As illustrated in Figure 2 (see below) at these workshops, the main problem we identified was that families had weak support, which led to poor HIV testing, linkage to care, and adherence to treatment. After clarifying the problem, we made efforts to understand its causes (the immediate and underlying influ- ences). Several causal pathways were identified, namely, strength and self-reliance being intrinsic to masculinity, entrenched gender inequalities, poverty and unemployment, hierarchical relationships between generations, absent fathers, men’s anxi- eties regarding exposing infidelity, poor communication skills between partners, poor intergenerational communication skills, and inability to discuss sex across generations (depicted on the left in Figure 2). This critical step of representing, diagrammati- cally, the causal pathways leading to the problem was essential to carefully consider how best to intervene to improve outcomes. These outcomes (depicted on the right in Figure 2) included delayed testing (especially among adolescents and men), poor linkage to care, poor adherence, and stigma. Without interven- tion, these causal and contextual factors ultimately contribute to lower CD4 counts, greater progression to AIDS, and worse treatment outcomes.
After adapting and producing the next version of the intervention and the accompanying materials, the next step involved program developers of Project Connect and the WCWHC reviewing the new CHC intervention and making further refinements. CCB members were also asked to comment on the hand- book that was developed for the CHC intervention, as well as practical issues related to implementing the intervention. Further minor refinements were made based on the feedback of these topical experts. Table 2 presents an overview of the final adapted interven- tion. The table explicates which interventions influ- enced the adaptation and which components were entirely new based on the earlier focus groups includ- ing using their voices, pictures of local shebeens and other issues that became apparent in the process (e. g., building on strengths of family, development of the couples handbook).
The MLRC program targeted Class 5 pupils (N=1846; 52.1% girls, 47.9% boys) in Catholic-sponsored public and private primary throughout Kenya. The Commission for Education and Religious Education within the Kenya Conference of Catholic Bishops (KCCB) administers approximately 30% of all educational institutions in Kenya. For specific age and gender demographic information on each module by assessment period (pre-test vs. post-test) (see Table 1). The number of pre-test and post-test measures that were completed by participants varied across both module and assessment period. This was primarily due to fluctuations in enrollment and attendance at the 46 different schools involved in the evaluation, although additional barriers to participation included competing family demands, safety concerns, environmental concerns, and health issues. In addition, since the measures were completed anonymously, there was no way to follow up with youth who missed an assessment. Of the 26 Catholic Dioceses (geographic districts under the supervision of a Bishop) that cover the country of Kenya, MLRC was implemented in schools located within 24 different Dioceses. All pupils in Class 5 of participating KCCB schools are offered the opportunity to participate in MLRC regardless of their faith affiliation.
healthy development into adulthood. While sex education in schools gives youth a glimpse into sexual health related topics, the sessions are often inadequate to achieve long lasting HIV prevention knowledge and the youth that are the most vulnerable to HIV are often not enrolled in such schools. Community based programs implemented by non- governmental organizations (NGO) are scant, but have promising results. Capoor and Mehta (1995) conducted a workshop to educate girls and boys ages 11-18 about sexual health at health fairs in Gujarat. They discussed emotional and physical changes that occur during adolescence, utilizing role-plays and case studies to convey their messages. The goal of the workshop was to explore adolescent’s existing sexual health knowledge and also educate and correct any misconceptions. While the researchers did not evaluate the outcomes of the workshop, they did find that that youth who participated in the workshop were willing to openly discuss sexual health related issues. In addition, they recommend small group discussions and suggest that group-based interventions are an effective method to broach sexual health related topics.
that could conceivably make a difference in body weight over time. However, despite parenting being a focus of our TP intervention, no signi ﬁ cant differences were observed in terms of parental feeding practices, ineffective parenting, household chaos, or child behavior. This may have occurred because the intervention offered to each family differed according to need such that managing parenting and child behavior was only a focus with some families. However, others 35 have suggested that general
A first limitation is that the dropout was quite high: 19% at the first post-test. However, Internet-based interventions often have a comparable high dropout. 7,8 In the current study no baseline differences were found between dropouts and completers, which indicates that no specific characteristics were related to dropout and that the results may be generalised. Second, only self-report measures were used, instead of other measures such as interviews which can be used for diagnostic purposes. However, a diagnosis of depression was not an inclusion criterion in the current study and interviews would have been time consuming. Third, it is possible that participants in the intervention group met participants in the control group and shared experiences. However, since participants lived throughout the country we expect that these chances were small. Fourth, waiting list control conditions may inflate the effects of interventions in studies and it is possible that this also occurred in the current study. Though, this study used an attention only waiting list control condition, which was more active than only waiting. This may have reduced the inflation. Fifth, the intervention was developed by the researchers. However, we did everything we could to avoid contact with participants after allocation to conditions. Independent replication of this study is
In keeping with earlier comments, almost all interviewees identified extra funding as the most important priority for the future. There was strong support for governments and other funders contributing more resources to support well-structured, long-term interventions. While all interviewees supported the need to pilot programs to ensure interventions are well designed and effective, most interviewees wanted to see a commitment from governments to support successful pilot programs across the State. Six interviewees also nominated additional funding for research and evaluation as vital. More generally, a number of interviewees stressed that governments needed to adopt a ‘whole of government’ approach to addressing drug and alcohol problems within the family. As one interviewee stressed, “AOD problems arise out of multiple, long-term factors including not only family break-up and social and economic disadvantage but also poor housing, low employment prospects, sub-standard education facilities and poor community infrastructure. Governments need to address all of these issues in a way that is sensitive to the needs of families if they want to prevent alcohol and drug problems in families”. Another interviewee stated that “people are beginning to realise that families can be very supportive in reducing drug harms, particularly for adolescents, yet this is not always
“ Our first experience with the Infants and Toddlers Program (ITP) happened soon after our first newborn son came home from the hospital. As new parents with a baby already exhibiting atypical development, we were nothing less than overwhelmed. Rather than joining infant play groups, we started researching support groups for parents of children with disabilities. Our son was referred to our local ITP. The ITP team came to our family and provided us with solutions after one simple phone call. Through the ITP, our son was evaluated by a team of professionals. Soon after the initial assessment, we began receiving therapeutic and family-focused interventions. The ITP taught us how to interact with our son in a way that supported his overall development. His once absent smile began to spread across his face when he recognized his family and surroundings.
totaling 450,000 individuals—even though a wide variety of HIV prevention approaches exist (1, 2). Given the absence of an effective vaccine to prevent new HIV infections, behavioral interventions remain a primary tool for reducing the risk and transmission of HIV (3). Experts believe that wide deployment of more effective behavioral interventions would enhance our ability to reduce the rate of new HIV infections (4). A number of behavioral interventions have shown evidence of effective- ness within target populations and are now widely available ‘‘in a box’’ as complete intervention packages (see http:==www.effectiveintervention- veinterventions.org). Thus, there is great potential to integrate effective HIV risk reduction interventions into substance abuse treatment pro- grams where large numbers of high-risk individuals present for treatment. Regrettably, analogous efforts to disseminate evidence-based inter- ventions for treating drug dependence have shown that broad availability of effective interventions does not dramatically change implementation by clinicians in ‘‘real-world’’ clinical settings (5). Thus, even though an intervention may have been developed with the intent for it to be ulti- mately implemented in clinical settings, this goal can be impeded by a host of factors that typically distinguish clinical settings from the research settings in which interventions are tested. Particularly salient are the differences between these 2 settings with respect to the quantity and qual- ity of resources available to competently deliver, monitor, and evaluate interventions that are often lengthy and complex (6, 7). Such barriers can disrupt intervention deployment at one or more organizational levels, ranging from the intervention participants to the organizational leaders (8, 9).
defined as a service objective in IBI programming (Perry, 2002). However, level of responsiveness is not currently being evaluated and the satisfaction of families who have received the Ontario IBI service has yet to be examined in the literature. Including caregiver perspectives in the development of treatment plans for children with autism has been shown to enhance the long-term sustainability of the treatment (Moes & Frea, 2002). How the variable features and outcomes of the provincial IBI program affect the perspectives of families warrants consideration. For example, are parents who receive more months of service more satisfied with IBI? Are the parents whose child had a better outcome more satisfied? Are the parents who were given more control in the programming more satisfied than other parents in the IBI program? Knowing the answer to some of these questions may increase the effectiveness of Ontario’s IBI program and ensure its long-term sustainability. The purpose of this study was to explore the views of families within the Ontario IBI program. Specifically, this study examined whether satisfaction of IBI is related to a number of variables (i.e., features of the IBI service delivery, characteristics of the child, and features related to the family), which are defined within Chapter Two. This research was completed through the administration of a questionnaire and by conducting a focus group with a subset of caregivers who had responded. The study explored the various aspects of the IBI service delivery model in Ontario and the effect that these have had on children with autism and their families who have completed the program.
which provide the full range of services; outreach services, involving 16 mobile teams that each go to the field for 18 days per month, 11 months per year, and provide a range of family planning methods (including tubal ligations and intrauterine devices) and also include voluntary counseling and testing (VCT); and six bajaji or auto-rickshaw models, in which family planning providers circulate in peri-urban areas using three-wheeled motorized rickshaws to provide all family planning methods except tubal ligation, for which they refer to clinics. MST charges user fees at their clinics to subsidize its family planning services, but the outreach and bajaji teams offer free services, funded by donors. 23 Most of MST’s mobile
Purpose: Determining and incorporating the perspective of the target population is important to the developments of effective and sustainable HIV prevention efforts. Cameroonian preadolescent females remain at high risk for contract- ing HIV and have not benefitted from targeted HIV prevention efforts. In this report, findings are presented from data collected from 60 Cameroonian preadolescent females; ages 10 - 12 years; following their completion of an HIV pre- vention intervention. Methods: The theory-basedintervention utilized the World Health Organization’s Responsible Behavior: Delaying Sex curriculum which had been tailored for the target population with the assistance of Cameroo- nian experts. The data reported here were collected as part of a questionnaire participants completed post-intervention. Results: With only a few exceptions, participants perceived the intervention to be appropriate and relevant. No signifi- cant differences were found in participants’ assessment of the intervention across different ages and ethnic groups. Discussion: Evaluating the appropriateness of interventions to the developmental level, gender, and culture of partici- pants is an essential step in developing effective and sustainable interventions. Findings in this study are encouraging and indicate that interventions adapted with the assistance of local experts can be perceived relevant and appropriate by participants.
with environmental education that society can be able to understand, accept and respect the inescapable man-nature relationship. And not only parents or guardians but mankind should learn to care, protect and preserve the environment. An important indicator of the overall outcomes achieved with the implementation of the NFEEP that has to be taken into account is that the call reached a total of 113 parents orguardians of three different schools and, that only 23 of them participated and completed the workshop. If this call’s response level were to be measured by the level of participation, then it could indicate a significant degree of indifference or lack of interest in environmental affairs among the potential participants who attended the presentation meetings. Although this is only a reading, it will be more than useful, for the following editions of this workshop, to consider seven or eight sessions instead of five, to give adult participants more chance to fit this activity in their daily agenda. In search of ways to increase the level of interest and participation of adults with great family responsibilities, to whom this and further editions of the NFEEP’S workshop "Environmental Culture for the Family" will be aimed at, we strongly believe that implementing some awareness-raising activities for the school´s community, before spreading the call to parents or guardians to participate in the workshop, may serve to encourage participation and commitment. Activities such as conferences, information leaflets on prevailing environmental problems in the locality and solution proposals, posters with questions on environmental culture and values, current information and data of what is happening nowadays, and a wide dissemination of environmental, social and economic benefits
You have advised Dale of the importance of a high protein high calorie well-balanced diet rich in vitamins and micronutrients in HIV. However, Dale lets you know that financing this is a problem. With Dale’s permission you write to his social assistance worker advocating for supplementary dietary allowances and a gym pass. At your suggestion Dale obtains additional help from the PWA assistance fund and a
Demonstration Project, where the goal was to demon- strate that higher-risk couples could be recruited and retained, couples who did not meet the risk score cri- teria were counseled about their ongoing HIV-1 risk and referred to public health clinics where they could access ART, as well as counseling services, STI screening and treatment, and medical male circumcision. PrEP is an ef- fective strategy for HIV-1 serodiscordant couples when the infected partner delays ART initiation or for a time- limited period (e.g., 6 months) after ART initiation by the infected partner prior to becoming virally suppressed . Future PrEP programs may use a similar scoring criterion to prioritize subsets of couples for PrEP; local context, including resource availability, would likely also shape prioritization decisions.
consideration to the role of culture and cultural norms in such areas as gender roles and power relations. How culture may increase risk for infection as well as how the HIV epidemic has been shaped by sexual relationships, family structure, socioeconomic status and race has also been studied (UNESCO, 2012). Cultural norms influence sexual practices and gender inequalities which put persons at risk for HIV and its sequelae. Thus, culture influences decision making regarding when or if to seek HIV testing, counseling or treatment, and engaging in risky behaviors (AAWH, 2012). HIV is a chronic illness accompanied by a host of demands ranging from social stigma to uncertainty of illness progression (Ball, Tannenbaum, Armistead & Maguen, et al., 2002). For women living with HIV, the biological impact of the illness interacts with profound personal, social and economic constraints. These demands are a crucial focus of study on how HIV affects women (Ball, et al., 2002). HIV infection is usually detected in women at either the presentation of advanced disease (AIDS) or when screening is done during pregnancy (Greenblatt, 2011; Waters, Fisher, Anderson, Wood, Delpech, Hill, et al., 2011). Therefore, many women discover they are HIV infected during their childbearing years, are raising children, and may be at especially high risk for emotional distress due to limited access to care and social support (Greenblatt, 2011; Melnick, et al., 1994). Women with HIV infection experience significant stresses grounded in poverty, discrimination, substance abuse and the social role as caregivers and mothers (Bova, 2001; Hellinger, 1993). Improvements in HIV treatment and care have resulted in women, including mothers, living longer. However, they are still shadowed by
to an average of 100% across all districts in the country in 2010/2011 . However, the PMTCT programme is clearly not involving men, as a birth in the last year was not associated with HIV testing in men. Future HIV testing strategies should include scale up of couple counseling and testing in antenatal care settings as well as home-based couples testing to reach more men, espe- cially those in the reproductive age. Furthermore in rural female dominated settings similar to the current study setting, where men largely work in the cities and are not at home for most of the year, interventions need to operate over holidays to reach these men.
this notion. Vpr/Vpx defective SIV virus has been shown to have a greatly attenuated course with no progression to AIDS in rhesus monkeys . In HIV- 1, Vpx is absent and Vpr is thought to carry out Vpx functions, suggesting that in humans a Vpr deletion would have similar effects. Infection of Vpr defective HIV-1 into tonsilar histocultures showed a fifty per- cent reduction in HIV-1 production, even though macrophages represented a small portion of total infectable cells . Further, an accidental infection of a lab worker with HIV-1 containing a frame shift mutation in codon 73 of the Vpr gene as well as infec- tion of rhesus macaques with Vpr mutated virus resulted in spontaneous reversion of the Vpr defective virus to the WT phenotype, which implies that Vpr containing virus obtained a selective advantage over the Vpr mutant [134,215]. Vpr has also been shown to reduce the efficacy of DNA and SIV-Nef vaccination in vivo , suggesting that in the absence of Vpr a more effective immune response to HIV would be possible [183,184]. Finally, a recent study of six vertically infected children that presented as long-term nonpro- gressors reported that every patient had a mutated Vpr gene in addition to mutations in other genes that were not present in all patients . Interestingly, all of these mutations involved a decrease in Vpr’s apoptotic effects, suggesting that the cytotoxic properties of Vpr are of key clinical importance. However, another report suggests that these effects are more related to nuclear localization . One of the major clinical conse- quences of Vpr in HIV-1 infected patients is the exis- tence of viral reservoirs in macrophages. Nucleoside reverse transcriptase inhibitors (NRTIs) are more effec- tive in macrophages than in CD4 +
rural), 18 the density of local fast food outlets per LSOA 19 and the built environment (based on factor analysis of the percentage of the LSOA made up of roads and green space). 20 We counted how many children attended each programme at baseline (hereafter referred to as ‘ programme group size ’ ) and the number of programmes that a local programme manager had managed as at the start of each programme. Approximately 80% of measured heights were rounded to whole or half centimetres. We derived a variable indicating if more than 20% of the height measures for a programme were rounded and included this in models to adjust for possible effects of data quality. We also derived a similar measure for weight rounding, where values were rounded to the nearest 0.5 kg. We categorised those attending fewer than 25% of sessions as non-completers, 25 – 75% as partial completers and more than 75% as completers.
Ethical approval was obtained from the Ethics Commis- sion of the Friedrich-Schiller-University Jena. Participants will be informed about the content, purpose, and pro- cedure of the study, and written informed consent will be obtained. The person with dementia will also receive information on the study. An indirect positive effect is expected on the well-being of the persons with demen- tia. In the previous study, the intervention did not pose any risks. No negative impact on the study participants is expected, since in case of severe depression or a sus- pected suicide intention, the caregiving relatives will be transferred to the institutions of usual care. Personal data will be stored separately from research data. The first, second, and third assessment (T0, T1, and T2) will be linked to each other by means of a researcher generated identification code. All personal data will be deleted after completion of the study. Participation in the study will be voluntary and the participants may withdraw consent at any time.