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INTRODUCTION Unmet need for HIV prevention continues to persist worldwide, particularly in Eastern and Southern Africa, where nearly 21 million people, 53% of the global total, are living with HIV, [...], : Introduction: The Dual Prevention Pill (DPP) combines oral pre‐exposure prophylaxis (PrEP) with oral contraception (OC) to prevent HIV and pregnancy. Noting the significant role played by the private sector in delivering family planning (FP) services in countries with high HIV burden, high level of private sector OC uptake, and the recent growth in self‐care and technology‐based private sector channels, we undertook qualitative research in Kenya, South Africa and Zimbabwe to prioritize private sector service delivery approaches for the introduction of the DPP. Methods: Between March 2022 and February 2023, we conducted a literature review and key informant interviews with 34 donors and implementing partners, 19 government representatives, 17 private sector organizations, 13 pharmacy and drug shop representatives, and 12 telehealth agencies to assess the feasibility of DPP introduction in private sector channels. Channels were analysed thematically based on policies, level of coordination with the public sector, data systems, supply chain, need for subsidy, scalability, sustainability and geographic coverage. Results: Wide geographic reach, ongoing pharmacy‐administered PrEP pilots in Kenya and South Africa, and over‐the‐counter OC availability in Zimbabwe make pharmacies a priority for DPP delivery, in addition to private networked clinics, already trusted for FP and HIV services. In Kenya and South Africa, newer, technology‐based channels such as e‐pharmacies, telehealth and telemedicine are prioritized as they have rapidly grown in popularity due to nationwide accessibility, convenience and privacy. Findings are limited by a lack of standardized data on service uptake in newer channels and gaps in information on commodity pricing and willingness‐to‐pay for all channels. Conclusions: The private sector provides a significant proportion of FP services in countries with high HIV burden yet is an untapped delivery source for PrEP. Offering users a range of access options for the DPP in non‐traditional channels that minimize stigma, enhance discretion and increase convenience could increase uptake and continuation. Preparing these channels for PrEP provision requires engagement with Ministries of Health and providers and further research on pricing and willingness‐to‐pay. Aligning FP and PrEP delivery to meet the needs of those who want both HIV and pregnancy prevention will facilitate integrated service delivery and eventual DPP rollout, creating a platform for the private sector introduction of multipurpose prevention technologies.

BackgroundWithin the context of high childhood obesity prevalence, there is a concern that community efforts intended to reduce childhood obesity may lead to unintended adverse outcomes.ObjectiveThis analysis examined relationships between community programs, policies, and environmental changes (CPPs) for obesity prevention with unhealthy dieting behaviours and body weight satisfaction in children.MethodsUsing the Healthy Communities Study 2013 to 2015 survey sample of 5138 US children aged 4 to 15 years old, multilevel models examined associations between standardized CPP intensity scores and child dieting behaviours and weight satisfaction, adjusting for community and child-level covariates and clustered study design.ResultsIn fully adjusted models, higher total, physical activity, and nutrition CPP intensity scores were associated with lower odds of dissatisfaction with weight (1 year total CPP odds ratio [OR]: 0.41, 95% confidence interval [CI], 0.22-0.73; 6 year total CPP OR: 0.48, 0.29-0.80). Higher physical activity CPP intensity over the past year was associated with greater odds of weight satisfaction (OR: 1.77, 95% CI, 1.10-2.84). No associations were observed with dieting behaviours.ConclusionsResults suggest that community efforts focusing on nutrition and physical activity to prevent childhood obesity may be associated with weight satisfaction and not with unhealthy dieting behaviours.

BACKGROUND: A dietary screener questionnaire (DSQ) was used to assess dietary outcomes among children in the Healthy Communities Study (HCS), a study of the relationships between programs and policies to prevent child obesity and child diet, physical activity and weight outcomes. METHODS: To compare dietary intake estimates derived from the DSQ against those from the Automated Self-Administered 24-Hour Recalls for Children (ASA24-Kids) among children, a measurement error model, using structural equation modelling, was utilized to estimate slopes, deattenuated correlation coefficients, and attenuation factors by age and sex, ethnicity, and BMI status. PARTICIPANTS/SETTING: A randomly selected sub-sample of HCS participants aged 4-15 years in 130 communities throughout the U.S. who completed the DSQ and up to two ASA24-Kids recalls (n = 656;13% of HCS participants). RESULTS: For most nutrient/foods examined, the DSQ yielded larger mean intake estimates than the ASA24-Kids, and agreement between the two measures varied by food/nutrient, age and sex, ethnicity, and BMI category. Deattenuated correlation coefficients of 0.4 or greater were observed for added sugars from SSBs (0.54), fruits and vegetables (0.40), and dairy foods (0.50). Lower deattenuated correlation coefficients were seen for total added sugars (0.37), whole grains (0.34), and fiber (0.34). Attenuation factors were most severe for total added sugars intake among overweight children, and for several other dietary outcomes among children aged 9-11 years. CONCLUSIONS: The DSQ was found to be a tool with acceptable agreement with the ASA24-Kids for measuring multiple dietary outcomes of interest in the HCS, although there may be potential due to measurement error to underestimate results (bias towards the null). In future studies, measurement error modelling and regression calibration may be possible solutions to correct for bias due to measurement error in most food/nutrient intake estimates from the DSQ when used among children.

BackgroundOur objective was to examine the association between school wellness committees and implementation of nutrition wellness policies and children's weight status and obesity-related dietary outcomes.MethodsA cross-sectional study was conducted of 4790 children aged 4-15 years recruited from 130 communities in the Healthy Communities Study. Multilevel statistical models assessed associations between school wellness policies and anthropometric (body mass index z-score [BMIz]) and nutrition measures, adjusting for child and community-level covariates.ResultsChildren had lower BMI z-scores (-0.11, 95% confidence interval [CI]: -0.19, -0.03) and ate breakfast more frequently (0.14 days/week, 95% CI: 0.02-0.25) if attending a school with a wellness committee that met once or more in the past year compared to attending a school with a wellness committee that did not meet/did not exist. Children had lower added sugar (p < .0001), lower energy-dense foods (p = .0004), lower sugar intake from sugar-sweetened beverages (p = .0002), and lower dairy consumption (p = .001) if attending a school with similar or stronger implementation of the nutrition components of the school wellness policies compared to other schools in the district.ConclusionsA more active wellness committee was associated with lower BMI z-scores in US schoolchildren. Active school engagement in wellness policy implementation appears to play a positive role in efforts to reduce childhood obesity.

Background: Research on the association between school meal consumption and overall dietary intake post-Healthy Hunger-Free Kids Act implementation is limited.Objective: This study examines the association between frequency of participating in the National School Lunch and School Breakfast Programs and children’s dietary intakes.Design: The Healthy Communities Study was a cross-sectional observational study conducted between 2013-2015.Participants/setting: U.S. children ages 4-15 years (n=5,106).Main outcome measures: Dietary measures were assessed using the National Health and Nutrition Examination Survey Dietary Screener Questionnaire. Dietary intake included fruit/vegetables, fiber, whole grains, dairy, calcium., total added sugar, sugar-sweetened beverages, and energy-dense foods of minimal nutritional value.Statistical analysis: Multivariate statistical models assessed associations between frequency of eating school breakfast or lunch (every day vs. not every day) and dietary intake, adjusting for child and community-level covariates. Results: Children who ate school breakfast every day compared to children who ate 0-4 days/week, reported consuming more fruits/vegetables (0.1 cup/day, 95% CI: 0.01, 0.1), dietary fiber (0.4 g/day, 95% CI: 0.2, 0.7), whole grains (0.1 oz/day, 95% CI: 0.05, 0.1), dairy (0.1 cup/day, 95% CI: 0.05, 0.1), and calcium (34.5 mg/day, 95% CI: 19.1, 49.9). Children who ate school lunch every day compared to those who ate less frequently, consumed more dairy (0.1 cup/day, 95% CI: 0.1, 0.2) and calcium (32.4 mg/day, 95% CI: 18.1, 46.6).  No significant associations were observed between school meal consumption and energy-dense nutrient poor foods or added sugars.Conclusions: Eating school breakfast and school lunch every day by U.S. schoolchildren was associated with modestly healthier dietary intakes. These findings suggest potential nutritional benefits of regularly consuming school meals.

IntroductionCommunity health workers (CHWs) are lay workers who have the potential to enhance services to prevent mother-to-child HIV transmission (PMTCT) and improve the health of women living with HIV infection. We conducted a cluster-randomized trial of an intervention to integrate CHWs with 'Option B+' PMTCT services in Shinyanga Region, Tanzania.MethodsThe intervention was implemented for 11 months and included four integrated components: 1) formal linkage of CHWs to health facilities; 2) CHW-led antiretroviral therapy (ART) adherence counseling; 3) loss to follow-up tracing by CHWs; and 4) distribution of Action Birth Cards (ABCs), a birth planning tool. We cluster-randomized 32 facilities offering PMTCT services, within strata of size, to the intervention (n = 15) or comparison (standard of care, n = 17) groups. Intervention effectiveness was determined with a difference-in-differences strategy based on clinical and pharmacy data from HIV-infected postpartum women at baseline (births in 2014) and endline (births April-Oct 2015). The primary outcome was retention in care between 60 and 120 days postpartum. Secondary outcomes included ART initiation, timing of ART initiation (as measured by week of gestation), and ART adherence 90 days postpartum, measured using the medication possession ratio (MPR≥95%).ResultsIntervention and comparison facilities were similar at baseline. Data were collected from 1,152 and 678 mother-infant pairs at baseline and endline, respectively. There were no significant differences in retention in care, ART initiation, or timing of ART initiation between the intervention and control groups. Adherence (MPR≥95%) at 90 days postpartum was 11.3 percentage points higher in the intervention group in ITT analyses (95% CI: -0.7, 23.3, p = 0.06), though this effect was attenuated after adjusting for baseline imbalance (9.5 percentage points, 95% CI: -2.9, 22.0, p = 0.13). Among only sites that had the greatest fidelity to the intervention, however, we found a stronger effect on adherence (13.6 percentage points, 95% CI: 2.5, 24.6).ConclusionsDespite being feasible and acceptable, the CHW-based intervention did not have strong effects on most PMTCT indicators. CHW involvement in PMTCT programs may improve ART adherence among HIV-infected postpartum women, however, and success appears heavily dependent on program implementation.Trial registrationRegistry for International Development Impact Evaluations (RIDIE, ID 552553838b402) and ClinicalTrials.gov (NCT03058484).

BackgroundIn developing countries, facility-based delivery is recommended for maternal and neonatal health, and for prevention of mother-to-child HIV transmission (PMTCT). However, little is known about whether or not learning one's HIV status affects one's decision to deliver in a health facility. We examined this association in Zimbabwe.MethodsWe analyzed data from a 2012 cross-sectional community-based serosurvey conducted to evaluate Zimbabwe's accelerated national PMTCT program. Eligible women (≥16 years old and mothers of infants born 9-18 months before the survey) were randomly sampled from the catchment areas of 157 health facilities in five of ten provinces. Participants were interviewed about where they delivered and provided blood samples for HIV testing.ResultsOverall 8796 (77 %) mothers reported facility-based delivery; uptake varied by community (30-100%). The likelihood of facility-based delivery was not associated with maternal HIV status. Women who self-reported being HIV-positive before delivery were as likely to deliver in a health facility as women who were HIV-negative, irrespective of when they learned their status - before (adjusted prevalence ratio (PRa) = 1.04, 95% confidence interval (CI) = 1.00-1.09) or during pregnancy (PRa = 1.05, 95% CI = 1.01-1.09). Mothers who had not accessed antenatal care or tested for HIV were most likely to deliver outside a health facility (69%). Overall, however 77% of home deliveries occurred among women who had accessed antenatal care and were HIV-tested.ConclusionsUptake of facility-based delivery was similar among HIV-infected and HIV-uninfected mothers, which was somewhat unexpected given the substantial technical and financial investment aimed at retaining HIV-positive women in care in Zimbabwe.

Multifaceted community interventions directed at improving food environments are emerging, but their impact on dietary change and obesity prevalence has not been adequately documented. The Healthy Communities Study (HCS) is seeking to identify characteristics and combinations of programs and policies that are associated with children's diets and obesity-related outcomes in various types of communities across the U.S. The purpose of this paper is to describe the methods used in 2013-2015 in the HCS to assess dietary intake, school nutrition environments, and other nutrition-related behaviors. The conceptual framework of the HCS is based on the socioecological model and behaviors shown in previous studies to be related to obesity in children guided selection of domains. Nine domains were identified as essential measures of nutrition in the HCS: (1) intake of selected foods and beverages; (2) food patterns and behaviors; (3) social support; (4) home environment; (5) school environment; (6) community environment; (7) breastfeeding history; (8) household food insecurity; and (9) dieting behaviors and body image. Children's dietary intake was assessed using a dietary screener and up to two automated 24-hour recalls. Dietary-related behaviors were assessed by a survey administered to the parent, child, or both, depending on child age. School nutrition measures were obtained from a combination of school staff surveys and researcher observations. Information from these measures is expected to contribute to a better understanding of "what is working" to improve the dietary behaviors that are likely to prevent obesity and improve health in children.

Introduction: The Dual Prevention Pill (DPP) combines oral pre‐exposure prophylaxis (PrEP) with oral contraception (OC) to prevent HIV and pregnancy. Noting the significant role played by the private sector in delivering family planning (FP) services in countries with high HIV burden, high level of private sector OC uptake, and the recent growth in self‐care and technology‐based private sector channels, we undertook qualitative research in Kenya, South Africa and Zimbabwe to prioritize private sector service delivery approaches for the introduction of the DPP. Methods: Between March 2022 and February 2023, we conducted a literature review and key informant interviews with 34 donors and implementing partners, 19 government representatives, 17 private sector organizations, 13 pharmacy and drug shop representatives, and 12 telehealth agencies to assess the feasibility of DPP introduction in private sector channels. Channels were analysed thematically based on policies, level of coordination with the public sector, data systems, supply chain, need for subsidy, scalability, sustainability and geographic coverage. Results: Wide geographic reach, ongoing pharmacy‐administered PrEP pilots in Kenya and South Africa, and over‐the‐counter OC availability in Zimbabwe make pharmacies a priority for DPP delivery, in addition to private networked clinics, already trusted for FP and HIV services. In Kenya and South Africa, newer, technology‐based channels such as e‐pharmacies, telehealth and telemedicine are prioritized as they have rapidly grown in popularity due to nationwide accessibility, convenience and privacy. Findings are limited by a lack of standardized data on service uptake in newer channels and gaps in information on commodity pricing and willingness‐to‐pay for all channels. Conclusions: The private sector provides a significant proportion of FP services in countries with high HIV burden yet is an untapped delivery source for PrEP. Offering users a range of access options for the DPP in non‐traditional channels that minimize stigma, enhance discretion and increase convenience could increase uptake and continuation. Preparing these channels for PrEP provision requires engagement with Ministries of Health and providers and further research on pricing and willingness‐to‐pay. Aligning FP and PrEP delivery to meet the needs of those who want both HIV and pregnancy prevention will facilitate integrated service delivery and eventual DPP rollout, creating a platform for the private sector introduction of multipurpose prevention technologies. [ABSTRACT FROM AUTHOR]

Less than 11% of young school-aged children eat the recommended amounts of fruits and vegetables, despite abundant evidence that these foods protect against many types of cancer, heart disease and diabetes, and when combined with other dietary changes can help protect against obesity. In 2005, California became the first state to address the availability of fresh and local produce in the federal School Breakfast Program through state funding. The California Fresh Start Program doubled the number of different fresh fruits offered to students. With the greater variety, the number of fresh fruit servings taken by students in the Fresh Start pilot program more than doubled. Evaluation of the program revealed many lessons, which are especially important now, as schools across the country prepare to increase the number of fruits and vegetables offered in the School Breakfast Program by or before July 2014 as mandated by the Healthy, Hunger-Free Kids Act.

INTRODUCTION Although significant gains have been made in reducing mother to child transmission (MTCT) of HIV globally, there still remains an unacceptably high number of transmissions estimated at 170,000 and [...], : Introduction: Despite improvements in prevention of mother?to?child transmission (PMTCT) of HIV outcomes, there remain unacceptably high numbers of mother?to?child transmissions (MTCT) of HIV. Programmes and research collect multiple sources of PMTCT data, yet this data is rarely integrated in a systematic way. We conducted a data integration exercise to evaluate the Zimbabwe national PMTCT programme and derive lessons for strengthening implementation and documentation. Methods: We used data from four sources: research, Ministry of Health and Child Care (MOHCC) programme, Implementer ? Organization for Public Health Interventions and Development, and modelling. Research data came from serial population representative cross?sectional surveys that evaluated the national PMTCT programme in 2012, 2014 and 2017/2018. MOHCC and Organization for Public Health Interventions and Development collected data with similar indicators for the period 2018 to 2019. Modelling data from 2017/18 UNAIDS Spectrum was used. We systematically integrated data from the different sources to explore PMTCT programme performance at each step of the cascade. We also conducted spatial analysis to identify hotspots of MTCT. Results: We developed cascades for HIV?positive and negative?mothers, and HIV exposed and infected infants to 24 months post?partum. Most data were available on HIV positive mothers. Few data were available 6?8 weeks post?delivery for HIV exposed/infected infants and none were available post?delivery for HIV?negative mothers. The different data sources largely concurred. Antenatal care (ANC) registration was high, although women often presented late. There was variable implementation of PMTCT services, MTCT hotspots were identified. Factors positively associated with MTCT included delayed ANC registration and mobility (use of more than one health facility) during pregnancy/breastfeeding. There was reduced MTCT among women whose partners accompanied them to ANC, and infants receiving antiretroviral prophylaxis. Notably, the largest contribution to MTCT was from postnatal women who had previously tested negative (12/25 in survey data, 17.6% estimated by Spectrum modelling). Data integration enabled formulation of interventions to improve programmes. Conclusions: Data integration was feasible and identified gaps in programme implementation/documentation leading to corrective interventions. Incident infections among mothers are the largest contributors to MTCT: there is need to strengthen the prevention cascade among HIV?negative women.

Abstract. Economic developers in Northwest Ohio have faced enormous challenges since the economic restructuring of the 1970s. Local factors also impact on local economic development efforts. This is a case [...]

Objective: To examine the prevalence of low serum folate and vitamin B12, in association with elevated serum homocysteine, in a representative sample of older Australians. Methods: During 1997-2000, 3,508 persons aged 50+ years were examined in a population-based cohort study conducted in two postcodes, west of Sydney, Australia. Of these, 2,901 participants (82.7%) provided fasting blood for estimates of serum folate, vitamin B12 and total homocysteine. Results: Low serum B12 ( Conclusions: Low serum levels of vitamin B12 and elevated serum homocysteine are relatively frequent in older Australians. Implications: Appropriate public health action should be considered to reduce the prevalence of low serum vitamin B12 and elevated homocysteine in older Australians.

Objective: To examine the validity of self-reported height and weight data reported over the telephone in the 1997 NSW Health Survey, and to determine its accuracy to monitor overweight and obesity in population surveys. Method: Self-reported and measured heights and weights were collected from 227 people living in Western Sydney, who had participated in the NSW Health Survey 1997. Results: Self-reported (SR) weights and heights led to misclassification of relative weight status. BMI, based on measured weights and heights, classified 62% of males and 47% of females as overweight or obese, compared with 39% and 32%, respectively, from self-report. Conclusions: Caution should be used when interpreting SR height and weight data from surveys, because BMI derived from these is likely to underestimate the true prevalence of overweight and obesity. Implications: SR data have a place in nutrition monitoring because they are relatively inexpensive and easy to collect. However, classifying people into weight categories on the basis of accepted cut-points, using SR heights and weights, yields inaccurate prevalence estimates. Periodic sub-studies of the validity of SR heights and weights are needed to indicate the extent to which the validity of SR is changing.

Objective: To describe the measured dietary intakes and anthropometry of a large, free-living population of middle-aged and older Australians who participated in the Australian Blue Mountains Eye Study (BMES), and to identify the sociodemographic characteristics associated with attainment or non-attainment of dietary goals. Method: Anthropometry and dietary intakes were compared with current population dietary goals and Recommended Dietary Intakes for 2,873 people (79% of eligible residents) aged >49 years who participated in the BMES. Nutrient intakes were measured by a validated food frequency questionnaire. Results: Nutrients for which mean intakes deviated most from nutrition goals included: percentages of energy from total and saturated fat, carbohydrate and alcohol (men), as well as absolute intakes of calcium, zinc and fibre. More than half the men (60%) and women (54%) were overweight or obese. Several micro-nutrient goals were more likely to be met in households where the respondents and/ or their spouses were independent. Married men were more likely to meet goals for fibre and iron, but less likely to meet the goal for cholesterol. Several goals were more likely to be met by men and women who had qualifications after leaving school, those with higher job status and non-pensioners, suggesting an socio-economic status dimension. Conclusions and implications: These results indicate that over- rather than under-nutrition is more prevalent among community-dwelling older people, although under-nutrition should not be overlooked. Particular sub-groups that are less likely to meet some dietary goals may require targeting in community nutrition interventions.

A study was conducted to assess the validity and reproductivity of a 145-item self-administered food frequency questionnaire (FFQ) in a sample population aged 63 to 80. FFQs were completed by 89% of 3,654 residents attending a community-based eye study. The validity of FFQ was assessed against three, four-day weighed food records. The results showed that it is possible to use simple but comprehensive self-administered FFQs to study nutrient exposure of the elderly.