In order to increase patient active engagement during patient–provider interactions, we developed and implemented patient training sessions in four antiretroviral therapy (ART) clinics in Namibia using a “Patient Empowerment” training curriculum. We examined the impact of these trainings on patient–provider interactions after the intervention. We tested the effectiveness of the intervention using a randomized parallel group design, with half of the 589 enrolled patients randomly assigned to receive the training immediately and the remaining randomized to receive the training 6 months later. The effects of the training on patient engagement during medical consultations were measured at each clinic visit for at least 8 months of follow-up. Each consultation was audiotaped and then coded using the Roter Interaction Analysis System (RIAS). RIAS outcomes were compared between study groups at 6 months. Using intention-to-treat analysis, consultations in the intervention group had significantly higher RIAS scores in doctor facilitation and patient activation (adjusted difference in score 1.19, p = .004), doctor information gathering (adjusted difference in score 2.96, p = .000), patient question asking (adjusted difference in score .48, p = .012), and patient positive affect (adjusted difference in score 2.08, p = .002). Other measures were higher in the intervention group but did not reach statistical significance. We have evidence that increased engagement of patients in clinical consultation can be achieved via a targeted training program, although outcome data were not available on all patients. The patient training program was successfully integrated into ART clinics so that the trainings complemented other services being provided.

The results are presented from a 2005 survey of 377 women in four HIV/AIDS treatment programs in Uganda. The aim of the study was to explore women's economic hardships and the association with four sexual risk behaviors: whether a woman was sexually active in the last 12 months, whether a condom was used during the last sex act, whether she reported having had a sexual partner in the last six months who she suspected had multiple partners and report of forced, coercive or survival sex in the last six months. Few women were sexually active (34%), likely due to the high proportion of widows (49%). Married women were likely to report forced, coercive or survival sex (35%). Eighty-four percent of women reported condom used at last sex act. Forced, coercive or survival sex was associated with number of meals missed per week (AOR=1.125, 95% CI 1.11, 1.587, p<0.05). Sex with a partner in the last six months who a woman suspected had multiple partners was also associated with number of missed meals per week (AOR=2.080, 95% CI 1.084, 3.992). Currently women in Ugandan antiretroviral therapy programs are not likely to be sexually active, except for married women. Many women need to find food and other support, which may put them at risk of forced, coercive or survival sex due to dependency on men.

Although numerous studies provide evidence that active patient engagement with health care providers improves critical outcomes such as medication adherence, very few of these have been done in low resource settings. In Namibia, patient education and empowerment trainings were conducted in four antiretroviral (ART) clinics to increase patient engagement during patient-provider interactions. This qualitative study supplements findings from a randomized controlled trial, by analyzing data from 10 in-depth patient interviews and 94 training evaluation forms. A blended approach of deductive and inductive coding was used to understand training impact. Findings indicated the trainings increased patients’ self-efficacy through a combination of improved HIV-related knowledge, greater communication skills and enhanced ability to overcome complex psychosocial barriers, such as fear of speaking up to providers. This study suggests patient empowerment training may be a powerful method to engage HIV patients in their own care and treatment.

Background: In countries where STI/HIV prevalence data and behavioural data are scarce UNAIDS second generation HIV surveillance guidelines recommend measuring STI/HIV prevalence and risk behaviours in vulnerable populations but do not recommend conducting these surveys concurrently because of concerns about participation rates, cost, and provision of services. Objectives: To assess the feasibility of conducting a national combined STD prevalence and behaviour survey in Mali among vulnerable populations with the intention of institutionalisation. Methods: From March to June 2000 an integrated STI prevalence and behaviour survey was conducted using cluster sampling among five risk groups in four sites in Mali, west Africa. 2229 individuals in non-traditional settings such as taxi/bus stations, market areas, households, and brothels participated in any one or all components of the study: (1) behavioural questionnaire, (2) urine sample for Neisseria gonorrhoeae (GC)/Chlamydia trachomatis (CT) testing, (3) a fingerstick drop of blood for syphilis, and/or (4) HIV testing. Results: High participation rates of 84%-100% were achieved despite specimen collection and HIV testing. Rates fell only slightly when participants were asked to provide biological samples and participants were more likely to provide urine than blood. Rates among the different groups for HIV and syphilis testing are similar and suggest that refusal was most probably because of a reluctance to give blood rather than because of HIV testing. The cost of the biological component added approximately $30 per participant. Included in the $30 are the costs of training, participant services, laboratory personnel and supplies, STI drugs, and STI testing costs. The total cost of the survey was $154 905. Biomarkers aided in validation of answers to behavioural questions. Consenting individuals received HIV pretest and post-test counselling and referral to a trained health provider for treatment of STI and the provision of services provided the framework for interventions in the groups following the survey. Conclusion: This represents an effective methodology for collecting risk behaviour and STI/HIV prevalence information concurrently and should be considered by countries expanding STI/HIV surveillance as part of UNAIDS second generation HIV surveillance. L essons learned from the epidemiology of HIV thus far indicate that governments need to act quickly once HIV has entered a population to ensure prevention of infection among those populations most likely to contract and spread HIV. 1 To accomplish this requires reliable information about the risk behaviours and the level of infection with HIV and other sexually transmitted infections (STI) in the general population and in these high risk "core" groups. 2 Behavioural and biological surveys in these groups provide this information and can be repeated over time in order to follow trends in the evolution of an HIV epidemic and assess where intervention is most likely to have an impact. Surveys in core groups are ...

For prescription use only.For in vitro diagnostic use only. For use under Food and Drug Administration'sEmergency Use Authorization (EUA) only. INTENDED USEThe WANTAI SARS-Co V-2 Ab Rapid Test is a lateral flow assay f or the qualitativ e detection of total antibodies (including IgG and Ig M) to SARS-CoV-2 in h uman serum, plasma (dipotassium ED TA, lithium hepa rin, and sodi um citrate), and v enous whole blood. The WANTAI SARS-CoV-2 Ab Rapid Test is intended f or use as an aid in identify ing indiv iduals with an adaptiv e immune response to SARS-CoV-2, indicating recent or prior inf ection. At this time, it is unknown f or how long antibodies persist following inf ection and if the presence of antibodies conf ers protectiv e immunity. The WANTAI SARS-CoV-2 Ab Rap id Test should not be used to diagnose or exclude acute SARS-CoV-2 inf ection. Testing is limited to laboratories certif ied under the Clinical Laboratory Improv ement Amendments of 1988 (CLIA), 42 U.S.C 263a, that meet requirements to perf orm moderate or high complexity tests.Results are f or the detection of SARS CoV-2 antibodies. Antibodies to SARS-CoV-2 are ge nerally detectable in blood sev eral days af ter initial inf ection, although the duration of time antibodies are present post-inf ection is not well characterized. Indiv iduals may hav e detectable v irus present f or sev eral weeks f ollowing seroconv ersion.Laboratories within the United States and its territories are requir ed to report all results to the appropriate pu blic health authorities. Samples should only be tested f rom indiv iduals that are 15 day s or more post-sy mptom onset.The sensitiv ity of the WANTAI SARS-CoV-2 AB Rapid Test early af ter inf ection is unknown. Negativ e results do not preclude acute SARS-CoV-2 inf ection. If acute inf ection is suspected, direct testing f or SARS-CoV-2 is necessary.False positiv e results f or the WANTAI SARS-CoV-2 Ab Rapid Test may occur due to cross-reactiv ity from pre-existing antibodies or other possible causes. Due to the risk of f alse positiv e results, conf irmation of positive results should be considered using a second, different serology assay.The WAN TAI SARS-Co V-2 Ab Ra pid Test is only for use under the Food and Drug Administration's Emergency Use Authorization.

IntroductionDespite the potential for community-based approaches to increase access to pre-exposure prophylaxis (PrEP) for adolescent girls and young women (AGYW), there is limited evidence of whether and how they improve PrEP persistence. We compared PrEP persistence among AGYW receiving services through community and hybrid models in Namibia to facility-based services. We subsequently identify potential mechanisms to explain how and why community and hybrid models achieved (or not) improved persistence to inform further service delivery innovation.MethodsData were collected from PrEP service delivery to AGYW over two-years in Namibia's Khomas Region. We used Kaplan-Meier analysis to estimate survival curves for PrEP persistence beyond three-months after initiation and report the cumulative probability of persistence at one- and three-months. Persistence was defined as any PrEP use within three months after initiation followed by a PrEP refill or previously prescribed supply of at least 30 days at the three-month visit. Interviews were conducted with 28 AGYW and 19 providers and analyzed using a deductive-inductive thematic approach.ResultsFrom October 2017 through September 2019, 372 (18.7%) AGYW received services through a facility model, 302 (15.1%) through a community model, and 1,320 (66.2%) through a hybrid model. PrEP persistence at one- and three-months was 41.2% and 34.9% in the community model and 6.2% and 4.8% in the hybrid model compared to 36.8% and 26.7% in the facility model. Within the community and hybrid models, we identified three potential mechanisms related to PrEP persistence. Individualized service delivery offered convenience and simplicity which enabled AGYW to overcome barriers to obtaining refills but did not work as well for highly mobile AGYW. Consistent interactions and shared experiences fostered social connectedness with providers and with peers, building social networks and support systems for PrEP use. PrEP and HIV-related stigma, however, was widely experienced outside of these networks. Community-to-facility referral for PrEP refill triggered apprehension towards unfamiliar PrEP services and providers in AGYW, which discouraged persistence.ConclusionService delivery approaches that offer convenience and simplicity and foster social connectedness may reduce access barriers and increase social support enabling AGYW to self-manage their PrEP use and achieve improved PrEP persistence.

Background Successful conduct of HIV vaccine efficacy trials entails identification and enrollment of at-risk populations, assessment of appropriate endpoints as measures of vaccine efficacy for prevention of HIV acquisition and amelioration of disease course among infected vaccinees, as well as identification of potential confounders or effect modifiers. While not invariably useful and bringing their own cost in terms of measurement and validation, a variety of biomarkers may aid at each stage of trial conduct. Methods A review of selected articles, chosen based on quality, relevance of the biomarker to HIV vaccine trials, and availability of the publication, was conducted. The authors also drew experience from current trials and other planned or ongoing trials. Conclusions Biomarkers are available to assess HIV incidence in potential study populations but care is needed in interpreting results of these assays. During trial conduct, STIs such as HSV-2 may act as effect modifiers on primary and secondary endpoints, including HIV incidence and set point viral load. The utility of STI biomarkers will likely depend heavily on local epidemiology at clinical trial sites. Analyses from recent large HIV vaccine efficacy trials point to the complexities in interpreting trial results and underscore the potential utility of biomarkers in evaluating confounding and effect modification.

The Nurses and Midwives Council of Malawi (NMCM) has engaged in significant efforts to reform nursing and midwifery pre-service education in Malawi. To that end NMCM decided to revise and strengthen existing syllabi and curricula for nurse midwifery cadres, starting with the nurse midwife technician (NMT). In an attempt to make evidence-based decisions for syllabus revision, NMCM conducted a task analysis to assess how prepared NMTs were to perform tasks in their daily jobs. NMCM used the activity to identify curricular gaps and key NMT tasks. In the task analysis, quantitative and qualitative methods identified NMTs' perceptions of tasks required for daily practice, competency to perform such tasks, factors influencing quality of care, and pre-service programmatic gaps. NMCM collected data from 48 NMTs randomly selected from a weighted sample of NMTs from all districts in the country. The most frequently performed tasks (≥ 50%) were found to be in infectious diseases and midwifery. NMTs felt inadequately prepared to handle human immunodeficiency virus (HIV) cases, obstetric complications, and certain family planning methods. Findings also identified gaps in clinical training and faculty supervision of students. The task analysis provided a robust approach to curriculum revision through identifying key content gaps. Other countries might consider adopting this approach to improving the content and relevancy of nursing and midwifery syllabi and curricula.