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Abstract Background HIV self-testing (HIVST) provides young people with a convenient, discreet, and empowering way to know their HIV status. However, there is limited knowledge of young people’s preferences for HIVST services and potential factors that may influence the uptake of HIVST among this population. The purpose of this research was to use qualitative methods to examine HIVST preferences among Nigerian youth. Methods Semi-structured in-depth interviews with a purposive sample of young people 14–24 years old were conducted in Lagos, Nigeria. Data were analyzed thematically to identify themes and domains related to preferences and factors influencing the use of HIV self-testing. Results A total of 65 youth with mean age of 21 years, were interviewed, and the majority were females (56%). Four themes emerged as the most important characteristics that may influence young people’s preferences for HIV self-testing: 1) Cost (i.e. majority of participants noted that they would pay between NGN500 to NGN1,500 naira (USD1.38–USD4.16) for oral HIV self-testing kits); 2) Testing method (i.e. although blood-based sample kits were more popular than oral-based self-testing kits, most preferred the oral-based option due to its perceived benefits and for some, phobia of needles); 3) Access location (i.e. participants suggested they preferred to obtain the HIVST kits from youth-friendly centers, pharmacies, private health facilities, and online stores); and 4) Continuing care and support (i.e. participants highlighted the importance of linkage to care with trained youth health workers for positive or negative test results or toll-free helpline). Conclusion HIV self-testing preferences among Nigerian youth appear to be influenced by several factors including lower cost, less invasive testing method, location of testing, and linkage to care and support post testing. Findings underscore the need to address young people’s HIV self-testing preferences as a foundation for implementing programs and research to increase the uptake of HIVST.

It is important to understand how to frame the formats for promoting HIV self-testing to increase uptake among young people. In this study, we used a culture-centered model to understand the narratives of HIV self-testing preferences among young people in Nigeria. We conducted a crowdsourcing contest to solicit ideas surrounding HIV self-testing promotion among young people (10–24 years) in Nigeria from October to November 2018 as part of the 2018 World AIDS Day event. We received 903 submissions and employed thematic content analysis to evaluate 769 eligible youth narratives. Thematic content analysis of the statements from the youth narratives was guided by the PEN-3 cultural model to examine the positive, existential, and negative perceptions (beliefs and values), enablers (resources), and nurturers (roles of friends and family) of HIV self-testing promotion among young people in Nigeria. Several themes emerged as factors that influence the uptake of HIV self-testing among young people in Nigeria. Specifically, seven themes emerged as perceptions: HIV testing accessibility, stigma reduction, and autonomy (positive); HIV self-testing kit packaging and advertisements (existential); lack of knowledge and increased stigma (negative). Seven themes emerged as enablers: social media, school, and government promotion (positive); gamification and animation (existential); high cost and access to linkage to care services (negative); And seven themes emerged as nurturers: peer, families, and faith-based communities (positive); parents and family-centered approach (existential); and partners and family (negative). Our data suggests that increased awareness around HIV self-testing on current youth-friendly platforms, de-stigmatization of HIV and HIV self-testing, decreased prices for HIV self-testing kits, reliability of testing kits, increased linkage to care services, and promotion of self-testing among family members and the community will be beneficial for HIV self-testing scale-up measures among young people in Nigeria.

Abstract Background Economic empowerment (EE) HIV prevention programs for adolescent girls and young women (AGYW) in sub-Saharan Africa are gaining traction as effective strategies to reduce HIV risk and vulnerabilities among this population. While intervention effectiveness is critical, there are numerous factors beyond effectiveness that shape an intervention’s impact. The objective of this systematic review was to assess the reporting of implementation outcomes of EE HIV prevention programs for AGYW in SSA, as conceptualized in the RE-AIM (reach, efficacy/effectiveness, adoption, implementation, and maintenance) framework. Methods We searched PubMed, Ovid/MEDLINE, Science Direct, Ebscohost, PsycINFO, Scopus, and Web of Science for EE HIV interventions for AGYW in SSA. Study selection and data extraction were conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Two researchers coded each article using a validated RE-AIM data extraction tool and independently extracted information from each article. The reporting of RE-AIM dimensions were summarized and synthesized across included interventions. Results A total of 25 unique interventions (reported in 45 articles) met the predefined eligibility criteria. Efficacy/effectiveness 19(74.4%) was the highest reported RE-AIM dimension, followed by adoption 17(67.2%), reach 16(64.0%), implementation 9(38.0%), and maintenance 7(26.4%). Most interventions reported on RE-AIM components such as sample size 25(100.0%), intervention location 24(96.0%), and measures and results for at least one follow-up 24(96.0%). Few reported on RE-AIM components such as characteristics of non-participants 8(32.0%), implementation costs 3(12.0%), and intervention fidelity 0(0.0%). Conclusions Results of the review emphasize the need for future economic empowerment HIV prevention interventions for AGYW in SSA to report multiple implementation strategies and highlight considerations for translating such programs into real-world settings. Researchers should pay close attention to reporting setting-level adoption, implementation cost, and intervention maintenance. These measures are needed for policy decisions related to the full merit and worth of EE HIV interventions and their long-term sustainability for AGYW.

The prevalence and pervasive nature of emerging chemicals of concern have created widespread environmental injustice apprehensions in vulnerable communities. To alleviate and address these concerns, identifying, engaging, and training a diverse environmental health research workforce will be critical and necessary steps to combat and prevent the consequences of environmental injustice. While there is an obvious need to enhance diversity in environmental health research, this process is hampered by facets of systemic racism that reduce access to educational resources needed to build interest and knowledge in students and teachers. We present here a historical perspective to offer a guide for building programs and relationships with underserved schools to help overcome limiting factors that have plagued certain public school systems. With the proper training and mentorship, the untapped workforce present within these schools will be empowered to understand and address current and emerging environmental health and safety threats. Through this transformative 8-week high school research program, we will develop well-prepared, ethical researchers committed to scientific inquiry, intensive fieldwork, and collaborative problem solving to address environmental health challenges. Following the four-step risk assessment process, students, teachers, and faculty mentors will work collaboratively to identify toxicants, potential hazards and risks, and environmental disparities in urban neighborhoods, which provides the necessary training to formulate critical thinking skills for use in academic or nonacademic careers.

Background: Providing a platform to engage young people as active participants and decision-makers in the design and delivery process of HIV testing efforts is critical to optimise uptake of HIV testing and other preventive services among this population. Designathon, an intensive team-based contest to crowdsource solutions, is a form of participatory approach that may increase the effectiveness of implementation strategies by fully engaging the end users in the design process. In this study, we explore strategies for HIV self-testing (HIVST) delivery developed at a designathon contest in Nigeria. Methods: The 48-h HIVST designathon held from March 29 to March 31, 2019, in Lagos state, Nigeria, occurred in three phases. First, we solicited solutions from Nigerian youth on how to encourage self-testing for HIV and other sexually transmitted infections in a way that is low-cost, accessible, youth-friendly and confidential. Second, submissions were shortlisted by an advisory committee and the top teams were invited to compete at the designathon contest. Third, the top teams presented their strategies using the business model canvas (BMC) to an expert panel. The BMC included: (1) description of the value of the HIVST service; (2) how and where to deliver HIVST; and (3) youth-friendly HIVST service strategies. Thematic analysis was used to explore key elements of the business model canvas. Findings: Of the 127 submissions received, 13 teams (with a total of 42 participants) were selected to participate at the designathon. Participants' median age was 22·5 years (IQR 21–24 years) and 28 (67%) were male. Teams developed segment-specific approaches such as online (ie, unstructured supplementary service data (USSD) services, gamification) and offline (ie, vending machines, community youth mobilisers) options for distributing and promoting the HIVST kit to reach a wider range of young people in both urban and rural settings. Multi-stakeholder partnerships at the local, state, and federal level were identified as key implementation mechanisms to drive scale-up and sustainability efforts. Interpretation: Designathons are a feasible method of facilitating meaningful youth engagement to develop deployable strategies to increase the uptake of HIV testing in young people in Nigeria. Additional refinement and rigorous evaluations of the proposed strategies in practice is an important next step to assess the effectiveness and impact of the models. Funding: Eunice Kennedy Shriver National Institute of Child Health and Human Development Grant number: 1UG3HD096929 and NIAID K24AI143471

Background: There is a critical gap in the uptake of HIV testing among young people in sub-Saharan Africa. In Nigeria, only a quarter of young people aged 14–24 years have ever tested for HIV. Recent evidence suggests that HIV self-testing (HIVST) may play a role in addressing gaps in HIV testing coverage and serve as an entry point for HIV prevention services. However, there is limited information on strategies that may increase the uptake of HIV testing among young people. Current strategies rarely include young people in the design stages, which often results to poor adoption of HIV interventions. We aimed to address this gap with the development of an innovation bootcamp for participants aged 14–24 years to generate interventions to promote HIVST among young people in Nigeria. Methods: The innovation bootcamp was a 4-week accelerated training programme to build entrepreneurial and research capacities among young people to develop HIV self-testing social enterprise. The training programme consisted of social enterprise and research development modules. At the completion of the bootcamp, we also examined participants' perspectives of the programme using surveys. Findings: Between May 6 and May 30, 2019, 20 people participated in the innovation bootcamp in Lagos State, Nigeria; 13 (65%) were male and age range was 22–24 years. The innovation bootcamp generated five youth-participatory HIVST social enterprises. Two of the social enterprise focused on repacking HIVST kits to increase their appeal among young people, one idea focused on leveraging community engagement platforms (vocational skills training and youth community events) to promote HIVST, and another social enterprise seeks to use a reward-referral system to promote HIVST in young people. Participants' survey responses suggest that the innovation bootcamp fostered an environment for young people to connect with their peers to generate ideas and solutions. The bootcamp also provided opportunities for skills development such as logistics management and research (protocol writing, data collection, and needs assessment) skills. Interpretation: The innovation bootcamp model can leverage the resourcefulness, capabilities, and resilience of youth to generate youth-centred and youth-sensitive interventions to promote HIV testing. The innovation bootcamp led to the development of five youth-centred and participatory interventions to promote uptake of HIV self-testing among young people in Nigeria. Funding: Eunice Kennedy Shriver National Institute of Child Health and Human Development Grant number: 1UG3HD096929 and NIAID K24AI143471

INTRODUCTION:Crowdsourcing, a participatory approach to solicit ideas from a large group of diverse individuals, provides an opportunity to nurture youth participation in HIV self-testing service design. The objective of this study was to describe the responses to a crowdsourcing contest aimed at soliciting ideas on how to promote HIV self-testing (HIVST) among young people in Nigeria. METHODS:The "4 Youth by Youth" HIV Self-Testing Crowdsourcing contest was an online and off-line contest that asked Nigerian youth (10-24 years old) for ideas in response to the following: How might we promote HIVST among young people in Nigeria? All data were collected and analyzed between October 2018, and June 2019. Ideas and perceptions generated from the crowdsourcing contest were qualitatively analyzed using thematic content analysis. Specifically, four reviewers analyzed whether the ideas generated were desirable (appealing to young people), feasible (easy to implement) and impactful (will significantly influence HIVST uptake among young people). RESULTS:A total of 903 entries were received in response to the contest prompt. Participants submitted entries in various forms: online form (39.7%), offline Dropbox (44.6%), email (6.1%) and WhatsApp (9.7%). Of the total entries, 85% (n = 769/903) entries were eligible and were scored as having either high, moderate or low level of feasibility, impact and desirability, on a 3-point Likert scale. A significant portion of the entries were given a score of 3 for feasibility (4.9%), desirability (7.1%), impact (3.0%) or a total overall score of 7 or more (8.2%). The three main themes that emerged from the entries include:1) Peer-to-peer distribution and leveraging on existing infrastructures 2) Youth-Oriented Branding of the HIVST Kit 3) Mobile platforms and social media technology. CONCLUSION:The "4 Youth by Youth" Self-Testing contest engaged a broad audience of young people to generate ideas and perspectives on how to promote HIVST. This process informed the development of youth innovated implementation strategies to increase uptake of HIVST among adolescents and youth at risk for HIV.

Hypertension, once a rare problem in Sub-Saharan Africa (SSA), is predicted to be a major cause of death by 2020 with mortality rates as high as 75%. However, comprehensive knowledge of provider-level factors that influence optimal management is limited. The objective of the current study was to discover physicians’ perceptions of factors influencing optimal management and control of hypertension in SSA. Twelve physicians attending the Cardiovascular Research Training (CaRT) Institute at the University of Ghana, College of Health Sciences, were invited to complete a concept mapping process that included brainstorming the factors influencing optimal management and control of hypertension in patients, sorting and organizing the factors into similar domains, and rating the importance and feasibility of efforts to address these factors. The highest ranked important and feasible factors include helping patients accept their condition and availability of adequate equipment to enable the provision of needed care. The findings suggest that patient self-efficacy and support, physician-related factors, policy factors, and economic factors are important aspects that must be addressed to achieve optimal hypertension management. Given the work demands identified by physicians, future research should investigate cost-effective strategies of shifting physician responsibilities to well-trained no-physician clinicians in order to improve hypertension management.

As part of a capacity-building research project, this study examined the extent to which caring for people living with HIV and AIDS (PLWHA) affects both professional and personal relationships of nurse caregivers. The data were collected using focus group interviews with 17 female nurses at two Limpopo hospitals. The PEN-3 cultural model was used as a theoretical framework for exploring how nurses balance job demands with family responsibilities. The results generated three themes: the multiple identities nurses experience within their family and professional lives; nurse attitudes related to patient gender; and stigma experienced by nurses who care for PLWHA. Caring for PLWHA influences nurses' personal and professional lives by interfering with their perceptions and emotions as they relate to spousal, parental, and gendered relationships. The findings offer insight into factors requiring consideration when designing interventions to help nurses cope with the stress associated with caring for PLWHA while simultaneously managing family responsibilities. [ABSTRACT FROM AUTHOR]