Reported reasons for non-use of insecticide-treated nets in large national household surveys, 2009-2021.

BACKGROUND: Insecticide-treated nets (ITN) are the cornerstone of modern malaria vector control, with nearly 3 billion ITNs delivered to households in endemic areas since 2000. ITN access, i.e. availability within the household, based on the number of ITNs and number of household members, is a pre-requisite for ITN use. Factors determining ITN use are frequently examined in published literature, but to date, large household survey data on reasons given for non-use of nets have not been explored. METHODS: A total of 156 DHS, MIS, and MICS surveys conducted between 2003 and 2021 were reviewed for questions on reasons why nets were not used the previous night, identifying twenty-seven surveys. The percent of nets that were reported used the previous night was calculated for the 156 surveys, and frequencies and proportions of reasons for non-use were calculated within the twenty-seven surveys. Results were stratified by household supply of ITNs in three categories (not enough", "enough", and "more than enough") and by residence (urban/rural). RESULTS: The proportion of nets used the previous night averaged over 70% between 2003 and 2021, with no discernible change over this period. Reported reasons for why a net goes unused fell largely into three categories-nets that are extra/being saved for future use; the perception that there is little risk of malaria (particularly in dry season); and "other" responses. Net attributes such as colour, size, shape, and texture, and concerns related to chemicals were the least frequent reasons given. Reasons for non-use of nets varied by household net supply, and in some surveys by residence. In Senegal's continuous DHS, the proportion of nets used peaked during high transmission season, and the proportion of nets that went unused due to "no/few mosquitoes" peaked during the dry season. CONCLUSIONS: Unused nets were primarily those being saved for later use, or were not used due to perceived low risk of malaria. Classifying reasons for non-use into broader categories facilitates the design of appropriate social and behaviour change interventions to address the major underlying reasons for non-use, where this is feasible.

Community Mobilization is Associated with HIV Testing Behaviors and Their Psychosocial Antecedents Among Zambian Adults: Results from a Population-Based Study.

Community mobilization (CM) is a vital yet under-explored avenue for increasing HIV testing in generalized HIV epidemic settings. Using multi-stage cluster sampling, a population-based sample of 3535 Zambian adults (mean age: 28 years, 50% women) were recruited from 14 districts to complete a household survey. Exploratory factor analysis (EFA) was used to re-validate a 23-item, 5-factor CM scale. Multivariable logistic and Poisson regression were then used to identify associations of CM with HIV testing behaviors and their psychosocial antecedents. A 21-item, 3-factor ("Leadership", "Collective Action Capacity", and "Social Cohesion") CM solution emerged from EFA (Cronbach's α 0.88). Among men and in rural settings, higher CM was significantly (p < 0.05) associated with elevated odds of HIV testing and more past-year HIV testing discussion sources, controlling for socio-demographics and sexual behaviors. Results underscore the importance of prioritizing CM to cultivate more favorable environments for HIV testing uptake, especially for men and rural residents.

Ideational factors associated with net care behaviour: a multi-country analysis.

BACKGROUND: Malaria is endemic to sub-Saharan African countries. Mass and routine distribution, promotion, and use of ITNs are critical components of malaria prevention programmes. Correct and consistent use of insecticide-treated mosquito nets (ITN) is an effective strategy for malaria prevention. To extend bed-net lifespan, the World Health Organization recommends folding or tying up ITNs when they are not in use. This study analyses factors associated with net care practices in three African countries. METHODS: Researchers collected household data nationwide in Côte d'Ivoire, from the North and Far North regions of Cameroon, and from Port Loko and Bo districts in Sierra Leone, between 2018 and 2019. The dependent variable was respondents reporting that they fold or tie up their nets. The study adjusted for selected sociodemographic, ideational (psychosocial), and household variables using multilevel models. The analysis was limited to women of reproductive age and their male spouses/partners from households with at least one ITN: 2,940 respondents in Cameroon, 6,105 in Côte d'Ivoire, and 2,730 in Sierra Leone. RESULTS: Among respondents, 50.2% in Cameroon, 52.0% in Côte d'Ivoire and 75.6% in Sierra Leone reported folding or tying up their net when it was not in use. In all three countries, the data showed significant clustering at both household and community levels, indicating the influence of factors operating at these levels on net-care behaviour. The odds of reporting the behaviour varied significantly by geographic unit in each country. Consistent use of nets was strongly correlated with net-care behaviour. Furthermore, five ideational variables were positively associated with the outcome behaviour in all three countries: positive attitude towards net care, perceived susceptibility for malaria, response-efficacy of ITNs, perceived self-efficacy for net use, and the perception that net use was a community norm. Additional significant ideational variables included positive attitudes towards net use (Cameroon and Côte d'Ivoire), perceived severity of malaria (Côte d'Ivoire), and interpersonal communication about malaria (Côte d'Ivoire). CONCLUSIONS: The study identified ideational variables associated with recommended net-care practice. Programme efforts designed to promote net-care practices and extend average lifespan of ITNs may be more effective if they emphasize positive attitudes towards net care, perceived susceptibility of malaria infection, response-efficacy of ITNs, perceived self-efficacy for net use, and promote net-care behaviour as a positive community norm.

Barriers, benefits, and behaviour: Voluntary medical male circumcision ideation in a population-based sample of Zambian men.

Reaching ambitious voluntary medical male circumcision (VMMC) coverage targets requires a deeper understanding of the multifaceted processes shaping men's willingness to access VMMC. Guided by the Ideation Model for Health Communication, this population-based study identifies correlates of Zambian men's future VMMC intentions. Multistage cluster sampling was used to identify households with adult men in 14 districts. Multivariable Poisson regression with robust standard errors modelled associations of future VMMC intent with ideational factors (e.g. perceived benefits and barriers) and sexual behaviours respectively. Forty per cent (40%) of uncircumcised men (N = 1 204) expressed future VMMC intentions. In multivariable analysis, VMMC intent was associated with secondary education or higher (Adjusted Prevalence Ratio [APR] 1.30, 95% Confidence Interval [95% CI]: 1.02-1.66), perceiving VMMC to increase sexual satisfaction (APR 1.45, 95% CI: 1.11-1.89), reporting distance to services as a barrier to VMMC uptake (APR = 0.54, 95% CI: 1.27-1.87), unprotected last sex (APR 1.54, 95% CI: 1.11-2.14), and ≥ 2 sexual partners in the past 12 months (APR 1.45, 95% CI: 1.05-1.99). Being aged ≥ 45 years (vs 18-24 years: APR 0.23, 95% CI: 0.13-0.40) and perceiving that circumcision: (1) is unimportant (APR 0.71, 95% CI: 0.51-0.98); (2) is incompatible with local customs (APR 0.41, 95% CI: 0.18-0.94); or (3) reduces sexual satisfaction (APR 0.10, 95% CI: 0.02-0.62) were inversely associated with future VMMC intent. Demand-creation efforts must confront salient cognitive and social barriers to VMMC uptake, including concerns around incompatibility with local customs. Simultaneously, promotional efforts should emphasise relevant VMMC benefits beyond HIV prevention that resonate with men (e.g. penile hygiene) without reinforcing harmful gender norms.

Use of short message service for monitoring Zika-related behaviors in four Latin American countries: lessons learned from the field.

BACKGROUND: Effective response to widespread epidemics relies in part on rapidly changing information from affected communities as individuals react to emergency response efforts. The short message service (SMS) approach was used to monitor knowledge, prevention, and behavior during an outbreak of Zika cases in Honduras, El Salvador, the Dominican Republic, and Guatemala in 2017. SMS methods supported collection of monitoring data at a time of heightened reliance on communication via mobile phones, and when the use of phones for epidemic-related communication was amplified. SMS methods were used to collect monitoring data on knowledge of Zika risk and prevention, and behaviors to prevent Zika infection. METHODS: Serial SMS surveys were conducted over a seven-month period to capture changing community perceptions of risk and behaviors to prevent Zika during the epidemic. This article discusses the development of the SMS surveys, from planning and designing tools to collecting the data, and the unique experiences encountered during survey implementation. RESULTS: Special considerations for the effective use of SMS for data collection are described, including market penetration of mobile phones, predominant phone types in use, preparation of communities and the target audience, options for tailoring questionnaires to the available technology, relationships with telecommunication companies, and supporting participants' ability to complete questionnaires. The article discusses issues related to the development of the questionnaires, context-specific challenges before and during implementation of the surveys, and creative strategies to overcome barriers. Lessons learned, and recommendations to increase opportunities for a successful SMS survey, are included. CONCLUSIONS: Understanding the social and economic context of mobile phone use in the target area and careful crafting of SMS questionnaires can produce useful data that may rival information captured through other approaches, such as Knowledge, Attitudes and Practices (KAP) surveys. Despite the challenges experienced, there is room for more consistent and widespread use of SMS for data collection in Latin America.

Alcohol Consumption and Risky Sexual Behavior Among Persons Attending Alcohol Consumption Venues in Gaborone, Botswana.

Alcohol use is a known key risk factor associated with risky sexual behavior that contributes to HIV transmission. This cross-sectional study used time location sampling to investigate alcohol use and risky sexual behaviors that occurred after ingesting alcohol among 609 patrons of alcohol venues in Gaborone, Botswana. Alcohol Use Disorders Identification Test (AUDIT) scores were categorized as low (1-7), medium (8-15), and high (16+) for analysis. Logistic regression models stratified by gender assessed the association between alcohol use and condom use at last sex after drinking alcohol. Among females, the odds of condom use during last sex after drinking alcohol were significantly lower for high compared to low AUDIT scores (AOR = 0.17, 95% CI 0.06-0.54). Among males, factors significantly associated with condom use at last sex after alcohol use were low levels of education (primary level compared to university and above AOR = 0.13; 95% CI 0.03-0.55) and beliefs that alcohol use did not increase risky sexual behaviors (AOR = 0.26; 95% CI 0.11-0.62). HIV prevention interventions should target females and emphasize sexual risks associated with alcohol use.

HIV knowledge and sexual risk behaviors of street children in Takoradi, Ghana.

A pilot survey was conducted among 100 street children aged 11-19 years and data collected regarding HIV knowledge, risk behaviors, home and sexual experiences, and factors that contributed to their relocation to the street environment. Data indicated that 80% of the street children had at least minimal knowledge of HIV and 54% perceived themselves to be at risk for contracting HIV. More than three-fourths of the females, and over half of the boys reported ever having sex. There were significant differences between males and females for sexual activity, physical and sexual abuse, and prostitution, as girls were more likely to be sexually active, physically abused, and involved in prostitution.

Treatment perceptions and attitudes of older human immunodeficiency virus-infected adults.

OBJECTIVE: To apply the Health Belief Model (HBM) in assessing the association of health beliefs, perceived benefits, perceived barriers, alternative therapy use, and sexual risk behaviors in relation to the treatment of human immunodeficiency virus (HIV) in a group of older HIV-infected patients. METHODS: A convenience sample of 100 older (50 years and above) HIV-infected patients in 2 Washington, DC, clinics was enrolled. A cross-sectional methodology used structured interviews to investigate the association among antiretroviral adherence, use of alternative therapies, treatment perceptions, and risk behaviors. Student t tests were conducted to examine significant relationships between HBM perceptions and demographic characteristics. Logistic regressions were conducted to assess likelihood of antiretroviral and alternative therapy use. RESULTS: The majority of the participants were black and had a high school education. Although participants believed that HIV was a severe disease, they did not perceive themselves to be susceptible to early progression to acquired immunodeficiency syndrome. Participants believed that antiretrovirals were beneficial, and they were not particularly burdened by perceived costs of antiretrovirals. The perceived costs (or barriers) of antiretrovirals were inversely associated with CD4 count (r=-0.25, P=.01) and positively associated with viral load (r=0.33, P < .01). Overall 21% of patients in this population indicated use of alternative therapies. Patients who tended to have a higher perception of severity of HIV and a higher perceived burden in using antiretrovirals were more likely to use alternative therapy. There was no difference in HBM perceptions among antiretroviral users and nonusers. CONCLUSIONS: In general, the benefits of taking antiretrovirals were clear to most patients, and the same patients did not view access to antiretrovirals as a significant barrier to treatment. Many patients, although aware of the severity of HIV disease, were not seeking modifications to sexual behavior. Furthermore, the actual medication-taking behavior of these patients resulted in significant impacts to their clinical status. Study results can be applied in the development of specific interventions that are intended to decrease HIV transmission among older adults and to improve medication-taking behavior among those who are already infected with HIV.