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An intensive model of care for hepatitis C virus screening and treatment with direct-acting antivirals in people who inject drugs in Nairobi, Kenya: a model-based cost-effectiveness analysis

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ADDICTION 2022年第2期117卷 411-424页

作者： Mafirakureva, Nyashadzaishe Stone, Jack Fraser, Hannah Nzomukunda, Yvonne Maina, Aron Thiong'o, Angela W. Kizito, Kibango Walter Mucara, Esther W. K. Gonzalez Diaz, C. Ines Musyoki, Helgar Mundia, Bernard Cherutich, Peter Nyakowa, Mercy Lizcano, John Chhun, Nok Kurth, Ann Akiyama, Matthew J. Waruiru, Wanjiru Bhattacharjee, Parinita Cleland, Charles Donchuk, Dmytro Luhmann, Niklas Loarec, Anne Maman, David Walker, Josephine Vickerman, Peter Univ Bristol Bristol Med Sch Populat Hlth Sci Bristol Avon England Med Sans Frontieres MSF Nairobi Kenya Med Monde MdM Nairobi Kenya Natl AIDS & STI Control Programme NASCOP Nairobi Kenya Kenya Aids NGO Consortium KANCO Nairobi Kenya Minist Hlth Republ Kenya Nairobi Kenya Yale Univ New Haven CT USA Montefiore Med Ctr Albert Einstein Coll Med New York NY USA Univ Calif San Francisco San Francisco CA 94143 USA Univ Manitoba Winnipeg MB Canada NYU New York NY 10003 USA Med Sans Frontieres MSF Brussels Belgium Med Monde MdM Paris France Epicentre Paris France

Background and aims Hepatitis C virus (HCV) treatment is essential for eliminating HCV in people who inject drugs (PWID), but has limited coverage in resource-limited settings. We measured the cost-effectiveness of a pilot HCV screening and treatment intervention using directly observed therapy among PWID attending harm reduction services in Nairobi, Kenya. Design We utilized an existing model of HIV and HCV transmission among current and former PWID in Nairobi to estimate the cost-effectiveness of screening and treatment for HCV, including prevention benefits versus no screening and treatment. The cure rate of treatment and costs for screening and treatment were estimated from intervention data, while other model parameters were derived from literature. Cost-effectiveness was evaluated over a life-time horizon from the health-care provider's perspective. One-way and probabilistic sensitivity analyses were performed. Setting Nairobi, Kenya. Population PWID. Measurements Treatment costs, incremental cost-effectiveness ratio (cost per disability-adjusted life year averted). Findings The cost per disability-adjusted life-year averted for the intervention was $975, with 92.1% of the probabilistic sensitivity analyses simulations falling below the per capita gross domestic product for Kenya ($1509;commonly used as a suitable threshold for determining whether an intervention is cost-effective). However, the intervention was not cost-effective at the opportunity cost-based cost-effectiveness threshold of $647 per disability-adjusted life-year averted. Sensitivity analyses showed that the intervention could provide more value for money by including modelled estimates for HCV disease care costs, assuming lower drug prices ($75 instead of $728 per course) and excluding directly-observed therapy costs. Conclusions The current strategy of screening and treatment for hepatitis C virus (HCV) among people who inject drugs in Nairobi is likely to be highly cost-effective with curre

关键词： Chronic hepatitis C cost-effectiveness direct-acting antiviral treatment Kenya low-income setting people who inject drugs

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Rapid situational assessment of people who inject drugs (PWID) in Nairobi and coastal regions of Kenya: a respondent driven sampling survey

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BMC PUBLIC HEALTH 2021年第1期21卷 1-18页

作者： Oguya, Francis O. Kenya, Patrick R. Ongecha, Francisca Mureithi, Patrick Musyoka, Helgar Muraguri, Nicholas Mundia, Ben Angira, Caleb Shose, Mohammed Basheeb, Taib A. Mohamed, Abdalla Ahmed Oyore, John P. Ochieng, Otieno G. Dida, Gabriel O. Abdalla, Saade Abdool, Reychard Tech Univ Kenya Dept Hlth Syst Management & Publ Hlth Nairobi Kenya Int Ctr Hlth Intervent Res Africa ICHIRA Nairobi Kenya Kenyatta Univ Dept Clin Med Nairobi Kenya Natl AIDS Control Council NACC Nairobi Kenya Natl AIDS & STDs Control Programme NASCOP Nairobi Kenya Nairobi Outreach Serv Trust NOSET Nairobi Kenya OMARI Malindi Nairobi Kenya Reachout Ctr Trust Nairobi Kenya Muslim Educ Welf Assoc MEWA Nairobi Kenya Kenyatta Univ Sch Publ Hlth Nairobi Kenya United Nations Off Drugs Crime UNODC ROEA Nairobi Kenya

Background A Cross-sectional Rapid Situational Assessment of People Who Inject Drug (PWIDs) applying Respondent Driven sampling techniques (RDS) was used to recruit subjects/participants in a study aimed at assessing HIV prevalence and risk behaviors among injecting drug users in Nairobi and Coastal regions of Kenya. There is paucity of data and information on injecting drug use in sub-Saharan Africa and there is sufficient evidence of existence of the environment for development and growth of injecting drug use. Past studies on PWID and its association to HIV and aids that have been conducted in Kenya do not provide sufficient information to support effective planning and comprehensive national response to the HIV and aids epidemic. Methods A cross-sectional study design was adopted in which a set of initial subjects referred to as 'seeds' were first identified from which an expanding chain of referrals were obtained, with subjects from each wave referring subjects of subsequent waves. The seeds were drawn randomly from the population and interviewed to pick the one with the largest network and other unique characteristics. A maximum of twelve seeds were recruited. The second stage involved conducting assessment visits to the sites to identify potential collaborators that included non-governmental organizations (NGOs), drug treatment centres, health facilities, community based organizations (CBO's) among others. Three NGOs located in the coast region and one in Nairobi region were identified to assist in identifying drug injection locations and potential participants. Key informant interviews (KIIs) and Focus Group Discussions (FGDs) were also conducted using interview guides. Results A total of 646 individuals (344 in Nairobi and 302 at the coast) were recruited for the study between January and March 2010. Of these 590 (91%) were male and 56 (9%) were female. Findings showed that most PWIDs initiated injecting drug use between the ages of 20-29 years, with the yo

关键词： HIV-related behaviors Injection drug users (PWIDs) Mombasa Nairobi Respondent driven sampling Kenya

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A decade and beyond: learnings from HIV programming with underserved and marginalized key populations in Kenya

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JOURNAL OF THE INTERNATIONAL aids SOCIETY 2021年第S3期24卷 e25729页

作者： Musyoki, Helgar Bhattacharjee, Parinita Sabin, Keith Ngoksin, Ed Wheeler, Tisha Dallabetta, Gina Minist Hlth Natl AIDS & STI Control Programme NASCOP Nairobi Kenya Univ Manitoba Inst Global Publ Hlth Winnipeg MB Canada Partners Hlth & Dev Africa Nairobi Kenya Joint United Nations Programme HIV AIDS UNAIDS Geneva Switzerland Global Fund Fight AIDS TB & Malaria GFATM Geneva Switzerland US Agcy Int Dev USAID Washington DC USA Bill & Melinda Gates Fdn Seattle WA USA

Introduction Key populations (KP) continue to account for high HIV incidence globally. Still, prioritization of KP in the national HIV prevention response remains insufficient, leading to their suboptimal access to HIV programmes. This commentary aims to share Kenya's challenges and successes in achieving 2020 global HIV targets and scaling up the KP programme in the last decade. Discussion The KP programme in Kenya has scaled up in the last decade with the inclusion of female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), transgender people and people in prisons as priority populations in the national HIV response. KP coverage based on official size estimates for FSW is 73%, for MSM is 82%, for PWID through needle syringe programme (NSP) is 71%, and through opioid substitution therapy (OST) is 26% and for transgender people is 5%. The service outcomes for KP have been relatively strong in prevention with high condom use at last paid sex for FSW (92%) and use of sterile equipment among PWID (88%), though condom use at last sex with a non-regular partner among MSM (78%) is still low. The KP programme has not met care continuum targets for all subpopulations with low case findings. The national KP programme led by the Ministry of Health has scaled up the programme through (a) strategic partnerships with KP-led and competent organizations, researchers and donors;(b) development of policy guidance and programme standards;(c) continuous sensitization and advocacy to garner support;(d) development of national reporting systems, among others. However, the programme is still struggling with uncertain size estimates;lack of updated bio-behavioural survey data;inadequate scale-up of interventions among transgender people and people in prison settings;gaps in reaching adolescent and young KP, and effectively addressing structural barriers like violence and stigma. Conclusions To reach the ambitious global HIV targets, sufficient coverage of

关键词： key populations scale 2020 global HIV targets Kenya HIV programmes

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The effects of COVID-19 on the health and socio-economic security of sex workers in Nairobi, Kenya: Emerging intersections with HIV

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GLOBAL PUBLIC HEALTH 2020年第7期15卷 1073-1082页

作者： Kimani, Joshua Adhiambo, Joyce Kasiba, Rosemary Mwangi, Peninah Were, Veronica Mathenge, John Macharia, Pascal Cholette, Francois Moore, Samantha Shaw, Souradet Becker, Marissa Musyoki, Helgar Bhattacharjee, Parinita Moses, Stephen Fowke, Keith R. McKinnon, Lyle R. Lorway, Robert Univ Manitoba Dept Med Microbiol & Infect Dis 504-745 Bannatyne Ave Winnipeg MB R3M 1N4 Canada Univ Nairobi Dept Med Microbiol Nairobi Kenya Sex Worker Outreach Program SWOP Nairobi Kenya Bar Hostess Empowerment & Support Programme BHESP Nairobi Kenya Hlth Opt Young Men HIV AIDS STI HOYMAS Nairobi Kenya Univ Manitoba Inst Global Publ Hlth IGPH Winnipeg MB Canada Univ Manitoba Dept Community Hlth Sci Winnipeg MB Canada Minist Hlth Natl AIDS & STI Control Programme NASCOP Nairobi Kenya Partners Hlth & Dev Africa PHDA Nairobi Kenya Ctr AIDS Programme Res South Africa CAPRISA Durban South Africa

The COVID-19 pandemic, and its attendant responses, has led to massive health, social, and economic challenges on a global scale. While, so far, having a relatively low burden of COVID-19 infection, it is the response in lower- and middle- income countries that has had particularly dire consequences for impoverished populations such as sex workers, many of whom rely on regular income in the informal economic sector to survive. This commentary captures the challenges in Kenya posed by daily curfews and lost economic income, coupled with further changes to sex work that increase potential exposure to infection, stigmatisation, violence, and various health concerns. It also highlights the ways in which communities and programmes have demonstrated resourcefulness in responding to this unprecedented disruption in order to emerge healthy when COVID-19, and the measures to contain it, subside.

关键词： COVID-19 sex workers Africa public health response stigma

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Point-of-care testing can achieve same-day diagnosis for infants and rapid ART initiation: results from government programmes across six African countries

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JOURNAL OF THE INTERNATIONAL aids SOCIETY 2021年第3期24卷 e25677页

作者： Boeke, Caroline E. Joseph, Jessica Wang, Melody Abate, Zelalem M. Atem, Charles Coulibaly, Khady Diatou Kebede, Adisu Kiernan, Brianan Kingwara, Leonard Mangwendeza, Phibeon Maparo, Tatenda Mbaye, Rose Nadege Mukungunugwa, Solomon Ngugi, Catherine Nzuobontane, Divine Assoumou, Marie Claire Okomo Reta, Yemsirach Wambugu, Barbara Rioja, Maria R. Peter, Trevor Doi, Naoko Vojnov, Lara Khan, Shaukat Sacks, Jilian A. Clinton Hlth Access Initiat Boston MA USA Clinton Hlth Access Initiat Addis Ababa Ethiopia Clinton Hlth Access Initiat Yaounde Cameroon Minist Sante & Act Sociale Div Lutte SIDA & IST Dakar Senegal Ethiopian Publ Hlth Inst Addis Ababa Ethiopia Clinton Hlth Access Initiat Dakar Senegal Natl HIV Reference Lab Nairobi Kenya Natl AIDS & STI Control Programme NASCOP Nairobi Kenya Clinton Hlth Access Initiat Harare Zimbabwe Minist Hlth & Child Care Harare Zimbabwe Natl Publ Hlth Lab Yaounde Cameroon

Introduction Point-of-care (POC) early infant diagnosis (EID) testing has been shown to dramatically decrease turnaround times from sample collection to caregiver result receipt and time to ART initiation for HIV-positive infants compared to centralized laboratory testing. As governments in sub-Saharan Africa implement POC EID technologies, we report on the feasibility and effectiveness of POC EID testing and the impact of same-day result delivery on rapid ART initiation within national programmes across six countries. Methods This pre-/post-evaluation compared centralized laboratory-based (pre) with POC (post) EID testing in 52 facilities across Cameroon, Democratic Republic of Congo, Ethiopia, Kenya, Senegal and Zimbabwe between April 2017 and October 2019 (country-dependent). Data were collected retrospectively from routine records at health facilities for all infants tested under two years of age. Hazard ratios and 95% confidence intervals were calculated to compare time-to-event outcomes, visualized with Kaplan-Meier curves, and the Somers' D test was used to compare continuous outcomes. Results Data were collected for 2892 EID tests conducted on centralized laboratory-based platforms and 4610 EID tests on POC devices with 127 (4%) and 192 (4%) HIV-positive infants identified, respectively. POC EID significantly reduced the time from sample collection to caregiver result receipt (POC median: 0 days, IQR: 0 to 0 vs. centralized: 35 days, IQR: 26 to 56) and time from sample collection to ART initiation for HIV-positive infants (POC median: 1 day, IQR: 0 to 7 vs. centralized: 39 days, IQR: 26 to 57). With POC testing, 72% of infants received results on the same day as sample collection;HIV-positive infants with a same-day diagnosis had six times the rate of ART initiation compared to those diagnosed one or more days after sample collection (HR: 6.39;95% CI: 3.44 to 11.85). Conclusions Same-day diagnosis and treatment initiation for infants is possible with POC EID

关键词： point of care early infant diagnosis Africa ART initiation turnaround times

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Evaluation of near point-of-care viral load implementation in public health facilities across seven countries in sub-Saharan Africa

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JOURNAL OF THE INTERNATIONAL aids SOCIETY 2021年第1期24卷 e25663页

作者： Boeke, Caroline E. Joseph, Jessica Atem, Charles Banda, Clement Coulibaly, Khady Diatou Doi, Naoko Gunda, Andrews Kandulu, James Kiernan, Brianan Kingwara, Leonard Maokola, Werner Maparo, Tatenda Mbaye, Rose Nadege Mtumbuka, Esther Mziray, Joseph Ngugi, Catherine Nkakulu, Jeanine Nzuobontane, Divine Assoumo, Marie Claire Okomo Peter, Trevor Rioja, Maria R. Sacks, Jilian A. Simbi, Raiva Vojnov, Lara Khan, Shaukat A. Clinton Hlth Access Initiat Boston MA USA Clinton Hlth Access Initiat Yaounde Cameroon Clinton Hlth Access Initiat Lilongwe Malawi Minist Sante & Act Sociale Div Lutte SIDA & IST Dakar Senegal Minist Hlth & Populat Lilongwe Malawi Clinton Hlth Access Initiat Dakar Senegal Natl HIV Reference Lab NASCOP SI Unit Nairobi Kenya MOHCDGEC NACP Dar Es Salaam Tanzania Clinton Hlth Access Initiat Harare Zimbabwe Clinton Hlth Access Initiat Dar Es Salaam Tanzania Natl AIDS & STI Control Programme NASCOP Nairobi Kenya Clinton Hlth Access Initiat Kinshasa DEM REP CONGO Natl Publ Hlth Lab Yaounde Cameroon Minist Hlth & Child Care Harare Zimbabwe

Introduction In many low- and middle-income countries, HIV viral load (VL) testing occurs at centralized laboratories and time-to-result-delivery is lengthy, preventing timely monitoring of HIV treatment adherence. Near point-of-care (POC) devices, which are placed within health facility laboratories rather than clinics themselves (i.e. "true" POC), can offer VL in conjunction with centralized laboratories to expedite clinical decision making and improve outcomes, especially for patients at high risk of treatment failure. We assessed impacts of near-POC VL testing on result receipt and clinical action in public sector programmes in Cameroon, Democratic Republic of Congo, Kenya, Malawi, Senegal, Tanzania and Zimbabwe. Methods Routine health data were collected retrospectively after introducing near-POC VL testing at 57 public sector health facilities (2017 to 2019, country-dependent). Where possible, key indicators were compared to data from patients receiving centralized laboratory testing using hazard ratios and the Somers' D test. Results Data were collected from 6795 tests conducted on near-POC and 17614 tests on centralized laboratory-based platforms. Thirty-one percent (2062/6694) of near-POC tests were conducted for high-risk populations: pregnant and breastfeeding women, children and those with suspected failure. Compared to conventional testing, near-POC improved the median time from sample collection to return of results to patient [six vs. sixty-eight days, effect size: -32.2%;95% CI: -41.0% to -23.4%] and to clinical action for individuals with an elevated HIV VL [three vs. fourty-nine days, effect size: -35.4%;95% CI: -46.0% to -24.8%]. Near-POC VL results were two times more likely to be returned to the patient within 90 days compared to centralized tests [50% (1781/3594) vs. 27% (4172/15271);aHR: 2.22, 95% CI: 2.05 to 2.39]. Thirty-seven percent (340/925) of patients with an elevated near-POC HIV VL result had documented clinical follow-up actions with

关键词： point of care viral load monitoring Africa viral suppression

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Effects and cost of different strategies to eliminate hepatitis C virus transmission in Pakistan: a modelling analysis

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LANCET GLOBAL HEALTH 2020年第3期8卷 E440-E450页

作者： Lim, Aaron G. Walker, Josephine G. Mafirakureva, Nyashadzaishe Khalid, Gul Ghuttai Qureshi, Huma Mahmood, Hassan Trickey, Adam Fraser, Hannah Aslam, Khawar Falq, Gregoire Fortas, Camille Zahid, Hassaan Naveed, Ammara Auat, Rosa Saeed, Quaid Davies, Charlotte F. Mukandavire, Christinah Glass, Nancy Maman, David Martin, Natasha K. Hickman, Matthew May, Margaret T. Hamid, Saeed Loarec, Anne Averhoff, Francisco Vickerman, Peter Univ Bristol Bristol Med Sch Populat Hlth Sci Bristol BS8 2BN Avon England Med Sans Frontieres Brussels Belgium Doctors Plaza Karachi Pakistan Pakistan Hlth Res Council Islamabad Pakistan WHO Islamabad Pakistan Med Sans Frontieres Epictr Paris France Pasteur Inst Paris France Pakistan Kidney & Liver Inst & Res Ctr Dept Gastroenterol & Hepatol Lahore Pakistan Natl AIDS Control Programme Islamabad Pakistan Imperial Coll London Dept Infect Dis Epidemiol London England Ctr Dis Control & Prevent Div Viral Hepatitis Natl Ctr HIV AIDS Viral Hepatitis STD & TB Preven Atlanta GA USA Univ Calif San Diego Dept Med Div Infect Dis & Global Publ Hlth La Jolla CA 92093 USA Aga Khan Univ Karachi Pakistan

Background The WHO elimination strategy for hepatitis C virus advocates scaling up screening and treatment to reduce global hepatitis C incidence by 80% by 2030, but little is known about how this reduction could be achieved and the costs of doing so. We aimed to evaluate the effects and cost of different strategies to scale up screening and treatment of hepatitis C in Pakistan and determine what is required to meet WHO elimination targets for incidence. Methods We adapted a previous model of hepatitis C virus transmission, treatment, and disease progression for Pakistan, calibrating using available data to incorporate a detailed cascade of care for hepatitis C with cost data on diagnostics and hepatitis C treatment. We modelled the effect on various outcomes and costs of alternative scenarios for scaling up screening and hepatitis C treatment in 2018-30. We calibrated the model to country-level demographic data for 1960-2015 (including population growth) and to hepatitis C seroprevalence data from a national survey in 2007-08, surveys among people who inject drugs (PWID), and hepatitis C seroprevalence trends among blood donors. The cascade of care in our model begins with diagnosis of hepatitis C infection through antibody screening and RNA confirmation. Diagnosed individuals are then referred to care and started on treatment, which can result in a sustained virological response (effective cure). We report the median and 95% uncertainty interval (UI) from 1151 modelled runs. Findings One-time screening of 90% of the 2018 population by 2030, with 80% referral to treatment, was projected to lead to 13.8 million (95% UI 13.4-14.1) individuals being screened and 350 000 (315 000-385 000) treatments started annually, decreasing hepatitis C incidence by 26.5% (22.5-30.7) over 2018-30. Prioritised screening of high prevalence groups (PWID and adults aged >= 30 years) and rescreening (annually for PWID, otherwise every 10 years) are likely to increase the number screened

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Cost-effectiveness of screening and treatment using direct-acting antivirals for chronic hepatitis C virus in low- and middle-income settings

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JOURNAL OF HEPATOLOGY 2020年 73卷 S812-S813页

作者： Walker, Josephine Mafirakureva, Nyashadzaishe Marquez, Lara Stone, Jack Lim, Aaron G. Campbell, Linda Khalid, Gul Ghuttai Iwamoto, Momoko Aslam, Khawar Wailly, Yves Zahid, Hassaan Donchuk, Dmytro Fortas, Camille Falq, Gregoire Soe, Kyi Piar Chaillon, Antoine Lo Re, Vincent, III Wynn, Adriane McIntosh, Craig Johnson, Derek Zosso, Jean-Marc Nguyen, Aude Kiene, Susan Brodine, Stephanie Garfein, Richard Hastings, Reuben Kimchamroeun, San Le Paih, Mickael Dousset, Jean-Philippe Balkan, Suna Marquardt, Tonia Mucara, Esther Gonzalez, C. Ines Kizito, Walter Nzomukunda, Yvonne Cherutich, Peter Cleland, Charles Lizcano, John Chhun, Nok Kurth, Ann Musyoki, Helgar Bhattacharjee, Parinita Waruiru, Wanjiru Mundia, Ben Maman, David Luhmann, Niklas Coast, Joanna Loarec, Anne Martin, Natasha Vickerman, Peter Univ Bristol Bristol Avon England Univ Calif San Diego La Jolla CA 92093 USA Med Sans Frontieres Brussels Belgium Epicentre Paris France Univ Penn Philadelphia PA 19104 USA San Diego State Univ San Diego CA 92182 USA Med Monde Paris France Kenya Minist Hlth Nairobi Kenya NYU New York NY 10003 USA Yale Univ New Haven CT 06520 USA Kenya Natl AIDS & STI Control Programme NASCOP Nairobi Kenya Univ Manitoba Winnipeg MB Canada Univ Calif San Francisco San Francisco CA 94143 USA Kenya Aids NGO Consortium KANCO Nairobi Kenya

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Impact of COVID-19 & Response Measures on HIV-HCV Prevention Services and Social Determinants in People Who Inject Drugs in 13 Sites with Recent HIV Outbreaks in Europe, North America and Israel

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aids AND BEHAVIOR 2023年第4期27卷 1140-1153页

作者： Wiessing, Lucas Sypsa, V Abagiu, A. O. Arble, A. Berndt, N. Bosch, A. Buskin, S. Chemtob, D. Combs, B. Conyngham, C. Feelemyer, J. Fitzgerald, M. Goldberg, D. Hatzakis, A. Patrascu, R. E. Keenan, E. Khan, I Konrad, S. Leahy, J. McAuley, A. Menza, T. Merrick, S. Metcalfe, R. Rademaker, T. Revivo, S. Rosca, P. Seguin-Devaux, C. Skinner, S. Smith, C. Tinsley, J. Wilberg, M. Des Jarlais, D. European Monitoring Ctr Drugs & Drug Addict EMCDD Publ Hlth Unit Praca Europa 1 P-1249289 Lisbon Portugal Natl & Kapodistrian Univ Athens Med Sch Dept Hyg Epidemiol & Med Stat Athens Greece Natl Inst Infect Dis Bucharest Romania Hamilton Cty Publ Hlth Cincinnati OH USA Luxembourg Natl Focal Point European Monitoring C Directorate Hlth Dept Epidemiol & Stat Luxembourg Luxembourg Minnesota Dept Hlth STD HIV & TB Sect Infect Dis Epidemiol Prevent & Control St Paul MN USA Univ Washington Seattle WA 98195 USA Publ Hlth Seattle & King Cty Seattle WA USA Minist Hlth Dept TB & AIDS Jerusalem Israel Hebrew Univ Jerusalem Braun Sch Publ Hlth & Community Med Hadassah Med Sch Jerusalem Israel Scott Cty Hlth Dept Scottsburg IN USA Philadelphia Dept Publ Hlth Philadelphia PA USA NYU Sch Global Publ Hlth New York NY USA Hlth Serv Execut Natl Social Inclus Off Dublin Ireland Publ Hlth Scotland Glasgow Lanark Scotland Indigenous Serv Canada First Nations & Inuit Hlth Branch Regina SK Canada Oregon Hlth Author Portland OR USA Glasgow Caledonian Univ Sch Hlth & Life Sci Glasgow Lanark Scotland Oregon Hlth & Sci Univ Portland OR 97201 USA Sandyford Sexual Hlth Serv Glasgow Lanark Scotland Minist Hlth Dept Treatment Subst Abuse Jerusalem Israel Luxembourg Inst Hlth Dept Infect & Immun Esch Sur Alzette Luxembourg Univ Saskatchewan Saskatoon SK Canada Minnesota Dept Human Serv St Paul MN USA Publ Hlth Assoc Izhar Needle & Syringe Programme Jerusalem Israel

HIV/HCV prevention among people who inject drugs (PWID) is of key public health importance. We aimed to assess the impact of COVID-19 and associated response measures on HIV/HCV prevention services and socio-economic status of PWID in high-HIV-risk sites. Sites with recent (2011-2019) HIV outbreaks among PWID in Europe North America and Israel, that had been previously identified, were contacted early May 2020. Out of 17 sites invited to participate, 13 accepted. Semi-structured qualitative site reports were prepared covering data from March to May 2020, analyzed/coded and confirmed with a structured questionnaire, in which all sites explicitly responded to all 103 issues reported in the qualitative reports. Opioid maintenance treatment, needle/syringe programs and antiretroviral treatment /hepatitis C treatment continued, but with important reductions and operational changes. Increases in overdoses, widespread difficulties with food and hygiene needs, disruptions in drug supply, and increased homelessness were reported. Service programs rapidly reformed long established, and politically entrenched, restrictive service delivery policies. Future epidemic control measures should include mitigation of negative side-effects on service provision and socio-economic determinants in PWID.

关键词： HIV Hepatitis C COVID-19 People who inject drugs (PWID) Treatment Prevention Services Epidemiology Social determinants Outbreaks Homelessness Overdose

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Water insecurity and sexual and gender-based violence among refugee youth: qualitative insights from a humanitarian setting in Uganda

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JOURNAL OF WATER SANITATION AND HYGIENE FOR DEVELOPMENT 2022年第12期12卷 883-893页

作者： Logie, Carmen Okumu, Moses Coelho, Madelaine Loutet, Miranda Narasimhan, Manjulaa Lukone, Simon Odong Kisubi, Nelson Musoke, Daniel Kibuuka Kyambadde, Peter Dorea, Caetano Taing, Lina Univ Toronto Factor Inwentash Fac Social Work Toronto ON M5S 1V4 Canada United Nations Univ Inst Water Environm Hlth Hamilton ON L8P 0A1 Canada Ctr Gender & Sexual Hlth Equ Vancouver BC V6Z 2K5 Canada Womens Coll Hosp Womens Coll Res Inst Toronto ON M5G 1N8 Canada Univ Illinois Sch Social Work Urbana IL 61801 USA Uganda Christian Univ Sch Social Sci Mukono Uganda Univ Toronto Dept Sociol Toronto ON M5S 2J4 Canada Univ Toronto Dalla Lana Sch Publ Hlth Toronto ON M5T 3M7 Canada UNDP UNFPA UNICEF WHOWorld Bank Special Programme ResDept Sexual & Geneva Switzerland Uganda Refugee & Disaster Management Council URDMC Yumbe Uganda Int Res Consortium Kampala Uganda Natl STD HIV AIDS Control Program Ugandan Minist Hlth Kampala Uganda Most Risk Populat Initiat MARPI Kampala Uganda Univ Victoria Dept Civil Engn Victoria BC V8W 2Y2 Canada McMaster Univ Sch Geog & Earth Sci Hamilton ON L8S 4K1 Canada

Refugee youth disproportionately experience sexual and gender-based violence (SGBV) and water insecurity, yet their SGBV experiences in the context of water insecurity are understudied. In this qualitative study, we conducted six focus groups (n = 48) and in-depth individual interviews (IDI) (n = 12) with refugee youth aged 16-24, and IDI with refugee elders (n = 8) in Bidi Bidi refugee Settlement, Uganda. We applied thematic analysis informed by a social contextual framework and found that (1) SGBV is gendered, whereby adolescent girls and young women (AGYW) were targets for violence (symbolic context), and is intertwined with gender norms linked to AGYW's water collection roles (relational context);(2) water scarcity and off-site access to water infrastructure, combined with limited lighting, provide insecure environments that exacerbate AGYW's SGBV risks (material context);(3) participant generated solutions to water insecurity-related SGBV included engaging men and communities in dialogue and water collection (relational context), technology (e.g., solar lighting), improved security, and additional water points (material context). Findings signal the need to integrate water and sanitation hygiene development with SGBV prevention and sexual health (e.g., post-rape care) interventions. Refugee youth and communities should be meaningfully engaged in developing contextually relevant, gender transformative services to mitigate SGBV risks and advance health and rights.

关键词： focus group discussions refugees safety self-care sexual and gender-based violence WASH water insecurity youth

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