1
|
Mavragani A, McKenzie-White J, Saxton R, Grieb SM, Nonyane B, Graham C, Cano A, Johnson S, Childs L, Greenbaum A, Flynn C, Pearlowitz M, Celano S, Chang LW, Page KR. Leveraging mHealth and Patient Supporters for African Americans' and Latinxs' Engagement in HIV Care (LEAN): Protocol for a Randomized, Controlled, Effectiveness-Implementation Trial. JMIR Res Protoc 2023; 12:e42691. [PMID: 36787165 PMCID: PMC9975915 DOI: 10.2196/42691] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/02/2022] [Accepted: 11/18/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite substantial investments in ending the HIV epidemic, disparities in HIV care persist, and there is an urgent need to evaluate novel and scalable approaches to improving HIV care engagement and viral suppression in real-world settings. OBJECTIVE This paper aims to describe a study protocol for a pragmatic type II hybrid effectiveness-implementation randomized controlled trial comparing existing standard of care clinic HIV linkage, adherence, and retention (LAR) protocols to a mobile health (mHealth)-enhanced linkage, adherence, and retention (mLAR) intervention. METHODS The study will enroll 450 participants from clinics in Baltimore City. Eligibility criteria include being ≥18 years of age, having a new HIV diagnosis or being HIV-positive and out of care, or being HIV-positive and deemed by clinic staff as someone who could benefit from linkage and retention services. Participants randomized to the intervention receive mHealth-supported patient navigation for 12 months. Participants in the control group receive the referring clinic's standard of care patient support. The primary outcome is HIV virologic suppression at 12 months. A subset of participants will be interviewed at 12 months to learn about their HIV care experiences and, for those in the intervention arm, their experiences with the mLAR intervention. This protocol was developed in collaboration with the Baltimore City Health Department (BCHD) and the Maryland Department of Health (MDH) and with input from a community advisory board. RESULTS Enrollment began on February 25, 2020. As of August 11, 2022, 411 of the 450 target participants had been enrolled. CONCLUSIONS Pragmatic implementation science trials designed with input from key stakeholders, including health departments and community members, can help evaluate the evidence for mHealth interventions to reduce HIV health disparities. TRIAL REGISTRATION ClinicalTrials.gov NCT03934437; https://clinicaltrials.gov/ct2/show/NCT03934437. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/42691.
Collapse
Affiliation(s)
| | | | - Ronald Saxton
- School of Medicine, Johns Hopkins, Baltimore, MD, United States
| | - Suzanne M Grieb
- School of Medicine, Johns Hopkins, Baltimore, MD, United States
| | - Bareng Nonyane
- Bloomberg School of Public Health, Johns Hopkins, Baltimore, MD, United States
| | - Cadeesha Graham
- School of Medicine, Johns Hopkins, Baltimore, MD, United States
| | - Anthony Cano
- School of Medicine, Johns Hopkins, Baltimore, MD, United States
| | - Sheridan Johnson
- School of Medicine, Johns Hopkins, Baltimore, MD, United States.,Baltimore City Health Department, Baltimore, MD, United States
| | - Lanisha Childs
- Baltimore City Health Department, Baltimore, MD, United States
| | - Adena Greenbaum
- Baltimore City Health Department, Baltimore, MD, United States
| | - Colin Flynn
- Maryland Department of Health, Baltimore, MD, United States
| | | | - Shivaun Celano
- School of Medicine, Johns Hopkins, Baltimore, MD, United States
| | - Larry W Chang
- School of Medicine, Johns Hopkins, Baltimore, MD, United States
| | - Kathleen R Page
- School of Medicine, Johns Hopkins, Baltimore, MD, United States
| |
Collapse
|
2
|
Anderson DM, Bear AB, Zacher T, Endres K, Saxton R, Richards F, Robe LB, Harvey D, Best LG, Cloud RR, Thomas ED, Gittelsohn J, O’Leary M, Navas-Acien A, George CM. Implementing a Community-Led Arsenic Mitigation Intervention for Private Well Users in American Indian Communities: A Qualitative Evaluation of the Strong Heart Water Study Program. Int J Environ Res Public Health 2023; 20:2681. [PMID: 36768048 PMCID: PMC9915175 DOI: 10.3390/ijerph20032681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
Arsenic is a naturally occurring toxicant in groundwater, which increases cancer and cardiovascular disease risk. American Indian populations are disproportionately exposed to arsenic in drinking water. The Strong Heart Water Study (SHWS), through a community-centered approach for intervention development and implementation, delivered an arsenic mitigation program for private well users in American Indian communities. The SHWS program comprised community-led water arsenic testing, point-of-use arsenic filter installation, and a mobile health program to promote sustained filter use and maintenance (i.e., changing the filter cartridge). Half of enrolled households received additional in-person behavior change communication and videos. Our objectives for this study were to assess successes, barriers, and facilitators in the implementation, use, and maintenance of the program among implementers and recipients. We conducted 45 semi-structured interviews with implementers and SHWS program recipients. We analyzed barriers and facilitators using the Consolidated Framework for Implementation Research and the Risks, Attitudes, Norms, Abilities, and Self-regulation model. At the implementer level, facilitators included building rapport and trust between implementers and participating households. Barriers included the remoteness of households, coordinating with community plumbers for arsenic filter installation, and difficulty securing a local supplier for replacement filter cartridges. At the recipient level, facilitators included knowledge of the arsenic health risks, perceived effectiveness of the filter, and visual cues to promote habit formation. Barriers included attitudes towards water taste and temperature and inability to procure or install replacement filter cartridges. This study offers insights into the successes and challenges of implementing an arsenic mitigation program tailored to American Indian households, which can inform future programs in partnership with these and potentially similar affected communities. Our study suggests that building credibility and trust between implementers and participants is important for the success of arsenic mitigation programs.
Collapse
Affiliation(s)
- Darcy M. Anderson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Annabelle Black Bear
- Missouri Breaks Industries Research, Cheyenne River Sioux Tribe, Eagle Butte, SD 57625, USA
| | - Tracy Zacher
- Missouri Breaks Industries Research, Cheyenne River Sioux Tribe, Eagle Butte, SD 57625, USA
| | - Kelly Endres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Ronald Saxton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Francine Richards
- Missouri Breaks Industries Research, Cheyenne River Sioux Tribe, Eagle Butte, SD 57625, USA
| | - Lisa Bear Robe
- Missouri Breaks Industries Research, Cheyenne River Sioux Tribe, Eagle Butte, SD 57625, USA
| | - David Harvey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Indian Health Service, Rockville, MD 20857, USA
| | - Lyle G. Best
- Missouri Breaks Industries Research, Cheyenne River Sioux Tribe, Eagle Butte, SD 57625, USA
| | - Reno Red Cloud
- Environmental Resource Department, Oglala Sioux Tribe, Pine Ridge, SD 57770, USA
| | - Elizabeth D. Thomas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Joel Gittelsohn
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Marcia O’Leary
- Missouri Breaks Industries Research, Cheyenne River Sioux Tribe, Eagle Butte, SD 57625, USA
| | - Ana Navas-Acien
- Department of Environmental Health Science, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| |
Collapse
|
3
|
Bisimwa L, Endres K, Williams C, Thomas ED, Kuhl J, Coglianese N, Bauler S, Masud J, François R, Saxton R, Sanvura P, Bisimwa JC, Mirindi P, Mwishingo A, Perin J, George CM. Diarrheal Disease Awareness Is Associated with Caregiver Handwashing with Soap in the Democratic Republic of the Congo (REDUCE Program). Am J Trop Med Hyg 2022; 106:tpmd210699. [PMID: 35313282 PMCID: PMC9128694 DOI: 10.4269/ajtmh.21-0699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 12/08/2021] [Indexed: 11/07/2022] Open
Abstract
Diarrhea is one of the leading causes of childhood illness and a major cause of infant and child mortality globally. In the Reducing Enteropathy, Undernutrition, and Contamination in the Environment (REDUCE) prospective cohort study, we investigated the association between diarrheal disease awareness and handwashing with soap among caregivers of children under 5 years of age. A total of 259 caregivers of children under 5 years of age in Walungu Territory, South Kivu, Democratic Republic of the Congo (DRC), were administered an open-ended questionnaire assessing awareness of diarrheal disease transmission and prevention, and key times to wash hands with soap. An overall diarrhea awareness score was developed based on the responses to these items. Five-hour structured observation of handwashing behaviors was conducted at the 6-month follow-up. Diarrheal disease awareness among caregivers was low. Only 32% of caregivers were able to correctly identify a method of diarrhea prevention. The median diarrhea awareness score was three out of 10 (SD: 1.7, range: 0-9). During structured observation, 9% of caregivers washed their hands with soap at a food-related event and 9% washed their hands with soap at a stool-related event. Higher diarrheal disease awareness was associated with an increased odds of handwashing with soap at food-related events (odds ratio: 1.40, 95% confidence interval: 1.03, 1.90). Our findings emphasize the need for targeted water, sanitation, and hygiene interventions to increase diarrhea awareness to facilitate handwashing with soap among caregivers of children under 5 years in rural DRC.
Collapse
Affiliation(s)
- Lucien Bisimwa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Food for the Hungry, Washington, District of Columbia
| | - Kelly Endres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Camille Williams
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Elizabeth D. Thomas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jennifer Kuhl
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Sarah Bauler
- Food for the Hungry, Washington, District of Columbia
| | - Jahed Masud
- International Center for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Ruthly François
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ronald Saxton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Presence Sanvura
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Food for the Hungry, Washington, District of Columbia
| | - Jean Claude Bisimwa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Food for the Hungry, Washington, District of Columbia
| | | | - Alain Mwishingo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
4
|
Harris R, Rosecrans A, Zoltick M, Willman C, Saxton R, Cotterell M, Bell J, Blackwell I, Page KR. Utilizing telemedicine during COVID-19 pandemic for a low-threshold, street-based buprenorphine program. Drug Alcohol Depend 2022; 230:109187. [PMID: 34890927 PMCID: PMC8619879 DOI: 10.1016/j.drugalcdep.2021.109187] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Changes in federal policy during the COVID-19 pandemic allowing for the use of telemedicine to treat opioid use disorder (OUD) have facilitated innovative strategies to engage and retain people in treatment. Since 2018, the Baltimore City Health Department has operated a mobile street medicine program called Healthcare on The Spot (The Spot) that provides treatment for OUD and infectious diseases. This study describes the transition of The Spot's buprenorphine service to telemedicine during the COVID-19 pandemic and one year treatment retention. METHODS Patients actively engaged in care at the time of transition to telemedicine and patients newly engaged in buprenorphine services through telemedicine were included in this descriptive analysis and assessed at one year for retention. RESULTS From March 16, 2020 to March 15, 2021, The Spot provided voice-only buprenorphine treatment services to 150 patients, 70.7% (n = 106) male and 80.0% (n = 120) Black; 131 were patients who transitioned from in person services and 19 were newly engaged via telemedicine. 80.7% (n = 121) of patients remained engaged in treatment at one year, 16.0% (n = 24) were lost to follow-up, and 3.3% (n = 5) were deceased. Patients newly engaged via telemedicine were more likely to be female and white than those retained from in person services. CONCLUSION The Spot's transition of patients from a street medicine program to telemedicine during the COVID-19 pandemic has implications for future practice. Increased flexibility of service delivery, extended prescription length, and decreased UDT likely contributed to high retention rates and should inform the future structure of low-threshold buprenorphine programs.
Collapse
Affiliation(s)
- Robert Harris
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Baltimore City Health Department, Baltimore, MD, USA.
| | - Amanda Rosecrans
- Johns Hopkins University School of Medicine, Baltimore, MD, USA,Baltimore City Health Department, Baltimore, MD, USA
| | - Meredith Zoltick
- Johns Hopkins University School of Medicine, Baltimore, MD, USA,Baltimore City Health Department, Baltimore, MD, USA
| | - Catherine Willman
- Johns Hopkins University School of Medicine, Baltimore, MD, USA,Baltimore City Health Department, Baltimore, MD, USA
| | - Ronald Saxton
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Margaret Cotterell
- Johns Hopkins University School of Medicine, Baltimore, MD, USA,Baltimore City Health Department, Baltimore, MD, USA
| | - Joy Bell
- Johns Hopkins University School of Medicine, Baltimore, MD, USA,Baltimore City Health Department, Baltimore, MD, USA
| | - Ingrid Blackwell
- Johns Hopkins University School of Medicine, Baltimore, MD, USA,Baltimore City Health Department, Baltimore, MD, USA
| | | |
Collapse
|
5
|
George CM, Cirhuza LB, Kuhl J, Williams C, Coglianese N, Thomas E, Bauler S, François R, Saxton R, Presence AS, Birindwa A, Jean Claude BR, Perin J, Mirindi P. Child Mouthing of Feces and Fomites and Animal Contact are Associated with Diarrhea and Impaired Growth Among Young Children in the Democratic Republic of the Congo: A Prospective Cohort Study (REDUCE Program). J Pediatr 2021; 228:110-116.e1. [PMID: 32918918 DOI: 10.1016/j.jpeds.2020.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/04/2020] [Accepted: 09/04/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To identify exposure pathways to fecal pathogens that are significant contributors to diarrheal diseases and impaired growth in young children, and to evaluate scalable interventions to reduce fecal contamination from these pathways. STUDY DESIGN Reducing Enteropathy, Undernutrition, and Contamination in the Environment (REDUCE) was a prospective cohort study of 370 children <5 years of age was conducted in Walungu Territory, South Kivu, Democratic Republic of the Congo. Child mouthing behaviors were assessed through caregiver reports and 5-hour structured observations. Caregiver reports of child contact with animals and child diarrhea were also obtained. Anthropometric measurements were collected at baseline and at a 6-month follow-up. RESULTS Children observed putting soil in their mouth during structured observation at baseline had a significantly higher odds of diarrhea at the 6-month follow-up (OR, 1.79; 95% CI, 1.04 to 3.07). Children observed mouthing feces during structured observation had a significant reduction in height-for-age z-score (HAZ) from baseline to the 6-month follow-up (ΔHAZ, -0.69; 95% CI, -1.34 to -0.04). A significant reduction in HAZ was also observed for children with caregiver reports of touching guinea pigs (-0.33; 95% CI, -0.58 to -0.08) and rabbits (-0.34; 95% CI, -0.64 to -0.04) and children with feces in their sleeping space during unannounced spot checks (-0.41; 95% CI, -0.74 to -0.09). CONCLUSIONS These findings emphasize the urgent need for infant water, sanitation, and hygiene interventions targeting child mouthing behaviors, fecal contamination in child living spaces, and child contact with domestic animals to reduce exposure to fecal pathogens among susceptible populations.
Collapse
Affiliation(s)
- Christine Marie George
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, MD.
| | - Lucien Bisimwa Cirhuza
- Food for the Hungry, Phoenix, AZ; Unit for Research and Training in Ecology and Control of Infectious Diseases, Microbiology Department, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jennifer Kuhl
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, MD
| | - Camille Williams
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, MD
| | | | - Elizabeth Thomas
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, MD
| | | | - Ruthly François
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, MD
| | - Ronald Saxton
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, MD
| | | | | | | | - Jamie Perin
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, MD
| | | |
Collapse
|
6
|
George CM, Cirhuza LB, Birindwa A, Williams C, Beck S, Julian T, Kuhl J, Coglianese N, Thomas E, Bauler S, François R, Saxton R, Presence AS, Rusanga JCB, Perin J, Mirindi P. Child hand contamination is associated with subsequent pediatric diarrhea in rural Democratic Republic of the Congo (REDUCE Program). Trop Med Int Health 2020; 26:102-110. [PMID: 33151587 DOI: 10.1111/tmi.13510] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The Reducing Enteropathy, Undernutrition, and Contamination in the Environment (REDUCE) program focuses on identifying exposure pathways to faecal pathogens for young children in the Democratic Republic of the Congo (DRC) and on developing scalable interventions to reduce faecal contamination from these pathways. METHODS A prospective cohort study of 690 participants was conducted to investigate the association between hand, food, and environmental faecal contamination and diarrhoeal disease prevalence among young children in Walungu Territory, South Kivu, DRC. A total of 1923 hand rinse, soil, food, object, surface, stored water and water source samples were collected during unannounced spot checks after baseline enrolment and analysed for Escherichia coli. Caregiver reports of diarrhoea were obtained from children < 5 years at a 6-month follow-up. RESULTS E.coli was detected in 73% of child and caregiver hand-rinse samples, 69% of soil samples from child play spaces, 54% of child food samples, 38% of objects and surfaces children were observed putting in their mouths, 74% of stored water samples, and 40% of source water samples. Children < 5 years with E. coli on their hands had significantly higher odds of diarrhoea at the 6-month follow-up (odds ratio: 2.03 (95% confidence interval: 1.05, 3.92)). CONCLUSION The cohort study findings from the REDUCE program have shown that child hand contamination is associated with diarrhoeal disease in rural DRC, and that there is high faecal contamination in child plays spaces and food. These findings provide evidence demonstrating the urgent need to provide clean play spaces for young children and interventions targeting hand hygiene to reduce paediatric exposure to faecal pathogens.
Collapse
Affiliation(s)
- Christine Marie George
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, Maryland, USA
| | - Lucien Bisimwa Cirhuza
- Food for the Hungry, Phoenix, Arizona, USA.,URF-ECMI, Microbiology Department, Faculty of Medicine, University of Kinshasa
| | | | - Camille Williams
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, Maryland, USA
| | - Sara Beck
- Department of Environmental Microbiology, Eawag, Swiss Federal Institute of Aquatic Science and Technology, Duebendorf, Switzerland
| | - Timothy Julian
- Food for the Hungry, Phoenix, Arizona, USA.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Jennifer Kuhl
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, Maryland, USA
| | | | - Elizabeth Thomas
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, Maryland, USA
| | - Sarah Bauler
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, Maryland, USA.,Food for the Hungry, Phoenix, Arizona, USA
| | - Ruthly François
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, Maryland, USA
| | - Ronald Saxton
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, Maryland, USA
| | | | | | - Jamie Perin
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, Maryland, USA
| | | |
Collapse
|
7
|
George CM, Monira S, Zohura F, Thomas ED, Hasan MT, Parvin T, Hasan K, Rashid MU, Papri N, Islam A, Rahman Z, Rafique R, Islam Bhuyian S, Saxton R, Labrique A, Alland K, Barman I, Jubyda FT, Afroze F, Sultana M, Johura FT, Khan MAH, Tahmina S, Munmun F, Sack DA, Perin J, Alam M. Effects of a Water, Sanitation and Hygiene Mobile Health Program on Diarrhea and Child Growth in Bangladesh: A Cluster-Randomized Controlled Trial of the CHoBI7 Mobile Health Program. Clin Infect Dis 2020; 73:e2560-e2568. [PMID: 32761174 PMCID: PMC8563223 DOI: 10.1093/cid/ciaa754] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/27/2020] [Indexed: 11/17/2022] Open
Abstract
Background The Cholera Hospital-Based Intervention for 7 Days (CHoBI7) mobile health (mHealth) program was a cluster-randomized controlled trial of diarrhea patient households conducted in Dhaka, Bangladesh. Methods Patients were block-randomized to 3 arms: standard message on oral rehydration solution use; health facility delivery of CHoBI7 plus mHealth (no home visits); and health facility delivery of CHoBI7 plus 2 home visits and mHealth. The primary outcome was reported diarrhea in the past 2 weeks collected monthly for 12 months. The secondary outcomes were stunting, underweight, and wasting at a 12-month follow-up. Analysis was intention-to-treat. Results Between 4 December 2016 and 26 April 2018, 2626 participants in 769 households were randomly allocated to 3 arms: 849 participants to the standard message arm, 886 to mHealth with no home visits arm, and 891 to the mHealth with 2 home visits. Children <5 years had significantly lower 12-month diarrhea prevalence in both the mHealth with 2 home visits arm (prevalence ratio [PR]: 0.73 [95% confidence interval {CI}, .61–.87]) and the mHealth with no home visits arm (PR: 0.82 [95% CI, .69–.97]). Children <2 years were significantly less likely to be stunted in both the mHealth with 2 home visits arm (33% vs 45%; odds ratio [OR]: 0.55 [95% CI, .31–.97]) and the mHealth with no home visits arm (32% vs 45%; OR: 0.54 [95% CI, .31–.96]) compared with children in the standard message arm. Conclusions The CHoBI7 mHealth program lowered pediatric diarrhea and stunting among diarrhea patient households. Clinical Trials Registration NCT04008134.
Collapse
Affiliation(s)
- Christine Marie George
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Shirajum Monira
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Fatema Zohura
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Elizabeth D Thomas
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - M Tasdik Hasan
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tahmina Parvin
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Khaled Hasan
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Mahamud-Ur Rashid
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Nowshin Papri
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Aminul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Zillur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Raisa Rafique
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Ronald Saxton
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Alain Labrique
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Kelsey Alland
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Indrajeet Barman
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Fatema Tuz Jubyda
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Farzana Afroze
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Marzia Sultana
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Fatema-Tuz Johura
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Sanya Tahmina
- Bangladesh Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Farzana Munmun
- Bangladesh Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - David A Sack
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Jamie Perin
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Munirul Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| |
Collapse
|
8
|
Islam Bhuyian MS, Saxton R, Hasan K, Masud J, Zohura F, Monira S, Kumar Biswas S, Tasdik Hasan M, Parvin T, Minhaj I, Md Zillur Rahman K, Papri N, Rashid MU, Sharin L, Teman A, Thomas ED, Alland K, Labrique A, Sack DA, Perin J, Alam M, George CM. Process evaluation for the delivery of a water, sanitation and hygiene mobile health program: findings from the randomised controlled trial of the CHoBI7 mobile health program. Trop Med Int Health 2020; 25:985-995. [PMID: 32406965 DOI: 10.1111/tmi.13414] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The Cholera-Hospital-Based Intervention for 7-days (CHoBI7) mobile health (mHealth) program delivers mobile messages to diarrhoea patient households promoting water treatment and handwashing with soap. The randomised controlled trial (RCT) of the CHoBI7 mHealth program demonstrated this intervention was effective in significantly reducing diarrhoea and stunting amoung young children. The objective of this study was to assess the implementation of the CHoBI7 mHealth program in delivering mHealth messages during this RCT. METHODS 517 diarrhoea patient households with 1777 participants received weekly text, voice and interactive voice response (IVR) messages from the CHoBI7 mHealth program over the 12-month program period. The program process evaluation indicators were the following: the percentage of CHoBI7 mHealth messages received and fully listened to by program households (program fidelity and dose), and household members reporting receiving and sharing an mHealth message from the program in the past two weeks (program reach). RESULTS Ninety two percent of text messages were received by program households. Eighty three percent of voice and 86% of IVR messages sent were fully listened to by at least one household member. Eighty one percent of IVR quiz responses from households were answered correctly. Program households reported receiving a CHoBI7 mHealth message in the past two weeks at 79% of monthly household visits during the 12-month program. Seventy seven percent of participants reported sharing a program message with a spouse, 55% with a neighbour and 49% with a child during the program period. CONCLUSION There was high fidelity, dose and reach of mobile messages delivered for the CHoBI7 mHealth program. This study presents an approach for process evaluation that can be implemented to evaluate future mHealth programs.
Collapse
Affiliation(s)
| | - Ronald Saxton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Khaled Hasan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jahed Masud
- International Centre for Diarrhoeal Disease Research, Bangladesh(icddr,b), Dhaka, Bangladesh
| | - Fatema Zohura
- International Centre for Diarrhoeal Disease Research, Bangladesh(icddr,b), Dhaka, Bangladesh
| | - Shirajum Monira
- International Centre for Diarrhoeal Disease Research, Bangladesh(icddr,b), Dhaka, Bangladesh
| | - Shwapon Kumar Biswas
- International Centre for Diarrhoeal Disease Research, Bangladesh(icddr,b), Dhaka, Bangladesh
| | - M Tasdik Hasan
- International Centre for Diarrhoeal Disease Research, Bangladesh(icddr,b), Dhaka, Bangladesh
| | - Tahmina Parvin
- International Centre for Diarrhoeal Disease Research, Bangladesh(icddr,b), Dhaka, Bangladesh
| | - Ismat Minhaj
- International Centre for Diarrhoeal Disease Research, Bangladesh(icddr,b), Dhaka, Bangladesh
| | | | - Nowshin Papri
- International Centre for Diarrhoeal Disease Research, Bangladesh(icddr,b), Dhaka, Bangladesh
| | | | - Lubaba Sharin
- International Centre for Diarrhoeal Disease Research, Bangladesh(icddr,b), Dhaka, Bangladesh
| | - Alana Teman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth D Thomas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kelsey Alland
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alain Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David A Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Munirul Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh(icddr,b), Dhaka, Bangladesh
| | - Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
9
|
Parvin T, Minhaj Uddin I, Islam Bhuyian MS, Saxton R, Zohura F, Sultana M, Johura FT, Monira S, Hasan MT, Papri N, Haque MA, Biswas SK, Sack DA, Perin J, Alam M, George CM. Prospective cohort study of child mouthing of faeces and fomites in Dhaka, Bangladesh (CHoBI7 Program). Trop Med Int Health 2020; 25:976-984. [PMID: 32406964 DOI: 10.1111/tmi.13413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To characterise childhood mouthing and handling behaviours and to assess the association between hand-to-object and object-to-mouth contacts and diarrhoea prevalence in young children in urban Dhaka, Bangladesh. METHODS A prospective cohort study was conducted among 494 children under 5 years of age in Dhaka, Bangladesh. This study was nested within the randomised controlled trial of the Cholera Hospital-Based Intervention for 7 Days (CHoBI7) mobile health (mHealth) program. The CHoBI7 mHealth program focuses on promoting handwashing with soap and water treatment to diarrhoea patients and their household members through mobile messages and a single in person visit. Mouthing and handling of faeces and fomites among young children was measured by five-hour structured observation and caregiver reports. Diarrhoea surveillance data was collected monthly for 12 months. RESULTS Fifty five percent of caregivers reported that their child put a visibly dirty fomite (object or soil) in their mouth in the past week. Caregivers reported that 50% of children had mouthed visibly dirty objects, 26% had mouthed dirt, and 2% had mouthed faeces. Forty five percent of children were observed mouthing a visibly dirty fomite during structured observation, 40% of children were observed mouthing a visibly dirty object, 10% were observed mouthing soil, and one child (0.2%) was observed mouthing faeces. Mouthing of visibly dirty fomites was highest for children 12-18 months of age with 69% of these children having caregiver reports and 54% having observed events. Children with caregiver reports of mouthing faeces had a significantly higher odds of diarrhoea over the subsequent month (Odds Ratio: 4.54; 95% Confidence Interval: 1.06, 19.48). CONCLUSION These findings demonstrate that mouthing of contaminated fomites among young children is frequent in urban environments in Bangladesh, and that mouthing faeces is associated with a significantly higher odds of diarrhoea. Interventions are urgently needed to protect young children from faecal pathogens in their play spaces.
Collapse
Affiliation(s)
- Tahmina Parvin
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ismat Minhaj Uddin
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Ronald Saxton
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Fatema Zohura
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Marzia Sultana
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fatema-Tuz Johura
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shirajum Monira
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Tasdik Hasan
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,University of Liverpool, Liverpool, UK
| | - Nowshin Papri
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Ahshanul Haque
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shwapon K Biswas
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,Rangpur Medical College and Hospital, Rangpur, Bangladesh
| | - David A Sack
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Jamie Perin
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Munirul Alam
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Christine Marie George
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| |
Collapse
|
10
|
|
11
|
Saxton R, Komossa S. Preface. EPJ Web of Conferences 2012. [DOI: 10.1051/epjconf/20123900001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
12
|
Anzai Y, McLachlan S, Morris M, Saxton R, Lufkin RB. Dextran-coated superparamagnetic iron oxide, an MR contrast agent for assessing lymph nodes in the head and neck. AJNR Am J Neuroradiol 1994; 15:87-94. [PMID: 7511324 PMCID: PMC8332075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE To investigate dextran-coated superparamagnetic iron oxide particles (BMS 180549) as an MR contrast agent for assessing lymph nodes. METHODS Five different doses ranging from 0.3 to 1.7 mg Fe/kg were evaluated in five healthy human male subjects as part of a phase 1 clinical study. T1-, T2-, and proton density-weighted spin-echo images as well as multiplanar gradient-echo and spoiled gradient-echo images were acquired before and 1 hour, 4 hours, and 24 hours after contrast administration. Image analysis was performed with visually selected regions of interest. Signal intensities were measured for neck lymph nodes and the adjacent muscle. Enhancement effects were evaluated as a function of dose, imaging time after contrast administration, and MR pulse sequence. RESULTS The iron oxide particles were phagocytized by macrophages within the normal functioning lymph nodes, resulting in a dramatic decrease in signal intensity because of magnetic susceptibility effects. T2*-weighted gradient echo and T2-weighted spin echo showed significant decrease in the signal intensity of normal lymph nodes at 24 hours after contrast injection at a dose of 1.7 mg Fe/kg. No significant changes in lymph node signal intensity on T1-weighted spin-echo images were noted at any dose or imaging time point. CONCLUSIONS This preliminary clinical evaluation demonstrates intravenous delivery of an iron-based contrast agent, resulting in negative enhancement of normal lymph nodes.
Collapse
Affiliation(s)
- Y Anzai
- Department of Radiological Sciences, University of California Los Angeles Medical Center 90024-1721
| | | | | | | | | |
Collapse
|
13
|
Abstract
S-100 protein, extracted from bovine brain, is the first described of the modern generation of marker molecules for melanocytic tumours. Despite the observation that many different types of cells express S-100 protein, detection of the molecule in tumour cells in appropriate clinical and pathological circumstances is a widely used and effective adjunct to the determination that a tumour is melanocytic. Antibodies to S-100 protein are best deployed as part of a package that includes antibodies to other melanoma-associated epitopes (HMB-45, NKI-C3/Beteb), cytokeratins and common leukocyte antigen. Antibodies to S-100 protein may also increase the accuracy of melanoma staging and permit detection of small numbers of metastatic tumour cells that are not detectable by conventional histology. Future applications will probably include the wider use of antibodies to the S-100 protein monomers (alpha and beta) and the detection and quantification of S-100 protein in body fluids and tissues.
Collapse
Affiliation(s)
- A J Cochran
- Department of Pathology and Laboratory Medicine, UCLA School of Medicine 90024-1732
| | | | | | | | | |
Collapse
|
14
|
Rabinov RC, Castro DJ, Calcaterra TC, Fu YS, Anderson CT, Bates E, Soudant J, Saxton R. Subglottic plasmacytoma: the use of jet ventilation and contact Nd:YAG laser for tissue diagnosis. J Clin Laser Med Surg 1993; 11:131-4. [PMID: 10146269 DOI: 10.1089/clm.1993.11.131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Extramedullary plasmacytomas (EMP) constitute only 1% of all head and neck malignancies, with the vast majority occurring in the upper respiratory tract. The diagnosis of laryngeal EMP can be difficult since the symptoms are non-specific and the tumor usually mucosally covered. This paper discusses the successful combination of jet Venturi ventilation technique with suspension microlaryngoscopy and contact Nd:YAG laser for tissue diagnosis in a patient presenting with a large subglottic mass. Previous attempts using standard endotracheal intubation and forceps technique for biopsy failed to reach the diagnosis and resulted in significant bleeding from the biopsy site. A review of the disease and technique is presented.
Collapse
Affiliation(s)
- R C Rabinov
- Department of Surgery, Division Head and Neck, UCLA School of Medicine, Los Angeles, CA
| | | | | | | | | | | | | | | |
Collapse
|
15
|
|