Abstract
South African Correctional Services health care assessment offers an agenda for health system strengthening
Amy Hagopian, PhD, MHA1, Sharlene Govender, B.Cur (Hons), BN2, Suzanne Jed, MSN, FNP-BC2, Jennifer Gilvydis, MPH1, Sean Galagan, MSPH3, Jessica Morris, MA4, Sipho Mazibuko, BA2, Fulufelo Malamatsho, BSocSci5, Julia DeKadt, PhD2 and Zingisa Nodada2
(1)University of Washington, Seattle, WA, (2)University of Washington International Training and Education Center for Health (I-TECH), Pretoria, South Africa, (3)University of Washington International Training and Education Center for Health (I-TECH), Seattle, WA, (4)South Africa office, University of Washington International Training and Education Center for Health (I-TECH), Pretoria, South Africa, (5)University of Washington International Training and Education Center for Health (I-TECH), P, South Africa
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
The South African National Department of Correctional Services (DCS) and University of Washington's International Training and Education Center for Health (I-TECH) conducted a situational analysis of TB and HIV-related behavior and health care services in 30 correctional centers in 2013. At each center, quantitative survey and open-ended items were utilized to assess healthcare workers and custodial officials' knowledge and attitudes. Staff of Department of Health (DOH) community facilities serving as referral sites for releases were also surveyed.
The mixed-methods assessment included 10 small (< 200 offenders), 13 medium (200-1000) and 7 large (> 1000) centers operating at a range of security levels. All centers had health facilities, typically employing 3 nurses, most (59%) of which were open 7 days a week.
Prevalence of HIV risk factors such as violence and sexual activity varied, with staff from larger centers reporting higher levels. While condoms were reportedly available inside centers, availability was not observed.
Intake screening for HIV /TB was adequate at many, but not all, facilities. Ability to initiate HIV treatment varied widely, while fewer than half reported initiating TB therapy. Lack of basic medical equipment and infrastructure impeded patient privacy and infection control. Drug stock-outs were common.
Staff knowledge of HIV transmission risk was relatively high, but lower for TB transmission. Stigmatizing attitudes toward people with HIV and TB was relatively low. Communication barriers between DOH clinics and DCS posed a challenge to uninterrupted healthcare following release.
The assessment creates an agenda for improvements in staff training, equipment, supply stocking, and procedures.
Administration, management, leadership Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs
Abstract
Can Calling a Hotline reduce intimate partner violence?: Evidence from Medellín Colombia
Adria Armbrister, PhD1, Olga Romero, MA2 and Claudia Peñaranda, MA2
(1)Inter-American Development Bank, Lima, Peru, (2)Econometria SA, Bogota, Colombia
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
In 2005, 35% of women in Medellin reported having ever experienced Intimate Partner Violence – IPV, a percentage slightly lower than Colombia's national average of 39%. Medellin's lower than average rates of IPV may have been of the result of the government's intentional efforts to improve public safety for women in the city, but evidence was lacking. The impact evaluation was carried out in response to a request from the city to investigate the impact of their investments in women's safety. Medellin implemented the 123 Mujer (123 Woman) hotline in 2013; the hotline is funded and administered under the Medellin city government's Women's Public Security Program in cooperation with the national police force.
Main questions: Does receiving services from the 123 Mujer hotline reduce women's experiences of IPV? Does receiving services increase the filing of formal police complaints? Does receiving services improve women victims' psychological well-being?
The natural experiment made possible by the characteristics of the 123 Mujer hotline during the period: the hotline functioned M-F, 7am to 7pm, creating an excess in demand for the service; after hours calls were wait-listed; and wait-listed callers were served in order rather than triaged. A sample of 1193 was randomized from the universe of callers to the hotline between September 2013 and May 2014; the final surveyed sample was of 749 women.
Receiving services promptly (in 12 hours or less) reduced: the number of reported IPV events by 19%; the number of moderate IPV events by 20%; the number of physical IPV events by 37%; and the number of psychological IPV events by 16%. The effects of prompt service diminished over time. Results of the comparison between immediate service receipt and no service were similar in that they showed diminishing returns and greater magnitude of difference. No other impacts were found.
Biostatistics, economics Conduct evaluation related to programs, research, and other areas of practice Public health or related public policy
Abstract
Strengthening Laboratory Capacity for Sickle Cell Diagnosis in Uganda
Arielle Hernandez, BA1, Charles Kiyaga, MSc MPhil2, Beverly Schaefer, MD1, Isaac Ssewanyana, MSc2, Thad Howard, MS1, Raymond Mugabe, BS2, Grace Ndeezi, MBChB MMed PhD3, Jane Ruth Aceng, MBChB MMED MPH4 and Russell Ware, MD PhD1
(1)Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (2)Central Public Health Laboratories, Uganda Ministry of Health, Kampala, Uganda, (3)Makerere University College of Health Sciences, Kampala, Uganda, (4)Uganda Ministry of Health, Kampala, Uganda
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Sickle cell disease contributes to childhood mortality in sub-Saharan Africa due to a lack of early and accurate diagnosis. A partnership between the Uganda Ministry of Health, Makerere University, and Cincinnati Children's Hospital Medical Center (CCHMC) was established to design and conduct the Uganda Sickle Surveillance Study (US3), which described the current burden of sickle cell disease at the national level, with emphasis on building local laboratory capacity. Between February 2014 and March 2015, nearly 100,000 dried blood spots were analyzed by hemoglobin electrophoresis with isoelectric focusing. Multiple approaches were implemented for quality assurance including weekly remote review of laboratory results by Skype, semi-annual on-site formal program assessment, and post-hoc molecular confirmation at CCHMC. The on-site program assessment determined the accuracy of results from a random selection of samples within specified study periods, revealing 97.0% concordance of results interpretation among laboratory personnel; 97.7% concordance between laboratory personnel and remote review; 73.1% concordance between first test and repeat test of sickle cell disease, trait, and indeterminate results; and 99.3% valid sample output. Of 188 blinded samples tested at CCHMC for confirmation, there was 87% accuracy between molecular diagnostics and the database results. An error analysis attributed the majority of these discordant results to data entry errors. Multiple demonstrated quality assurance approaches constituted an important part of local sickle cell laboratory capacity building in Uganda. Identification and implementation of process improvements for reliable and accurate testing practices help strengthen and expand laboratory capabilities to support national sickle cell programs and strategies.
Conduct evaluation related to programs, research, and other areas of practice
Abstract
Sex and gender: Barriers and facilitators to HIV data disaggregation and use in sub-Saharan Africa
Abby Cannon, MPH, MSW1, Carolina Mejia, PhD, MPH2 and Jessica Fehringer, PhD3
(1)University of North Carolina, Chapel Hill, NC, (2)University of North Carolina at Chapel Hill, Chapel Hill, NC, (3)MEASURE Evaluation, Chapel Hill, NC
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Part of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) strategy includes working with partner countries to increase use of data-driven decision-making in policy and development and making information available to the public to improve effectiveness of policies and programs. Furthermore, PEPFAR is prioritizing expansion of HIV prevention, care, and treatment to more people. In order to reach ambitious targets, gender-related data are critical to understanding how HIV/AIDS may manifest or impact different population groups and whether programs are meeting the unique needs of such groups. Sex- and age-disaggregated data, as well as gender-sensitive indicators that specifically measure gender equality, are important to efficient and effective use of limited resources. To better understand the barriers and facilitators to collecting, analyzing, and using sex- and age-disaggregated data, authors are conducting a desk review and interviews with key stakeholders and decision-makers at the national level, and a data quality assessment at the sub-regional level in Sub-Saharan Africa. Quantitative and qualitative data are being analyzed and interpreted with local partners to ensure findings grounded in the local context. Lack of policy and programmatic relevance, limited training and experience in gender and M&E, and quality and reliability of data are emerging as barriers. Lessons learned and recommendations will be shared on 1) improving the ability to collect and report high quality data for key gender-sensitive indicators; and 2) strengthening the capacity at the national level to use gender-related HIV data for program and policy decision-making to accelerate progress towards an AIDS-Free Generation.
Administer health education strategies, interventions and programs Other professions or practice related to public health Program planning Public health administration or related administration Public health or related organizational policy, standards, or other guidelines Public health or related public policy
Abstract
Guarding Haiti's water: Three years of evaluation efforts for a water treatment program in rural Haiti
Joanna Krajewski, MPH1, Kaitlin Flannery, MD, MPH2 and Christopher Buresh, MD, MPH3
(1)University of Iowa, Iowa City, IA, (2)Stanford University, (3)University of Iowa Hospitals and Clinics
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Around the world nearly one in ten people lack access to safe drinking water. This results in the premature deaths of millions of people each year. In Haiti, the water situation is even worse due to the cholera epidemic brought to the island by United Nations workers following the 2010 earthquake. Cholera is one of the most dangerous diarrheal diseases and has already killed over 9,000 Haitians. In an effort to decrease morbidity and mortality from cholera and other waterborne diarrheal diseases the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) recommend the use of in-home, point-of-use water treatment with disinfectant (such as chlorine) and community education programs. In October 2012, one such program was initiated in the rural communities surrounding Arcahaie, Haiti. Thus, the purpose of this research is to present a case study of the program; and report findings from three years of evaluation efforts. Multiple methods were used to collect this data, including surveys, in-depth interviews, water quality testing, focus groups with program employees, and community-wide meetings and education sessions. While findings indicate the program is reducing diarrheal rates in the community; several major barriers to the program's sustainability are also identified. These include: high employee turn-over, lack of continual chlorine purchase and inconsistencies with availability, dissemination of incorrect system information, and difficulty locating participants and recording chlorine-residual data. Recommendations for future program improvement include utilizing mobile technology for employee data collection and incorporating schools, churches, and other groups into the program.
Conduct evaluation related to programs, research, and other areas of practice Environmental health sciences Implementation of health education strategies, interventions and programs
Abstract
Reducing the Incidence of CLABSI in Latin American ICUs: A Multi-Country Quality Improvement Collaborative Project. Preliminary Results from the Second Phase
Jafet Arrieta Torres, MD, MMSc, IA1, Pedro Delgado, MSc2, Carolina Giuffre, BSN, ICN3, Carola Orrego4, Viviana Rodriguez, MD5, Dolores Macchiavello, MD5, Nuria Mora6, Marcela Colmenares, MD7 and Ezequiel Garcia Elorrio, MD, MSc, MBA, PhD5
(1)Harvard T.H. Chan School of Public Health, Boston, MA, (2)Institute for Healthcare Improvement, Cambridge, MA, (3)Hospital Britanico, Buenos Aires, Argentina, (4)Avedis Donabedian Research / Institute University Autonomous of Barcelona, Barcelona, Spain, (5)Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina, (6)Avedis Donabedian Research Institute / University Autonomous of Barcelona, Barcelona, Spain, (7)Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background
Central line-associated bloodstream infections (CLABSI) are the leading cause of healthcare-associated bloodstream infections, prolonging hospitalizations, and increasing healthcare costs, morbidity and mortality. The CLABSI rate has been estimated at 7.6 episodes per 1,000 central line days in Latin America. In developing countries, CLABSI are usually the result of failing to follow evidence-based, standardized health practices.
Objective
The second phase of the 'Goodbye Bacteremia' campaign aimed at reducing the CLABSI rate in Latin American Intensive Care Units (ICUs) by 50% or to less than 2 episodes per 1,000 central line days from self-reported baseline within 12 months of the implementation of the campaign.
Methods
Design: Uncontrolled before-and-after CLABSI rates comparison.
Setting: 95 ICUs from 37 hospitals from six Latin American countries.
Intervention: We used a quality-improvement collaborative to promote the adoption of bundles of care for the insertion and maintenance of central lines, coupled with education through virtual bi-weekly learning sessions, and continuous feedback, from June 2014 to June 2015.
Measures: CLABSI rate; percentage compliance with central line insertion bundle; percentage compliance with central line maintenance bundle.
Results
A total of 382 episodes of CLABSI occurred over 197,185 central line days (incidence rate [IR], 1.94) during the implementation of the campaign, compared to 127 episodes per 49,116 central lines days (IR, 2.59) at baseline. The overall reduction on the CLABSI rate was 26% (IR ratio, 0.75; 95% CI 0.61, 0.92). The median CLABSI rate was zero throughout the campaign for the participating ICUs. The average percentage compliance increased 23.24% from a baseline of 65.55% to 85.4% for the insertion bundle, and 15.05% from 80.71% at the beginning to 95.0% at the end of the campaign for the maintenance bundle.
Conclusions
Evidence-based interventions and multi-country collaborative work contributed to a significant reduction in the incidence of CLABSI in Latin American ICUs.
Public health or related organizational policy, standards, or other guidelines
Abstract
Assessing Institutional & Technical Capacity of Grassroots Community-Based Organizations Implementing Integrated Most at Risk Population Programming in Nigeria
Bartholomew Ochonye1 and Muyiwa Oladosun2
(1)Heartland Alliance, Abuja, Nigeria, (2)Covenant University, Ota-Lagos, Nigeria
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
This paper assesses the institutional and technical capacity of grassroots based organization providing integrated services to most at risk population (MARPs) in Nigeria. The grassroots organizations were formed by men who have sex with men (MSM) and other MARPs living in communities of the study. The quantitative component of the assessment included 436 MSM selected across five main cities in the country, and qualitative component included 27 focus groups, (FGDs), 46 key informant interviews (KII), and eight group interviews with key staff of the local implementing agency. Objectives of the assessment were (1) to review organizational and technical capacity, and (2) create an enabling and supportive environment for MARPs grassroots organization to foster. Response driven sampling technique was employed for the survey and ethnomethodology was applied to the qualitative methods. Qualitative findings buttressed the quantitative findings that MSM started same-sex sex at younger ages, are of low socioeconomic status, and experienced positive changes in behavior as a result of program influence. Qualitative findings include (1) co-location of international and local project staff at the grassroots increased on-the-job knowledge and skills on MARPs programming and implementation, (2) grassroots organizations were able to attract sub-grants from other finding agencies, and (3) investment in profit making ventures yielded returns. Future programming should be based on these evidence in scaling-up grassroots organizations service provision to meet the needs of MARPs at the grassroots.
Assessment of individual and community needs for health education Conduct evaluation related to programs, research, and other areas of practice Planning of health education strategies, interventions, and programs Program planning Public health or related research Social and behavioral sciences
Abstract
Health Related Content and Implications about Ebola in Social Media
Armine Lulejian, EdD, MPH, CHES1 and Yin Aphinyanaphongs, MD, PhD2
(1)Kean University, Union, NJ, (2)NYU, New York, NY
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Social media is becoming a widely used source of health information and has now been used in the prediction of outbreaks and, conversely, has been blamed for causing unnecessary public panic and misconception. In October 2014, Twitter was ablaze with tweets about Ebola after the first known Ebola patient in the U.S. died. The aim of this study was to conduct thematic analysis to understand emerging topics related to Ebola, health related content and its implications. Additionally, we aimed to identify misinformation related to Ebola. For this analysis, we examined 2,000 tweets immediately following the report of the patient's death. We categorized tweets based on tone (joke vs. serious), nature (e.g., opinion, news, retweet), projected feeling (e.g., sympathy, anger, fear) and health-related misinformation. Majority of the content was sharing of news or retweets of news (78%) and superficial content (9%). Among tweets that were identified to project feelings among tweeters, feelings projected included sadness (4%) and condolences (5%), anger (3%), and fear (4%). While misinformation (5%) was not a significant portion of tweets, nonetheless it is a significant number of the tweets (about 1 out of every 20). Further analysis revealed specific public perceptions and misunderstandings about Ebola, its spread and related personal risks. We will discuss next steps using machine learning and health behavior modeling for health education and disease prevention opportunities. We will also discuss proposals for social media content like this to use in public health promotion, health education and risk prevention.
Administer health education strategies, interventions and programs Assessment of individual and community needs for health education Communication and informatics Planning of health education strategies, interventions, and programs Public health or related education Social and behavioral sciences
Abstract
Leadership training as a tool for promoting public health through the One Health model: An evaluation
Kristin Garces, MPH
Florida Institute for Health Innovation, West Palm Beach, FL
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
One Health Mission: To enable and empower professionals from the health, agriculture and environmental sectors to play leadership roles on cross-sector issues in Caribbean countries.
One Health Activities: 4 modules; learning-by-doing workshop; themed, didactic presentations; problem-based group discussion; field trips; leadership development sessions.
Monitoring and Evaluation Objectives: To qualitatively and quantitatively assess the One Health Leadership Series to evaluate program impact, inform quality improvement, and to map sustainable success.
The Monitoring and Evaluation Plan had three objectives to 1) assess the impact and outcomes of the One Health Leadership Series 2) inform quality improvement during the series, 3) and evaluate whether participants were receiving and applying the tools and guidance necessary to establish sustainable success. This consisted of a planning phase followed by and overlapping with an implementation phase.
The One Health Leadership Series is centered on capacity building and comprehension; these were the foci for evaluating the effectiveness of achieving learning objectives during the program. Quantitative measures were established to track participation and involvement. Indicators were also measured by participant surveys and individual interviews. The plan was largely driven by qualitative data collection to capture a range of perceptions and experiences and to assess One Health leaders' application and adoption of One Health principles, leadership techniques and strategies. Key themes included perceived achievement, behavior change, appropriateness of the process and quality of execution. Surveys and interviews informed the process making recommendations for addressing needs, defining challenges, and identifying success. The program was evaluated by participants at each meeting to track comprehension of objectives and concepts, and to reveal gaps and strengths.
Conduct evaluation related to programs, research, and other areas of practice
Abstract
Building Tomorrow's Workforce: A Process Evaluation of the Improving Public Health Management for Action (IMPACT) Pilot Program in Bangladesh
Alison Yoos, MPH, Tat'Yana Kenigsberg, MPH, Stephanie Tavitian, MPH, Zahid Samad, MD, MPH, MBA and Erika Willacy, MPH
Centers for Disease Control and Prevention, Atlanta, GA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
As recent outbreaks have demonstrated, the health of individuals anywhere can threaten the health and security of the global population. In order to respond more rapidly and effectively to current and emerging health problems, an efficient and educated global public health workforce is imperative.
The goal of Improving Public Health Management for Action (IMPACT) is to train entry-level professionals to become highly competent public health managers. Collaborating with ministries of health in low-to-middle income countries, IMPACT is a two-year, competency-based training program that utilizes instructional methods and field training to build management skills. In addition, expert faculty and structured mentorship provide career guidance.
In 2016, Bangladesh launched the IMPACT pilot program. A comprehensive, mixed-methods evaluation was conducted to gain insight into the implementation process for future programming and workforce development activities. Using the RE-AIM Framework (Reach, Efficacy, Adoption, Implementation, Maintenance), baseline tools were used to assess field sites, mentors, IMPACT applicants and selected fellows. In addition, key informant interviews were held with CDC staff and the Bangladesh's Ministry of Health and Family Welfare staff to identify best practices and areas for improvement. Student and instructor observations were also conducted.
This process evaluation provides insights for the development of a workforce development training program in public health management; further, it serves as a critical tool to identify best practices and challenges to programmatic success. Greater insights into the validity and utility of the program's structure and implementation process have emerged, providing key lessons for workforce development activities within Bangladesh and beyond.
Conduct evaluation related to programs, research, and other areas of practice Public health or related education