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Hafez S, Ismail SA, Zibwowa Z, Alhamshary N, Elsayed R, Dhaliwal M, Samuels F, Fakoya A. Community interventions for pandemic preparedness: A scoping review of pandemic preparedness lessons from HIV, COVID-19, and other public health emergencies of international concern. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002758. [PMID: 38709792 PMCID: PMC11073720 DOI: 10.1371/journal.pgph.0002758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 04/06/2024] [Indexed: 05/08/2024]
Abstract
Community action is broadly recognised as central to comprehensive and effective system responses to pandemics. However, there is uncertainty about how and where communities can be best supported to bolster long-term resilience and preparedness. We applied a typology of community interventions (Community Informing, Consulting, Involving, Collaborating or Empowering-or CICICE) to cover the diverse range of interventions identified across the literature and used this to structure a scoping review addressing three linked topics: (i) how CICICE interventions have been understood and applied in the literature on epidemic and pandemic preparedness; (ii) the spectrum of interventions that have been implemented to strengthen CICICE and (iii) what evidence is available on their effectiveness in influencing preparedness for current and future emergencies. We drew on peer-reviewed and grey literature from the HIV (from 2000) and COVID-19 pandemics and recent public health emergencies of international concern (from 2008), identified through systematic searches in MEDLINE, Scopus, the Cochrane Collaboration database, supplemented by keyword-structured searches in GoogleScholar and websites of relevant global health organisations. Following screening and extraction, key themes were identified using a combined inductive/deductive approach. 130 papers met the criteria for inclusion. Interventions for preparedness were identified across the spectrum of CICICE. Most work on COVID-19 focused on informing and consulting rather than capacity building and empowerment. The literature on HIV was more likely to report interventions emphasising human rights perspectives and empowerment. There was little robust evidence on the role of CICICE interventions in building preparedness. Evidence of effect was most robust for multi-component interventions for HIV prevention and control. Much of the reporting focused on intermediate outcomes, including measures of health service utilisation. We put forward a series of recommendations to help address evidence shortfalls, including clarifying definitions, organising and stratifying interventions by several parameters and strengthening evaluation methods for CICICE.
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Affiliation(s)
- Sali Hafez
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sharif A. Ismail
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Zandile Zibwowa
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nadin Alhamshary
- The Nuffield Centre for International Health and Development, School of Medicine, The University of Leeds, Leeds, United Kingdom
| | - Reem Elsayed
- The University of Western Cape, Cape Town, South Africa
| | - Mandeep Dhaliwal
- HIV and Health Group, United Nations Development Program, New York, United States of America
| | - Fiona Samuels
- Centre for Public Health and Policy, Queen Mary University of London, London, United Kingdom
| | - Ade Fakoya
- Institute for Global Health, University College London, London, United Kingdom
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Sheira LA, Wekesa P, Cohen CR, Weke E, Frongillo EA, Mocello AR, Dworkin SL, Burger RL, Weiser SD, Bukusi EA. Impact of a livelihood intervention on gender roles and relationship power among people with HIV. AIDS 2024; 38:95-104. [PMID: 37788108 PMCID: PMC10842405 DOI: 10.1097/qad.0000000000003742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVE To evaluate the impact of an agricultural livelihood intervention on gender role conflict and sexual relationship power among people with HIV (PWH) in western Kenya. DESIGN Study participants were enrolled in Shamba Maisha , a cluster randomized controlled trial of an agricultural intervention conducted among PWH across 16 health facilities during 2016-2020. Intervention participants received a water pump, seeds, and agricultural and financial training; control participants received standard of HIV care. METHODS We assessed men's views on masculinity and gender roles via the validated gender role conflict score (GRCS; range 18-78, higher = greater gender role conflict). We measured gender power imbalances among women via the validated Sexual Relationship Power Scale (SRPS), which combines subscales of relationship control and decision-making dominance (range 1-4, higher = female holds more power). We compared changes over the study period by arm using longitudinal multilevel difference-in-difference linear regression models accounting for clustering of facilities using the intention-to-treat cohort. RESULTS We enrolled 720 participants (366 intervention, 354 control); 2-year retention was 94%. Median age was 40 and approximately 55% of participants were female. Among men, after 24-months the decrease in GRCS scores was 4.3 points greater in the intervention than the control arm ( P < 0.001). Among women, the intervention resulted in 0.25 points greater increase in the SRPS compared to the control arm ( P < 0.001). CONCLUSIONS Shamba Maisha resulted in less gender role conflict in men and greater sexual relationship power for women. Agricultural livelihood interventions may be a powerful tool to improve gender power imbalances, which may subsequently mitigate poverty and food insecurity.
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Affiliation(s)
- Lila A Sheira
- Division of HIV, ID and Global Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Pauline Wekesa
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, California
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Edward A Frongillo
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - A Rain Mocello
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, California
| | - Shari L Dworkin
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, Washington, USA
| | - Rachel L Burger
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, California
| | - Sheri D Weiser
- Division of HIV, ID and Global Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
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Odhiambo JA, Weiser SD, Frongillo EA, Burger RL, Weke E, Wekesa P, Bukusi EA, Cohen CR. Comparing the effect of a multisectoral agricultural intervention on HIV-related health outcomes between widowed and married women. Soc Sci Med 2023; 330:116031. [PMID: 37390805 PMCID: PMC10645573 DOI: 10.1016/j.socscimed.2023.116031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 07/02/2023]
Abstract
INTRODUCTION Widowed women make up 18-40% of the 12 million women living with HIV in eastern and southern Africa. Widowhood has also been associated with greater HIV morbidity and mortality. We compared the effectiveness of a multisectoral climate adaptive agricultural livelihood intervention (called Shamba Maisha) on food insecurity, and HIV related health outcomes among widowed and married women living with HIV in western Kenya. METHODS We implemented Shamba Maisha (NCT02815579) using a cluster-randomized control trial design. The intervention arm received an US$175 in-kind loan to purchase a micro-irrigation pump, seeds, and fertilizer, and received eight training sessions on sustainable agriculture and financial management. Study outcomes were measured every 6 months over a 24-month follow-up period and trends in outcomes assessed using multilevel mixed-effects models. RESULTS The trial enrolled 232 (61.5%) married and 145 (38.5%) widowed women. Widowed women (mean age 42.8 ± 8.4 years) were older than married women (35.8 ± 9.0 years) (p < 0.01). Almost all widowed women (97.2%) self-identified as household heads compared to 10.8% of married women. Comparing widowed vs married women, reduction in food insecurity (-3.13, 95%CI -4.42, -1.84 vs. -3.08, 95%CI -4.15, -2.02), depressive symptoms (-0.21, 95%CI -0.36, -0.07 vs. -0.19, 95%CI -0.29, -0.08), internalized stigma (-0.33, 95%CI -0.55, -0.11 vs. -0.38, 95%CI -0.57, -0.19), and anticipated stigma (-0.46 95%CI -0.65, -0.28 vs. -0.35, 95%CI -0.50, -0.21) was similar for both groups. In contrast, improvements in social support (-2.22, 95%CI -3.85, -0.59 vs. -4.00, 95%CI -5.16, -2.84; p = 0.08) and reduction in enacted stigma (0.01, 95%CI -0.06, 0.08 vs. -0.14, 95%CI -0.20, -0.09; p < 0.01) were weaker for widowed than married women. CONCLUSIONS Our study is among the first comparing the effect of a livelihood intervention on HIV health outcomes among widowed and married women. Widowed women experienced similar benefits as married women on individual-level outcomes, but weaker benefit on outcomes dependent on their external environment like enacted stigma and social support. Future trials and programs targeting widowed women should bolster stigma reduction and social support.
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Affiliation(s)
- Jackline A Odhiambo
- School of Public Health and Community Development, Maseno University, Maseno, Kenya; Nyanam Widows Rising, Kisumu, Kenya.
| | - Sheri D Weiser
- Department of Medicine, University of California San Francisco, CA, USA
| | | | - Rachel L Burger
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, CA, USA
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research Institute, Kenya
| | - Pauline Wekesa
- Centre for Microbiology Research, Kenya Medical Research Institute, Kenya
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Kenya
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, CA, USA
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Beyeler NS, Nicastro TM, Jawuoro S, Odhiambo G, Whittle HJ, Bukusi EA, Schmidt LA, Weiser SD. Pathways from climate change to emotional wellbeing: A qualitative study of Kenyan smallholder farmers living with HIV. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002152. [PMID: 37490427 PMCID: PMC10368256 DOI: 10.1371/journal.pgph.0002152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/19/2023] [Indexed: 07/27/2023]
Abstract
Climate change is associated with adverse mental and emotional health outcomes. Social and economic factors are well-known drivers of mental health, yet comparatively few studies examine the social and economic pathways through which climate change affects mental health. There is additionally a lack of research on climate change and mental health in sub-Saharan Africa. This qualitative study aimed to identify potential social and economic pathways through which climate change impacts mental and emotional wellbeing, focusing on a vulnerable population of Kenyan smallholder farmers living with HIV. We conducted in-depth, semi-structured interviews with forty participants to explore their experience of climate change. We used a thematic analytical approach. We find that among our study population of Kenyan smallholder farmers living with HIV, climate change is significantly affecting mental and emotional wellbeing. Respondents universally report some level of climate impact on emotional health including high degrees of stress; fear and concern about the future; and sadness, worry, and anxiety from losing one's home, farm, occupation, or ability to support their family. Climate-related economic insecurity is a main driver of emotional distress. Widespread economic insecurity disrupts systems of communal and family support, which is an additional driver of worsening mental and emotional health. Our study finds that individual adaptive strategies used by farmers in the face of economic and social volatility can deepen economic insecurity and are likely insufficient to protect mental health. Finally, we find that agricultural policies can worsen economic insecurity and other mental health risk factors. Our proposed conceptual model of economic and social pathways relevant for mental health can inform future studies of vulnerable populations and inform health system and policy responses to protect health in a changing climate.
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Affiliation(s)
- Naomi S Beyeler
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Tammy M Nicastro
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Stanley Jawuoro
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Gladys Odhiambo
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Henry J Whittle
- Division of Psychiatry, University College London, London, United Kingdom
| | - Elizabeth A Bukusi
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, United States of America
| | - Laura A Schmidt
- Philip R. Lee Institute for Health Policy Studies and Department of Humanities and Social Sciences, School of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Sheri D Weiser
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
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Thorp M, Bellos M, Temelkovska T, Mphande M, Cornell M, Hubbard J, Choko A, Coates TJ, Hoffman R, Dovel K. Mobility and ART retention among men in Malawi: a mixed-methods study. J Int AIDS Soc 2023; 26:e26066. [PMID: 36943753 PMCID: PMC10029992 DOI: 10.1002/jia2.26066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/30/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Mobility is associated with worse outcomes across the HIV treatment cascade, especially among men. However, little is known about the mechanisms that link mobility and poor HIV outcomes and what types of mobility most increase the risk of treatment interruption among men in southern Africa. METHODS From August 2021 to January 2022, we conducted a mixed-methods study with men living with HIV (MLHIV) but not currently receiving antiretroviral therapy (ART) in Malawi. Data collection was embedded within two larger trials (ENGAGE and IDEaL trials). We analysed baseline survey data of 223 men enrolled in the trials who reported being mobile (defined as spending ≥14 nights away from home in the past 12 months) using descriptive statistics and negative binomial regressions. We then recruited 32 men for in-depth interviews regarding their travel experiences and ART utilization. We analysed qualitative data using constant comparative methods. RESULTS Survey data showed that 34% of men with treatment interruptions were mobile, with a median of 60 nights away from home in the past 12 months; 69% of trips were for income generation. More nights away from home in the past 12 months and having fewer household assets were associated with longer periods out of care. In interviews, men reported that travel was often unplanned, and men were highly vulnerable to exploitive employer demands, which led to missed appointments and ART interruption. Men made major efforts to stay in care but were often unable to access care on short notice, were denied ART refills at non-home facilities and/or were treated poorly by providers, creating substantial barriers to remaining in and returning to care. Men desired additional multi-month dispensing (MMD), the ability to refill treatment at any facility in Malawi, and streamlined pre-travel refills at home facilities. CONCLUSIONS Men prioritize ART and struggle with the trade-offs between their own health and providing for their families. Mobility is an essential livelihood strategy for MLHIV in Malawi, but it creates conflict with ART retention, largely due to inflexible health systems. Targeted counselling and peer support, access to ART services anywhere in the country, and MMD may improve outcomes for mobile men.
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Affiliation(s)
- Marguerite Thorp
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | | | - Tijana Temelkovska
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | | | - Morna Cornell
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Julie Hubbard
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Partners in Hope, Lilongwe, Malawi
| | | | - Thomas J Coates
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Risa Hoffman
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Kathryn Dovel
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Partners in Hope, Lilongwe, Malawi
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Frongillo EA. Intersection of Food Insecurity and Water Insecurity. J Nutr 2023; 153:922-923. [PMID: 36848987 PMCID: PMC10101199 DOI: 10.1016/j.tjnut.2023.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023] Open
Affiliation(s)
- Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States.
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