{"title":"Publisher Correction: China's universal medical insurance scheme: progress and perspectives.","authors":"Jiajia Zhang, Dahai Zhao, Xiyan Zhang","doi":"10.1186/s44263-024-00099-6","DOIUrl":"10.1186/s44263-024-00099-6","url":null,"abstract":"","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"2 1","pages":"65"},"PeriodicalIF":0.0,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11622874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Helene-Mari van der Westhuizen, Rodney Ehrlich, Ncumisa Somdyala, Trisha Greenhalgh, Sarah Tonkin-Crine, Chris C Butler
{"title":"Stigma relating to tuberculosis infection prevention and control implementation in rural health facilities in South Africa - a qualitative study outlining opportunities for mitigation.","authors":"Helene-Mari van der Westhuizen, Rodney Ehrlich, Ncumisa Somdyala, Trisha Greenhalgh, Sarah Tonkin-Crine, Chris C Butler","doi":"10.1186/s44263-024-00097-8","DOIUrl":"10.1186/s44263-024-00097-8","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis (TB) is a stigmatised disease with intersectional associations with poverty, HIV, transmission risk and mortality. The use of visible TB infection prevention and control (IPC) measures, such as masks or isolation, can contribute to stigma.</p><p><strong>Methods: </strong>To explore stigma in this condition, we conducted in-depth individual interviews with 18 health workers and 15 patients in the rural Eastern Cape of South Africa using a semi-structured interview guide and narrative approach. We used reflexive thematic analysis guided by line-by-line coding. We then interpreted these key findings using Link and Phelan's theoretical model of stigma, related this to stigma mitigation recommendations from participants and identified levels of intervention with the Health Stigma and Discrimination Framework.</p><p><strong>Results: </strong>Participants shared narratives of how TB IPC measures can contribute to stigma, with some describing feeling 'less than human'. We found TB IPC measures sometimes exacerbated stigma, for example through introducing physical isolation that became prolonged or through a mask marking the person out as being ill with TB. In this context, stigma emerged from the narrow definition of what mask-wearing symbolises, in contrast with broader uses of masks as a preventative measure. Patient and health workers had contrasting perspectives on the implications of TB IPC-related stigma, with patients focussing on communal benefit, while health workers focussed on the negative impact on the health worker-patient relationship. Participant recommendations to mitigate TB IPC-related stigma included comprehensive information on TB IPC measures, respectful communication between health workers and patients, shifting the focus of TB IPC messages to communal safety (which could draw on ubuntu, a humanist framework) and using universal IPC precautions instead of measures targeted at someone with infectious TB.</p><p><strong>Conclusions: </strong>Health facilities may unwittingly perpetuate stigma through TB IPC implementation, but they also have the potential to reduce it. Evoking 'ubuntu' as an African humanist conceptual framework could provide a novel perspective to guide future TB IPC stigma mitigation interventions, including policy changes to universal IPC precautions.</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"2 1","pages":"66"},"PeriodicalIF":0.0,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11622938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emmeline Taylor, Caroline Gray, Matthew Stimmel, Ingrid A Binswanger, Erica Morse, Christine Timko, Alex H S Harris, David Smelson, Andrea K Finlay
{"title":"Influences of the criminal justice system on use of medications for opioid use disorder: a qualitative study.","authors":"Emmeline Taylor, Caroline Gray, Matthew Stimmel, Ingrid A Binswanger, Erica Morse, Christine Timko, Alex H S Harris, David Smelson, Andrea K Finlay","doi":"10.1186/s44263-024-00093-y","DOIUrl":"10.1186/s44263-024-00093-y","url":null,"abstract":"<p><strong>Background: </strong>Legal-involved veterans with opioid use disorder (OUD) have lower receipt of medications for opioid use disorder (MOUD) than other veterans served at the Veterans Health Administration (VHA). This qualitative study examined the influence of the criminal justice system on access to MOUD for legal-involved veterans in the U.S.</p><p><strong>Methods: </strong>VHA facilities (n = 14) that varied in their provision of MOUD to legal-involved veterans were selected for qualitative interviews. Interviewees included legal-involved veterans (n = 18), VHA Veterans Justice Programs Specialists (n = 15), substance use disorder treatment providers (n = 5), and criminal justice staff (n = 12). Team members applied codes to meaningful units of analysis (quotations) in the transcribed interviews. Using a matrix approach, team members created a spreadsheet matrix with codes, facility rate of MOUD, and relevant quotations summarized for each participant. Themes and connections between individual participants and cross-interview concepts were explored. Participants were not asked to provide feedback on the findings.</p><p><strong>Results: </strong>Themes identified were as follows: (1) Veterans Treatment Court policies both enhanced and limited MOUD treatment access and utilization among participants; (2) cross-system collaboration strengths and challenges existed; and (3) criminal justice system treatment preferences and policies both enhanced and limited MOUD in jails and prisons.</p><p><strong>Conclusions: </strong>The influence of the criminal justice system on MOUD has led to variable access to MOUD for legal-involved veterans. Our findings can help inform recommendations to enhance access to MOUD for veterans within the criminal justice system, including the development of a national database of MOUD education materials for Veterans Treatment Courts, strengthening community-court relationships, allowing individuals to use their own healthcare coverage within jails and prisons and extend Medicaid coverage into criminal justice settings, and applying national quality measures for MOUD to criminal justice settings and develop a national system for tracking these quality measures.</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"2 1","pages":"64"},"PeriodicalIF":0.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11622969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jacques Eugene Raubenheimer, Pieter Hermanus Myburgh, Akshaya Srikanth Bhagavathula
{"title":"Sweetening the deal: an infodemiological study of worldwide interest in semaglutide using Google Trends extended for health application programming interface.","authors":"Jacques Eugene Raubenheimer, Pieter Hermanus Myburgh, Akshaya Srikanth Bhagavathula","doi":"10.1186/s44263-024-00095-w","DOIUrl":"10.1186/s44263-024-00095-w","url":null,"abstract":"<p><strong>Background: </strong>Off-label use of semaglutide for non-diabetic weight loss (which regulators have linked to social media promotion) created worldwide supply shortages. We evaluated worldwide semaglutide interest measured by online search behavior to gauge social media and conventional print media reporting's effect on search interest.</p><p><strong>Methods: </strong>Using Google Trends Extended for Health (GTEH) multiple sampling, we retrieved regional online interest (ROI) for all countries and extracted timelines and top search queries for January 2021-August 2023 for countries with median ROI ≥ 20 using the \"semaglutide\" topic. We obtained semaglutide media reporting from the ProQuest database. We estimated the effect of media and within-country semaglutide interest on between-country interest with Granger causality analysis. We determined changepoints for trends within each country with joinpoint regression. We determined prominent themes in search queries for each country with natural language processing thematic analysis.</p><p><strong>Results: </strong>Twenty-seven countries were included. Most countries showed an increase in semaglutide interest over time, with Canada and the USA showing the largest sustained interest. Most of the search interest arose from 2022 onwards. Granger's analysis showed that media coverage could only partially explain interest, and interest in some countries partially preceded interest in others, with the UK and Germany showing strong relationships between news reports and lagged search interest. Joinpoint analysis identified up to four significant within-country changepoints. Most countries showed significant positive weekly trends in 2021-2022, although uptrends in search interest varied considerably between countries. One episode of the Dr. Oz show (TV media event) coincided with strong peaks in numerous countries. Natural language processing of top search queries showed some agreement between countries and country-specific themes. Weight loss was a major theme in most countries, while a diabetes theme was generally absent or weak. Some countries (Australia, Chile, South Africa, UK) had themes for buying Ozempic from (named) local retailers, and Germany had a theme related to buying Ozempic without a script.</p><p><strong>Conclusions: </strong>GTEH data provided insights into global search interest in semaglutide and regional variation. Studies focusing on specific countries which include social media data can elucidate specific drivers behind the surge in off-label use of semaglutide.</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"2 1","pages":"63"},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11622965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"China's universal medical insurance scheme: progress and perspectives.","authors":"Jiajia Zhang, Dahai Zhao, Xiyan Zhang","doi":"10.1186/s44263-024-00096-9","DOIUrl":"10.1186/s44263-024-00096-9","url":null,"abstract":"<p><p>China has built a universal medical insurance which covers 95% of the total population, up from approximately 10% two decades ago. However, this medical insurance neglects public health, reducing the health system's cost-effectiveness. Additionally, an affordable range of medical insurance payments by local governments and residents needs to be considered.</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"2 1","pages":"62"},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11622866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elizabeth Nkabane-Nkholongo, Mathildah Mpata Mokgatle, Timothy Bickmore, Clevanne Julce, David Thompson, Brian W Jack
{"title":"Change in sexual and reproductive health knowledge among young women using the conversational agent \"Nthabi\" in Lesotho: a clinical trial.","authors":"Elizabeth Nkabane-Nkholongo, Mathildah Mpata Mokgatle, Timothy Bickmore, Clevanne Julce, David Thompson, Brian W Jack","doi":"10.1186/s44263-024-00091-0","DOIUrl":"10.1186/s44263-024-00091-0","url":null,"abstract":"<p><strong>Background: </strong>Young women worldwide face problems like unwanted pregnancy and sexually transmitted infections. Providing sexual and reproductive health education to young women in low- and middle-income countries is a priority. It is unknown if using digital health interventions to deliver health education is effective in resource-constrained settings.</p><p><strong>Methods: </strong>We conducted an interventional trial among young women in the low-middle-income country of Lesotho to test the impact of the conversational agent system (\"Nthabi\") designed to deliver sexual and reproductive health information on either a smartphone or tablet for up to 6 weeks. We measured participant's knowledge before and after the discussion of family planning, folic acid use, and healthy eating. The main outcome measure was a change in knowledge among participants in these three topic areas. The number of correct pre- and post-test responses was compared using generalized linear models that directly estimated the proportions and percentages of correct responses.</p><p><strong>Results: </strong>We recruited 172 young women (mean age 22.5 years, 91% unmarried, 69% completed high school, 23% unemployed, 66% students) to use Nthabi on a mobile phone (11.6%) or loaned tablet device (88.4%). The mean number of interactions with Nthabi was 8.6. Family planning was chosen to be discussed by 82 of the 172 participants (52.2%), and of those, 49 (31.2%) completed the content on this topic, and 26 (16.6) completed the post-test. For the 11 questions about family planning, the total percent of correct responses increased from 85.5% (796 total responses) on the pre-test to 89.9% (320 responses) on the post-test (p = 0.0233). Folic acid use was chosen to be discussed by 74 (47.1%) of 172 participants, and of those, 27 (17.7%) completed the content on this topic, and all 27 (17.7%) completed the post-test. For the 5 questions about folic acid use, the total percent of correct responses was 45.3% (181 total responses) on the pre-test and 71.6% (111 responses) on the post-test (p < 0.0001).</p><p><strong>Conclusions: </strong>The Nthabi conversational agent system increased knowledge of family planning methods and folic acid use among young women in Lesotho. Digital health interventions like Nthabi have the potential to offer new ways to deliver reproductive health information.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov registration April 20, 2020; ID: NCT04354168 .</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"2 1","pages":"60"},"PeriodicalIF":0.0,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11622940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Mind the Gap: scaling-up access to culturally adapted mental health treatments for minority populations.","authors":"Olof Molander, Josefin Särnholm, Anna-Clara Hollander, Nitya Jayaram-Lindström","doi":"10.1186/s44263-024-00092-z","DOIUrl":"10.1186/s44263-024-00092-z","url":null,"abstract":"","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"2 1","pages":"61"},"PeriodicalIF":0.0,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11622950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fernando Pascual, Carmen Au, Chido Dziva Chikwari, Pierre Daram, Carolyn Deal, Angelica Espinosa Miranda, Yonatan H Grad, Edward Wiii Hook, Rossaphorn Kittiyaowamarn, Alison Luckey, Nicola Low, Venessa Maseko, Remco P H Peters, Teri Roberts, Magnus Unemo, Subasree Srinivasan
{"title":"Recommendations for the optimal introduction of novel antibiotics to treat uncomplicated gonorrhoea in the face of increasing antimicrobial resistance: a case study with zoliflodacin.","authors":"Fernando Pascual, Carmen Au, Chido Dziva Chikwari, Pierre Daram, Carolyn Deal, Angelica Espinosa Miranda, Yonatan H Grad, Edward Wiii Hook, Rossaphorn Kittiyaowamarn, Alison Luckey, Nicola Low, Venessa Maseko, Remco P H Peters, Teri Roberts, Magnus Unemo, Subasree Srinivasan","doi":"10.1186/s44263-024-00087-w","DOIUrl":"10.1186/s44263-024-00087-w","url":null,"abstract":"<p><p>New, first-in-class oral antibiotics like zoliflodacin, developed in a public-private partnership, require an optimal introduction strategy while ensuring antibiotic stewardship. Zoliflodacin, given as a single dose for uncomplicated urogenital gonorrhoea, recently demonstrated non-inferiority to ceftriaxone plus azithromycin and safety in a phase 3 randomised controlled trial. Following regulatory approval, zoliflodacin could improve sexually transmitted infection (STI) management and help address the threat of untreatable gonorrhoea, as levels of resistance to current first-line treatments increase. The Global Antibiotic Research & Development Partnership (GARDP) convened an expert meeting during the 2023 STI and HIV World Congress to discuss key questions about the introduction of zoliflodacin in low- and middle-income countries (LMICs). The questions included: which patients to treat in which situations, the timing of introduction, and what additional evidence is needed to change policy for the use of new antibiotics for gonorrhoea. Recommendations from the expert group included: the generation of evidence for the role of a drug like zoliflodacin in clinical treatment failures; the need for additional antimicrobial resistance surveillance; investigation of the role of novel diagnostic approaches, such as point-of-care tests, to improve stewardship; study of preferences and values among the population in need; and modelling of the emergence of N. gonorrhoeae resistance and transmission in different scenarios. Forthcoming World Health Organization (WHO) global guidelines could outline recommendations for a new oral antibiotic like zoliflodacin based on existing evidence, and rational approaches for certain populations or use cases, while the evidence base is further strengthened.</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"2 1","pages":"58"},"PeriodicalIF":0.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11622883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aurelie Nelson, Kalisha Bheemraj, Sarah Schoetz Dean, Alex de Voux, Lerato Hlatshwayo, Rufaro Mvududu, Natacha Berkowitz, Caroline Neumuller, Shahida Jacobs, Stephanie Fourie, Thomas Coates, Linda Gail-Bekker, Landon Myer, Dvora Joseph Davey
{"title":"Integration of HIV pre-exposure prophylaxis (PrEP) services for pregnant and breastfeeding women in eight primary care clinics: results of an implementation science study.","authors":"Aurelie Nelson, Kalisha Bheemraj, Sarah Schoetz Dean, Alex de Voux, Lerato Hlatshwayo, Rufaro Mvududu, Natacha Berkowitz, Caroline Neumuller, Shahida Jacobs, Stephanie Fourie, Thomas Coates, Linda Gail-Bekker, Landon Myer, Dvora Joseph Davey","doi":"10.1186/s44263-024-00089-8","DOIUrl":"10.1186/s44263-024-00089-8","url":null,"abstract":"<p><strong>Background: </strong>Although HIV vertical transmission has declined significantly in sub-Saharan Africa, incident HIV infection in pregnant and postpartum women is estimated to account for over one-third of HIV vertical transmission. Oral pre-exposure prophylaxis (PrEP) for pregnant and breastfeeding women (PBFW) is included in South African PrEP guidelines since 2021; however, integration of PrEP services within ante- and postnatal care remains limited.</p><p><strong>Methods: </strong>Between March 2022 and September 2023, we evaluated the integration of PrEP for PBFW in eight antenatal clinics in Cape Town, South Africa, following training and mentorship of providers. We applied an adapted Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to evaluate the integration of PrEP services for pregnant and breastfeeding women. Before the study, PrEP was not routinely offered. We implemented a staff didactic/practice-based training and mentorship on PrEP provision targeting PBFW. We evaluated the following: (1) Reach as the proportion of women initiating PrEP among women counselled and tested for HIV, (2) effectiveness as PrEP continuation up to 3 months by pregnant vs. breastfeeding women, (3) adoption of PrEP integration via pre- and post-training assessments and ongoing mentorship assessments, (4) implementation through clinic trends of PrEP offer over time, and (5) maintenance: continued PrEP offer 3 months following the intervention.</p><p><strong>Results: </strong>In 8 facilities providing ante- and postnatal care, we trained 224 healthcare providers (127 nurses and 37 counsellors). Of those, we mentored 60 nurses, midwives, and HIV counsellors working with pregnant and breastfeeding women, with 80% of nurse/midwives and 65% of counsellors scoring ≥ 80% on the final mentoring assessment. Overall, 12% of HIV-negative pregnant women started PrEP, and 41% of those continued PrEP up to 3 months. Among HIV-negative breastfeeding women, 14% initiated PrEP, and 25% continued PrEP up to 3 months. All eight facilities continued providing PrEP 3 months post intervention.</p><p><strong>Conclusions: </strong>In these high HIV prevalence clinics, the proportion of pregnant and breastfeeding women initiating and continuing PrEP rapidly increased but was limited among breastfeeding women. Staff training, mentorship, and PrEP integration were well-adopted by nurses and counsellors, and services continued following the intervention. Barriers included limited HIV testing of breastfeeding mothers and need for additional PrEP-trained nurses.</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"2 1","pages":"57"},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11622949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rebecca A Tenner, Emily D Grussing, David Manning, Yvane Ngassa, Jacob J van den Berg, Gabriela Andujar Vazquez, Shira Doron, Maureen Campion, Alysse G Wurcel
{"title":"\"It's easier to take a pill than fix a problem:\" qualitative analysis of barriers and facilitators to antimicrobial stewardship program implementation in carceral settings.","authors":"Rebecca A Tenner, Emily D Grussing, David Manning, Yvane Ngassa, Jacob J van den Berg, Gabriela Andujar Vazquez, Shira Doron, Maureen Campion, Alysse G Wurcel","doi":"10.1186/s44263-024-00090-1","DOIUrl":"10.1186/s44263-024-00090-1","url":null,"abstract":"<p><strong>Background: </strong>Widespread antibiotic prescribing contributes to globally emerging antimicrobial resistance (AMR). Despite stewardship recommendations by the Infectious Diseases Society of America, there is a lack of literature identifying barriers and facilitators to antimicrobial stewardship programs (ASPs) in United States (U.S.) carceral settings.</p><p><strong>Methods: </strong>Guided by the Theoretic Domains Framework, we performed in-depth interviews with 68 key stakeholders in Massachusetts carceral settings to contextualize barriers and facilitators to ASP implementation. We recruited 32 people incarcerated in Massachusetts jails and 36 carceral clinicians, correctional officers/administrators in Massachusetts and other U.S. states, and Massachusetts community clinicians for interviews.</p><p><strong>Results: </strong>From the completed semi-structured in-depth interviews, we identified seven salient themes-four barriers and three facilitators-both specific to and across stakeholder groups. Barriers included the following: (1) jail being viewed as a \"dirty place\" that increases the risk of infections; (2) variable awareness and knowledge of AMR and ASPs; (3) clinicians' opposition to change and oversight of their antibiotic prescribing; (4) competing priorities taking precedence over ASP implementation. Facilitators included (5) interest in changing the narrative about carceral healthcare through ASP implementation; (6) opportunities for education about ASP and AMR; and (7) the development of systems, policies, and regulations to improve antibiotic prescribing.</p><p><strong>Conclusions: </strong>To our knowledge, this is the first qualitative study to leverage broad criminal-legal stakeholder groups to inform the next steps in developing and implementing ASPs in carceral settings in the U.S.</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"2 1","pages":"59"},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11622897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}