Christopher G. Kemp

Death knocks, professional practice, and the public good: The media experience of suicide reporting in New Zealand

Health, government, and media organizations around the world have responded to research demonstrating the imitative effects of suicide coverage in the news media by developing guidelines to foster responsible reporting. Implementation of these guidelines has encountered some resistance, and little is known about the media perspective on suicide coverage and its effects on guideline use. This qualitative study provides an in-depth appreciation of this perspective by investigating the experiences of journalists covering suicide in New Zealand. Fifteen newspaper, television and radio journalists were interviewed between December 2008 and March 2009 and transcripts were analyzed using a grounded hermeneutic editing approach. Five themes were identified: public responsibility, media framing of suicide, professional practice, personal experience of suicide reporting, and restricted reporting. Participants asserted the role of the media in the protection of the public good. Though this stance aligns them with the goals of health policymakers, it is derived from a set of professional mores at odds with the perceived paternalism of suicide reporting guidelines. Participants were stakeholders in the issue of suicide coverage. We conclude that policymakers must engage with the news media and acknowledge the competing imperatives that provide the context for the application of suicide reporting guidelines by individual journalists. Collaborative guideline development will be vital to effective implementation.

Mixed-Methods Evaluation of a Novel, Structured, Community-Based Support and Education Intervention for Individuals with HIV/AIDS in KwaZulu-Natal, South Africa

People living with HIV in Sub-Saharan Africa face significant challenges accessing care. Community-based peer support groups can increase linkage to treatment, though the effectiveness of structured, scalable groups has not been demonstrated. This study aimed to measure the impact of the structured Integrated Access to Care and Treatment intervention on clients’ knowledge, attitudes, and practice regarding HIV/AIDS, including their experiences of stigma, in KwaZulu-Natal, South Africa. Data collection involved pre-/post-tests and client interviews. Pre-/post-test data from 66 clients were collected. 17 participants were interviewed. Paired t-tests did not detect significant changes in the main outcomes. Qualitative results suggested a psychosocial benefit as participants connected with their peers, expressed themselves openly, and re-engaged with their communities. Unfortunately, this study did not quantitatively measure psychosocial changes, and the results have limited generalizability to men. I ACT may be an effective complement to clinic-based support services, though further study should quantify the psychosocial benefit.ResumenLas personas viviendo con VIH en África subsahariana enfrentan desafíos importantes para acceder a servicios de salud. A pesar que la eficacia de grupos estructurados no se ha demostrado, los grupos de apoyo comunitarios pueden aumentar vinculación con tratamiento. El objetivo del estudio fue medir el impacto de la intervención de Acceso al Cuidado y Tratamiento Integrado en conocimientos, actitudes, y prácticas de clientes en relación con VIH/SIDA, incluyendo sus experiencias con estigma, en KwaZulu-Natal, Sudáfrica. La recolección de datos incluyó pruebas pre/post-test y entrevistas. Se recogieron datos post-test/pre procedentes de 66 clientes. 17 participantes fueron entrevistados. Las pruebas t apareadas no detectaron cambios significativos en los resultados principales. Los resultados cualitativos sugieren beneficios psicosociales para los participantes; al relacionarse con sus compañeros, se expresaron abiertamente, y se re-conectaron con sus comunidades. Desafortunadamente, este estudio no midió cambios psicosociales cuantitativamente y la generalización de los resultados a hombres puede ser limitada. I ACT puede ser un complemento eficaz de los servicios de apoyo basados en clínicas, aunque estudios posteriores deberían cuantificar el beneficio psicosocial.

The role of implementation science training in global health: from the perspective of graduates of the field’s first dedicated doctoral program

Bridging the ‘know-do gap’ is an enormous challenge for global health practitioners. They must be able to understand local health dynamics within the operational and social contexts that engender them, test and adjust approaches to implementation in collaboration with communities and stakeholders, interpret data to inform policy decisions, and design adaptive and resilient health systems at scale. These skills and methods have been formalized within the nascent field of Implementation Science (IS). As graduates of the worlds first PhD program dedicated explicitly to IS, we have a unique perspective on the value of IS and the training, knowledge, and skills essential to bridging the ‘know-do gap’. In this article, we describe the philosophy and curricula at the core of our program, outline the methods vital to IS in a global health context, and detail the role that we believe IS will increasingly play in global health practice. At this junction of enormous challenges and opportunities, we believe that IS offers the necessary tools for global health professionals to address complex problems in context and raises the bar of success for the global health programs of the future.

The role of service readiness and health care facility factors in attrition from Option B+ in Haiti: a joint examination of electronic medical records and service provision assessment survey data

Background Option B+ is a strategy wherein pregnant or breastfeeding women with HIV are enrolled in lifelong antiretroviral therapy (ART) for prevention of mother-to-child transmission (PMTCT) of HIV. In Haiti, attrition from Option B+ is problematic and variable across health care facilities. This study explores service readiness and other facility factors as predictors of Option B+ attrition in Haiti. Methods This analysis used longitudinal data from 2012 to 2014 from the iSanté electronic medical record system and cross-sectional data from Haitis 2013 Service Provision Assessment. Predictors included Service Availability and Readiness Assessment (SARA) measures for antenatal care (ANC), PMTCT, HIV care services and ART services; general facility characteristics and patient-level factors. Multivariable Cox proportional hazards models modelled the time to first attrition. Results Analysis of data from 3147 women at 63 health care facilities showed no significant relationships between SARA measures and attrition. Having integrated ANC/PMTCT care and HIV-related training were significant protective factors. Being a public-sector facility, having a greater number of quality improvement activities and training in ANC were significant risk factors. Conclusion Several facility-level factors were associated with Option B+ attrition. Future research is needed to explore unmeasured facility factors, clarify causal relationships, and incorporate community-level factors into the analysis of Option B+ attrition.

Implementation of eHealth Interventions Across the HIV Care Cascade: a Review of Recent Research

Purpose of ReviewWe review recent implementation science focusing on eHealth interventions to improve outcomes along the HIV care cascade. We highlight several gaps in the eHealth implementation literature and propose areas for future study.Recent FindingsWe identified 17 studies conducted in North America, Europe, and sub-Saharan Africa assessing the acceptability, appropriateness, adoption, cost, feasibility, fidelity, penetration, or sustainability of eHealth interventions targeting the HIV care cascade. Most interventions used SMS messages to improve cascade outcomes. Feasibility research has demonstrated the importance of adaptability for intervention scale-up and delivery. Key gaps in the literature remain related to predictors of the adoption of eHealth interventions by health facilities and staff. In addition, no studies explored sustainability and few used theoretical frameworks for implementation research or validated measures of implementation outcomes. We propose next steps for the future of eHealth implementation research to inform the delivery, scale-up, and maintenance of eHealth interventions in the real world.

Process and impact evaluation of a community gender equality intervention with young men in Rajasthan, India

Abstract This paper reports on the results of a process and impact evaluation to assess the effects of a project aiming to engage men in changing gender stereotypes and improving health outcomes for women in villages in Rajasthan, India. We conducted seven focus group discussions with participants in the programme and six in-depth interviews with intervention group leaders. We also conducted 137 pre- and 70 post-intervention surveys to assess participant and community knowledge, attitudes and behaviours surrounding gender, violence and sexuality. We used thematic analysis to identify process and impact themes, and hierarchical mixed linear regression for the primary outcome analysis of survey responses. Post-intervention, significant changes in knowledge and attitudes regarding gender, sexuality and violence were made on the individual level by participants, as well as in the community. Moderate behavioural changes were seen in individuals and in the community. Study findings offer a strong model for prevention programmes working with young men to create a community effect in encouraging gender equality in social norms.

HIV-Related Stigma and Viral Suppression Among African-American Women: Exploring the Mediating Roles of Depression and ART Nonadherence

We used baseline data from a sample of African-American women living with HIV who were recruited to participate in a stigma-reduction intervention in Chicago and Birmingham (2013–2015) to (1) evaluate the relationship between HIV-related stigma and viral suppression, and (2) assess the role of depression and nonadherence to antiretroviral therapy (ART) as mediators. Data from women were included in this secondary analysis if they were on ART, had viral load data collected within 8-weeks of study entry and had complete covariate data. We used logistic regression to estimate the total effect of HIV-related stigma (14-item Stigma Scale for Chronic Illness) on viral suppression (< 200 copies/mL), and serial mediation analysis to estimate indirect effects mediated by depressive symptoms (8-item Patient Health Questionnaire) and ART nonadherence (number of days with missed doses). Among 100 women who met study inclusion criteria, 95% reported some level of HIV-related stigma. In adjusted models, higher levels of HIV-related stigma were associated with lower odds of being virally suppressed (AOR = 0.93, 95% CI = 0.89–0.98). In mediation analysis, indirect effects through depression and ART nonadherence were not significant. Findings suggest that HIV-related stigma is common among African-American women living with HIV, and those who experience higher levels of stigma are less likely to be virally suppressed. However, the mechanisms remain unclear.

Pre/post evaluation of a pilot prevention with positives training program for healthcare providers in North West Province, Republic of South Africa

BackgroundPrevention interventions for people living with HIV/AIDS are an important component of HIV programs. We report the results of a pilot evaluation of a four-hour, clinic-based training for healthcare providers in South Africa on HIV prevention assessments and messages. This pre/post pilot evaluation examined whether the training was associated with providers delivering more prevention messages.MethodsSeventy providers were trained at four public primary care clinics with a high volume of HIV patients. Pre- and post-training patient exit surveys were conducted using Audio-Computer Assisted Structured Interviews. Seven provider appropriate messaging outcomes and one summary provider outcome were compared pre- and post-training using Poisson regression.ResultsFour hundred fifty-nine patients pre-training and 405 post-training with known HIV status were interviewed, including 175 and 176 HIV positive patients respectively. Among HIV positive patients, delivery of all appropriate messages by providers declined post-training. The summary outcome decreased from 56 to 50%; adjusted rate ratio 0.92 (95% CI = 0.87–0.97). Sensitivity analyses adjusting for training coverage and time since training detected fewer declines. Among HIV negative patients the summary score was stable at 32% pre- and post-training; adjusted rate ratio 1.05 (95% CI = 0.98–1.12).ConclusionsSurprisingly, this training was associated with a decrease in prevention messages delivered to HIV positive patients by providers. Limited training coverage and delays between training and post-training survey may partially account for this apparent decrease. A more targeted approach to prevention messages may be more effective.