The Tuberculosis Sentinel Research Network (TB-SRN) of the International epidemiology Databases to Evaluate AIDS (IeDEA): protocol for a prospective cohort study in Africa, Southeast Asia and Latin America

INTRODUCTION

Tuberculosis (TB) is a leading infectious cause of death globally. It is the most common opportunistic infection in people living with HIV, and the most common cause of their morbidity and mortality. Following TB treatment, surviving individuals may be at risk for post-TB lung disease. The TB Sentinel Research Network (TB-SRN) provides a platform for coordinated observational TB research within the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium.

METHODS AND ANALYSIS

This prospective, observational cohort study will assess treatment and post-treatment outcomes of pulmonary TB (microbiologically confirmed or clinically diagnosed) among 2600 people aged ≥15 years, with and without HIV coinfection, consecutively enrolled at 16 sites in 11 countries, across 6 of IeDEA's global regions. Data regarding clinical and sociodemographic factors, mental health, health-related quality of life, pulmonary function, and laboratory and radiographic findings will be collected using standardised questionnaires and data collection tools, beginning from the initiation of TB treatment and through 12 months after the end of treatment. Data will be aggregated for proposed analyses.

ETHICS AND DISSEMINATION

Ethics approval was obtained at all implementing study sites, including the Vanderbilt University Medical Center Human Research Protections Programme. Participants will provide informed consent; for minors, this includes both adolescent assent and the consent of their parent or primary caregiver. Protections for vulnerable groups are included, in alignment with local standards and considerations at sites. Procedures for requesting use and analysis of TB-SRN data are publicly available. Findings from TB-SRN analyses will be shared with national TB programmes to inform TB programming and policy, and disseminated at regional and global conferences and other venues.

Low birth weight among infants and pregnancy outcomes among women living with HIV and HIV-negative women in Rwanda

Introduction

In utero exposure to HIV and/or triple antiretroviral therapy (ART) have been shown to be associated with preterm births and low birth weight (LBW), but data from low-resources settings with high burden of HIV remain limited. This study utilized retrospective data to describe pregnancy outcomes among Rwandan women living with HIV (WLHIV) and HIV-negative women and to assess the association of HIV and ART with LBW.

Methods

This study used data from a large cohort of WLHIV and HIV-negative women in Rwanda for a cross-sectional analysis. Retrospective data were collected from antenatal care (ANC), delivery, and Prevention of Mother to Child Transmission (PMTCT) registries within the Central Africa International Epidemiology Databases to Evaluate AIDS (CA-IeDEA) in Rwanda. Data from women with documented HIV test results and known pregnancy outcomes were included in the analysis. Analyses for predictors of LBW (< 2,500 g) were restricted to singleton live births. Logistic models were used to identify independent predictors and estimate the odd ratios (OR) and 95% confidence intervals (CI) measuring the strength of their association with LBW.

Results and discussion

Out of 10,608 women with known HIV status and with documented pregnancy outcomes, 9.7% (n = 1,024) were WLHIV. We restricted the sample to 10,483 women who had singleton live births for the analysis of the primary outcome, LBW. Compared with HIV-negative women, WLHIV had higher rates of stillbirth, preterm births, and LBW babies. Multivariable model showed that WLHIV and primigravidae had higher odds of LBW. Lower maternal weight and primigravidae status were associated with greater odds of LBW. Among WLHIV, the use of ART was associated with significantly lower odds of LBW in a bivariate analysis. Even in a sample of relatively healthier uncomplicated pregnancies and women who delivered in low-risk settings, WLHIV still had higher rates of poor pregnancy outcomes and to have LBW infants compared to women without HIV. Lower maternal weight and primigravidae status were independently associated with LBW. Given that supplementary nutrition to malnourished pregnant women is known to decrease the incidence of LBW, providing such supplements to lower-weight WLHIV, especially primigravidae women, might help reduce LBW.

Techniques for Increasing Educational Motivation and the Need to Assess Students' Knowledge: The Effectiveness of Educational Digital Games in Learning English Grammatical Material

Educational digital games can be an effective way to teach English grammatical material because they provide an interactive and engaging learning experience. The purpose of this study is to clarify how playing digital games affects students' motivation and performance in university-level English grammar classes. [The North-Eastern Federal Institute of MK Ammosova in Neryungri] used a quasi-experimental study, testing, respondent survey, and statistical data analysis method for this purpose. 114 Fourth-year students were the participants, and they were split into the experimental and control groups at random. Students in the experimental group were given a learning format that included the use of digital games designed to teach English grammar (Quizlet and Kahoot!). The traditional teaching strategies offered by the university curriculum were used with the students in the control group (written assignments, textbooks, presentations, and tests). The post-test revealed that the control group's results were nearly identical to those of the pre-test. The students in the experimental group performed better. The proportion of students scoring "poor" fell from 30 to 10%, while the proportion scoring "moderate" fell from 42 to 27%. The "good" score increased from 17 to 40%, and the "excellent" score increased from 11 to 23%. These results suggest that digital games are a more productive and effective tool for teaching English grammar than traditional games. Students were also highly motivated, as they found digital games to be both entertaining and effective for language acquisition. Academic performance did not significantly improve. Based on this, future research might create electives or courses that teach English grammar more successfully using gamification techniques. These results can also be used to guide future research in education, language acquisition, and modern technology.

HIV disclosure and depressive symptoms among pregnant women living with HIV: a cross‐sectional study in the Democratic Republic of Congo

Introduction

Methods

Results

Conclusions

Worry, work, discrimination: Socioecological model of psychological distress among Central Asian immigrant women in Russia

The Russian Federation is a major immigrant-receiving nation and hosts large immigrant populations from post-Soviet countries including Central Asia. However, there is yet little research on their health needs, and especially on mental health of immigrant women. This study uses qualitative data from 72 interviews with women from Kyrgyzstan, Tajikistan, and Uzbekistan conducted in two large cities in Central Russia, Kazan and Nizhny Novgorod, from April 2014 to February 2017. This study examines psychological distress among immigrant women and applies a gendered socioecological lens to understand its causes. We have identified intersecting factors that operate at different levels and cause distress in Central Asian immigrant women in Russia. Gendered vulnerabilities, persistent worry about their families' well-being, separation from loved ones, and limited sources of social support are key individual and interpersonal level of distress factors. Poor working and housing conditions along with economic hardships and concerns over their ability to reach the goals that guided their decisions to move to Russia reinforce experienced distress among immigrant women. Discrimination against Central Asian nationals and structural racism amplify challenges for immigrants' psychological well-being and mental health in Russia. By investigating underlying factors of psychological distress among an understudied immigrant population, this study defines configurations of Russia's risk environment and contributes to an understanding of migration as an important determinant of mental health.

Financial and Emotional Support in Close Personal Ties among Central Asian Migrant Women in Russia

This study advances research on the role of personal networks as sources of financial and emotional support in immigrants' close personal ties beyond the immediate family. Because resource scarcity experienced by members of immigrant communities is likely to disrupt normatively expected reciprocal support, we explored multi-level predictors of exchange processes with personal network members that involve (1) only receiving support, (2) only providing support, and (3) reciprocal support exchanges. We focus on an understudied case of Central Asian migrant women in the Russian Federation using a sample of 607 women from three ethnic groups-Kyrgyz, Tajik, Uzbek-who were surveyed in two large Russian cities-Nizhny Novgorod and Kazan. The survey collected information on respondents' demographic, socioeconomic, and migration-related characteristics, as well as characteristics of up to five individuals with whom they had a close relationship. Multi-level multinomial regression analyses were used to account for the nested nature of the data. Our results revealed that closer social relationships (siblings and friends) and greater levels of resources (income and regularized legal status) at both ego and alter levels were positively related to providing, receiving, and reciprocally exchanging financial and emotional support. Egos were more likely to provide financial assistance to transnational alters, whereas they were more likely to engage in mutual exchanges of emotional support with their network members from other countries. Personal network size and density showed no relationship with support exchanges. These findings provide a nuanced picture of close personal ties as conduits for financial and emotional support in migrant communities in a major, yet understudied, migrant-receiving context.