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Hodder S.L.,New Jersey Medical School | Justman J.,Columbia University | Hughes J.P.,University of Washington | Wang J.,Fred Hutchinson Cancer Research Center | And 11 more authors.
Annals of Internal Medicine | Year: 2013

Background: Women account for 23% of newly diagnosed HIV infections in the United States, but there are few recent, wellcharacterized cohorts of U.S. women in whom behavior characteristics and HIV acquisition have been well-described. Objective: To evaluate HIV incidence and describe behaviors among U.S. women residing in areas of high HIV prevalence. Design: Multisite, longitudinal cohort of women who had HIV rapid testing and audio computer-assisted self-interviews at baseline and every 6 months for up to 12 months. (ClinicalTrials.gov: NCT00995176) Setting: 10 urban and periurban communities with high HIV prevalence and poverty rates, located in the northeastern and southeastern United States. Patients: Venue-based sampling was used to recruit women aged 18 to 44 years who recently had unprotected sex and had 1 or more additional personal or partner risk factors and no self-reported previous HIV diagnosis. Measurements: HIV prevalence and incidence, frequency of HIV risk behaviors, and health status perceptions. Results: Among 2099 high-risk women (85.9% black and 11.7% of Hispanic ethnicity), 32 (1.5%) were diagnosed with HIV infection at enrollment. Annual HIV incidence was 0.32% (95% CI, 0.14% to 0.74%). Older age, substance use, and knowing a partner had HIV were associated with HIV prevalence. Ten women died during the study (0.61% per year). Limitations: Longitudinal assessment of risk behaviors was limited to a maximum of 12 months. There were few incident HIV infections, precluding identification of characteristics predictive of HIV acquisition. Conclusion: This study enrolled a cohort of women with HIV incidence substantially higher than the Centers for Disease Control and Prevention national estimate in the general population of U.S. black women. Concerted efforts to improve preventive health care strategies for HIV and overall health status are needed for similar populations. Primary Funding Source: National Institutes of Health. © 2013 American College of Physicians.

News Article | October 26, 2016
Site: www.eurekalert.org

A multipronged approach to supporting healthy breastfeeding among new mothers was effective when implemented at the population level, according to research published in PLOS Medicine. In cluster-randomized evaluations of two programs in Viet Nam and Bangladesh, Purnima Menon of the International Food Policy Research Institute in Washington, DC, and colleagues compared the effect of a program combining intensive interpersonal counseling (IPC), mass media (MM), and community mobilization (CM) to encourage breastfeeding (intensive group) to that of standard nutrition counseling and less intensive MM and CM (non-intensive group). In Bangladesh IPC was delivered through a large non-governmental health program, while in Viet Nam it was integrated into government health facilities. The researchers compared surveyed breastfeeding practices in households with children less than 6 months old before the interventions started and again four years later. They found positive population-level impacts on breastfeeding practices, including higher rates of early initiation of breastfeeding and exclusive breastfeeding, and lower use of prelacteal feeding and bottle feeding, in areas that received the intensive package compared to areas that received the non-intensive program. In Bangladesh, the percentage of mothers reporting exclusive breastfeeding rose from 48.5% to 87.6% in areas receiving the intensive program, and in Viet Nam the EBF prevalence rose from 18.9% to 57.8%. This is compared to much smaller changes in the areas with the non-intensive program (51.2% to 53.5% in Bangladesh and 17.8% to 28.4% in Viet Nam). The authors note that the findings are reliant on self-reporting of the mothers, who may have felt pressure to report "desirable" behavior, and the surveys only asked the mothers to report their behavior from the previous day, and thus would not capture day-to-day fluctuations in breastfeeding practices. However, they note that this study "shows that comprehensive behavior change strategies implemented at scale, under real-life conditions, and delivered through outreach-based (Bangladesh) and facility-based (Viet Nam) platforms have strong and significant impacts on breastfeeding practices." Funding for this evaluation and the implementation of the interventions was provided by the Bill & Melinda Gates Foundation, through Alive & Thrive, managed by FHI360; additional financial support to the evaluation study was provided by the CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), led by the International Food Policy Research Institute (IFPRI). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. JB, TS, NH, SA, KA and RH are part of the implementation team who delivered the interventions described in this paper. They helped conceive and design the study, but played no role in research data collection or data analysis. Their contributions to this manuscript included written inputs to sections on intervention design, critical in-person discussions regarding interpretation of results, and written review of manuscript drafts. Final decisions about results to include, interpretation and conclusions rested with authors from the evaluation team (PM, RR, EAF, MR, PN, KKS, AKh, AKn, LTM). Menon P, Nguyen PH, Saha KK, Khaled A, Kennedy A, Tran LM, et al. (2016) Impacts on Breastfeeding Practices of At-Scale Strategies That Combine Intensive Interpersonal Counseling, Mass Media, and Community Mobilization: Results of Cluster-Randomized Program Evaluations in Bangladesh and Viet Nam. PLoS Med 13(10): e1002159. doi:10.1371/journal.pmed.1002159 Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, United States of America Alive & Thrive, FHI360, Washington, District of Columbia, United States of America Save the Children, Washington, District of Columbia, United States of America BRAC, Dhaka, Bangladesh University of South Carolina, Columbia, South Carolina, United States of America IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER:

Beksinska M.,University of Witwatersrand | Smit J.,University of Witwatersrand | Joanis C.,Joanis Consulting | Hart C.,FHI360
Contraception | Year: 2012

Background: Female condom (FC) failure (breakage, slippage, invagination and misdirection) declines with user experience. Participants in FC performance trials are commonly novice users, and failure rates may be inflated related to inexperience. Study Design: This was a randomized, crossover study assessing preference, safety, acceptability and function of three new FCs (WC, FC2 and V-Amour) among 170 women in Durban, South Africa. FC failure by condom type use period was investigated in women using five FCs of each type. Results: Of the 2411 condoms used during intercourse, 96 failures (breakage, slippage, invagination and misdirection) occurred in 86 condoms (77 condoms had one failure, 8 condoms had two failures, and 1 condom had three failures). Total clinical failure was comparable across FC types. The number of failures in the first condom use period was 58 (7.0%), and this decreased to 21 events (2.6%) in the second and, finally, 17 (2.1%) in the last condom use period. No failures were reported in the last use of the FC in the final condom use period. Conclusions: FC failure rates decreased markedly after use of the first five condoms, regardless of FC type, and stabilized in the second and third use periods. Consideration should be given to the number of condoms used in trials to ensure that failure rates are not inflated by limiting the numbers of condoms used by novice users. © 2012 Elsevier Inc. All rights reserved.

This Lao PDR trade, which endangers the region's biodiversity, has the potential to be a serious human health threat globally. At seven markets surveyed three times over the course of the study, WCS (Wildlife Conservation Society) researchers and Laos PDR partners observed more than a ton of living and/or recently killed mammals offered for human consumption. The species observed represented 12 taxonomic families capable of hosting 36 serious zoonotic pathogens. Such pathogens can "jump" from animals to humans and cause serious and sometimes rapidly spreading diseases. Examples of these 'zoonotic' pathogens include rabies virus, ebolaviruses, hantaviruses, Severe Acute Respiratory Syndrome (SARS) virus, and highly pathogenic avian influenza H5N1 virus. The market surveillance work was undertaken in Lao PDR by WCS, their government partners, the National Animal Health Laboratory, and FHI360 as part of the USAID-funded PREDICT (predict.global) and PREVENT projects to identify new emerging infectious disease threats and to reduce the risk of transmission to humans. "As veterinarians we have responsibilities for ensuring the public's health," said Dr. Watthana Theppangna, co-author and Head of the PREDICT partner Bio-Safety Level III Laboratory at the Lao PDR National Animal Health Laboratory. "We are worried about the presence of wildlife in markets and the potential for pathogens to spread to people through the wildlife trade." On average, 92 individual mammals per day were observed in conditions that support frequent wildlife/human contact—and ultimately could facilitate pathogen spillover. In addition to the frequent wildlife/human contact due to the volume of animals, researchers observed a lack of biosecurity practices in the seven markets, further indicating the potential for pathogen transmission from infected wildlife to humans. For example, only one of 11 vendors handling and butchering wildlife practiced hand washing, and running water was not present in all markets. In addition, vegetable or other fresh-food products were frequently in contact with wildlife products, providing a route for cross-contamination. According to Dr. Sarah Olson, a co-lead author of the study with WCS's Wildlife Health & Health Policy Program, "Human disease-causing pathogens clearly lurk in wildlife markets. The danger to your health is just less visible than the dangers to conservation. You can usually observe endangered species illegally on sale, but a range of largely invisible pathogens are likely there as well." To understand the conservation threats, the researchers analyzed 375 daily surveys conducted across 93 wildlife markets. A total of 238 individual animals were classified as "threatened with extinction" according to the globally recognized IUCN Red List. Nationally, all wildlife sold in the markets are protected under the Lao PDR Wildlife and Aquatic Law. Of particular concern for conservation were the high volumes of endangered animals observed (turtles, tortoises, deer, lorises, etc.). Also of interest was the finding that wildlife meat was consistently more expensive than domestic animal meat. This sheds light on the present dynamics of wildlife consumption in Lao PDR, suggesting that wildlife is sold in markets to affluent urban consumers, rather than for subsistence consumption. This has further implications for potential disease spread due to the biosecurity conditions in the trade and the movement of wildlife around the country to urban centers. Mr. Soubanh Silithammavong, co-author and PREDICT Country Coordinator in Lao PDR said, "Although enforcement efforts are being made by the Government of Lao PDR to curb the illegal trade in wildlife, the government needs more support to raise capacity to conduct investigations and prosecutions of wildlife traders. This study should help raise awareness of the serious threat that wildlife trade in Lao PDR poses to both biodiversity and human health." More information: Zoe F. Greatorex et al. Wildlife Trade and Human Health in Lao PDR: An Assessment of the Zoonotic Disease Risk in Markets, PLOS ONE (2016). DOI: 10.1371/journal.pone.0150666

Kaale E.,Muhimbili University of Health and Allied Sciences | Manyanga V.,Muhimbili University of Health and Allied Sciences | Makori N.,Supply Chain Management System | Jenkins D.,FHI360 | And 2 more authors.
Tropical Medicine and International Health | Year: 2014

Objective: To assess the sustainability, robustness and economic advantages of high-performance thin layer chromatography (HPTLC) for quality control of pharmaceutical products. Method: We compared three laboratories where three lots of cotrimoxazole tablets were assessed using different techniques for quantifying the active ingredient. Result: The average assay relative standard deviation for the three lots was 1.2 with a range of 0.65-2.0. Conclusion: High-performance thin layer chromatography assessments are yielding valid results suitable for assessing product quality. The local pharmaceutical manufacturer had evolved the capacity to produce very high quality products. © 2014 John Wiley & Sons Ltd.

Guedou F.A.,Laval University | Van Damme L.,FHI360 | Deese J.,FHI360 | Crucitti T.,Institute of Tropical Medicine | And 4 more authors.
BMC Infectious Diseases | Year: 2013

Background: Data on risk factors of recurrent bacterial vaginosis (RBV) are still scarce. We used data from female sex workers (FSW) participating in a randomized controlled microbicide trial to examine predictors of BV recurrence.Methods: Trial's participants with at least an episode of BV which was treated and/or followed by a negative BV result and at least one subsequent visit offering BV testing were included in the analysis. Behavioural and medical data were collected monthly while laboratory testing for STI and genital tract infections were performed quarterly. The Andersen-Gill proportional hazards model was used to determine predictors of BV recurrence both in bivariate and multivariate analyses.Results: 440 women were included and the incidence rate for RBV was 20.8 recurrences/100 person-months (95% confidence interval (CI) =18.1-23.4). In the multivariate analysis controlling for the study site, recent vaginal cleansing as reported at baseline with adjusted hazard-ratio (aHR)=1.30, 95% CI = 1.02-1.64 increased the risk of BV recurrence, whereas consistent condom use (CCU) with the primary partner (aHR=0.68, 95% CI=0.49-0.93) and vaginal candidiasis (aHR=0.70, 95% CI=0.53-0.93), both treated as time-dependent variables, were associated with decreased risk of RBV.Conclusion: This study confirms the importance of counselling high-risk women with RBV about the adverse effects of vaginal cleansing and the protective effects of condom use with all types of partners for the prevention of sexually transmitted infections, including BV. More prospective studies on risk factors of BV recurrence are warranted.Trial registration: Trial registration: NCT00153777. © 2013 Guédou et al.; licensee BioMed Central Ltd.

Rosenbaum J.,FHI360 | Derby E.,Winrock International | Dutta K.,Winrock International
Journal of Health Communication | Year: 2015

The USAID/WASHplus project conducted a comprehensive assessment to understand consumer needs and preferences as they relate to increasing the uptake and consistent, exclusive, and correct use of improved cookstoves (ICSs) in Bangladesh. The assessment included household ICS trials, fuel and stove use monitoring, and consumers perceived value of and willingness to pay for ICSs. Results showed that cooks appreciated and liked the ICS, but that no models met consumer needs sufficiently to replace traditional stoves. Initially, many preferred ICSs over traditional stoves, but this preference decreased over the 3-week trial period. Complaints and suggestions for improvement fell into two general categories: those that can be addressed through fairly simple modifications to the stove design, and those more appropriately addressed through point-of-purchase consumer education and follow-up from service agents or health outreach workers. Most households using the ICS realized fuel use reductions, although these were lower than expected, partly because of continued parallel traditional stove use. When given the option to purchase the stoves at market value, only one of 105 households did so; however, a separate assessment showed that 80% of participants (12 of 15 households) preferred to keep the stove rather than receive a cash buyout at market value. This indicates that users value the ICS when acquisition barriers are removed and highlights the need for better financing options. Copyright © 2015 Taylor & Francis Group, LLC.

Altman D.G.,University of Oxford | Moher D.,Ottawa Hospital Research Institute | Schulz K.F.,FHI360
Statistics in Medicine | Year: 2012

An extensive and growing number of reviews of the published literature demonstrate that health research publications have frequent deficiencies. Of particular concern are poor reports of randomised trials, which make it difficult or impossible for readers to assess how the research was conducted, to evaluate the reliability of the findings, or to place them in the context of existing research evidence. As a result, published reports of trials often cannot be used by clinicians to inform patient care or to inform public health policy, and the data cannot be included in systematic reviews. Reporting guidelines are designed to identify the key information that researchers should include in a report of their research. We describe the history of reporting guidelines for randomised trials culminating in the CONSORT Statement in 1996. We detail the subsequent development and extension of CONSORT and consider related initiatives aimed at improving the reliability of the medical research literature. © 2012 John Wiley & Sons, Ltd.

This study reports on findings of a pilot of community-based distribution (CBD) of injectable contraceptives in two local government areas (LGAs) of Gombe State, Nigeria. From August 2009 to January 2010, the project enrolled, trained and equipped community health extension workers (CHEWs) to distribute condoms, oral and injectable contraceptives in communities. The project mobilized communities and stakeholders to promote Family Planning (FP) services in the selected communities. Using anonymised unlinked routine service data, the mean couple years of protection (CYP) achieved through CBD was compared to that achieved in FP clinics. The CBD mean CYP for injectables- depo medroxy-progesterone acetate (DMPA) and norethisterone enantate was higher (27.72 & 18.16 respectively) than the facility CYP (7.21 & 5.08 respectively) (p < 0.05) with no injection related complications. The CBD's mean CYP for all methods was also found to be four times higher (11.65) than that generated in health facilities (2.86) (p < 0.05). This suggests that the CBD of injectable contraceptives is feasible and effective, even in a setting like northern Nigeria that has sensitivities about FP.

Sutherland E.G.,University of North Carolina at Chapel Hill | Otterness C.,FHI360 | Janowitz B.,FHI360
International Perspectives on Sexual and Reproductive Health | Year: 2011

Context: Although the introduction of a new method is generally hailed as a boon to contraceptive prevalence, uptake of new methods can reduce the use of existing methods. It is important to examine changing patterns of contraceptive use and method mix after the introduction of new methods. Methods: Demographic and Health Survey data from 13 countries were used to analyze changes in method use and method mix after the introduction of the injectable in the early 1990s. Subgroup analyses were conducted among married women who reported wanting more children, but not in the next two years (spacers), and those who reported wanting no more children (limiters). Results:Modern method use and injectable use rose for each study country. Increases in modern method use exceeded those in injectable use in all but three countries. Injectable use rose among spacers, as well as among limiters of all ages, particularly those younger than 35. In general, the increase in injectable use was partially offset by declines in use of other methods, especially long-acting or permanent methods. Conclusion: Family planning programs could face higher costs and women could experience more unintended pregnancies if limiters use injectables for long periods, rather than changing to longer acting and permanent methods, which provide greater contraceptive efficacy at lower cost, when they are sure they want no more children.

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