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The burden of depression and anxiety disorders is high in sub-Saharan Africa, especially for people with HIV (PWH). The Patient Health Questionnaire-4 (PHQ-4) and Electronic Mental Wellness Tool-3 (E-mwTool-3) are ultra-brief screening tools for these disorders. We compared the performance of PHQ-4 and E-mwTool-3 for screening MINI-International Neuropsychiatric Interview diagnoses of depression and anxiety among a sample of individuals with and without HIV in two primary care clinics and one general hospital in Maputo City, Mozambique. Areas-under-the-curve (AUC) were calculated along with sensitivities and specificities at a range of cutoffs. For PWH, at a sum score cutoff of ≥ 1, sensitivities were strong: PHQ-4:Depression = 0.843; PHQ-4:Anxiety = 0.786; E-mwTool-3:Depression = 0.843; E-mwTool-3:Anxiety = 0.929. E-mwTool-3 performance was comparable to PHQ-4 among people with and without HIV.

International audience; Natural radioactive gases and anthropogenic radionuclides such as radon, xenon, hydrogen and krypton isotopes, need to be carefully monitored to be properly managed as pathogenic agents, radioactive diagnostic agents or indicators of nuclear activity. State-of-the-art gas detectors based on liquid scintillators suffer from many drawbacks such as lengthy sample preparation procedures and limited solubility of gaseous radionuclides, which produces a detrimental effect on measurement sensitivity. A potential breakthrough solution to this problem is the use of solid porous scintillators that act as gas concentrators and therefore could increase detection sensitivity. Highly porous scintillating metal-organic frameworks (MOFs) stand out as relevant materials for the realization of these devices. We demonstrate the capability of porous hafnium-based MOF nanocrystals exploiting dicarboxy-9,10-diphenylanthracene (DPA) as a scintillating conjugated linker to detect gas radionuclides. The nanocrystals show fast scintillation properties in the nanosecond domain, a fluorescence quantum yield of ~40% and an accessible porosity suitable to host noble gas atoms and ions. The MOFs have been tested for the adsorption and detection of the radionuclides 85Kr, 222Rn and 3H in a customized newly developed device based on a time coincidence technique. For all of them, MOF nanocrystals demonstrate an improved sensitivity with respect to a reference detector, showing an excellent linear response down to an activity value lower than 1 kBq·m-3 that outperforms that of commercial devices. The results obtained strongly support the possible use of scintillating porous MOF nanocrystals as the building block of ultrasensitive sensors for the detection of natural and anthropogenic radioactive gases.

BACKGROUND: Mental health conditions impose a major burden worldwide, especially in low- and middle-income countries (LMICs), where health specialists are scarce. A challenge to closing LMICs’ mental health treatment gap is determining the most cost-effective task-shifting pathway for delivering mental health services using evidence-based interventions (EBIs). This article discusses the protocol for the first study implementing comprehensive mental health services in LMICs. METHODS: In partnership with the Mozambican Ministry of Health, this cluster-randomized, hybrid implementation effectiveness type-2 trial will evaluate implementation, patient, and service outcomes of three task-shifting delivery pathways in 20 Mozambican districts (population 4.7 million). In pathway 1 (usual care), community health workers (CHWs) and primary care providers (PCPs) refer patients to district-level mental health clinics. In pathway 2 (screen, refer, and treat), CHWs screen and refer patients to PCPs for behavioral and pharmacological EBIs in community clinics. In pathway 3 (community mental health stepped care), CHWs screen patients and deliver behavioral EBIs in the community and refer medication management cases to PCPs in clinics. Mixed-methods process evaluation will be used to examine factors affecting pathway implementation, adoption, and sustainability. Clinical activities will occur without research team support. Ministry of Health personnel will coordinate training and supervision. RESULTS: The most cost-effective pathway will be scaled up in all districts for 12 months. NEXT STEPS: This novel study integrating comprehensive mental health services into primary care will inform a toolkit to help the Mozambican Ministry of Health scale up the most cost-effective pathway for mental health services and can be a template for other LMICs.

Community-based delivery of HIV pre-exposure prophylaxis (PrEP) to South African adolescent girls and young women's (AGYW) could increase access but needs evaluation. We integrated PrEP services via home-based services and pop-up tents into existing community-based HIV testing services (CB-HTS) in Eastern Cape Province, South Africa.After accessing CB-HTS via a "pop-up" tent or home-based services, HIV-negative AGYW aged 16-25 years were invited to complete a baseline questionnaire and referred for PrEP services at a community-based PrEP site co-located with pop-up HTS tents. A 30-day supply of PrEP was dispensed. PrEP uptake, time-to-initiation, cohort characteristics and first medication refill within 90 days were measured using descriptive statistics.Of the 1164 AGYW who tested for HIV, 825 (74.3%) completed a questionnaire and 806 (97.7%) were referred for community-based PrEP. Of those, 624 (77.4%) presented for PrEP (482/483 [99.8%] from pop-up HTS and 142/323 [44.0%] from home-based HTS), of which 603 (96.6%) initiated PrEP. Of those initiating PrEP following home-based HTS, 59.1% initiated within 0-3 days, 25.6% within 4-14 days and 15.3% took ≥15 days to initiate; 100% of AGYW who used pop-up HTS initiated PrEP the same day. Among AGWY initiating PrEP, 37.5% had a detectable sexually transmitted infection (STI). Although AGYW reported a low self-perception of HIV risk, post-hoc application of HIV risk assessment measures to available data classified most study participants as high risk for HIV acquisition. Cumulatively, 329 (54.6%) AGYW presented for a first medication refill within 90 days of accepting their first bottle of PrEP.Leveraging CB-HTS platforms to provide same-day PrEP initiation and refill services was acceptable to AGYW. A higher proportion of AGYW initiated PrEP when co-located with CB-HTS sites compared to those referred following home-based HTS, suggesting that proximity of CB-HTS and PrEP services facilitates PrEP uptake among AGYW. The high prevalence of STIs among those initiating PrEP necessitates the integration of STI and HIV prevention programs for AGYW. Eligibility for PrEP initiation should not be required among AHYW in high HIV burden communities. Community-based service delivery will be crucial to maintaining access to PrEP services during the COVID-19 pandemic and future health and humanitarian emergencies.

ObjectiveTo report the interim results from the training of providers inevidence-based psychotherapies (EBPs) and use of mobile applications.Design and SettingThe Partnerships in Research to Implement and Disseminate Sustainable and Scalable Evidence (PRIDE) study is a cluster-randomised hybrid effectiveness-implementation trial comparing three delivery pathways for integrating comprehensive mental healthcare into primary care in Mozambique. Innovations include the use of EBPs and scaling-up of task-shifted mental health services using mobile applications.Main outcome measuresWe examined EBP training attendance, certification, knowledge and intentions to deliver each component. We collected qualitative data through rapid ethnography and focus groups. We tracked the use of the mobile applications to investigate early reach of a valid screening tool (Electronic Mental Wellness Tool) and the roll out of the EBPsParticipantsPsychiatric technicians and primary care providers trained in the EBPs.ResultsPRIDE has trained 110 EBP providers, supervisors and trainers and will train 279 community health workers in upcoming months. The trainings improved knowledge about the EBPs and trainees indicated strong intentions to deliver the EBP core components. Trained providers began using the mobile applications and appear to identify cases and provide appropriate treatment.ConclusionsThe future of EBPs requires implementation within existing systems of care with fidelity to their core evidence-based components. To sustainably address the vast mental health treatment gap globally, EBP implementation demands: expanding the mental health workforce by training existing human resources; sequential use of EBPs to comprehensively treat mental disorders and their comorbid presentations and leveraging digital screening and treatment applications.

Adolescent girls and young women (AGYW) are a priority population for pre-exposure prophylaxis (PrEP), a highly effective HIV prevention method. However, effective PrEP use among AGYW has been low. Interventions to support PrEP effective use may improve pill-taking. Affordability of PrEP programs depends on their cost. We, therefore, evaluated the cost of community-based PrEP with effective use counselling.Cost data from a randomized controlled trial were used to evaluate the cost of PrEP provision with effective use counselling offered to AGYW through community-based HIV testing platforms between November 2018 and November 2019. AGYW were randomized to receive (1) group-based community health club effective use counselling, (2) individualized effective use counselling or (3) community-based PrEP dispensary. Task shifting of effective use counselling from nurses to trained lay counsellors was implemented in groups 1 and 2. Personnel costs were estimated from time-and-motion observations and staff interviews. Expenditure and ingredients-based approaches were used to estimate costs for medical and non-medical supplies.In total, 603 AGYW initiated PrEP and accrued a total of 1280 months on PrEP. Average cost per person-month on PrEP with group-based community health club, individualized effective use counselling and community-based PrEP dispensary under the Department of Health scenario were similar and high (USD $55.32, $55.65 and $55.46, respectively) due to low PrEP client volume observed in the clinical trial. Increasing client volume (scaled Department of Health scenario) reduced cost per-person month estimates to USD $15.48, $26.40 and $13.99, respectively.As designed, individualized effective use counselling increased the cost of standard-of-care PrEP delivery by 89%, group-based community health effective use counselling increased the cost of standard-of-care PrEP delivery by 11%. These estimates can inform cost-effectiveness and budget impact analysis for PrEP provision with effective use counselling services.

A high efficiency emission with a massive Stokes shift is obtained by fluorescent conjugated acene building blocks arranged in nanocrystals. The two ligands of equal molecular length and connectivity, yet complementary electronic properties, are co-assembled by zirconium oxy-hydroxy clusters, generating highly crystalline hetero-MOF nanoparticles The fast diffusion of singlet molecular excitons in the framework, coupled with the fine matching of ligands absorption and emission properties, enables to achieve an ultrafast activation of the low energy emission by diffusion-mediated non-radiative energy transfer in the 100 ps time scale, by using a low amount of co-ligands. This allow to obtain MOF nanocrystals with a fluorescence quantum efficiency of ̴ 70% and an actual Stokes shift as large as 750 meV. This large Stokes shift suppresses the reabsorption of fast emission issues in bulk devices, pivotal for a plethora of applications in photonics and photon managing spacing from solar technologies, imaging, and detection of high energy radiation. These features allowed to realize a prototypal fast nanocomposite scintillator that shows an enhanced performance with respect to the homo-ligand nanocrystals, achieving benchmark. values which compete with those of some inorganic and organic commercial systems.

Rotors, motors and switches in the solid state find a favorable playground in porous materials, such as Metal Organic Frameworks (MOFs) and Porous Aromatic Frameworks (PAFs), thanks to their large free volume, which allows for fast dynamics. We have realized a fast molecular rotor in the solid state whose rotation speed approaches that of unhindered rotations in organic moieties even at very low temperatures (2 K). Continuos, unidirectional hyperfast rotation with an energy barrier of 6.2 cal/mol and a high frequency persistent for several turns are achieved (10 GHz below 2 K).[1] Responsive porous switchable framework materials endowed with light-responsive overcrowded olefins, took advantage of both the quantitative photoisomerization in the solid state and the porosity of the framework to reversibly modulate the gas adsorption in response to light. [2] Motors were inserted into metal-organic frameworks wherein two linkers with complementary absorption-emission properties were integrated into the same materials. Unidirectional motion was achieved by simple exposure to sun-light of the solid particles, which thus behave as autonomous nanodevices.[3] MOF nanocrystals comprising high-Z linking nodes interacting with the ionizing radiation, arranged in an orderly fashion at a nanometric distance from diphenylanthracene ligand emitters showed ultrafast sensitization of the ligand fluorescence, thus supporting the development of new engineered scintillators.[4,5] References 1. A. Comotti, P. Sozzani et al Nature Chem. 2020, 12, 845. 2. A. Comotti, B. L. Feringa et al Nature Chem. 2020, 12, 595. 3. A. Comotti, B. L. Feringa et al J. Am. Chem. Soc. 2020, 142, 9048. 4.P. E. Sozzani, A. Comotti, A. Monguzzi et al Adv. Mater. 2019, 31, 1903309. 5. A. Comotti, A. Monguzzi et al Nature Photonics 2021, doi 10.1038/s41566-021-00769-z.

The search for new sophisticated functions integrated in porous solids prompted us to engineer switches and motors in metal-organic and covalent architectures for the construction of working nanodevices. 3D Porous Aromatic Frameworks were built with photo-active monomer units, and could be switched on command between two permanent states, entailing structure breathing and gas sorption switching. A fast molecular rotor in the solid state whose rotation speed approaches that of unhindered rotations in organic moieties even at very low temperatures (10 GHz below 2 K) was realized generating continuous, unidirectional hyperfast rotation with an energy barrier of 6.2 cal/mol. The energy transfer effect with radiation up-grading was also realized in Porous Emitting Frameworks (PEFs): porphyrin (red absorber) and diphenyl-antracene (blue emitter) were integrated in a 3D network showing very effective convertion of low energy light into photons of higher energy. With a similar concept, motors were inserted into metal-organic frameworks (MOFS), wherein two linkers with complementary absorption-emission properties were integrated in the same materials. The linkers were put in action by the visible light up-grading to UV-radiation, for fuelling the motors. MOF nanocrystals comprising high-Z linking nodes interacting with the ionizing radiation, arranged in an orderly fashion at a nanometric distance from ligand emitters showed ultrafast sensitization of the ligand fluorescence, thus supporting the development of new engineered scintillators. A. Comotti, B. L. Feringa et al Nature Chem. 2020, 12, 595; A. Comotti, P. Sozzani et al Nature Chem. 2020, 12, 845; P. Sozzani, A. Comotti, A. Monguzzi et al Adv. Mater. 2019, 31, 1903309; A. Comotti, B. L. Feringa et al J. Am. Chem. Soc. 2020, 142, 9048; A. Comotti, A. Monguzzi et al Nature Photonics 2021, doi 10.1038/s41566-021-00769-z.

Introduction Unhealthy alcohol use (UAU) is a major public health challenge, particularly in low- and middle-income countries. Mozambique is the fourth poorest country in the world where half of the population lives below the poverty line. UAU is frequent among drinkers in Mozambique; however, resources and infrastructure to treat UAU are very limited. This paper examines how task-shifting and a provider-facing mobile health application are being used to improve access to care. In this paper, the feasibility, acceptability and appropriateness of a provider-facing mobile health application being used under a task-shifting model to identify UAU and provide a four-session brief motivational interviewing intervention are described. Method The study used a sequential exploratory mixed-methods design with a QUAL → quan structure. First, 15 psychiatric technicians and primary care providers in Mozambique's Nampula Province participated in semi-structured interviews. These interviews were recorded and transcribed. Then, 45 providers completed a 12-item quantitative survey on tablets. Quantitative analysis used descriptive statistic calculation and qualitative analysis used thematic analysis. Results Nonspecialized providers found the mobile health app to be acceptable, appropriate, and feasible when delivering a 4-session brief motivational intervention under a task-shifting model. Central benefits of the technology were enhanced standardization and efficiency of sessions as well as feelings of legitimacy when interacting with patients. Main concerns were feasibility of implementing the intervention due to time constraints of workload and internet connectivity issues. Conclusions Provider-facing technology shows promise in supporting task-shifting models that can expand alcohol intervention services and increase access to care in low- and middle-income countries. Providers without specialized training in behavioral health interventions can provide critical services to patients with UAU and provider-facing mobile health applications may help bring such models to scale.