Introduction: The effect of stigma on health and health inequity is increasingly recognized. While many medical conditions trigger stigmatization, the negative effects of HIV stigma are particularly well documented. HIV stigma undermines access, uptake, and adherence to both HIV prevention and treatment. People living with HIV face stigma in all aspects of their daily lives; however, stigma in the health system is particularly detrimental. A key component for health facility stigma-reduction interventions is participatory training of staff, often through several days of in-person training. Though this approach shows promise, it is time intensive and poses challenges for busy health facilities. In response, the DriSti study has developed a brief blended-learning approach to stigma reduction in Karnataka State, India. This paper describes the process and final content of the intervention development. The intervention is currently being tested. Final evaluation results will be published upon study completion.Methods: Grounded in behavior change strategies based on social cognitive theory principles that stress the importance of combining interpersonal interactions with specific strategies that promote behavior change, we used a three-phase approach to intervention development: (1) content planning—review of existing participatory stigma-reduction training activities; (2) story boarding—script development and tablet content production; and (3) pilot testing of tablet and in-person session materials.Results: The final intervention curriculum consists of three sessions. Two initial self-administered tablet sessions focus on stigma awareness, attitudes, fears of HIV transmission, and use of standard precautions. The third small group session covers the same material but includes skill building through role-play and testimony by a person living with HIV. A study team member administers the tablet sessions, explains the process, and is present throughout to answer questions.Conclusion: This paper describes the theoretical underpinning and process of developing the blended-learning curriculum content, and practical lessons learned.The approach covers three key drivers of HIV stigma—stigma awareness, fear of HIV transmission, and attitudes. Developing video content for the self-directed learning is complex, requires a diverse set of people and skills, and presents unexpected opportunities for stigma reduction. Co-facilitation of the in-person session by someone living with HIV is a critical component.

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Introduction: The World Health Organization recommends exclusive breastfeeding for every newborn during the first 6 months of life, yet women come across various challenges to continuing it. Aim: This systematic review was intended to identify barriers to exclusive breastfeeding among mothers. Methods: MEDLINE, Cumulative Index to Nursing and Allied health literature, ProQuest, Web of Science and Scopus databases were searched from January 1990 to October 2017. The systematic review included quantitative, qualitative and mixed-methods studies to identify barriers to exclusive breastfeeding among mothers of reproductive age with an infant aged between 0 and 12 months. All studies were screened based on titles, abstracts and full text by two reviewers independently. The methodological quality of included studies was assessed using appropriate tools. Of the 9737 eligible records, 44 studies were included for analysis. Classification of barriers to exclusive breastfeeding was adopted from the conceptual framework of factors affecting breastfeeding practices given by Hector and colleagues. Results: In total 32 barriers were grouped under individual, group and society level factors. Meta-analysis indicated that mothers who smoked had 2.49 times more odds of not exclusively breastfeeding than non-smoking mothers and mothers who had undergone caesarean section had 1.69 times more risk of cessation of exclusive breastfeeding than mothers who have had a vaginal childbirth. Conclusion: The systematic review revealed a complex interplay of various barriers related to exclusive breastfeeding. It is recommended that context-specific strategies should be designed in accordance with barriers existing in a region or country.

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Transportation is among the key aspects that influence active ageing. This realist review intends to understand the mechanisms of urban mobility infrastructure interventions and policies in low- and middle-income countries for older adults and to identify factors, which influenced the success or failure of interventions. We followed the steps suggested by Pawson and colleagues for a realist review. Electronic databases were searched from inception until August 2020. Studies were screened based on titles, abstracts and full text. The quality of included studies was assessed based on rigour and relevance. The evidence was obtained from 36 articles with diverse study designs conducted in 36 low- and middle-income countries. Findings were validated through stakeholder consultations from three low- and middle-income countries. Of the various individual factors identified, behaviour change communication interventions were low-cost, had a long-term impact and were efficient in increasing awareness among users to improve safety, social inclusion and about transport schemes for older adults. Improved transport infrastructure resulted in a shift from private to public transportation. For a sustainable urban transport infrastructure, good governance and involvement of stakeholders for planning and implementing transport interventions were considered necessary. Lack of evaluation, experience of transport planners, and inter-sectoral coordination were key challenges to successful interventions. The review highlighted a lack of older adult-specific transportation policies, and gender-targeted interventions for older women, suggesting a need for interventions and policies based on the contextual factors existing in a region.