BMJ Global Health最新文献

{"title":"Factors associated with successful implementation of Clean Cut: a perioperative surgical site infection prevention quality improvement programme-a cohort study of low-resource hospitals.","authors":"Maia R Nofal, Natnael Gebeyehu, Nichole Starr, Assefa Tesfaye, Sedera Arimino, Sara Taye Haile, Tihitena Negussie Mammo, Thomas G Weiser","doi":"10.1136/bmjgh-2024-018049","DOIUrl":"10.1136/bmjgh-2024-018049","url":null,"abstract":"<p><strong>Introduction: </strong>\"Clean Cut\" is an adaptive, multimodal surgical quality improvement (QI) programme that has been associated with significant reductions in surgical site infections. Following implementation in multiple hospitals and countries, we noted variability in impact. We aimed to understand the attributes of hospitals that contribute to the success of a perioperative QI programme in resource-limited settings. We hypothesised that factors related to hospital context before implementation influenced programme success.</p><p><strong>Methods: </strong>Hospital context assessments were undertaken in 18 hospitals in low-income countries prior to the implementation of Clean Cut, which focuses on improving perioperative infection prevention and control (IPC) standards. We assessed staffing, training, infrastructure and prior QI experience. Hospitals also self-assessed compliance with six standards embedded in the IPC programme and compared reported compliance to the baseline compliance observed by trained data collectors. We defined high-improvement hospitals as those who improved three or more of the six standards by either doubling compliance while also achieving a minimum final compliance>50% or reaching a final compliance>90%. We compared context assessments of high- and low-improvement hospitals.</p><p><strong>Results: </strong>Infrastructure, trainings and QI experience were not associated with larger improvements. However, high-improvement hospitals had fewer operating room staff (p=0.046) and overestimated their baseline compliance with IPC standards (p=0.032).</p><p><strong>Conclusion: </strong>Clean Cut implementation was more successful with smaller staff numbers, reflecting challenges with engaging large numbers of stakeholders. High-improvement hospitals overestimated baseline IPC practices, suggesting that this programme is most beneficial when it identifies gaps that hospitals were previously unaware of. Reassuringly, improvements were not dependent on specific resources, indicating that the approach can be implemented in many environments.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal anaemia and risk of neonatal and infant mortality in low- and middle-income countries: a secondary analysis of 45 national datasets.","authors":"Eleni Tsamantioti, Tobias Alfvén, Muhammad Zakir Hossin, Neda Razaz","doi":"10.1136/bmjgh-2023-014654","DOIUrl":"10.1136/bmjgh-2023-014654","url":null,"abstract":"<p><strong>Background: </strong>Anaemia in pregnancy has been recognised worldwide as a growing public health concern and an important cause of adverse neonatal outcomes. However, only a limited number of studies have been done in low-income settings, which have the highest prevalence of anaemia. We aimed to investigate the association between maternal anaemia and neonatal and infant mortality in low- and middle-income countries.</p><p><strong>Methods: </strong>Secondary analysis of pooled data from 45 national demographic and health surveys (2010-2020). We included all women between 15 and 49 years old, who had singleton live birth within 1 year preceding the survey, with a valid maternal measurement of haemoglobin. We used logistic regression models to estimate the crude and adjusted OR (aOR) with 95% CIs of the association between maternal anaemia (measured at the time of the survey) and the risk of neonatal and infant mortality.</p><p><strong>Results: </strong>Among 106 143 women included in our analysis, there were 53 348 (50.5%) women with no anaemia, 24 670 (23.2%) with mild anaemia, 25 937 (24.3%) with moderate anaemia and 2188 (2.0%) with severe anaemia. Overall, there were 2668 (2.5%) neonatal and 3756 (3.5%) infant deaths. Moderate (aOR 1.20; 95% CI 1.06 to 1.35) and severe (aOR 1.89; 95% CI 1.46 to 2.44) maternal anaemia were associated with increased odds of neonatal mortality, respectively. Similar estimates were observed for moderate and severe anaemia and infant mortality. No increased risk was noted for mild anaemia.</p><p><strong>Interpretation: </strong>Moderate and severe maternal anaemia in low- and middle-income settings are associated with increased risks of neonatal and infant mortality. Future research should examine how targeted interventions for prepregnancy and antenatal treatment of anaemia in reproductive-age women can enhance maternal and child health in low- and middle-income settings.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a virtual asylum medicine curriculum: applying a medical education model to a global health priority.","authors":"Triveni DeFries, Eleanor Emery, C Nicholas Cuneo, Emily Mei, Emilie Folsom, Ranit Mishori, Katherine McKenzie","doi":"10.1136/bmjgh-2024-016646","DOIUrl":"10.1136/bmjgh-2024-016646","url":null,"abstract":"<p><p>Each year, millions of people fleeing persecution seek asylum in the USA and elsewhere. Many have experienced psychological and/or physical trauma that can be documented with objective forensic medical and mental evaluations (FMEs) performed by trained clinicians. FMEs can assist adjudicators in deciding claims, and asylum seekers who undergo an FME are significantly more likely to be granted asylum. However, there is a shortage of clinicians trained to perform FMEs, and existing training models have shortcomings, including lack of accessibility and consensus-driven best practices. To meet the rising need for FMEs and improve training in the burgeoning field of asylum medicine, we used Kern's model to design an interdisciplinary, consensus-driven, virtual curriculum that prepares clinicians to conduct FMEs. The curriculum development process involved a diverse group of 80 contributors from over 40 US organisations and academic centres. We used a staged needs assessment to identify critical issues in the existing training paradigm. Through an iterative process, we then developed an introductory curriculum consisting of eleven modules paired with assessments. Contributors reported high rates of satisfaction with the curriculum development process. To our knowledge, this is the first consensus-based training in asylum medicine that is national in scope, and it has since been adopted by Physicians for Human Rights as the standard for FME training. The process employed here offers a model for developing and improving training relevant to other global health priorities internationally.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic review of the barriers and facilitators to the implementation of non-pneumatic antishock garments in low- and middle-income countries: lessons for global health.","authors":"Qin Xiang Ng, Clyve Yu Leon Yaow, Hiang Khoon Tan, Marcus Eng Hock Ong, Heta Kosonen, Jonas Karlström","doi":"10.1136/bmjgh-2024-017681","DOIUrl":"10.1136/bmjgh-2024-017681","url":null,"abstract":"<p><strong>Background: </strong>Obstetric haemorrhage is a leading global cause of maternal mortality, particularly in rural and resource-poor settings where delays in care are common. Non-pneumatic antishock garments (NASGs) have been proposed as a temporising measure to reduce blood loss and improve survival rates. Despite positive outcomes from clinical trials, the uptake of the NASG has been slow and faced various implementation challenges. This review thus aims to identify and analyse the barriers and facilitators of NASG implementation in low- and middle-income countries (LMICs) using the Consolidated Framework for Implementation Research (CFIR).</p><p><strong>Methods: </strong>Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive search strategy was developed to search for studies related to NASG use in Medline, Embase, CINAHL and the Cochrane Library from inception up to August 2024. Grey literature was also reviewed. Two independent reviewers screened identified records using Covidence, assessing relevant studies for inclusion. Data were synthesised using a narrative approach structured around the CFIR's five domains.</p><p><strong>Results: </strong>A total of 17 studies were reviewed. Common barriers included high initial procurement costs. Inadequate training and knowledge among healthcare providers were another obstacle, resulting in low confidence in the proper use of NASG. Logistical issues, such as inconsistent supply chains and difficulties in maintaining NASG devices, were highlighted, alongside the challenges posed by under-resourced health infrastructures. Facilitators included effective training programmes, support from health authorities, advocacy by local and national champions, and successful integration into clinical protocols and health systems.</p><p><strong>Conclusions: </strong>The implementation experience of NASG in LMICs highlights important lessons for stakeholders in the global health space, with challenges such as high initial costs and inadequate training being common obstacles in LMICs. Addressing these barriers and leveraging facilitators (eg, through comprehensive training, garnering local and international support and active sourcing for locally produced materials to reduce costs) across multilevel contexts influence implementation.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early warning and response systems for respiratory disease outbreaks: lessons learnt from cluster-associated cases of acute respiratory illnesses in Gilgil subcounty, Nakuru County, Kenya, 2021.","authors":"Philip Ngere, Radhika Gharpure, Stella Mamuti, Peninah Munyua, M Kariuki Njenga, Lyndah Makayotto, Linus Ndegwa, Erenius Lochede Nakadio, Rosalia Kalani, Ahmed Abade, Elizabeth Kiptoo, Jacob Rotich, Emily Cheruiyot, Gideon O Emukule, Eric Osoro, Shirley Lidechi, Amy Herman-Roloff, Arunmozhi Arunmozhi Balajee","doi":"10.1136/bmjgh-2024-016418","DOIUrl":"10.1136/bmjgh-2024-016418","url":null,"abstract":"<p><p>Investigating acute respiratory illnesses (ARIs) is difficult due to non-specific symptoms, varied health-seeking behaviors, and resource limitations; yet early detection is critical to global health security. Kenya's Ministry of Health (MOH) uses the Integrated Disease Surveillance strategy for public health surveillance, incorporating event-based surveillance (EBS) and indicator-based surveillance (IBS) for early warning system. MOH, supported by the US-CDC, established Influenza Sentinel Surveillance (ISS) in 2006 and later launched community EBS (CEBS) and health facility EBS (HEBS) pilots to enhance surveillance for COVID-19. On March 2, 2021, the CEBS system detected a signal of \"Two or more people presenting with similar signs and symptoms in a community within a week\" in a county. Investigations launched on March 4, 2021, investigations revealed unreported ARI cases which had been missed by both the ISS and IBS. A total of 176 ARI cases were line-listed with 91/176 (51.7%) aged <5-years and 46/176 (26.1%) hospitalized. RT-PCR tests confirmed 34/79 (43.0%) SARS-CoV-2 and 1/7 (14.3%) A/H3N2 cases. Of the CEBS, HEBS, IBS, and ISS systems deployed by the county to strengthen the early warning for respiratory diseases, CEBS detected a signal of unreported ARIs that facilitated further investigations and response.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A health systems approach to more effective decentralised HIV prevention: development of Malawi's Blantyre Prevention Strategy.","authors":"Gift Kawalazira, Yohane Kamgwira, Sara M Allinder, Chimwemwe Mablekisi, Rose Nyirenda, Deborah Hoege, Alinafe Mbewe, Suzike Likumbo, Tyler Smith, Grace Kumwenda, Betha O Igbinosun, Charles B Holmes","doi":"10.1136/bmjgh-2024-016880","DOIUrl":"10.1136/bmjgh-2024-016880","url":null,"abstract":"<p><p>Achieving global targets to end the HIV/AIDS epidemic as a public health threat by 2030 and beyond requires enhanced health system capacity for HIV prevention at national and subnational levels. Specifically, this system's capacity must enable countries to reach high-risk populations effectively, systematically engage communities to generate demand for HIV prevention services, build diverse delivery channels to meet this demand and address structural barriers that undermine prevention programmes. Integrating these capacities at the local level is especially critical to creating sustainable uptake and impact of emerging highly efficacious prevention options, such as long-acting injectable pre-exposure prophylaxis. Decentralised, locally led approaches that reflect the local context-yet are linked to national systems and policies-are needed to embed these capacities and strengthen the ability of local governments to coordinate and implement HIV prevention. Within this framework, the Government of Malawi is developing a district-based approach to enhance local institutional capacity for more effective and sustainable HIV prevention, starting in Blantyre-a large urban district noted for its high HIV incidence. This article provides the conceptual basis for, and early implementation experience of, the Blantyre Prevention Strategy (BPS), a health systems-based approach to HIV prevention that directs investments towards embedding essential functions within Blantyre City and District. The approach includes developing district-led systems and capabilities in effective disease surveillance and data-driven targeting, demand generation, quality service delivery and promoting the sustained use of HIV prevention interventions. Early learnings from BPS offer lessons for other low- and middle-income countries seeking to implement HIV prevention strategies that bolster their health system capacity and integrate with broader health responses.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A right to health denied: access to oral healthcare during the war on the Gaza Strip.","authors":"Hossam Almadhoon, Nada Flaifl, Rawand Samy Abu Nahla, Susan Abunijela, David Mills","doi":"10.1136/bmjgh-2024-017408","DOIUrl":"10.1136/bmjgh-2024-017408","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143499119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The persistence of failure in water, sanitation and hygiene programming: a qualitative study.","authors":"Dani J Barrington, Rebecca C Sindall, Annatoria Chinyama, Tracy Morse, May N Sule, Joanne Beale, Tendai Kativhu, Sneha Krishnan, Kondwani Luwe, Rossanie Daudi Malolo, Onike Mcharo, Anthony C Odili, Kristin T Ravndal, Jo Rose, Esther Shaylor, Eleanor Wozei, Faida Chikwezga, Barbara E Evans","doi":"10.1136/bmjgh-2024-016354","DOIUrl":"10.1136/bmjgh-2024-016354","url":null,"abstract":"<p><strong>Introduction: </strong>Unsafe water, sanitation and hygiene (WASH) causes millions of deaths and disability-adjusted life-years annually. Despite global progress towards universal WASH, much of WASH programming continues to fail to improve health outcomes or be sustainable in the longer term, consistently falling short of internal performance indicators and sometimes negatively impacting the well-being of local stakeholders. Although sector experts in high-income countries have often provided explanations for such failures, the opinions of those implementing WASH programming at the ground level are rarely published.</p><p><strong>Methods: </strong>In 2020, we purposively recruited 108 front-line WASH professionals in Malawi, South Africa, Tanzania and Zimbabwe to participate in 96 in-depth interviews, explaining why they believe WASH failure persists. Through participatory analysis, including framework analysis with additional axial coding and member-checking of our findings, we determined the core reasons for WASH failure as perceived by participants.</p><p><strong>Results: </strong>Interviewees reported poor engagement and commitment of intended users, unrealistic and idealistic expectations held by funders and implementers, and a general lack of workforce and financial capacity as significant contributors to WASH failure. Our analysis shows that these issues stem from WASH programming being implemented as time and budget-constrained projects. This projectisation has led to reduced accountability of funders and implementers to intended users and a focus on measuring inputs and outputs rather than outcomes and impacts. It has also placed high expectations on intended users to sustain WASH services and behaviour change after projects officially end.</p><p><strong>Conclusions: </strong>Our findings imply that WASH programming needs to move away from projectisation towards long-term investments with associated accountability to local governments and longitudinal measurements of WASH access, as well as realistic considerations of the needs, abilities and priorities of intended users. Funders need to reconsider the status quo and how adjusting their systems could support sustainable WASH services.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143499121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Legal residency status and its relationship with health indicators among Syrian refugees in Lebanon: a nested cross-sectional study.","authors":"Marie-Elizabeth Ragi, Hala Ghattas, Berthe Abi Zeid, Hazar Shamas, Noura Joseph El Salibi, Sawsan Abdulrahim, Jocelyn DeJong, Stephen J McCall, The Caep Study Group","doi":"10.1136/bmjgh-2024-017767","DOIUrl":"10.1136/bmjgh-2024-017767","url":null,"abstract":"<p><strong>Background: </strong>Failure to possess or renew legal residency permits increases the burden on a vulnerable refugee population. It risks detention or deportation, and hinders access to basic services including healthcare. This study aimed to examine the association between legal residency status and health of Syrian refugees living in Lebanon.</p><p><strong>Methods: </strong>Data were from two independent nested cross-sectional studies collected in 2022 through telephone surveys. In the first study, all Syrian refugees aged 50 years or older from households that received humanitarian assistance were invited to participate. The second included all adult Syrian refugees residing in a suburb of Beirut. The exposure was self-reported possession of a legal residency permit in Lebanon. The self-reported health outcomes were mental health status, COVID-19 vaccine uptake, and access to needed healthcare services. Separate logistic regression models examined the association between lacking a legal residency permit and each health outcome, adjusted for age, length of stay in Lebanon, education, employment, wealth index and receipt of assistance.</p><p><strong>Results: </strong>The first sample included 3357 participants (median age 58 years (IQR: 54-64), 47% female), of whom 85% reported lacking a legal residency permit. The second sample included 730 participants (median age 34 years (IQR: 26-42), 49% female), of whom 79% lacked a legal residency permit. In both studies, lacking a legal residency permit increased the odds of having poor mental health (adjusted odds ratio (aOR): 1.46 (95% CI: 1.07 to 1.99); aOR: 1.62 (95% CI: 1.01 to 2.60)) and decreased the odds of COVID-19 vaccine uptake (aOR: 0.66 (95% CI: 0.54 to 0.80); aOR: 0.51 (95% CI: 0.32 to 0.81)). In the subsample who needed primary healthcare, lacking a legal residency permit decreased the odds of access to primary healthcare, which was statistically significant in the second study (aOR: 0.37 (95% CI: 0.17 to 0.84)).</p><p><strong>Conclusions: </strong>The majority of Syrian refugees from these two samples reported lacking a legal residency permit in Lebanon. This was associated with poor mental health and lower uptake of COVID-19 vaccination, potentially originating from fear of detention or deportation. These findings call for urgent action to support access to legal documentation for refugees in Lebanon.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differentiated community-based point-of-care early infant diagnosis to improve HIV diagnosis and ART initiation among infants and young children in Zambia: a quasi-experimental cohort study.","authors":"Albert Manasyan, Tannia Tembo, Helen Dale, Jake M Pry, Megumi Itoh, Dhelia Williamson, Herbert Kapesa, Josip Derado, Rachel Suzanne Beard, Shilpa Iyer, Salome Gass, Annie Mwila, Michael E Herce","doi":"10.1136/bmjgh-2024-015759","DOIUrl":"10.1136/bmjgh-2024-015759","url":null,"abstract":"<p><strong>Introduction: </strong>An estimated 800 000 children (<15 years) globally living with HIV remain undiagnosed. To reach these children with timely HIV testing services during infancy, we implemented a community-based differentiated care model using mobile point-of-care (POC) technology for early infant diagnosis (EID) of HIV, and assessed its effects on EID positivity, antiretroviral therapy (ART) initiation and 3-month retention in care.</p><p><strong>Methods: </strong>Between 1 June 2019 and 31 May 2020 at six health facilities in Lusaka, Zambia, we enrolled mother-infant pairs (MIPs) at high risk for vertical transmission of HIV based on missing or late infant EID testing or other maternal risk factors. We offered these MIPs community POC EID testing (post-intervention), and compared their outcomes to historical high-risk controls at the same sites (1 June 2017-31 May 2018; pre-intervention). We used propensity score matched weighting and mixed effects regression modelling to estimate outcome differences pre-intervention and post-intervention, and to identify MIP characteristics predictive of vertical transmission of HIV.</p><p><strong>Results: </strong>2577 MIPs were included in the analysis: 1763 and 814 high-risk MIPs from the pre-intervention and post-intervention periods, respectively. Infant HIV positivity was significantly higher in the post-intervention (2.2%) vs pre-intervention (1.1%) period (p=0.038), however this difference was attenuated (0.83%, 95% CI: -0.50%, 2.15%) after adjusting for differences in maternal age, maternal antenatal care visits, infant birth month and facility. During the post-intervention period, MIPs where the mother disengaged from care were 12.97 (95% CI: 2.41, 69.98) times as likely to have an infant diagnosed with HIV vs those in which the infant received late EID testing without maternal care disengagement. Among 18 infants diagnosed with HIV by the intervention, 16 (88.9%) initiated same-day ART and all continued ART at 3-month follow-up.</p><p><strong>Conclusion: </strong>Community-based differentiated care employing POC EID technology increased testing positivity in unadjusted analyses, and resulted in high ART initiation and early care retention, suggesting it may be a promising approach for reaching infants and young children living with HIV being missed by current facility-based approaches.</p><p><strong>Trial registration number: </strong>This trial is registered under the following Clinicaltrials.gov Identifier: NCT03133728.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}