Deborah Bain Brickley

Linking family planning with HIV/AIDS interventions: a systematic review of the evidence.

Objective:To conduct a systematic review of the literature and examine the effectiveness, optimal circumstances, and best practices for strengthening linkages between family planning and HIV interventions. Design:Systematic review of peer-reviewed articles and unpublished program reports (‘promising practices’) evaluating interventions linking family planning and HIV services. Methods:Articles were included if they reported post-intervention evaluation results from an intervention linking family planning and HIV services between 1990 and 2007. Systematic methods were used for searching, screening, and data extraction. Quality assessment was conducted using a 9-point rigor scale. Results:Sixteen studies were included in the analysis (10 peer-reviewed studies and six promising practices). Interventions were categorized into six types: family planning services provided to HIV voluntary counseling and testing (VCT) clients, family planning and VCT services provided to maternal and child health clients, family planning services provided to people living with HIV, community health workers provided family planning and HIV services, VCT provided to family planning clinic clients, and VCT and family planning services provided to women receiving postabortion care. Average study design rigor was low (3.25 out of 9). Most studies reported generally positive or mixed results for key outcomes; no negative results were reported. Conclusion:Interventions linking family planning and HIV services were generally considered feasible and effective, though overall evaluation rigor was low.

A Qualitative Study of Stigma and Discrimination against People Living with HIV in Ho Chi Minh City, Vietnam

Stigma and discrimination against people living with HIV/AIDS (PLHIV) are a pressing problem in Vietnam, in particular because of propaganda associating HIV with the “social evils” of sex work and drug use. There is little understanding of the causes and sequelae of stigma and discrimination against PLHIV in Vietnam. Fifty-three PLHIV participated in focus group discussions in Ho Chi Minh City. Nearly all participants experienced some form of stigma and discrimination. Causes included exaggerated fears of HIV infection, misperceptions about HIV transmission, and negative representations of PLHIV in the media. Participants faced problems getting a job, perceived unfair treatment in the workplace and experienced discrimination in the healthcare setting. Both discrimination and support were reported in the family environment. There is a need to enforce laws against discrimination and provide education to decrease stigma against PLHIV in Vietnam. Recent public campaigns encouraging compassion toward PLHIV and less discrimination from healthcare providers who work with PLHIV have been encouraging.

Community, Family, and Partner-Related Stigma Experienced by Pregnant and Postpartum Women with HIV in Ho Chi Minh City, Vietnam

Pregnant and postpartum women with HIV often face stigma and discrimination at home and in the community. In Vietnam, associations between HIV and the “social evils” of drug use and sex work contribute to stigmatization of people with HIV. We conducted a qualitative study to explore discrimination experienced by HIV-positive pregnant and postpartum women in Ho Chi Minh City at home and in the community. We conducted 20 in-depth interviews and two focus group discussions. Participants described managing disclosure of their HIV infection because of fear of stigma and discrimination, particularly to the wider community. In cases where their HIV status was disclosed, women experienced both discrimination and support. The findings highlight the need for targeted interventions to support pregnant and postpartum women with HIV, particularly during this period when they are connected to the healthcare system and more readily available for counseling.

Sexual and reproductive health services for people living with HIV: a systematic review.

Abstract People living with HIV often have unmet needs for sexual and reproductive health (SRH) services. We present results of a systematic review of studies offering SRH services targeted to people living with HIV. Studies were selected from a broader SRH and HIV linkages review. Inclusion criteria included: (1) peer-reviewed journal articles with a pre–post or multiple-arm study design; (2) reported post-intervention evaluation data; and (3) published 1 January 1990 through 31 December 2007. Nine studies were identified with an average rigour score of 5.1 out of 9. Services included family planning (one study), sexually transmitted infection (STI) services (two studies), combined family planning and STI services (three studies) and multiple services (three studies). The review identified mostly positive effects on the outcomes measured, including condom and contraceptive use and quality of services. Yet gaps remain in the research to establish the best approaches for addressing needs and choices of people living with HIV. There is a need for high-quality intervention studies to determine the most successful and cost-effective strategies for providing SRH services to people living with HIV.

International traineeships in AIDS prevention studies: 25 years of collaborative research.

The International Traineeships in AIDS Prevention Studies (ITAPS) program is commemorating its 25th year as the joint UCSF Global Health Sciences’ and Center for AIDS Prevention Studies’ premier training program for researchers from resource-limited settings. Since 1988, we have trained 248 early- and mid-career scientists from 46 countries, who have gone on to publish more than 1800 manuscripts in the peer-reviewed literature and present their research at national, regional, and international conferences. Each year, we select a new group of promising scientists from low- and middle-income countries (LMIC) to collaborate with UCSF faculty on AIDS prevention and care research projects. Our program has historically offered three training tracks. In our research methods/protocol development track, incoming scholars develop new pilot research projects, either through an intensive summer workshop at UCSF or a blended-learning course involving face-to-face short courses combined with distance learning. Subsequently, these trainees field their projects in their home countries with continued technical assistance from UCSF. The second track is a scientific manuscript writing course for scholars who have already completed data collection, either as part of the ITAPS research methods track or through other means or partnerships. We provide guidance and mentoring as scholars conduct data analysis and prepare the results of their studies for publication. We also offer a grant writing track for select ITAPS alumni who are preparing to write NIH grant applications. Mentoring is the cornerstone of the ITAPS educational approach. Each incoming scholar works closely with a UCSF faculty mentor throughout the didactic portions of the program as well as during data collection and analysis, manuscript writing and publishing. Many scholars work with more than one mentor—e.g., a primary mentor with topical expertise and a secondary mentor with methodological expertise. These mentoring relationships often last for years as the scholars and UCSF faculty continue to work together designing new studies or publishing additional papers. We are currently designing a mentor training program for our most accomplished HIV prevention scientists from LMIC to prepare them to effectively support the professional goals of early-career investigators in their home countries and regions. These mentoring skills are often lacking among faculty in many academic institutions, and the absence of a mentoring culture is particularly pronounced in some of the LMIC in which we work. ITAPS has by most metrics been a great success. Because the cost of international travel has increased dramatically in recent years, one could argue that it is now too expensive to bring scientists from LMIC for short-term study at UCSF. It is our experience, however, that providing these scientists with protected time away from competing professional responsibilities at home is the only way to guarantee that they will be able to focus on designing a research project or completing a scientific manuscript. Recently there has been intense interest in asynchronous training, made possible through evolving digital pedagogies, with hope that it can provide the same result as individual mentoring but without the expense. We have begun to experiment with these technologies, and our experience has been that there is simply no substitute for the personal touch that only individual mentoring can bring. We believe that without this style of mentoring, the long-term capacity building that is the main goal of our program will not happen. By the time the trainees complete their experience as ITAPS scholars, they will have designed pilot research protocols for which they are the principal investigators and they will have vetted their study through multiple institutional review boards (IRBs), usually including the UCSF IRB, a local IRB, and the IRB of the funding institution. Each trainee will have fielded his/her study with ongoing technical assistance from an ITAPS faculty mentor. Each will have conducted preliminary data analysis on his/her own then completed it under the guidance of a mentor. Most will have published their results in peer-reviewed journals, often using English rather than their native language(s). Most will have presented their results at national and international AIDS conferences or through other less formal means of dissemination, to stakeholders and colleagues. And importantly, many will go on to conduct subsequent studies with funding from their own governments or as principal investigator or co-investigator of an NIH grant. In this special issue of AIDS & Behavior, we present 16 papers first authored by our ITAPS alumni. These scientists represent the regions from which we have drawn promising early-career investigators into our program since 1988. Four are from sub-Saharan Africa; four are from East, Southeast, and Central Asia; three are from Central and South America; and one is from Eastern Europe. While most of these scientists are recent ITAPS alumni, two of them participated in ITAPS as far back as 1989 and 1997.

AIDS Prevention Research in Low and Middle-Income Countries: Generating the Evidence upon Which Local Decisions are Made

The authors discuss engaging scientists from low-and middle-income countries as lead investigators on research projects and the contributions that are made in doing so. Points made in this editorial are: publishing the research findings of scientists from LAMICs requires a multi-faceted approach to peer-reviewing and copyediting. To bring some of these articles to press we needed to address the limitations of their facility with the English language the effect of resource constraints that sometimes result in less-than optimal research designs and some reviewers’ lack of familiarity with the realities of conducting research in these international settings. Concomitantly we concentrated on the relevance and potential of submissions to address local issues. Some articles were returned for multiple revisions but always with the understanding that the underlying scientific contribution was valuable. Some articles required a heavier than usual hand in copyediting to help translate unclear ideas--ideas that were usually crystal clear in the investigators’ own languages--into writing that would pass muster in international peer-reviewed journals. (excerpt)

Home-Based Care and Perceived Quality of Life Among People Living with HIV in Ho Chi Minh City, Viet Nam

We conducted a cross-sectional study to examine the perceptions of quality of life among people living with HIV who received home-based care services administered through outpatient clinics in Ho Chi Minh City, Viet Nam. Data were collected from a sample of 180 consecutively selected participants (86 cases, 94 controls) at four outpatient clinics, all of whom were on antiretroviral therapy. Quality of life was evaluated using the WHOQOL-BREF instrument. In adjusted analysis, those who received home-based care services had a quality of life score 4.08 points higher (on a scale of 100) than those who did not receive home-based care services (CI 95%, 2.32–5.85; p < 0.001). The findings suggest that home-based care is associated with higher self-perceptions of quality of life among people living with HIV.

AIDS Prevention Research: Training and Mentoring the Next Generation of Investigators from Low- and Middle-Income Countries

In this special issue, we present research from scientists from lowand middle-income countries (LMIC) who have participated in the University of California, San Francisco (UCSF) International Traineeships in AIDS Prevention Studies (ITAPS) program. The goal of ITAPS is to teach skills to early-career LMIC investigators so they can more independently perform and publish their research going forward. We currently focus on training in analysis and interpretation of research results and development and submission of manuscripts for publication. We also provide a mentor training program in which we enroll more experienced LMIC investigators, many of whom are alumni of the ITAPS manuscript writing program, to learn mentorship skills and to practice them by participating side-by-side with UCSF faculty in all aspects of training. Trained mentors are then supported and encouraged to provide training and workshops for junior investigators in their own institutions or countries. We partner closely with ongoing international research networks, particularly with the International AIDS Vaccine Initiative (IAVI), the Blood Systems Research Institute (BSRI), and the WHO Collaborating Center for HIV Surveillance in Iran. We have also collaborated with the Elizabeth Glaser Pediatric AIDS Foundation and the Centers for Disease Control and Prevention (CDC)—President’s Emergency Plan for AIDS Relief (PEPFAR). These collaborations are vital; they allow us to leverage existing support, and to identify trainees who are already embedded in research projects and can apply skills learned during the ITAPS training to their existing research roles. ITAPS has evolved considerably since its start in 1988, from an initial focus on developing and implementing research protocols to manuscript writing and mentorship training. The delivery of training has also evolved, based in part on funding constraints, but also in response to the wide availability of reliable internet and ease of real-time distance communication. We currently use a mix of UCSF-based and in-country workshops, distance learning and online teaching modules. Since 2007, we have trained 97 LMIC earlycareer investigators who to date have published 74 manuscripts based on their research. Of the 12 mentors trained since 2014, 10 have implemented 16 in-country workshops, enrolling 336 participants. Although the program has been highly successful, it is not without its hurdles. Funding for international training is limited, particularly to support the extensive faculty time needed to mentor and train LMIC early-career investigators, which invariably continues beyond the end of the formal training period. ITAPS has been funded through an R25 mechanism by the U.S. National Institute of Mental Health/ NIH but is also supported by our partners IAVI and BSRI, as well as the Starr Foundation. Without this additional support, our training capacity would be highly constrained. Furthermore, understanding the fundamentals of study design, data management and biostatistics is critical to analyzing and interpreting the results of one’s research; however, many early-career LMIC investigators have not had formal training or do not have a working knowledge of these areas. In response, we are expanding the content of training to include workshops and distance learning in targeted biostatistics and analysis, which we hope will improve trainees’ skills and future research independence. LMIC investigators face additional barriers to publishing and mentorship. Many must juggle heavy clinical and teaching responsibilities so that carving out time to conduct research and write manuscripts can be particularly challenging. In addition, mentoring junior investigators is often not recognized as an important component of a researcher’s responsibilities. Unless mentoring junior staff is supported * Deborah B. Brickley debbie.bainbrickley@ucsf.edu