Using starling murmuration as a model for creating a global health community of practice to advance equity in scholarship.

BACKGROUND: Disparities in scholarship exist between authors in low- or middle-income countries (LMIC) and high-income countries. Recognizing these disparities in our global network providing pediatric, adolescent, and maternal healthcare to vulnerable populations in LMIC, we sought to improve access and provide resources to address educational needs and ultimately impact the broader scholarship disparity. METHODS: We created a virtual community of practice (CoP) program underpinned by principles from starling murmuration to promote interdisciplinary scholarship. We developed guiding principles- autonomy, mastery and purpose- to direct the Global Health Scholarship Community of Practice Program. Program components included a continuing professional development (CPD) program, an online platform and resource center, a symposium for scholarship showcase, and peer coaching. RESULTS: From February 2021 to October 2022, 277 individuals joined. Eighty-seven percent came from LMIC, with 69% from Africa, 6% from South America, and 13% from other LMIC regions. An average of 30 members attended each of the 21 CPD sessions. Thirty-nine authors submitted nine manuscripts for publication. The symposium increased participation of individuals from LMIC and enhanced scholarly skills and capacity. Early outcomes indicate that members learned, shared, and collaborated as scholars using the online platform. CONCLUSION: Sharing of knowledge and collaboration globally are feasible through a virtual CoP and offer a benchmark for future sustainable solutions in healthcare capacity building. We recommend such model and virtual platform to promote healthcare education and mentoring across disciplines.

Disparities in Accessing Sexual and Reproductive Health Services and Rights Among Adolescents and Young People During COVID-19 Pandemic: Culture, Economic, and Gender Perspectives.

Purpose of Review: As the world grapples with the health systems' challenges during the COVID-19 pandemic, addressing the needs of the already vulnerable adolescents and young people is vital. This narrative synthesis is aimed to highlight the current gender, cultural, and socioeconomic dynamics fueling inequalities to accessing sexual, reproductive health and rights (SRHR) services among adolescents and young people in low- and middle-income countries (LMIC). Recent Findings: The COVID-19 pandemic has in most countries exacerbated already existing inequalities due to economic, gender, cultural, and legal aspects. Strategies implemented by most governments to mitigate the spread of the virus have also had a negative impact on the access to SRHR services, some of which are long term. Few published studies have assessed the extent to which the pandemic has fueled each of these paradigms regarding access to SRHR, especially among adolescents and young people (AYP). Additionally, there is paucity in data on the same in most countries, as the systems to track such effects were not available at the inception of the pandemic. Summary: Despite efforts to mitigate the effects of the pandemic on this population, deficits remain and a multi-stakeholder approach is needed to achieve the intended goals, especially where cultural and gender values are deeply rooted. Further research is needed to quantify how the pandemic has fueled economic, gender, and cultural aspects to influence access to SRHR services among AYP especially in LMIC.

Factors associated with prior engagement in high-risk sexual behaviours among adolescents (10-19 years) in a pastoralist post-conflict community, Karamoja sub-region, North eastern Uganda.

BACKGROUND: Adolescent sexual risky behaviours continue to be significant drivers of the HIV epidemic globally. The objective of this study was to determine factors associated with prior engagement in high-risk sexual behaviours among adolescents (10-19 years) in Karamoja sub-region, a pastoralist and post-conflict community in North-eastern Uganda. METHODS: Between August and September 2016, we conducted a cross-sectional study among 1439 adolescents receiving primary healthcare services at nine public health facilities located in five of the seven districts that make up Karamoja sub-region. High-risk sexual behaviour was defined as engaging in sex with two or more (2+) sexual partners in the 6 months preceding the survey or exchanging sex for money or gifts with no or inconsistent use of condoms over the same period of time. Factors associated with prior engagement in high-risk sexual behaviours were analysed using a modified Poison regression model with log-link and Poisson-family via a generalized linear model. RESULTS: Eighty-two percent (81.8%, n = 1177) of the respondents had ever tested for HIV while 62 % (61.5%, n = 885) had ever had sex. Of those that had ever had sex, 11.4% (n = 101) reported prior engagement in high-risk sexual behaviours. Prior engagement in high-risk sexual behaviours was lower among men than women (adjusted prevalence ratio (adj. PR) = 0.46; 95% Confidence Interval (95% CI): 0.33, 0.62) and those whose sex debut was above 14 years (adj.PR = 0.63; 95% CI: 0.57, 0.69). However, prior engagement in high-risk sexual behaviours was significantly higher in adolescents who were not aware of their recent sexual partner's HIV status (adj.PR = 2.43; 95% CI: 1.68, 3.52) and those who used illicit drugs (adj.PR = 2.76; 95% CI: 1.88, 4.05). CONCLUSION: Prior engagement in high-risk sexual behaviours was significantly associated with having sex with partners of unknown HIV sero-status and use of illicit drugs. These findings suggest a need for targeted interventions to improve mutual HIV status disclosure between sexual partners while minimizing their use of illicit drugs/substances.

Prevalence and correlates of HIV testing among adolescents 10-19 years in a post-conflict pastoralist community of Karamoja region, Uganda.

BACKGROUND: Adolescents are a priority group in HIV prevention and treatment. This study sought to determine the prevalence and correlates of HIV testing services (HTS) among adolescents in the pastoralist post-conflict area of Karamoja sub region, Uganda. METHODS: A cross sectional study of 1439 adolescents aged 10-19 years, attending nine public health facilities in five of the seven districts of Karamoja, was conducted between August to September 2016. Adolescents were consecutively selected and interviewed using structured interviewer administered questionnaires. All respondents who had never tested for HIV were offered HTS. The main outcome was ever tested for HIV. Correlates of ever tested were analysed using multivariate logistic regression model. RESULTS: Of the 1439 adolescents, 904 (62.8%) were females, 1203 (83.6%) were aged 15-19 years, 618 (43.0%) had attained primary education and 885 (61.5%) had ever had sex. Overall 1177 (81.8%) had ever tested and received HIV results. Older age (15-19 years) (adj.OR = 2.71, 95% CI: 1.85-3.96), secondary level education or higher (adj.OR = 2.33, 95% CI: 1.33-4.10), and ever had sex (adj.OR = 2.03, 95% CI: 1.42-2.90) were associated with higher odds of HIV testing. Of the 262 who had never tested, 169 (64.5%) accepted testing and 2.4% were HIV positive. Reasons for not accepting the test included fear of being tested and not ready for an HIV test because of perceived suffering HIV positive clients go through. CONCLUSION: Awareness of HIV status and uptake of HTS among adolescents in this hard-to-reach post-conflict region was high and close to the global UNAIDS target of 90%. However, the HIV prevalence of 2.4% among the non-testers who accepted to be tested was high and emphasises the need for targeted testing to reach the undiagnosed HIV infected adolescents in this region.