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Income interventions with pro-poor targeting is a common fiscal policy around the world. However their distributional effects on consumption and savings are not well understood. Motivated by the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA), we use longitudinal data on income and consumption of Indian households to estimate distributional effects of such interventions in a model with endogenous consumption and savings distribution, where households face uninsured income risks. In the model, a standard scheme of interventions that consistently targets low-income cohorts, has small distributional impacts on targeted and non-targeted cohorts alike. In contrast, a fiscally-equivalent scheme that changes the expected income profile of the targeted households in the same initial cohort irrespective of their future incomes, generates larger effects by changing income mobility for both the targeted and non-targeted cohorts. This mobility-based channel generates consumption responses even though the magnitude of the shock is lesser for the initially targeted cohort, as it more than offsets the effect from permanent income shock. Quantitatively, such an intervention in the order of 0.6 percent of output, approximating the Indian scenario, increases consumption share of the targeted cohort by nearly 2.5 percent, five times as large as the effect of standard interventions. The distributional effects are similar to those arising from a counterfactual policy of universal basic income. [ABSTRACT FROM AUTHOR]

Schools are increasingly encouraged to adopt evidence‐based or evidence informed interventions and implement them using insights from implementation science. The literature relating to implementation of interventions in schools has focused largely on universal interventions, particularly for social and emotional learning (SEL), which are designed for all children and young people. In contrast, targeted interventions provide additional support for those pupils who may require small group or individual support over and above that provided at the universal level. To date there has been limited consideration of factors which are important for the implementation of targeted SEL interventions. Data from an exploratory case study with two schools implementing Lego therapy are used to illustrate the implementation factors relevant to this targeted intervention. Findings indicate similarities in universal and targeted intervention core components and factors but also a number of distinct elements that are important to consider when implementing Lego therapy and potentially other targeted SEL interventions. Key considerations include the interaction with the wider school system, the pivotal role of the intervention champion, and the importance of external support for problem solving and sustainability. The resulting model may inform further development of implementation frameworks for Lego therapy and other targeted SEL interventions. [ABSTRACT FROM AUTHOR]

Limited attention from the modelling community has been given to ecological approaches which aim to predict geographical patterns of malaria by accounting for the joint effects of different vectors and environmental drivers.A hierarchical multivariate joint spatial Gaussian generalised linear model was developed to provide joint parameters inference and mapping of counts of Anopheles gambiae, An. funestus, An. nili and malaria incidence collected in an area of Cote d'Ivoire. Variable‐selection methods were applied to select important predictors for each mosquito species and malaria incidence.The proposed joint model led to a general reduction of the variance in the estimates compared to independent modelling. There was high variability in the composition of Anopheles mosquito species in the villages with each species suitability only partly overlapping geographically.Abundances of An. gambiae, An. funestus and An. nili were primarily determined by temperature. None of the species were found as a significant predictor for the others. Anopheles gambiae was the predominant species and only An. gambiae female abundance was an important variable (linear predictor) for malaria incidence. However, the geographic correlation analyses show that the rest of Anopheles species are likely playing a role in malaria suitability.Residuals from the models of mosquito abundance and malaria cases are also correlated with each other and overlapping but in geographic patches, meaning that local drivers of vector‐malaria suitability are still present and not represented by the predictors used in the model.Synthesis and applications: Joint modelling improve predictive estimation compared to individual modelling. The accurate predictions highlighted high diversity in the association between malaria and vector species, with most of the area having more than one species suitability correlated with malaria suitability. These zones are unlikely to benefit from species‐specific interventions. Areas with correlated malaria and vector species suitability residuals contain local information, not included in the model, that requires further investigation. This will identify additional communal malaria and vectors factors that need to be considered for optimal malaria control and elimination strategies since these factors are expected to be linked to the local malaria transmission. [ABSTRACT FROM AUTHOR]

During four decades, numerous school-based bullying prevention programmes have been developed and evaluated. Meta-analyses indicate that such programmes have positive average effects, as compared with treatment as usual. However, the effects are small to moderate, and they are especially weak among some specific groups, such as adolescents. After all the progress made, too many young people still suffer from being bullied. Furthermore, findings suggest that the remaining victims may be even worse off than before in contexts where the overall level of victimization decreases - the phenomenon known as the Healthy Context Paradox. It is suggested that besides the average effects of preventive, universal multi-component programmes, more attention should be devoted to targeted interventions addressing specific cases of bullying. More precisely, we should investigate the characteristics and conditions of youth who remain victimized or continue bullying others despite targeted interventions, and identify factors - at multiple levels - that are related to intervention failure. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to develop and externally validate multivariable prediction models for future pain intensity outcomes to inform targeted interventions for patients with neck or low back pain in primary care settings. Methods Model development data were obtained from a group of 679 adults with neck or low back pain who consulted a participating United Kingdom general practice. Predictors included self-report items regarding pain severity and impact from the STarT MSK Tool. Pain intensity at 2 and 6 months was modeled separately for continuous and dichotomized outcomes using linear and logistic regression, respectively. External validation of all models was conducted in a separate group of 586 patients recruited from a similar population with patients' predictor information collected both at point of consultation and 2 to 4 weeks later using self-report questionnaires. Calibration and discrimination of the models were assessed separately using STarT MSK Tool data from both time points to assess differences in predictive performance. Results Pain intensity and patients reporting their condition would last a long time contributed most to predictions of future pain intensity conditional on other variables. On external validation, models were reasonably well calibrated on average when using tool measurements taken 2 to 4 weeks after consultation (calibration slope = 0.848 [95% CI = 0.767 to 0.928] for 2-month pain intensity score), but performance was poor using point-of-consultation tool data (calibration slope for 2-month pain intensity score of 0.650 [95% CI = 0.549 to 0.750]). Conclusion Model predictive accuracy was good when predictors were measured 2 to 4 weeks after primary care consultation, but poor when measured at the point of consultation. Future research will explore whether additional, nonmodifiable predictors improve point-of-consultation predictive performance. Impact External validation demonstrated that these individualized prediction models were not sufficiently accurate to recommend their use in clinical practice. Further research is required to improve performance through inclusion of additional nonmodifiable risk factors. [ABSTRACT FROM AUTHOR]

IntroductionTriple burden of malnutrition in children remains a significant public health issue. This scoping review aims to assess the information on undernutrition, micronutrient deficiencies and the quality of complementary feeding in various regions in Nigeria.MethodsA literature search was conducted using PubMed and Google Scholar databases from January 1, 2018 to January 31, 2023 to include studies focusing on 0 to 5 years old children in Nigeria, reporting data on nutritional status, nutrient deficiencies, and published in English.Results73 out of 1,545 articles were included. Stunting remained alarmingly high ranging from 7.2% (Osun, South West) to 61% (Kaduna, North Central), while wasting varied from 1% (Ibadan, South West) to 29% (FCT Abuja, Central) and underweight from 5.9% (Osun, South West) to 42.6% (Kano, North West) respectively. The overall prevalence of anemia and vitamin A deficiency ranged between 55.2 to 75.1 % and 5.3 to 67.6%, respectively. Low rates of achieving minimum dietary diversity and minimum meal frequency were reported across different states depicting the suboptimal quality of complementary feeding. The prevalence of overweight/obesity ranged from 1.5% (Rivers, South South) to 25.9% (Benue, North Central).ConclusionMultiple early childhood malnutrition issues exist with a wide disparity across states in Nigeria, particularly in the Northern region. Targeted nutrition interventions must be implemented to improve the situation.

Abstract Background Since 2004, malaria transmission on Bioko Island has declined significantly as a result of the scaling-up of control interventions. The aim of eliminating malaria from the Island remains elusive, however, underscoring the need to adapt control to the local context. Understanding the factors driving the risk of malaria infection is critical to inform optimal suits of interventions in this adaptive approach. Methods This study used individual and household-level data from the 2015 and 2018 annual malaria indicator surveys on Bioko Island, as well as remotely-sensed environmental data in multilevel logistic regression models to quantify the odds of malaria infection. The analyses were stratified by urban and rural settings and by survey year. Results Malaria prevalence was higher in 10–14-year-old children and similar between female and male individuals. After adjusting for demographic factors and other covariates, many of the variables investigated showed no significant association with malaria infection. The factor most strongly associated was history of travel to mainland Equatorial Guinea (mEG), which increased the odds significantly both in urban and rural settings (people who travelled had 4 times the odds of infection). Sleeping under a long-lasting insecticidal net decreased significantly the odds of malaria across urban and rural settings and survey years (net users had around 30% less odds of infection), highlighting their contribution to malaria control on the Island. Improved housing conditions indicated some protection, though this was not consistent across settings and survey year. Conclusions Malaria risk on Bioko Island is heterogeneous and determined by a combination of factors interacting with local mosquito ecology. These interactions grant further investigation in order to better adapt control according to need. The single most important risk factor identified was travel to mEG, in line with previous investigations, and represents a great challenge for the success of malaria control on the Island.

Background: High HIV prevalence among injecting drug users (IDUs) remains a cause of concern and are considered key drivers of concentrated epidemic in India. The present paper aims to assess the effectiveness of the targeted intervention (TI) program on the risk behaviors among IDUs across regions of India. Materials and Methods: This paper used the data from the integrated biological and behavioral surveillance 2014–2015 among the IDUs in India. Descriptive statistics and propensity score matching analysis was carried out to understand the effectiveness of the TI program on the new needle/syringe used and needle/syringe shared in the last injecting episode by accounting for the covariates. Results: The matched samples estimate, i.e., average treatment effect on treated of new needles/syringe used and shared in the last injecting episode by those who received needles/syringes from peer educator or outreach workers (PE/ORWs) and those who did not receive was 2.8% (confidence interval [CI]: 0.05–5.6) increase in the use of new needles/syringes and 6.5% (CI: −9.7–−3.3) decrease in the needles/syringes shared in last injecting episode indicating that IDUs who received new needles/syringes from PE/ORWs are more likely to use new needle/syringe and less likely to share needle/syringes to those who did not receive needles/syringes. The results vary across the different regions of India. Conclusion: TI program proves to be an effective initiative in the behavior change among IDUs as substantiated by use of new needles/syringes and decreased sharing of needles/syringes. TI program coverage varies from region to region and may further be expanded to accelerate the program services to prevent HIV/AIDS.

Innovation-driven growth demands that organisations periodically assess the innovative behaviour of employees and facilitate appropriate interventions to nurture it. Human behaviour is complex. Corporate researchers rely on standard measures to appreciate employee behaviours at work. Quality tools support decision-making by detecting gaps and creating opportunities for improvement at work. One promising measure is the Innovative Behaviour Inventory (IBI). Although the IBI was developed and validated in Europe, it can still be applied in other contexts if it exhibits adequate psychometric properties and diagnostic utility. Using a probability sample drawn from Zimbabwe, the study used bifactor analysis to assess the dimensionality of the IBI measurement model. The study assessed the measurement invariance of the IBI using multi-group confirmatory factor analysis. The study modelled the general factor of the IBI. Multiple tests confirmed the internal consistency reliability, convergent and discriminant validity of the measure. The IBI was invariant across gender groups. The IBI adds to the suite of available tools for assessing innovative work behaviour as part of a dedicated leadership excellence agenda. The IBI offers practical advantages because of its integrated, multi-faceted nature, diagnostic utility and robust psychometric properties. Periodic surveys, using the IBI, provide corporate researchers and organisational leaders with information on the quality of innovative behaviour that resides in their organisations. The IBIs invariance and ability to quantify, as summative scores, the levels of innovative behaviour enable sub-group analysis. Sub-group analytical outputs facilitate targeted interventions in the workplace. Contribution: Appreciating the quality of the IBI measurement model carries ethical and practical significance. Studies of this nature safeguard the subjects of research and promote purpose-driven corporate and scholarly work.

Introduction: Individuals working in the sex industry continue to experience many negative health outcomes such as sexually transmitted infections and HIV/ AIDS, owing to lack of knowledge, careless attitude, inaccessibility of contraceptives or practice of unprotected sex. Aims/objectives: To assess the targeted interventions done to improve the health of female sex workers (FSWs) in Amritsar. Material & Methods: This cross-sectional study, in 4 randomly selected hotspot areas under targeted intervention (TI) included 180 FSWs after obtaining written informed consent. We used one to one interview for collecting required information on structured questionnaire. The data was compiled using Microsoft excel and analyzed using EpiInfo07 by calculating proportions and inferential statistics. Results: Age of study participants ranged from 19-45 years and most (66%) belonged to middle socio-economic class. Majority (73%) were in the profession for 3-5 years. Majority i.e. 98% underwent regular health checkups and HIV testing conducted by T.I. site. None was HIV positive. All FSWs (100%) were provided condom regularly by T.I. site. 85% reported to have knowledge about STIs. 95% reported regular conduction of health education programs by T.I. site. Conclusion: Targeted interventions play a key role in conducting regular health check-ups of FSWs, imparting knowledge about STIs, its prevention and provision of condoms. [ABSTRACT FROM AUTHOR]

Abstract Introduction Cancer screening programs are routinely available in high‐income countries, but participation rates are low, especially among men. This narrative review aims to identify male‐specific access barriers to cancer‐related healthcare in high‐income countries that offer statutory insurance/subsidized health care. Methods We searched PubMed, Science Direct, and Web of Science for peer‐reviewed journal articles published within the past 10 years on cancer healthcare access, help‐seeking behavior, and men. Step‐wise screening of title, abstract, and full text resulted in 23 studies that fit the selection criteria for findings in high‐income countries. The results were analyzed descriptively using qualitative thematic synthesis. Results In the reviewed studies, barriers for men in accessing cancer‐related healthcare offers could be broadly categorized under sociocultural norms, personal behaviors, and structural problems. The most common barriers were related to sociocultural influences and included notions of masculinity, distrust in the medical system, and personnel/social commitments. Major personal barriers included fear of getting cancer or screening methods, lack of awareness about cancer, and problems in communication with healthcare professionals. Accessibility and lack of insurance were reported as common structural barriers. Conclusions The reluctance of men in approaching medical help was rooted in sociocultural norms of traditional masculinity with direct and indirect consequences such as fear, lack of awareness, distrust of medical personnel, and problems in communicating with healthcare professionals. Gender‐specific, male‐oriented information via digital, anonymous interventions may be helpful for increasing participation of men in cancer care.

Objectives This study provides insights on the impact of a targeted intervention (TI) programme on behaviour change among injecting drug users (IDUs) in India. Methods This paper examined the data from the Integrated Biological and Behavioural Surveillance 2014–2015 for IDUs in India. Logistic regression was performed to understand the factors (TI programme services) that affected injecting risk behaviours by adjusting for covariates. Propensity score matching was conducted to understand the impact of the TI programme on using new needles/syringes and sharing needles/syringes in the most recent injecting episode by accounting for the covariates that predicted receiving the intervention. Results Participants who received new needles and syringes from peer educators or outreach workers were 1.3 times (adjusted odds ratio, 1.29; 95% confidence interval [CI], 1.09 to 1.53) more likely to use new needles/syringes during most recent injecting episode than participants who did not receive needles/syringes. The matched-samples estimate (i.e., average treatment effect on treated) of using new needles in the most recent injecting episode showed a 2.8% (95% CI, 0.0 to 5.6) increase in the use of new needles and a 6.5% (95% CI, −9.7 to −3.3) decrease in needle sharing in the most recent injecting episode in participants who received new needles/syringes. There was a 2.2% (95% CI, −3.8 to −0.6) decrease in needle sharing in the most recent injecting episode among participants who were referred to other services (integrated counselling and testing centre, detox centres, etc.). Conclusions The TI programme proved to be effective for behaviour change among IDUs, as substantiated by the use of new needles/syringes and sharing of needles/syringes.

Background: Since 2004, malaria transmission on Bioko Island has declined significantly as a result of the scaling-up of control interventions. The aim of eliminating malaria from the Island remains elusive, however, underscoring the need to adapt control to the local context. Understanding the factors driving the risk of malaria infection is critical to inform optimal suits of interventions in this adaptive approach. Methods: This study used individual and household-level data from the 2015 and 2018 annual malaria indicator surveys on Bioko Island, as well as remotely-sensed environmental data in multilevel logistic regression models to quantify the odds of malaria infection. The analyses were stratified by urban and rural settings and by survey year. Results: Malaria prevalence was higher in 10–14-year-old children and similar between female and male individuals. After adjusting for demographic factors and other covariates, many of the variables investigated showed no significant association with malaria infection. The factor most strongly associated was history of travel to mainland Equatorial Guinea (mEG), which increased the odds significantly both in urban and rural settings (people who travelled had 4 times the odds of infection). Sleeping under a long-lasting insecticidal net decreased significantly the odds of malaria across urban and rural settings and survey years (net users had around 30% less odds of infection), highlighting their contribution to malaria control on the Island. Improved housing conditions indicated some protection, though this was not consistent across settings and survey year. Conclusions: Malaria risk on Bioko Island is heterogeneous and determined by a combination of factors interacting with local mosquito ecology. These interactions grant further investigation in order to better adapt control according to need. The single most important risk factor identified was travel to mEG, in line with previous investigations, and represents a great challenge for the success of malaria control on the Island. [ABSTRACT FROM AUTHOR]

Background: The Pediatric Transplant Rating Instrument (P‐TRI) is a 17‐item scale developed to assess psychosocial risk factors for poor outcomes after solid organ transplantation. Research has identified the limitations of the original instrument and proposed revisions to improve clinical utility. This project examined patterns of risk in children being evaluated for kidney transplant using a revised P‐TRI. Methods: A multidisciplinary kidney transplant team revised the P‐TRI. A social worker and a psychologist collaboratively completed the modified instrument for 37 children after the psychosocial pretransplant evaluation. Electronic medical records were reviewed for transplant status (transplanted, active waitlist, inactive) 1 year later. Exploratory cluster analyses and chi‐square tests examined patterns of risk and correlates with cluster membership. Results: Three clusters were identified. The high‐risk group (29.7%) had difficulties with medication and appointment adherence, strained relationships with the medical team, and the presence of parent psychiatric history. The medium‐risk group (35.1%) had difficulties with parent knowledge, financial strain, and risk factors for medication nonadherence. The low‐risk group (35.1%) demonstrated no difficulties with adherence or financial strain. Clusters were prospectively associated with transplant status, such that those in the high‐risk group were less likely to be transplanted within 1 year post‐evaluation. Conclusions: The revised P‐TRI demonstrated good construct validity as risk level appeared to be associated with transplant listing status 1 year post‐evaluation. These results suggest that standardized pretransplant psychosocial risk assessment tools may have value in optimizing transplant access if they can be paired with targeted, multidisciplinary interventions to address concerns early in the transplant process. [ABSTRACT FROM AUTHOR]

Innovation-driven growth demands that organisations periodically assess the innovative behaviour of employees and facilitate appropriate interventions to nurture it. Human behaviour is complex. Corporate researchers rely on standard measures to appreciate employee behaviours at work. Quality tools support decision-making by detecting gaps and creating opportunities for improvement at work. One promising measure is the Innovative Behaviour Inventory (IBI). Although the IBI was developed and validated in Europe, it can still be applied in other contexts if it exhibits adequate psychometric properties and diagnostic utility. Using a probability sample drawn from Zimbabwe, the study used bifactor analysis to assess the dimensionality of the IBI measurement model. The study assessed the measurement invariance of the IBI using multi-group confirmatory factor analysis. The study modelled the general factor of the IBI. Multiple tests confirmed the internal consistency reliability, convergent and discriminant validity of the measure. The IBI was invariant across gender groups. The IBI adds to the suite of available tools for assessing innovative work behaviour as part of a dedicated leadership excellence agenda. The IBI offers practical advantages because of its integrated, multi-faceted nature, diagnostic utility and robust psychometric properties. Periodic surveys, using the IBI, provide corporate researchers and organisational leaders with information on the quality of innovative behaviour that resides in their organisations. The IBIs invariance and ability to quantify, as summative scores, the levels of innovative behaviour enable sub-group analysis. Sub-group analytical outputs facilitate targeted interventions in the workplace. Contribution: Appreciating the quality of the IBI measurement model carries ethical and practical significance. Studies of this nature safeguard the subjects of research and promote purpose-driven corporate and scholarly work. [ABSTRACT FROM AUTHOR]

In this paper, we present a unifying framework for analyzing equilibria and designing interventions for large network games sampled from a stochastic network formation process represented by a graphon. To this end, we introduce a new class of infinite population games, termed graphon games, in which a continuum of heterogeneous agents interact according to a graphon, and we show that equilibria of graphon games can be used to approximate equilibria of large network games sampled from the graphon. This suggests a new approach for design of interventions and parameter inference based on the limiting infinite population graphon game. We show that, under some regularity assumptions, such approach enables the design of asymptotically optimal interventions via the solution of an optimization problem with much lower dimension than the one based on the entire network structure. We illustrate our framework on a synthetic data set and show that the graphon intervention can be computed efficiently and based solely on aggregated relational data. [ABSTRACT FROM AUTHOR]

Introduction: High-risk women are the major drivers of India's HIV epidemic. The targeted intervention (TI) project is working for the prevention and control of sexually transmitted infections (STIs) including HIV/AIDS among them. The current study was carried out among high-risk women to identify the predictors for HIV positivity through a model generation and assess the impact of targeted interventions in averting new HIV infections. Aims and Objectives: To generate the model for HIV positivity among high-risk women based on various independent variables using logistic regression analysis. Each year, how many HIV infections have been averted among them based on probability calculations of HIV positivity with positive and negative predictors? Methodology: Study Design: Prospective cohort with retrospective comparison. Study Setting: It was done at two different drop-in center clinics (DICs) and project field areas of the city. Sample Size: In total, 2,193 registered women availing services through NGOs/DIC clinics were enrolled. Data Entry and Analysis: Done using Excel and SPSS software. Association between the dichotomous dependent variables and continuous or categorical variables was assessed using the binary logistic regression model. Each year, how many HIV infections have been averted among them was calculated. Results: Statistically significant predictors of HIV positivity were alcohol consumption, category "A" and "C" women, partner status, regular medical check-ups, and attendance at counseling sessions. The number of HIV infections averted from 2009–10 to 2013–14 came out to be 52. Conclusion: Category C of high-risk women, alcohol consumption, and regular medical check-ups as (negative predictors) came out to be statistically significant predictors for HIV positivity. [ABSTRACT FROM AUTHOR]

Partnerships between mental health (MH) clinics and school systems in which providers deliver MH services on school grounds are growing. To date, however, there is little research examining MH clinic administrator perspectives on how this service delivery model affects continuity and quality of MH services among low-income youth. We conducted a state-wide (online and mail) survey of administrators at MH clinics (n = 60) to assess their perspectives on the advantages and challenges of school MH services for Medicaid-enrolled youth. Among survey respondents (n = 44), 86% reported that their clinic had at least one school partnership. With respect to advantages, more than four-fifths reported that school-based MH services (compared to clinic-based services) were very helpful or extremely helpful (versus not helpful at all, a little helpful, or somewhat helpful) for: (1) reducing gaps in MH treatment (86.8%); (2) improving communication between MH providers and teachers (86.9%), and (3) improving the overall quality of MH care (89.5%). In addition, the estimated no-show rate for appointments in school settings (7.2%) was lower than the estimated no show-rate for clinic appointments (23.9%; p < 0.01). Several challenges were also reported; more than two-thirds of respondents reported difficulties when delivering school-based services related to parent engagement (i.e., appointment attendance [89.5%], communication [81.6%], timely consent [68.4%]) that occurred sometimes, often, or always (versus rarely or never). As MH clinics continue to enter into and expand partnerships with schools, stakeholders should implement family-centered strategies to enhance engagement. Nevertheless, MH clinic administrators highlight potential benefits of school MH services (compared to clinic-based services) with respect to continuity and quality of MH care. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Compare rates of identification of families with health-related social needs (HRSN) and connection to resources by targeted versus universal, pediatric clinic-based interventions. METHODS: This observational cohort study included 1677 families that received care (January 2017-May 2020) at 8 pediatric medical homes in 3 states implementing Developmental Understanding and Legal Collaboration for Everyone (DULCE)--a universal, evidence-based intervention that addresses HRSN for families with infants. We divided the cohort into 2 groups using 4 common risk criteria in targeted programs serving families with infants; 862 families had no high-risk characteristics (Risk Criteria Absent [RCA]); 815 families had high-risk characteristics (Risk Criteria Present [RCP]). We compared both groups by prevalence of HRSN and connection to supports and estimated the performance of high-risk criteria to identify HRSN. RESULTS: DULCE identified 990 families with HRSN, compared to an estimated 274 families, if a risk-targeted approach had been used. More than half of RCA families had HRSN, 11% used resources at enrollment, and 42.5% accessed resources through DULCE. Simultaneously, 68.8% of RCP families had ongoing HRSN although 46.0% used resources at enrollment; 63.9% accessed additional resources through DULCE. Commonly used risk criteria had a sensitivity of 55.3% (95% confidence interval [CTJ, 52.2%-58.5%), specificity of 61.1% (95% CI, 57.2%-64.9%), positive predictive value of 68.8% (95% CI, 65.4%-72.0%), and negative predictive value of 46.9% (95% CI. 43.5%-50.49). CONCLUSIONS: Risk criteria commonly used to identify families for targeted interventions are imperfect proxies for HRSN. Universal, medical home-based approaches can play a key role in supporting families with infants. [ABSTRACT FROM AUTHOR]

Abstract Background Leprosy incidence remained at around 200,000 new cases globally for the last decade. Current strategies to reduce the number of new patients include early detection and providing post-exposure prophylaxis (PEP) to at-risk populations. Because leprosy is distributed unevenly, it is crucial to identify high-risk clusters of leprosy cases for targeting interventions. Geographic Information Systems (GIS) methodology can be used to optimize leprosy control activities by identifying clustering of leprosy cases and determining optimal target populations for PEP. Methods The geolocations of leprosy cases registered from 2014 to 2018 in Pasuruan and Pamekasan (Indonesia) were collected and tested for spatial autocorrelation with the Moran’s I statistic. We did a hotspot analysis using the Heatmap tool of QGIS to identify clusters of leprosy cases in both areas. Fifteen cluster settings were compared, varying the heatmap radius (i.e., 500 m, 1000 m, 1500 m, 2000 m, or 2500 m) and the density of clustering (low, moderate, and high). For each cluster setting, we calculated the number of cases in clusters, the size of the cluster (km2), and the total population targeted for PEP under various strategies. Results The distribution of cases was more focused in Pasuruan (Moran’s I = 0.44) than in Pamekasan (0.27). The proportion of total cases within identified clusters increased with heatmap radius and ranged from 3% to almost 100% in both areas. The proportion of the population in clusters targeted for PEP decreased with heatmap radius from > 100% to 5% in high and from 88 to 3% in moderate and low density clusters. We have developed an example of a practical guideline to determine optimal cluster settings based on a given PEP strategy, distribution of cases, resources available, and proportion of population targeted for PEP. Conclusion Policy and operational decisions related to leprosy control programs can be guided by a hotspot analysis which aid in identifying high-risk clusters and estimating the number of people targeted for prophylactic interventions.

Introduction: High-risk women are the major drivers of India's HIV epidemic. The targeted intervention (TI) project is working for the prevention and control of sexually transmitted infections (STIs) including HIV/AIDS among them. The current study was carried out among high-risk women to identify the predictors for HIV positivity through a model generation and assess the impact of targeted interventions in averting new HIV infections. Aims and Objectives: To generate the model for HIV positivity among high-risk women based on various independent variables using logistic regression analysis. Each year, how many HIV infections have been averted among them based on probability calculations of HIV positivity with positive and negative predictors? Methodology: Study Design: Prospective cohort with retrospective comparison. Study Setting: It was done at two different drop-in center clinics (DICs) and project field areas of the city. Sample Size: In total, 2,193 registered women availing services through NGOs/DIC clinics were enrolled. Data Entry and Analysis: Done using Excel and SPSS software. Association between the dichotomous dependent variables and continuous or categorical variables was assessed using the binary logistic regression model. Each year, how many HIV infections have been averted among them was calculated. Results: Statistically significant predictors of HIV positivity were alcohol consumption, category “A” and “C” women, partner status, regular medical check-ups, and attendance at counseling sessions. The number of HIV infections averted from 2009–10 to 2013–14 came out to be 52. Conclusion: Category C of high-risk women, alcohol consumption, and regular medical check-ups as (negative predictors) came out to be statistically significant predictors for HIV positivity.

Abstract Objective The proliferation of false information on COVID-19 mostly through social media is adversely affecting control efforts. The objective of this study was to identify areas where targeted effective messaging can be useful in demystifying misinformation against COVID-19. Results The study showed high levels of misinformation on COVID-19 in the study area [mean score 2.71; standard deviation (SD) 1.5]. The highest levels of misinformation were observed in Dr. Ruth Segomotsi Mompati district, North West province (mean score: 3.84; SD: 2.1) and Sedibeng district, Gauteng province (mean score: 3.56; SD 1.7). Higher levels of misinformation were reported by those aged 18–24 years (mean score: 3.48; SD: 1.8), and men (mean score: 2.73; SD: 1.8). Across the two provinces, we identified geospatial hot and coldspots of misinformation highlighting the need to implement point of care strategies such as targeted messaging. Findings showed the need for targeted interventions to young people, students, those with low levels of education and the self-employed in the two districts more importantly, as South Africa expands its nationwide vaccination roll-out.

Knowing which intervention strategies work best and for which student is essential for teachers when they intervene in cases of bullying. The effects of teachers' (1) condemning, (2) empathy-raising, and (3) combined (including elements of both) messages on students' intention to stop bullying were tested in a between-subject experimental design. A total of 277 seventh grade students (Mage = 12.93, SD = 0.49; 47% female) were asked to imagine they had bullied a peer and were invited to a discussion with a teacher. They saw a video vignette with one of the above messages. Hierarchical regression analyses indicated that students' intention to stop bullying was highest among those who saw the combined message. Callous-unemotional traits were negatively, and affective and cognitive empathy positively associated with intention to stop bullying. Students' level of cognitive empathy moderated the relative effect of the condemning message on intention to stop bullying. At low levels of cognitive empathy, the condemning message was the least effective, whereas among those with high cognitive empathy, all messages were equally likely to lead to intention to stop bullying. Together, the findings suggest that for educators intervening in bullying among adolescents, an approach involving both condemning and empathy-raising messages is the 'best bet', most likely to lead to intention to stop bullying. [ABSTRACT FROM AUTHOR]

Healthcare workers (HCWs) from minoritized communities are a critical partner in moving vaccine-hesitant populations toward vaccination, yet a significant number of these HCWs are delaying or deciding against their own COVID-19 vaccinations. Our study aims to provide a more nuanced understanding of vaccine hesitancy among racially and ethnically minoritized HCWs and to describe factors associated with vaccine non-acceptance. Analysis of a sub-sample of racially and ethnically minoritized HCWs (N = 1131), who participated in a cross-sectional study at two large Southern California medical centers, was conducted. Participants completed an online survey consisting of demographics, work setting and clinical role, influenza vaccination history, COVID-19 knowledge, beliefs, personal COVID-19 exposure, diagnosis, and impact on those closest to them. While overall most HCWs were vaccinated (84%), 28% of Black, 19% of Hispanic, and 8% of Asian American HCWs were vaccine-hesitant. Age, education level, occupation, history of COVID-19, and COVID-19 related knowledge were predictive of vaccine hesitancy. We found significant variations in COVID-19 related knowledge and reasons for vaccine hesitancy among Black (governmental mistrust), Hispanic (preference for physiological immunity), and Asian-American HCWs (concern about side effects) who were vaccine-hesitant or not. Our findings highlight racial and ethnic differences in vaccine-hesitancy and barriers to vaccination among HCWs of color. This study indicates the necessity of targeted interventions to reduce vaccine hesitancy that are mindful of the disparities in knowledge and access and differences between and among racial and ethnic groups. [ABSTRACT FROM AUTHOR]

Equitable allocation of resources targeting the human immunodeficiency virus (HIV) at the local level requires focusing interventions in areas of the greatest need. Understanding the geographical variation in the HIV epidemic and uptake of selected HIV prevention and treatment programmes are necessary to identify such areas. Individual-level HIV data were obtained from a 2012 national HIV survey in South Africa. Spatial regression models on each outcome measure (HIV infection, sub-optimal condom use or non-anti-retroviral treatment (ART) adjusted for spatial random effects at the ward level were fitted using WINBUGS software. In addition, ward-level data was utilized to estimate condom use coverage and ART initiation rates which were obtained from routinely collected data in 2012. Ordinary Kriging was used to produce smoothed maps of HIV infection, condom use coverage and ART initiation rates. HIV infection was associated with individuals undertaking tertiary education [posterior odds ratio (POR): 19.53; 95% credible intervals (CrI): 3.22- 84.93]. Sub-optimal condom use increased with age (POR: 1.09; 95%CrI: 1.06-1.11) and was associated with being married (POR: 4.14; 95%CrI: 1.23-4.28). Non-ART use was associated with being married (POR: 6.79; 95%CrI: 1.43-22.43). There were clusters with high HIV infection, sub-optimal condom use, and non- ART use in Ekurhuleni, an urban and semi-urban district in Gauteng province, South Africa. Findings show the need for expanding condom programmes and/or strengthening other HIV prevention programmes such as pre-exposure prophylaxis and encouraging sustained engagement in HIV care and treatment in the identified areas with the greatest need in Ekurhuleni Metropolitan Municipality.

Data on population movements can be helpful in designing targeted policy responses to curb epidemic spread. However, it is not clear how to exactly leverage such data and how valuable they might be for the control of epidemics. To explore these questions, we study a spatial epidemic model that explicitly accounts for population movements and propose an optimization framework for obtaining targeted policies that restrict economic activity in different neighborhoods of a city at different levels. We focus on COVID-19 and calibrate our model using the mobile phone data that capture individuals' movements within New York City (NYC). We use these data to illustrate that targeting can allow for substantially higher employment levels than uniform (city-wide) policies when applied to reduce infections across a region of focus. In our NYC example (which focuses on the control of the disease in April 2020), our main model illustrates that appropriate targeting achieves a reduction in infections in all neighborhoods while resuming 23.1%–42.4% of the baseline nonteleworkable employment level. By contrast, uniform restriction policies that achieve the same policy goal permit 3.92–6.25 times less nonteleworkable employment. Our optimization framework demonstrates the potential of targeting to limit the economic costs of unemployment while curbing the spread of an epidemic. This paper was accepted by Carri Chan, healthcare management. [ABSTRACT FROM AUTHOR]

In India, the nationwide lockdown was implemented from March to May 2020 due to COVID-19 pandemic. As of March 2020, there were 13.08 lakh PLHIV availing ART free of cost from Government run ART centres, To maintain the continuum of care, National AIDS Control Programme (NACP) of India adopted Multi Months Dispensation (MMD) through ART centres and Community Dispensation of ART through the various Targeted Interventions (TI) and Community Based Organizations (CBO). A mixed methods study was designed, with desk review of programmatic data, semi qualitative interviews of 250 PLHIV and 15 In-Depth Interviews of ART centre and TI/CBO staff to document the process, strengths and challenges of these strategies in Surat city of South Gujarat. While administrative, technical and networking strengths were documented, manpower constraints, interrupted laboratory services, migration and relatively passive role of PLHIV in availing services were major challenges described in this study among several others. [ABSTRACT FROM AUTHOR]

Background: Leprosy incidence remained at around 200,000 new cases globally for the last decade. Current strategies to reduce the number of new patients include early detection and providing post-exposure prophylaxis (PEP) to at-risk populations. Because leprosy is distributed unevenly, it is crucial to identify high-risk clusters of leprosy cases for targeting interventions. Geographic Information Systems (GIS) methodology can be used to optimize leprosy control activities by identifying clustering of leprosy cases and determining optimal target populations for PEP.Methods: The geolocations of leprosy cases registered from 2014 to 2018 in Pasuruan and Pamekasan (Indonesia) were collected and tested for spatial autocorrelation with the Moran's I statistic. We did a hotspot analysis using the Heatmap tool of QGIS to identify clusters of leprosy cases in both areas. Fifteen cluster settings were compared, varying the heatmap radius (i.e., 500 m, 1000 m, 1500 m, 2000 m, or 2500 m) and the density of clustering (low, moderate, and high). For each cluster setting, we calculated the number of cases in clusters, the size of the cluster (km2), and the total population targeted for PEP under various strategies.Results: The distribution of cases was more focused in Pasuruan (Moran's I = 0.44) than in Pamekasan (0.27). The proportion of total cases within identified clusters increased with heatmap radius and ranged from 3% to almost 100% in both areas. The proportion of the population in clusters targeted for PEP decreased with heatmap radius from > 100% to 5% in high and from 88 to 3% in moderate and low density clusters. We have developed an example of a practical guideline to determine optimal cluster settings based on a given PEP strategy, distribution of cases, resources available, and proportion of population targeted for PEP.Conclusion: Policy and operational decisions related to leprosy control programs can be guided by a hotspot analysis which aid in identifying high-risk clusters and estimating the number of people targeted for prophylactic interventions. [ABSTRACT FROM AUTHOR]

In trials of infectious disease interventions, rare outcomes and unpredictable spatiotemporal variation can introduce bias, reduce statistical power, and prevent conclusive inferences. Spillover effects can complicate inference if individual randomization is used to gain efficiency. Ring trials are a type of cluster-randomized trial that may increase efficiency and minimize bias, particularly in emergency and elimination settings with strong clustering of infection. They can be used to evaluate ring interventions, which are delivered to individuals in proximity to or contact with index cases. We conducted a systematic review of ring trials, compare them with other trial designs for evaluating ring interventions, and describe strengths and weaknesses of each design. Of 849 articles and 322 protocols screened, we identified 26 ring trials, 15 cluster-randomized trials, 5 trials that randomized households or individuals within rings, and 1 individually randomized trial. The most common interventions were postexposure prophylaxis (n  = 23) and focal mass drug administration and screening and treatment (n  = 7). Ring trials require robust surveillance systems and contact tracing for directly transmitted diseases. For rare diseases with strong spatiotemporal clustering, they may have higher efficiency and internal validity than cluster-randomized designs, in part because they ensure that no clusters are excluded from analysis due to zero cluster incidence. Though more research is needed to compare them with other types of trials, ring trials hold promise as a design that can increase trial speed and efficiency while reducing bias. [ABSTRACT FROM AUTHOR]

Objective: The proliferation of false information on COVID-19 mostly through social media is adversely affecting control efforts. The objective of this study was to identify areas where targeted effective messaging can be useful in demystifying misinformation against COVID-19. Results: The study showed high levels of misinformation on COVID-19 in the study area [mean score 2.71; standard deviation (SD) 1.5]. The highest levels of misinformation were observed in Dr. Ruth Segomotsi Mompati district, North West province (mean score: 3.84; SD: 2.1) and Sedibeng district, Gauteng province (mean score: 3.56; SD 1.7). Higher levels of misinformation were reported by those aged 18–24 years (mean score: 3.48; SD: 1.8), and men (mean score: 2.73; SD: 1.8). Across the two provinces, we identified geospatial hot and coldspots of misinformation highlighting the need to implement point of care strategies such as targeted messaging. Findings showed the need for targeted interventions to young people, students, those with low levels of education and the self-employed in the two districts more importantly, as South Africa expands its nationwide vaccination roll-out. [ABSTRACT FROM AUTHOR]

Context: HIV continues to be a major global public health issue. Links between sex work and HIV vulnerability have been recognized since the earliest days of the epidemic. Targeted Interventions (TIs) are aimed at offering prevention and care services to high risk populations within communities. Present research is an endeavor to grasp the different aspects indigenous to NGOs implementing TI projects. Aim: To understand the perspectives of NGOs implementing TIs projects for prevention of HIV/AIDS in Female Sex Workers. Settings and Design: A cross sectional qualitative study. Methods and Materials: Six NGOs registered with District AIDS Control Society, working for implementation of TIs projects for FSWs in a Metropolitan City were studied. Statistical Analysis: Data was analysed with SPSS version 20. Results: Rapid turnover of ORWs is major constraint faced by project managers in recruitment of ORWs. In PEs' recruitment, availability of candidates is major constraint. Stigma related to STI clinic and interference of key stakeholders are the major barriers preventing service utilization by FSWs. Client's dislike for using condom is one of the major barriers in condom utilization by FSWs. Conclusion: The realistic problems, constraints experienced by the programme managers became evident during the study. Integration of programs into the existing system and interventions should be tailor-made to local needs. Here lies the opportunity of 'Operational Research' for the institute like NACO to have the practical insights from TI projects.

Almost 20% of English pupils still experience difficulties with reading despite the use of a predominantly phonics-based approach that works well for most children, but not for all; therefore, other approaches need to be explored. The Integrated Group Reading (IGR) programme involves an inclusive approach to targeted teaching led by class teachers using group-based class organisation and the integration of diverse, research-based approaches (language and phonics-based). IGR has been evaluated in 34 English schools across 5 varied local authority areas using a cluster randomised design and a process evaluation. IGR was found to support enjoyment of reading and attain as much reading gains as the more phonics-oriented programmes used in the control classes. Following its use there were gains in teachers' self-efficacy in teaching reading, and no negative effects on the class (non-IGR) pupils' reading skills were found. This study shows what a more inclusive approach to targeted reading intervention can achieve through a well-resourced programme. Questions can be asked about the interpretation of randomised controlled trial (RCT) findings when it comes to classroom-based educational interventions, and about teacher choice in opting for alternative teaching approaches. [ABSTRACT FROM AUTHOR]

Introduction: Targeted intervention (TI) project aimed to interrupt HIV transmission among highly vulnerable population and their clients. Aims and Objectives: To compare survival among HIV-positive versus survival among HIV-negative women. Subjects and Methods: Study Design: Prospective cohort with retrospective comparison. Study Setting: Two drop in center clinics. Study Tool and Process of Data Collection: Data were collected for 5 years from 2009 to 2014. Pretested semi-structured questionnaire was used for data collection. Results: The mean age of high-risk women was 32.48 ± 4.67 years. The mean survival among HIV-negative women was 110.62 ± 0.6 months and mean survival among HIV-positive women was 91.09 ± 7.67 months. The mean interval to death among women with sexually transmitted diseases (STDs) was 113.50 ± 1.30, whereas the mean interval to death among women with no STDs was 105.65 ± 0.76. P = 0.00 by log-rank test. Conclusion: Status of high-risk women according to HIV, STDs, typology, category and partner wise were found to have a significant difference in survival experience, whereas PRR positivity for syphilis, literacy, alcohol intake do not have a significant difference. [ABSTRACT FROM AUTHOR]

Context: HIV continues to be a major global public health issue. Links between sex work and HIV vulnerability have been recognized since the earliest days of the epidemic. Targeted Interventions (TIs) are aimed at offering prevention and care services to high risk populations within communities. Present research is an endeavor to grasp the different aspects indigenous to NGOs implementing TI projects. Aim: To understand the perspectives of NGOs implementing TIs projects for prevention of HIV/AIDS in Female Sex Workers. Settings and Design: A cross sectional qualitative study. Methods and Materials: Six NGOs registered with District AIDS Control Society, working for implementation of TIs projects for FSWs in a Metropolitan City were studied. Statistical Analysis: Data was analysed with SPSS version 20. Results: Rapid turnover of ORWs is major constraint faced by project managers in recruitment of ORWs. In PEs' recruitment, availability of candidates is major constraint. Stigma related to STI clinic and interference of key stakeholders are the major barriers preventing service utilization by FSWs. Client's dislike for using condom is one of the major barriers in condom utilization by FSWs. Conclusion: The realistic problems, constraints experienced by the programme managers became evident during the study. Integration of programs into the existing system and interventions should be tailor-made to local needs. Here lies the opportunity of 'Operational Research' for the institute like NACO to have the practical insights from TI projects. [ABSTRACT FROM AUTHOR]

Smallholder farmers in sub-Saharan Africa are at a greater risk to the impacts of climate variability. We therefore sought to assess vulnerability of smallholder sorghum farmers to climate variability in Kigezi highlands of south-western Uganda. A vulnerability index that integrates selected socio-economic and biophysical variables was obtained through key informant interviews and household surveys, from 230 conveniently sampled sorghum farming households within three sub-counties differentiated by altitude. Rainfall data were obtained from Uganda National Meteorological Authority. Quantitative data were analysed using Statistical Package for Social Sciences (version 23) and STATA software to generate inferential and descriptive statistics, notably frequencies, percentages and chi-square tests, to establish relationship between variables. Content analysis was used to generate themes emerging from the qualitative data. The overall vulnerability index results indicate Kashambya as the most vulnerable (6.9), followed by Bubare (1.8), while Kamwezi was the least vulnerable (–0.2). This study recommends targeted extension services such as access to customised weather information and better agronomic practices to reduce smallholder sorghum farmers’ vulnerability.

The diversity of smallholder farms in space, resource endowment, production and consumption decisions are often a hindrance to the design, targeting, implementation and scaling out of agricultural development projects. Understanding farm heterogeneity is crucial in targeting interventions that can potentially contribute to improved crop productivity, food security and livelihood sustainability. The study sought to define and understand farm typology in a resettlement smallholder food-cash crop production area in Zimbabwe. Data was collected from five focus group discussions (FGDs), and 102 household interviews. Principal component analysis (PCA), multiple correspondence analysis (MCA) and cluster analysis were used to analyse quantitative and qualitative data variables and aggregate farms into clusters according to production means, socio-economics and demographics. The three identified farm types were (i) resource-endowed, commercial oriented farms, (ii) medium resourced and (iii) resource constrained farms practising subsistence and income oriented production. Labour was cited as a major challenge, with high labour cost relevant for type I farms, while household size has more bearing for type II and III farms. Ownership of tillage implements and operations varied from mechanised on resource endowed farms, to animal drawn on some medium and resource constrained farms. The farms exhibited variable livelihood strategies and all clusters exhibited market participation, albeit to varying extents. Thus strengthening of market links is imperative. Use of multivariate methods allowed for identification of the most discriminating variables for farm delineation and subsequent clustering of farms forms the basis for further exploring variability across farm types for the targeting of management interventions for livelihood sustainability.

Perceived stress plays an important role in the development and course of psychiatric disorders and early dropout from treatment. This study examined the effect of different types of childhood maltreatment on the current perceived stress level of patients with concurrent substance use and psychiatric disorders. One hundred patients (25% females) were recruited from a residential center for treatment of concurrent substance use and psychiatric disorders and assessed for the histories of childhood maltreatment and level of perceived stress. Results indicated that all types of childhood maltreatment (emotional and physical neglect, and emotional, physical and sexual abuse) were associated with elevated levels of perceived stress regardless of demographic characteristics, diagnoses of psychiatric disorders, and length of stay in the center. Findings support the need for additional targeted interventions for managing perceived stress and improving emotional regulation and coping skills in psychiatric patients with childhood maltreatment histories. [ABSTRACT FROM AUTHOR]

Smallholder farmers in sub-Saharan Africa are at a greater risk to the impacts of climate variability. We therefore sought to assess vulnerability of smallholder sorghum farmers to climate variability in Kigezi highlands of south-western Uganda. A vulnerability index that integrates selected socio-economic and biophysical variables was obtained through key informant interviews and household surveys, from 230 conveniently sampled sorghum farming households within three sub-counties differentiated by altitude. Rainfall data were obtained from Uganda National Meteorological Authority. Quantitative data were analysed using Statistical Package for Social Sciences (version 23) and STATA software to generate inferential and descriptive statistics, notably frequencies, percentages and chi-square tests, to establish relationship between variables. Content analysis was used to generate themes emerging from the qualitative data. The overall vulnerability index results indicate Kashambya as the most vulnerable (6.9), followed by Bubare (1.8), while Kamwezi was the least vulnerable (–0.2). This study recommends targeted extension services such as access to customised weather information and better agronomic practices to reduce smallholder sorghum farmers' vulnerability. [ABSTRACT FROM AUTHOR]

Livestock movements are an important mechanism of infectious disease transmission. Where these arewell recorded, network analysis tools have been used to successfully identify system properties, highlight vulnerabilities to transmission, and inform targeted surveillance and control. Here we highlight the main uses of network properties in understanding livestock disease epidemiology and discuss statistical approaches to infer network characteristics from biased or fragmented datasets. We use a 'hurdle model' approach that predicts (i) the probability of movement and (ii) the number of livestock moved to generate synthetic 'complete' networks of movements between administrative wards, exploiting routinely collected government movement permit data from northern Tanzania. We demonstrate that this model captures a significant amount of the observed variation. Combining the cattle movement network with a spatial between-ward contact layer, we create a multiplex, over which we simulated the spread of 'fast' (R0 = 3) and 'slow' (R0 = 1.5) pathogens, and assess the effects of random versus targeted disease control interventions (vaccination andmovement ban). The targeted interventions substantially outperform those randomly implemented for both fast and slow pathogens. Our findings provide motivation to encourage routine collection and centralization of movement data to construct representative networks. [ABSTRACT FROM AUTHOR]

The goal of this Special Issue is to introduce prevention scientists to an emerging form of healthcare, called precision medicine. This approach integrates investigation of the mechanisms of disease and health-compromising behaviors with prevention, treatment, and cure resolved at the level of the individual. Precision Medicine and its derivative personalized prevention represents a promising paradigm for prevention science as it accounts for response heterogeneity and guides development of targeted interventions that may enhance program effect sizes. If successfully integrated into prevention science research, personalized prevention is an approach that can inform the development of decision support tools (screening measures, prescriptive algorithms) and enhance the utility of mobile health technologies that will enable practitioners to use personalized consumer data to inform decisions about the best type and/or intensity of a prevention strategy for particular individuals or subgroups of individuals. In this special issue, we present conceptual articles that provide a heuristic framework for precision-based, personalization prevention research and empirical studies that address research questions exemplary of a new generation of precision-based personalized preventive interventions focused on children's mental health, behavioral health, and education. [ABSTRACT FROM AUTHOR]

Targeted interventions have been delivered to neighbors of cholera cases in major epidemic responses globally despite limited evidence for the impact of such targeting. Using data from urban epidemics in Chad and Democratic Republic of the Congo, we estimate the extent of spatiotemporal zones of increased cholera risk around cases. In both cities, we found zones of increased risk of at least 200 meters during the 5 days immediately after case presentation to a clinic. Risk was highest for those living closest to cases and diminished in time and space similarly across settings. These results provide a rational basis for rapidly delivering targeting interventions. [ABSTRACT FROM AUTHOR]

Spatial variations in rates of registered organ donors have not been studied in the UK at detailed spatial scales despite some evidence of national and regional differences. By drawing on the findings from the existing literature, this study examines associations between small-area variations in rates of new registrants to the UK organ donor register (ODR) within Wales and key demographic factors. Using map-based visualisations and statistical regression methods, spatial patterns in new registrants to the ODR are identified within Wales, a country which moved to an opt-out system of consent for organ donation following the Human Transplantation (Wales) Act 2013. By identifying the underlying factors associated with trends in rates of new ODR sign-up, this study aims to highlight the types of approaches that could be used to help to inform future targeted interventions aimed at improving registration rates. [ABSTRACT FROM AUTHOR]

Increased awareness of the secondary preventive benefits of antiretroviral treatment (ART) has strengthened the desire to optimize health care systems' response to HIV/AIDS. We identified clusters of health resource utilization (HRU) among people living with HIV (PLHIV) to inform targeted interventions aimed to optimize the cascade of HIV care. Using linked population-level health databases in British Columbia, Canada, we selected two analytic samples of PLHIV with 3 years of follow-up between 2006-2011 that were classified as intermittently retained in care or intermittently engaged in ART, and executed a probabilistic model-based clustering analysis for each sample with 5 and 9 quarterly HRU variables, respectively. We found clear HRU profile differences among both samples with similar HIV-related care: one featured active involvement in non-HIV care, the other little or no health care interaction following linkage to care. Differential reengagement intervention strategies capitalizing on missed opportunities in non-HIV care and further engaging physicians delivering HIV care are needed to optimize the response to the HIV epidemic. [ABSTRACT FROM AUTHOR]

Introduction: Focusing resources for HIV control on geographic areas of greatest need in countries with generalized epidemics has been recommended to increase cost-effectiveness. However, socioeconomic inequalities between areas of high and low prevalence could raise equity concerns and have been largely overlooked. We describe spatial patterns in HIV prevalence in east Zimbabwe and test for inequalities in accessibility and uptake of HIV services prior to the introduction of spatially-targeted programmes. Methods: 8092 participants in an open-cohort study were geo-located to 110 locations. HIV prevalence and HIV testing and counselling (HTC) uptake were mapped with ordinary kriging. Clusters of high or low HIV prevalence were detected with Kulldorff statistics, and the socioeconomic characteristics and sexual risk behaviours of their populations, and levels of local HIV service availability (measured in travel distance) and uptake were compared. Kulldorff statistics were also determined for HTC, antiretroviral therapy (ART), and voluntary medical male circumcision (VMMC) uptake. Results: One large and one small high HIV prevalence cluster (relative risk [RR] = 1.78, 95% confidence interval [CI] = 1.53-2.07; RR = 2.50, 95% CI = 2.08-3.01) and one low-prevalence cluster (RR = 0.70, 95% CI = 0.60-0.82) were detected. The larger high-prevalence cluster was urban with a wealthier population and more high-risk sexual behaviour than outside the cluster. Despite better access to HIV services, there was lower HTC uptake in the high-prevalence cluster (odds ratio [OR] of HTC in past three years: OR = 0.80, 95% CI = 0.66-0.97). The low-prevalence cluster was predominantly rural with a poorer population and longer travel distances to HIV services; however, uptake of HIV services was not reduced. Conclusions: High-prevalence clusters can be identified to which HIV control resources could be targeted. To date, poorer access to HIV services in the poorer low-prevalence areas has not resulted in lower service uptake, whilst there is significantly lower uptake of HTC in the high-prevalence cluster where health service access is better. Given the high levels of risky sexual behaviour and lower uptake of HTC services, targeting high-prevalence clusters may be cost-effective in this setting. If spatial targeting is introduced, inequalities in HIV service uptake may be avoided through mobile service provision for lower prevalence areas. [ABSTRACT FROM AUTHOR]

Background: Alcohol-related trauma remains high among underserved patients despite ongoing preventive measures. Geographic variability in prevalence of alcohol-related injury has prompted reexamination of this burden across different regions. We sought to elucidate demographic and socioeconomic factors influencing the prevalence of alcohol-related trauma among underserved patients and determine alcohol effects on selected outcomes.Methods: A retrospective analysis examined whether patients admitted to a suburban trauma center differed according to their blood alcohol concentration (BAC) on admission. Patients were stratified based on their BAC into four categories (undetectable BAC, BAC 1-99mg/dL, BAC 100-199mg/dL, and BAC ≥ 200mg/dL). T-tests and X2 tests were used to detect differences between BAC categories in terms of patient demographics and clinical outcomes. Multivariate linear and logistic regressions were used to investigate the association between patient variables and selected outcomes while controlling for confounders.Results: One third of 738 patients analyzed were BAC-positive, mean (SD) BAC was 211.4 (118.9) mg/dL, 80% of BAC-positive patients had levels ≥ 100mg/dL. After risk adjustments, the following patient characteristics were predictive of having highly elevated BAC (≥200mg/dL) upon admission to the Trauma Center; Hispanic patients (adjusted odds ratio (OR)=1.91, 95% confidence interval (CI): 1.14-3.21), unemployment (OR=1.74, 95% CI: 1.09-2.78), Medicaid beneficiaries (OR=3.59, 95% CI: 1.96-6.59), and uninsured patients (OR=2.86, 95% CI: 1.60-5.13). Patients with BAC of 100-199mg/dL were likely to be more severely injured (P=0.016) compared to undetectable-BAC patients. There was no association between being intoxicated, and being ICU-admitted or having differences in length of ICU or hospital stay.Conclusion: Demographic and socioeconomic factors underlie disparities in the prevalence of alcohol-related trauma among underserved patients. These findings may guide targeted interventions toward specific populations to help reduce the burden of alcohol-related injury. [ABSTRACT FROM AUTHOR]

Abstract Objectives: To determine the utility of the Risk Acceptance Ladder (RAL) as a measure for gauging self-reported reasons for participation in a range of health behaviours, and as a basis for targeting behaviour change interventions. Design: Randomised controlled trial. Methods: A sample of 639 UK adults (18+ years) were recruited into an online study and asked about their participation in four health behaviours; smoking, alcohol consumption, physical activity, fruit and vegetable consumption. Those with a health behaviour to modify (N=130) were allocated a behaviour change target and completed the RAL. Eligible participants (N=97) were then randomised to one of two groups; an intervention group received brief motivating information based on their RAL response (on-target), the control received information mismatched to their RAL response (off-target). Following intervention delivery, behavioural response was measured by recording whether participants clicked on a link to find out more about changing their target behaviour. Results: Three-quarters (N= 97, 74.60%, 95% CI: 67.12 – 82.08) of participants felt the RAL provided a suitable response option that identified why they had not changed their target behaviour and 60% (N=78, 95% CI: 51.58 – 68.42) agreed that it was easy to select just one option. Logistic regression confirmed that those in the intervention group had greater odds of clicking the link than those in the control group (OR: 2.83, 95% CI: 1.01 – 7.91). Conclusions: The response to the RAL was generally positive and this pilot study provides tentative support for the use of the RAL to develop effective, targeted interventions.

Background: The period 2006-2009 saw intensive scale-up of HIV prevention efforts and an increase in reported safer sex among brothel and street-based sex workers in Mumbai and Thane (Maharashtra, India). Yet during the same period, the prevalence of HIV increased in these groups. A better understanding of sex workers' risk environment is needed to explain this paradox.Methods: In this qualitative study we conducted 36 individual interviews, 9 joint interviews, and 10 focus group discussions with people associated with HIV interventions between March and May 2012.Results: Dramatic changes in Mumbai's urban landscape dominated participants' accounts, with dwindling sex worker numbers in traditional brothel areas attributed to urban restructuring. Gentrification and anti-trafficking efforts explained an escalation in police raids. This contributed to dispersal of sex work with the sex-trade management adapting by becoming more hidden and mobile, leading to increased vulnerability. Affordable mobile phone technology enabled independent sex workers to trade in more hidden ways and there was an increased dependence on lovers for support. The risk context has become ever more challenging, with animosity against sex work amplified since the scale up of targeted interventions. Focus on condom use with sex workers inadvertently contributed to the diversification of the sex trade as clients seek out women who are less visible. Sex workers and other marginalised women who sell sex all strictly prioritise anonymity. Power structures in the sex trade continue to pose insurmountable barriers to reaching young and new sex workers. Economic vulnerability shaped women's decisions to compromise on condom use. Surveys monitoring HIV prevalence among 'visible' street and brothel-bases sex workers are increasingly un-representative of all women selling sex and self-reported condom use is no longer a valid measure of risk reduction.Conclusions: Targeted harm reduction programmes with sex workers fail when implemented in complex urban environments that favour abolition. Increased stigmatisation and dispersal of risk can no longer be considered as unexpected. Reaching the increasing proportion of sex workers who intentionally avoid HIV prevention programmes has become the main challenge. Future evaluations need to incorporate building 'dark logic' models to predict potential harms. [ABSTRACT FROM AUTHOR]