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Teacher turnover is associated with administrative leadership; however, there is an empirical gap in the practices that principals enact that influence teacher turnover. This article uses in-depth case studies and interviews with 32 teachers across two high-turnover and two low turnover middle schools in one large urban public school district to examine teachers' perceptions of principals' leadership practices. When compared to principals leading high-turnover schools, we found three common practices that characterized principals of low-turnover schools: (a) recognizing teachers as knowledgeable contributors, (b) clearly communicating the school's vision around high-quality teaching, and (c) centering student learning.

Abstract Background Pregnant women and children living with HIV in Kenya achieve viral suppression (VS) at lower rates than other adults. While many factors contribute to these low rates, the acquisition and development of HIV drug resistance mutations (DRMs) are a contributing factor. Recognizing the significance of DRMs in treatment decisions, resource-limited settings are scaling up national DRM testing programs. From provider and patient perspectives, however, optimal ways to operationalize and scale-up DRM testing in such settings remain unclear. Methods Our mixed methods study evaluates the attitudes towards, facilitators to, and barriers to DRM testing approaches among children and pregnant women on antiretroviral therapy (ART) in five HIV treatment facilities in Kenya. We conducted 68 key informant interviews (KIIs) from December 2019 to December 2020 with adolescents, caregivers, pregnant women newly initiating ART or with a high viral load, and providers, laboratory/facility leadership, and policy makers. Our KII guides covered the following domains: (1) DRM testing experiences in routine care and through our intervention and (2) barriers and facilitators to routine and point-of-care DRM testing scale-up. We used inductive coding and thematic analysis to identify dominant themes with convergent and divergent subthemes. Results The following themes emerged from our analysis: (1) DRM testing and counseling were valuable to clinical decision-making and reassuring to patients, with timely results allowing providers to change patient ART regimens faster; (2) providers and policymakers desired an amended and potentially decentralized DRM testing process that incorporates quicker sample-to-results turn-around-time, less burdensome procedures, and greater patient and provider “empowerment” to increase comfort with testing protocols; (3) facility-level delays, deriving from overworked facilities and sample tracking difficulties, were highlighted as areas for improvement. Conclusions DRM testing has the potential to considerably improve patient health outcomes. Key informants recognized several obstacles to implementation and desired a more simplified, time-efficient, and potentially decentralized DRM testing process that builds provider comfort and confidence with DRM testing protocols. Further investigating the implementation, endurance, and effectiveness of DRM testing training is critical to addressing the barriers and areas of improvement highlighted in our study. Trial Registration NCT03820323.

Abstract Background Viral suppression (VS) is a marker of effective HIV therapy, and viral load (VL) testing is critical for treatment monitoring, especially in high-risk groups such as children and pregnant/postpartum women. Although routine VL testing, via centralized laboratory networks, was implemented in Kenya starting in 2014, optimization and sustainable scale up of VL testing are still needed. Methods We conducted a mixed methods study to evaluate the impact of higher frequency, point-of-care (POC) VL testing in optimizing VS among children and pregnant/postpartum women on antiretroviral treatment (ART) in five HIV treatment facilities in western Kenya in the Opt4Kids and Opt4Mamas studies. We conducted 68 key informant interviews (KIIs) from December 2019 to December 2020 with children and pregnant women living with HIV, child caregivers, providers, laboratory/facility leadership, and county- or national-level policymakers. Our KII guide covered the following domains: (1) barriers and facilitators to ART use and VS, (2) literacy and experiences with VL in routine care and via study, and (3) opinions on how to scale up VL testing for optimal programmatic use. We used inductive coding and thematic analysis to identify dominant themes with convergent and divergent subthemes. Results Three main themes regarding VL testing emerged from our analysis. (1) Key informants uniformly contrasted POC VL testing’s faster results turnaround, higher accessibility, and likely cost-effectiveness against centralized VL testing. (2) Key informants also identified areas of improvement for POC VL testing in Kenya, such as quality control, human resource and infrastructure capacity, supply chain management, and integration of VL testing systems. (3) To enable successful scale-up of VL testing, key informants proposed expanding the POC VL testing scheme, electronic medical records systems, conducting quality checks locally, capacity building and developing strong partnerships between key stakeholders. Conclusion The more accessible, decentralized model of POC VL testing was deemed capable of overcoming critical challenges associated with centralized VL testing and was considered highly desirable for optimizing VS for children and pregnant/postpartum women living with HIV. While POC VL testing has the potential to improve VS rates among these populations, additional research is needed to develop strategies for ensuring the sustainability of POC VL testing programs. Trial registration NCT03820323, 29/01/2019

Increasing HIV drug resistance (DR) among children with HIV (CHIV) on antiretroviral treatment (ART) is concerning. CHIV ages 1–14 years enrolled from March 2019 to December 2020 from five facilities in Kisumu County, Kenya, were included. Children were randomized 1:1 to control (standard-of-care) or intervention (point-of-care viral load (POC VL) testing every three months with targeted genotypic drug resistance testing (DRT) for virologic failure (VF) (≥1000 copies/mL)). A multidisciplinary committee reviewed CHIV with DRT results and offered treatment recommendations. We describe DR mutations and present logistic regression models to identify factors associated with clinically significant DR. We enrolled 704 children in the study; the median age was 9 years (interquartile range (IQR) 7, 12), 344 (49%) were female, and the median time on ART was 5 years (IQR 3, 8). During the study period, 106 (15%) children had DRT results (84 intervention and 22 control). DRT detected mutations associated with DR in all participants tested, with 93 (88%) having major mutations, including 51 (54%) with dual-class resistance. A history of VF in the prior 2 years (adjusted odds ratio (aOR) 11.1; 95% confidence interval (CI) 6.3, 20.0) and less than 2 years on ART at enrollment (aOR 2.2; 95% CI 1.1, 4.4) were associated with increased odds of major DR. DR is highly prevalent among CHIV on ART with VF in Kenya. Factors associated with drug resistance may be used to determine which children should be prioritized for DRT.

IntroductionThe COVID-19 pandemic has impacted access to health services. Our objective was to understand the pandemic's impact on access to HIV, pregnancy, and family planning (FP) care among women living with HIV (WLHIV).MethodsData were collected after June 2020, when questions about the pandemic were added to two ongoing mixed methods studies using telephone surveys and in-depth interviews among WLHIV in western Kenya. The Chaguo Langu (CL) study includes primarily non-pregnant WLHIV receiving HIV care at 55 facilities supported by AMPATH and the Opt4Mamas study includes pregnant WLHIV receiving antenatal care at five facilities supported by FACES. Our outcomes were self-reported increased difficulty refilling medication, accessing care, and managing FP during the pandemic. We summarized descriptive data and utilized multivariable logistic regression to evaluate predictors of difficulty refilling medication and accessing care. We qualitatively analyzed the interviews using inductive coding with thematic analysis.ResultsWe analyzed 1,402 surveys and 15 in-depth interviews. Many (32%) CL participants reported greater difficulty refilling medications and a minority (14%) reported greater difficulty accessing HIV care during the pandemic. Most (99%) Opt4Mamas participants reported no difficulty refilling medications or accessing HIV/pregnancy care. Among the CL participants, older women were less likely (aOR = 0.95, 95% CI: 0.92–0.98) and women with more children were more likely (aOR = 1.13, 95% CI: 1.00–1.28) to report difficulty refilling medications. Only 2% of CL participants reported greater difficulty managing FP and most (95%) reported no change in likelihood of using FP or desire to get pregnant. Qualitative analysis revealed three major themes: (1) adverse organizational/economic implications of the pandemic, (2) increased importance of pregnancy prevention during the pandemic, and (3) fear of contracting COVID-19.DiscussionThe two unique participant groups included in our study encountered overlapping problems during the COVID-19 epidemic. Access to HIV services and antiretrovirals was interrupted for a large proportion of non-pregnant WLHIV in western Kenya, but access to pregnancy/family planning care was less affected in our cohort. Innovative solutions are needed to ensure HIV and reproductive health outcomes do not worsen during the ongoing pandemic.

Introduction Burmese patients resettled in the United States as refugees constitute one of the country's largest refugee populations. As health inequities within the wider Asian and Asian American population have garnered more attention, medical professionals have worked to better understand how to provide care to Burmese and Burmese American patients. This workshop addresses the pressing need to provide culturally responsive care to this growing population. Methods Our interactive 60-minute workshop was developed to increase the knowledge and confidence of health care providers and trainees regarding the specific needs of Burmese communities in the United States. It was implemented once in person and twice virtually. The workshop included a PowerPoint presentation and case studies. Pre- and postworkshop evaluation forms assessed the effectiveness of the module. Results The workshop's 70 attendees included an interdisciplinary group of medical students, academic faculty, graduate students, and health care staff. Following module completion, all learning objectives were met. Paired-samples t tests revealed significant increases in average number of correct responses for all learning objectives. Discussion This module is part of a larger initiative to provide current and future health care providers with information to empower them to supply culturally responsive care to Burmese and Burmese American patients and their families. We offer recommendations for improving care for this patient population on individual, provider, and systemic levels. We hope that this module will inspire opportunities to advocate for change in policy and health care/research funding for Burmese and Burmese American patients.

Abstract Adopting the Standard Halo Model (SHM) of an isotropic Maxwellian velocity distribution for dark matter (DM) particles in the Galaxy, the most stringent current constraints on their spin-dependent scattering cross-section with nucleons come from the IceCube neutrino observatory and the PICO-60 $$\hbox {C}_3\hbox {F}_8$$ C 3 F 8 superheated bubble chamber experiments. The former is sensitive to high energy neutrinos from the self-annihilation of DM particles captured in the Sun, while the latter looks for nuclear recoil events from DM scattering off nucleons. Although slower DM particles are more likely to be captured by the Sun, the faster ones are more likely to be detected by PICO. Recent N-body simulations suggest significant deviations from the SHM for the smooth halo component of the DM, while observations hint at a dominant fraction of the local DM being in substructures. We use the method of Ferrer et al. (JCAP 1509: 052, 2015) to exploit the complementarity between the two approaches and derive conservative constraints on DM-nucleon scattering. Our results constrain $$\sigma _{\mathrm{SD}} \lesssim 3 \times 10^{-39} \mathrm {cm}^2$$ σ SD ≲ 3 × 10 - 39 cm 2 ( $$6 \times 10^{-38} \mathrm {cm}^2$$ 6 × 10 - 38 cm 2 ) at $$\gtrsim 90\%$$ ≳ 90 % C.L. for a DM particle of mass 1 TeV annihilating into $$\tau ^+ \tau ^-$$ τ + τ - ( $$b\bar{b}$$ b b ¯ ) with a local density of $$\rho _{\mathrm{DM}} = 0.3~\mathrm {GeV/cm}^3$$ ρ DM = 0.3 GeV / cm 3 . The constraints scale inversely with $$\rho _{\mathrm{DM}}$$ ρ DM and are independent of the DM velocity distribution.

Introduction: Breastfeeding is associated with improved maternal and child outcomes. Women with a higher body mass index (BMI), who comprise about 50% of the population, are at increased risk of poorer breastfeeding practices and are a population who would benefit from breastfeeding. Methods: This protocol is for a multi-centre, randomised controlled trial of perinatal breastfeeding support among primiparous women with a BMI >25 kg/m2, using a previously-tested, multi-component intervention. The primary outcome is any breastfeeding at 3 months. The intervention will support mothers and their partners and spans from late pregnancy to six weeks postpartum. Intervention components include group antenatal breastfeeding education, individual face-to-face education in the immediate postnatal period, professional support to six weeks’ postpartum and weekly phone calls in the immediate postpartum period from an International Board Certified Lactation Consultant (IBCLC). The intervention will target attitudes towards breastfeeding, breastfeeding self-efficacy, and subjective norms around infant feeding with the aim to normalise the behaviour. Results: We anticipate that the intervention will be well-accepted and feasible to carry out within four maternity units in the East of Ireland. Furthermore, essential formative qualitative work has been conducted to inform the intervention design and to ensure that it is contextually appropriate. Conclusion: The proposed intervention will be invaluable to policy-makers in providing insights into what specific interventions are effective in improving breastfeeding rates for women with a raised BMI.