventional levels. Conclusions HTC, PMTCT, and VMMC provider knowledge was low in Kenya, Rwanda, South Africa, and Zambia. Our study suggests that unobservable organizational factors may facilitate communication, learning, and knowledge. On the one hand, our study shows that the presence of senior staff and staff dedication may enable knowledge acquisition. On the other hand, our study provides a note of caution on the potential knowledge depreciation correlated with the time staff spend in a position and program age.

Health equity implications of COVID-19 on dementia care in community for people of African descent

This presentation shares results from an analysis of interviews conducted to understand the health equity implications of COVID-19 responses on dementia care in the community for people of African descent in Nova Scotia, Canada. Interviews were embedded within a larger multi-method rapid research project that aimed to assess the impact of COVID-19 on dementia care for geographically and socially marginalized groups in the province. Data from the interviews was analyzed using a constructivist thematic analysis method, guided by an intersectional theoretical scaffold. Three themes were identified related to systemic barriers, mental health, system navigation and self-care, and collected under the overarching theme of ‘facing the unknown with dementia’. Results emphasized the value and notable absence of community driven, culturally specific dementia programs, resources and navigators for people living with dementia, family caregivers and care workers of African descent. Participants identified lack of health system and care provider knowledge and understanding of the cultures and histories of people of African descent as a barrier to quality care and to addressing dementia-related stigma. Conversations focused on the need for practical and accessible tools, strategies and perspectives responsive to the actually lived realities and needs of people in community, and for research that actually contributes to individual and collective life in tangible, timely and culturally meaningful ways. Recommendations focus on the importance of centering community in dementia care programs, policy, practice and research to improve services and supports for people of African descent.

SIDE EFFECTS OF INJECTABLE AND ORAL CONTRACEPTIVE AND UNINTENDED PREGNANCY AMONG REPRODUCTIVE WOMEN IN INDONESIA

Using contraception is essential for protecting women from the risk of unintended pregnancy. However, contraceptive discontinuation, caused by side effects of contraceptives or health problems, is still high. This study aimed to assess the impact of injectable and pill contraception discontinuation due to side effects or health problems on unintended pregnancy among women aged 15-49 years in Indonesia. This study is based on the 2017 Indonesia Demographic and Health Survey. As many as 1,613 women who discontinued their oral contraceptives and 5,022 women who discontinued their injectables were followed retrospectively. Pregnancy rates were tested for differences between categories using survival analysis. It was found that one year after stopping contraceptives due to side effects, almost 16-17% of oral/injectable contraceptive users were already pregnant. The pregnancy rate was higher among women aged less than 25 years. Unplanned pregnancy occurred more frequently among women who were not working than women who were working. Counseling services need to be strengthened by improving provider knowledge and skills to give comprehensive information including contraceptives’ side effects.

Abstract P221: Effect Of Instructional Videos To Enhance Healthcare Provider Knowledge For Hypertension (htn) Management In Tanzania

Introduction: The growing burden of HTN is a major public health problem in Tanzania, with the estimated prevalence of 28%. The healthcare system faces major capacity constraints, including inadequate provider competencies; <60% of providers reported fair knowledge of HTN, and only 42% had access to HTN guidelines. Knowledge of HTN management standards and guidelines is prerequisite to improving HTN management. Objective: Determine the effect of instructional training videos in improving healthcare provider knowledge for HTN management. Methods: Eighteen primary healthcare facilities in the Dar es Salaam region were selected using stratified random sampling. In each facility, providers, who screened and managed patients for HTN, completed pre-test knowledge assessments. Subsequently, they were invited to an instructional training, using four, 4-5minute videos developed by investigators at Johns Hopkins. Post-test was conducted 5 months after the introduction of the videos. Results: Thirty-three clinicians participated in the pre-post study and consented to attending the video training workshop. Knowledge competencies showed significant improvement in most but not all aspects of HTN management (Table). For example, adequate knowledge about HTN increased from 78.8% to 100% (p<0.01), and knowledge of patient preparation prior to Blood Pressure (BP) screening increased from 69.7% to 93.9% ( p<0.05). Conclusion: In the context of a resource-constrained setting, low-cost training videos have the potential to improve healthcare provider knowledge for HTN management.