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We sought to evaluate the impact of transitioning a multi-country HIV training program from in-person to online by comparing digital training approaches implemented during the pandemic with in-person approaches employed before COVID-19. We evaluated mean changes in pre-and post-course knowledge scores and self-reported confidence scores for learners who participated in (1) in-person workshops (between October 2019 and March 2020), (2) entirely asynchronous, Virtual Workshops [VW] (between May 2021 and January 2022), and (3) a blended Online Course [OC] (between May 2021 and January 2022) across 16 SSA countries. Learning objectives and evaluation tools were the same for all three groups. Across 16 SSA countries, 3023 participants enrolled in the in-person course, 2193 learners participated in the virtual workshop, and 527 in the online course. The proportions of women who participated in the VW and OC were greater than the proportion who participated in the in-person course (60.1% and 63.6%, p

Background: The changing landscape of nursing education to competency-based education has strengthened the importance of simulation learning in the process of developing the required graduate competencies. Aim: This study aimed to develop a model that guides the implementation of simulationbased education (SBE) in under-resourced nursing education institutions in Lesotho. Setting: Four Nursing Education Institutions in Lesotho. Methods: An explanatory sequential mixed methods design was adopted. Sampling methods included stratified systematic random, purposive and systematic sampling. The total sample was 390 comprising students, nurse educators and principals. Data were collected through questionnaires, focus group discussions and in-depth unstructured individual interviews. Statistical analysis was employed for quantitative data while a grounded theory approach guided the qualitative data analysis and model development. Results: Implementation of simulation emerged as a multilevel, multi-actor and multistage process of adopting, introducing and implementing SBE. This education takes place in a simulated environment that serves as a connecting bridge between the learning of theory in the classroom and clinical learning in real-life settings. The model generated from this study has simulation implementation as the main concept that is supported by four major concepts: (1) simulation initiation at the strategic level, (2) simulation implementation at the tactical level, (3) simulation implementation at the operational level and (4) simulation outcomes. Conclusion: Successful implementation of simulation requires buy-in from key stakeholders. Simulation-based education policy, competent facilitators and a well-resourced clinical skills laboratory may facilitate the development of the required competencies. Contribution: The study provides guidance on how SBE can be implemented in resourcelimited settings. [ABSTRACT FROM AUTHOR]

Background: Before 19th century, in KwaZulu-Natal, South Africa, male circumcision was regarded as a right to passage to manhood; however, during the ruling of King Shaka Zulu, circumcision was abolished. It was only in 2010 that it was re-introduced, but this time in the form of medical male circumcision. The aim was to circumcise as many men as possible to avert new human immunodeficiency virus (HIV) infections, but few males utilise the circumcision services. Aim: The aim of this study was to gain an understanding of the factors that hinder effective uptake of medical male circumcision. Setting: This study was conducted at Untunjambili area under iLembe district in KwaZulu-Natal province. Methods: This qualitative, exploratory, descriptive and contextual study was conducted using in-depth unstructured face-to-face individual interviews at Untunjambili area under iLembe district in KwaZulu-Natal. A convenience sampling method was employed and participants aged between 18 and 49 years participated in the study. Results: Factors that hinder effective uptake of medical male circumcision are organised into five categories: (1) fear (fear of pain, fear of death, fear of HIV test and fear of delayed wound healing, (2) personal factors (age at circumcision, lack of role models, procrastination and lack of volition, fertility and faithfulness), (3) knowledge deficit on circumcision, (4) influence of culture and (5) natural circumcision. Conclusion: Factors that hinder effective uptake of medical male circumcision services are manifold. Cultivating a positive attitude towards medical male circumcision can promote uptake of circumcision services and a supportive social support system of men needs to be utilised to encourage men to be circumcised. [ABSTRACT FROM AUTHOR]

Background: Little is known about the impact of knowledge of HIV serostatus on pregnancy intention and contraceptive use in high-HIV-burden southern African settings in the era of widespread antiretroviral treatment availability. Methods: We analyzed interview data collected among 473 HIV-uninfected and 468 HIV-infected pregnant and recently postpartum women at two sites in southern Botswana. Participants were interviewed about their knowledge of their HIV status prior to pregnancy, intendedness of the pregnancy, contraceptive use, and future childbearing desires. Results: The median age of the 941 women was 27 years, median lifetime pregnancies was 2, and 416 (44 %) of pregnancies were unintended. Among women reporting unintended pregnancy, 36 % were not using a contraceptive method prior to conception. Among contraception users, 81 % used condoms, 13 % oral contraceptives and 5 % an injectable contraceptive. In univariable analysis, women with unintended pregnancy had a higher number of previous pregnancies (P = <0.0001), were less educated (P = 0.0002), and less likely to be married or living with a partner (P < 0.0001). Thirty-percent reported knowing that they were HIV-infected, 48 % reported knowing they were HIV-uninfected, and 22 % reported not knowing their HIV status prior to conception. In multivariable analysis, women who did not know their HIV status pre-conception were more likely to report their pregnancy as unintended compared to women who knew that they were HIV-uninfected (aOR = 1.7; 95%CI: 1.2-2.5). After controlling for other factors, unintended pregnancy was not associated with knowing one’s HIV positive status prior to conception (compared with knowing one’s negative HIV status prior to conception). Among women with unintended pregnancy, there was no association between knowing their HIV status and contraceptive use prior to pregnancy in adjusted analyses. Sixty-one percent of women reported not wanting any more children after this pregnancy, with HIV-infected women significantly more likely to report not wanting any more children compared to HIV-uninfected women (aOR = 3.9; 95%CI: 2.6-5.8). Conclusions: The high rates of reported unintended pregnancy and contraceptive failure/misuse underscore an urgent need for better access to effective contraceptive methods for HIV-uninfected and HIV -infected women in Botswana. Lower socioeconomic status and lack of pre-conception HIV testing may indicate higher risk for unintended pregnancy in this setting.

Interpretations of Rb–Sr and Sm–Nd data from the Grunehogna Granite demonstrate that anatexis of and mixing with Høgfonna Formation sedimentary rocks, caused by hot basic sills of ~1100 Ma Borgmassivet Suite, are consistent, with the granite εNdεSr 100Ma data, partially overlapping Borgmassivet Suite data and are marginally displaced toward published data from the Høgfonna Formation. Upper intercept LA-ICPMS U–Pb data from the Grunehogna Granite and Borgmassivet Suite zircons are within error at 1088 ± 17Ma and 1088 ± 68Ma, and are consistent with with unpublished data for the gabbro of 1107Ma. Interpretations of syn-depositional anatexis of semi-consolidated sediments under, high pH 2 O, are consistent with deposition at ~1130-1107Ma for the Høgfonna Formation. Sm–Nd data define an age of 3058 ± 116Ma for the Annandagstoppane Granite, consistent with a reported U–Pb zircon age of 3067± 8Ma. Rb–Sr data for the Annandagstoppane Granite define an errorchron of 2252 ± 82Ma. Differences between Rb–Sr and Sm–Nd data suggest that Rb–Sr systematics in many samples from all units have experienced open system behaviour in contrast to Sm–Nd systematics from which no disturbance is apparent. Localised tonalitic partial melts of gabbro yield an upper intercept LA-ICPMS U–Pb age from zircon of 1114 ± 47Ma. [ABSTRACT FROM AUTHOR]