Feasibility and acceptability of integrating mass distribution of azithromycin to children 1-11 months into a trachoma mass drug administration campaign to reduce child mortality in Côte d'Ivoire.

Evidence suggests that bi-annual mass drug administration (MDA) of single-dose azithromycin to 1-11 month-old children reduces child mortality in high child-mortality settings. Several countries conduct annual MDAs to distribute azithromycin to individuals ages 6 months and older to prevent trachoma infection. This study examined the feasibility and acceptability of reaching 1-11 months-old children during a trachoma MDA in Côte d'Ivoire by extending azithromycin distribution to infants 1-5 months old during the campaign. In November 2020, the study piloted single-dose azithromycin for 1-5 month-olds during a trachoma MDA in one health district. Monitoring data included the number of children reached and occurrences of adverse drug reactions. Feasibility, the extent to which the target population received the intervention (coverage), was assessed through a population-based, household survey with parents/caregivers of eligible children conducted after the MDA. Acceptability was explored through in-depth interviews (IDIs) with parents/caregivers of eligible children, focus group discussions (FGDs) with community drug distributors (CDDs), and IDIs with their supervisors. CDD FGDs and supervisor IDIs also documented implementation challenges and recommendations for scale-up. 1,735 1-5 month-olds received azithromycin during the pilot activity (estimated population coverage of 90.2%). Adverse drug reactions were reported for 1% (n = 18) infants; all were mild and self-limited. The post-MDA coverage survey interviewed 267 parents/caregivers; survey-based intervention coverage was 95.4% of 1-5 month-olds. Qualitative data revealed high intervention acceptability among parents, CDDs, and supervisors. Implementation challenges included the need to weigh babies to calculate dosage for 1-5 month-olds and the need to obtain written informed consent from parents to provide the drug to 1-5 month-olds. CDDs also indicated the need for more information on azithromycin and possible side effects during training. Delivering azithromycin to younger infants appears acceptable to parents and implementers; >90% coverage indicates feasibility to integrate into a trachoma MDA. (Clinicaltrials.gov ID number: NCT04617626).

'It is human work': qualitatively exploring community roles that facilitate cultural food security for people from refugee backgrounds.

OBJECTIVES: Cultural food security is crucial for cultural health and, for people from refugee backgrounds, supports the settlement journey. Cultural communities are vital in facilitating access to cultural foods; however, it is not understood how refugee-background communities sustain cultural food security in the Australian context. This study aimed to explore key roles in refugee-background communities to understand why they were important and how they facilitate cultural food security. DESIGN: Interviews were conducted by community researchers, and data analysis was undertaken using best-practice framework for collaborative data analysis. SETTING: Greater Brisbane, Australia. PARTICIPANTS: Six interviews were conducted between August and December 2022 with people from a refugee-background community, lived in Greater Brisbane and who fulfilled a key food role in the community that facilitated access to cultural foods. RESULTS: Fostering improved cultural food security supported settlement by creating connections across geographical locations and cultures and generated a sense of belonging that supported the settlement journey. Communities utilised communication methods that prioritised the knowledge, wisdom and experience of community members. It also provided community members with influence over their foodways. Community leaders had an ethos that reflected collectivist values, where community needs were important for their own health and well-being. CONCLUSIONS: Communities are inherently structured and communicate in a way that allows collective agency over foodways. This agency promotes cultural food security and is suggestive of increased food sovereignty. Researchers and public health workers should work with communities and recognise community strengths. Food security interventions should target cultural food security and autonomy.

Practice-based insights from specialized clinicians into youth suicide risk assessment and psychotherapy: A qualitative study.

Objective: The experience of frontline clinicians is an underutilized source of knowledge about improving youth suicide intervention. This qualitative study explored the perspectives of highly experienced, specialized mental health clinicians on the practical application of risk assessment, stabilization, and treatment and their experience of working in this practice area.Method: Data were collected from seven focus groups with 28 clinicians and analyzed using consensual qualitative research methods.Results: Four domains emerged, describing 1) youth suicide intervention as relationally focused and attachment-informed, 2) the need for flexible and tailored care balancing individual and family intervention in the context of family complexity and fractured relationships, 3) a nuanced, therapeutic approach to managing the complexity and uncertainty of adolescent suicide risk, and 4) working in youth suicide intervention as emotionally demanding and facilitated or hampered by the organizational and systems context.Conclusion: The importance of harnessing family systems and attachment-informed approaches to alliance, risk assessment, and treatment was emphasized, along with the parallel need for systemic clinician support and consideration of the potential negative consequences of administrative and risk management protocols.

"Africans, we know how to adapt indeed": Adaptations to family planning and reproductive health services in humanitarian settings in Nigeria during the COVID-19 pandemic.

On March 30, 2020, the Government of Nigeria implemented its first COVID-19 related lockdown. We worked with two humanitarian projects in Nigeria, the Integrated Humanitarian Assistance to Northeast Nigeria (IHANN II) in Borno State and the United Nations High Commissioner for Refugees South-South Health and Nutrition Intervention (UNHCR-SS-HNIR) for Cameroon Refugees and vulnerable populations in Cross River State, to document the programmatic adaptations to Family Planning/Reproductive Health (FP/RH) services in response to COVID-19 and identify successes and challenges of those adaptations. A mixed methods approach including quantitative analysis of data from routine programmatic activities, qualitative data from in-depth interviews (IDIs) with project staff and process documentation of programmatic activities and modifications was used to 1) identify modifications in FP/RH services due to COVID-19, 2) understand staff perception of their utility and impact, and 3) gauge trends in key FP/RH in-service delivery indicators to assess changes prior to and after the March 2020 lockdown. Monitoring data shows notable declines in service utilization after lockdowns in antenatal care, postnatal care, and outreach campaigns, followed by a return to pre-lockdown levels by July 2020. Results show projects introduced numerous COVID-19 precaution strategies including: community sensitization; triage stations and modification of service flow in facilities; and appointment scheduling for essential services. Findings from IDIs speak to a well-coordinated and implemented COVID-19 response with project staff noting improvements in their time management and interpersonal communication skills. Lessons learned included the need to better sensitize and educate communities, maintain FP commodities and increase support provided to health workers. Deliberate adaptations in IHANN II and UNHCR-SS-HNIR projects turned challenges to opportunities, ensuring continuity of services to the most vulnerable populations.

Organizational readiness to implement task-strengthening strategy for hypertension management among people living with HIV in Nigeria.

BACKGROUND: Hypertension (HTN) is highly prevalent among people living with HIV (PLHIV), but there is limited access to standardized HTN management strategies in public primary healthcare facilities in Nigeria. The shortage of trained healthcare providers in Nigeria is an important contributor to the increased unmet need for HTN management among PLHIV. Evidence-based TAsk-Strengthening Strategies for HTN control (TASSH) have shown promise to address this gap in other resource-constrained settings. However, little is known regarding primary health care facilities' capacity to implement this strategy. The objective of this study was to determine primary healthcare facilities' readiness to implement TASSH among PLHIV in Nigeria. METHODS: This study was conducted with purposively selected healthcare providers at fifty-nine primary healthcare facilities in Akwa-Ibom State, Nigeria. Healthcare facility readiness data were measured using the Organizational Readiness to Change Assessment (ORCA) tool. ORCA is based on the Promoting Action on Research Implementation in Health Services (PARIHS) framework that identifies evidence, context, and facilitation as the key factors for effective knowledge translation. Quantitative data were analyzed using descriptive statistics (including mean ORCA subscales). We focused on the ORCA context domain, and responses were scored on a 5-point Likert scale, with 1 corresponding to disagree strongly. FINDINGS: Fifty-nine healthcare providers (mean age 45; standard deviation [SD]: 7.4, 88% female, 68% with technical training, 56% nurses, 56% with 1-5 years providing HIV care) participated in the study. Most healthcare providers provide care to 11-30 patients living with HIV per month in their health facility, with about 42% of providers reporting that they see between 1 and 10 patients with HTN each month. Overall, staff culture (mean 4.9 [0.4]), leadership support (mean 4.9 [0.4]), and measurement/evidence-assessment (mean 4.6 [0.5]) were the topped-scored ORCA subscales, while scores on facility resources (mean 3.6 [0.8]) were the lowest. CONCLUSION: Findings show organizational support for innovation and the health providers at the participating health facilities. However, a concerted effort is needed to promote training capabilities and resources to deliver services within these primary healthcare facilities. These results are invaluable in developing future strategies to improve the integration, adoption, and sustainability of TASSH in primary healthcare facilities in Nigeria. TRIAL REGISTRATION: NCT05031819.

An Exploratory Study of School Psychology Students' Perceptions of Religious and Spiritual Diversity Training in their Graduate Programs.

Religiosity and spirituality are essential aspects of individuals' cultural identities. However, the field of school psychology has generally avoided in-depth discussion regarding the implications of religious/spiritual diversity within the context of multiculturalism and culturally responsive practice. One aim of this study was to examine school psychology students' perceptions of their current training relative to religious and spiritual diversity, because graduate training is critical for helping emerging practitioners develop attitudes, knowledge, and skills to employ culturally responsive services. Results showed that students received limited preparation and explicit teaching to address issues related to religious and spiritual diversity; and programs most frequently addressed disability diversity, socioeconomic diversity, and racial/ethnic diversity. Furthermore, the participants most frequently identified practicum experiences as facilitating their capacity to respond to religious and spiritual diversity in their professional practice. Key results suggest that school psychology graduate students may benefit from more explicit instruction during their graduate training to respond to religion and spirituality as  aspects of cultural diversity in their professional work.

Bridging Across the Digital Divide: Identifying the Extent to Which LGBTIQ+ Health Service Websites Engage Culturally and Linguistically Diverse (CALD) Users.

eHealth is promoted as a viable platform for health service provision, as it can deliver relevant information instantaneously and anonymously, whilst circumventing geographical and discriminatory barriers that can occur in face-to-face settings. Lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ+) communities stand to benefit greatly from eHealth services, however, the way in which culturally and linguistically diverse (CALD) LGBTIQ+ users are included within eHealth service provision is currently unknown. The current study observed the way in which Australian LGBTIQ+ health service websites are inclusive of CALD users. Quantitative content analysis was performed on 19 Australian LGBTIQ+ health service websites, with a focus on translation of services and materials, English and digital literacy, and CALD specific resources. Results showed limited translated information across all websites, an absence of translation tools embedded in the home page, as well as moderate to high levels of digital and English literacy required, and largely absent CALD specific resources. These results suggest that Australian LGBTIQ+ health service websites are not currently meeting the unique needs of their CALD constituents. Increased availability of translation services, navigation tools, and CALD LGBTIQ+ stakeholder inclusion during website development is recommended to ensure more equitable access for CALD LGBTIQ+ communities.

The Importance of Local and Global Social Ties for the Mental Health and Well-Being of Recently Resettled Refugee-Background Women in Australia.

Social connections are foundational to the human condition and are inherently disrupted when people are forcibly displaced from their home countries. At a time of record high global forced migration, there is value in better understanding how refugee-background individuals engage theirsocial supports or ties in resettlement contexts. A mixed methods research design aimed to understand the complexities of how 104 refugee-background women experienced their social networks in the first few months of resettlement in Australia. One of the research activities involved participants completing a survey with both quantitative and qualitative components. The quantitative analyses identified the impact of post-migration living difficulties that represented social stressors (worry about family, loneliness and boredom, feeling isolated, and racial discrimination) on the women's mental health outcomes in the months following resettlement. The qualitative data highlighted the complexities of social relationships serving as both stressors and sources of support, and the importance of recognizing extended families and supports around the globe. The findings point to the need for nuanced accounts of the social contexts surrounding refugee resettlement as important influences able to promote trauma-informed and gender sensitive practices to support mental health and well-being in new settings.

Determinants of food security among people from refugee backgrounds resettled in high-income countries: A systematic review and thematic synthesis.

Food is intrinsically linked to culture, identity, and for people with lived refugee experiences, cultural foods are a critical part of settlement into a new country, which is often a time of high stress and dislocation from friends and family. However, cultural foods in settlement countries may be unavailable or inaccessible, adversely impacting on food security. This systematic review aimed to identify facilitators and barriers to accessing foods in high-income countries for people with lived refugee experiences. Sixteen health databases were searched from June 2020 and April 2021 and 22 articles met the inclusion criteria. Bias was assessed using a modified thematic synthesis method and the relevant Joanna Briggs Institute risk assessment checklist. Findings were thematically synthesised and the socio-ecological model and postcolonialism were used as a lens through which the data was viewed. Analysis revealed three themes: "Practicalities and Pragmatism"; "Identity, Belonging and Placemaking"; and "Postcolonial and Societal Influences". The determinants of food security were present across all levels of the socio-ecological model and people with lived refugee experiences used practical and pragmatic strategies to feed their families. Food was intrinsically linked to identity, belonging and placemaking, and as such, people preferred consuming cultural foods. Societies adversely affected the food security of people from refugee backgrounds by limiting their access to resources and restricting cultural food gathering practices, impacting on their ability to access or afford foods, especially cultural foods. To improve food security for people with lived refugee backgrounds, governments and organisations should collaborate with the cultural communities with lived experiences of accessing cultural foods, appreciate their strengths, and recognise the value of social and cultural capital.

Crossing the digital divide: A content analysis of mainstream Australian mental health websites for languages other than English.

Growth in e-mental health services in the past decade has been significant, corresponding with rising rates of mental health concerns and amplified by social isolation strategies imposed by the COVID-19 global pandemic. Governments, mental health services and practitioners have identified this as a significant area for investment and highlight its capacity for widespread reach, prevention and early intervention. At a time of growth and investment, it is critical to evaluate the extent to which online mental health platforms are effective in reaching the diverse populations they aim to serve. The current study used content analysis to evaluate 33 Australian mental health websites receiving government funding for the availability of translated materials and resources for culturally and linguistically diverse people. The websites analysed covered a range of mental health topics and overall had limited translated materials available. Only four websites (12.12%) provided a translation tool and none of the interactive tools offered, such as web chat services, were available in languages other than English. From a total of 1100 subsections across all websites, eight subsections (0.73%) were specifically targeting populations identifying as culturally and linguistically diverse. Strategic reconsideration and investment are required to enhance the capacity of current mental health platforms to engage and support the mental health needs of the diverse communities they intend to serve. The research and its findings can provide a basis for research and reflection within other health and social services as online platforms proliferate.

Experiences of abuse in Australian family carers and predictors of mental health and well-being.

Caregivers for family or friends who are elderly people or have a disability provide critical supports, with a range of positive and negative consequences associated with their role. This research explores the positive and negative aspects of care-giving, including the experience of abuse within the caring relationship, through an anonymous online survey of the mental health, well-being and caring experience of Australian family carers (N = 305). The voluntary participants were recruited through local and national carer associations. Over 40% of respondents reported having experienced abuse by the person they cared for, with the most common form of abuse being verbal abuse (35% of the respondents reporting abuse) and physical abuse (14%). The experience of abuse was related to poorer mental health as measured by the DASS-21 and a lower reported quality of life. Financial stress, lack of support and the negative impacts of care-giving were also significantly associated with mental health and well-being outcomes. The current research is among the first to directly assess the experience of abuse within a broad sample of caregivers, identifying this as a significant issue for caregivers. The findings have clear implications for programs and policies that protect the rights, safety and well-being of caregivers.

Testing the feasibility and acceptability of a culturally adapted physical activity intervention for adult Somali women.

Despite growing numbers in the USA, immigrant populations are underrepresented in existing physical activity (PA) research, in particular Muslim immigrant women. The current study is a pilot evaluation of a culturally adapted evidence-based PA intervention for adult Somali women. Stratified randomization was used to assign participants from a sample of 27 Somali women, aged 18 to 65, to a PA group or a waitlist control group. Bicultural Somali community research team members delivered a 12-week culturally adapted intervention available in English and Somali in a community-based setting. Process and outcome evaluation assessed changes in PA, self-efficacy for PA, access to PA resources, and wellbeing as well as feasibility and satisfaction with the program. Participants in the PA group increased their moderate to vigorous PA significantly more than those from the waitlist group from baseline to post-intervention (2 (SD = 15) to 100 (SD = 53) vs 12 (SD = 21) to 32 (SD = 44) minutes per week). Participants in the PA group had significantly greater scores in wellbeing at post-intervention compared to the waitlist group though there was no significant change from pre- to post-intervention for either group. Participants reported a high level of satisfaction with the program and preliminary evidence supports the general feasibility and acceptability of the program. Findings show that a culturally adapted intervention increased engagement in PA and was feasible and acceptable within a pilot sample of Somali women.

Identifying the Links Between Trauma and Social Adjustment: Implications for More Effective Psychotherapy With Traumatized Youth.

Background: Past research has highlighted the role of trauma in social adjustment problems, but little is known about the underlying process. This is a barrier to developing effective interventions for social adjustment of traumatized individuals. The present study addressed this research gap through a cognitive model. Methods: A total of 604 young adults (aged 18-24; living in Australia) from different backgrounds (refugee, non-refugee immigrant, and Australian) were assessed through self-report questionnaires. The data were analyzed through path analysis and multivariate analysis of variance. Two path analyses were conducted separately for migrant (including non-refugee and refugee immigrants) and Australian groups. Results: Analyses indicated that cognitive avoidance and social problem solving can significantly mediate the relation between trauma and social adjustment (p < 0.05). The model explaining this process statistically fit the data (e.g., NFI, TLI, CFI > 0.95). According to the model, reacting to trauma by cognitive avoidance (i.e., chronic thought suppression and over-general autobiographical memory) can disturb the cognitive capacities that are required for social problem solving. Consequently, a lack of effective social problem solving significantly hinders social adjustment. There were no significant differences among the Australian, non-refugee immigrant and refugee participants on the dependent variables. Moreover, the hypothesized links between the variables was confirmed similarly for both migrant (including refugee and non-refugee immigrants) and Australian groups. Conclusion: The findings have important implications for interventions targeting the social adjustment of young individuals. We assert that overlooking the processes identified in this study, can hinder the improvement of social adjustment in young adults with a history of trauma. Recommendations for future research and practice are discussed.

Reproductive empowerment and contraceptive self-care: a systematic review.

Contraceptive self-care interventions are a promising approach to improving reproductive health. Reproductive empowerment, the capacity of individuals to achieve their reproductive goals, is recognised as a component of self-care. An improved understanding of the relationship between self-care and empowerment is needed to advance the design, implementation and scale-up of self-care interventions. We conducted a systematic review of the peer-reviewed and grey literature published from 2010 through 2020 to assess the relationship between reproductive empowerment and access, acceptability, use or intention to use contraceptive self-care. Our review adheres to PRISMA guidelines and is registered in PROSPERO (ID CRD42020205235). A total of 3036 unique records were screened and 37 studies met our inclusion criteria. Most studies were conducted in high-income countries, were cross-sectional and had high risk of bias. Almost half included only women. Over 80% investigated male condoms. All but one study focused on use of self-care. We found positive relationships between condom use self-efficacy and use of/intention to use condoms. We found similar evidence for other self-care contraceptive methods, but the low number of studies and quality of the evidence precludes drawing strong conclusions. Few studies assessed causal relationships between empowerment and self-care, indicating that further research is warranted. Other underexplored areas include research on power with influential groups besides sexual partners, methods other than condoms, and access and acceptability of contraceptive self-care. Research using validated empowerment measures should be conducted in diverse geographies and populations including adolescents and men.

Persistent psychological distress in resettled refugee women-at-risk at one-year follow-up: Contributions of trauma, post-migration problems, loss, and trust.

The mental health of women has been largely neglected in the refugee literature, notwithstanding the specific gender-related issues that confront women seeking asylum. Furthermore, a specific category of women, deemed to be women-at-risk, face particular challenges in their journey and resettlement process. This longitudinal study investigated psychological distress in refugee women-at-risk one year after resettlement in Australia. Follow-up survey of 83 women-at-risk (mean age = 33.41 years; SD = 11.93) assessed: trauma events and symptoms; loss events and loss distress; level of post-migration problems; anxiety, depression, and somatic symptoms; and absence of trust in community members. Participants demonstrated no symptom change since initial assessment (p > .05). Substantial proportions of women reported traumatization (39%), PTSD (20%), anxiety (32%), and depression (39%) above clinical cut-offs, and high levels of somatization and loss distress. Post-migration problems, trauma events, and region of birth were associated with all symptoms, with post-migration problems the strongest predictor. Absence of trust in community members was associated with trauma, depression, and somatic symptoms. Initial trauma and somatic symptoms were associated with follow-up traumatic and somatic symptoms. Loss and trauma events were associated with loss distress. Findings underline the role of post-migration problems on psychological distress and the need to consider women's psychological wellbeing in the context of their trauma and loss history, potential impacts of ethnicity, and complex socio-cultural dynamics underpinning issues of trust within communities. Effective service delivery requires that practitioners screen for and address psychological distress in women-at-risk at least up to 18 months after resettlement.

The City Under COVID-19: Podcasting As Digital Methodology.

This critical commentary reflects on a rapidly mobilised international podcast project, in which 25 urban scholars from around the world provided audio recordings about their cities during COVID-19. New digital tools are increasing the speeds, formats and breadth of the research and communication mediums available to researchers. Voice recorders on mobile phones and digital audio editing on laptops allows researchers to collaborate in new ways, and this podcast project pushed at the boundaries of what a research method and community might be. Many of those who provided short audio 'reports from the field' recorded on their mobile phones were struggling to make sense of their experience in their city during COVID-19. The substantive sections of this commentary discuss the digital methodology opportunities that podcasting affords geographical scholarship. In this case the methodology includes the curated production of the podcast and critical reflection on the podcast process through collaborative writing. Then putting this methodology into action some limited reflections on cities under COVID-19 lockdown and social distancing initiatives around the world are provided to demonstrate the utility and limitations of this method.

A Social Media-Based Support Group for Youth Living With HIV in Nigeria (SMART Connections): Randomized Controlled Trial.

BACKGROUND: Youth living with HIV (YLHIV) enrolled in HIV treatment experience higher loss to follow-up, suboptimal treatment adherence, and greater HIV-related mortality compared with younger children or adults. Despite poorer health outcomes, few interventions target youth specifically. Expanding access to mobile phone technology, in low- and middle-income countries (LMICs) in particular, has increased interest in using this technology to improve health outcomes. mHealth interventions may present innovative opportunities to improve adherence and retention among YLHIV in LMICs. OBJECTIVE: This study aimed to test the effectiveness of a structured support group intervention, Social Media to promote Adherence and Retention in Treatment (SMART) Connections, delivered through a social media platform, on HIV treatment retention among YLHIV aged 15 to 24 years and on secondary outcomes of antiretroviral therapy (ART) adherence, HIV knowledge, and social support. METHODS: We conducted a parallel, unblinded randomized controlled trial. YLHIV enrolled in HIV treatment for less than 12 months were randomized in a 1:1 ratio to receive SMART Connections (intervention) or standard of care alone (control). We collected data at baseline and endline through structured interviews and medical record extraction. We also conducted in-depth interviews with subsets of intervention group participants. The primary outcome was retention in HIV treatment. We conducted a time-to-event analysis examining time retained in treatment from study enrollment to the date the participant was no longer classified as active-on-treatment. RESULTS: A total of 349 YLHIV enrolled in the study and were randomly allocated to the intervention group (n=177) or control group (n=172). Our primary analysis included data from 324 participants at endline. The probability of being retained in treatment did not differ significantly between the 2 study arms during the study. Retention was high at endline, with 75.7% (112/163) of intervention group participants and 83.4% (126/161) of control group participants active on treatment. HIV-related knowledge was significantly better in the intervention group at endline, but no statistically significant differences were found for ART adherence or social support. Intervention group participants overwhelmingly reported that the intervention was useful, that they enjoyed taking part, and that they would recommend it to other YLHIV. CONCLUSIONS: Our findings of improved HIV knowledge and high acceptability are encouraging, despite a lack of measurable effect on retention. Retention was greater than anticipated in both groups, likely a result of external efforts that began partway through the study. Qualitative data indicate that the SMART Connections intervention may have contributed to retention, adherence, and social support in ways that were not captured quantitatively. Web-based delivery of support group interventions can permit people to access information and other group members privately, when convenient, and without travel. Such digital health interventions may help fill critical gaps in services available for YLHIV. TRIAL REGISTRATION: ClinicalTrials.gov NCT03516318; https://clinicaltrials.gov/ct2/show/NCT03516318.

The effects of the integration of an economic strengthening and HIV prevention education programme on the prevalence of sexually transmitted infections and savings behaviours among adolescents: a full-factorial randomised controlled trial in South Africa.

Background: Multisectoral approaches are thought necessary to prevent HIV among adolescents. We examined whether an economic strengthening (ES) and an HIV-prevention education intervention improved outcomes when combined versus separately. Methods: We conducted a full-factorial randomised controlled study to randomise participants into all possible intervention groups based on the two interventions: economic strengthening only (ES-only), HIV-prevention only (HIV-only), both interventions combined (ES+HIV) and no intervention (control). We measured sexually transmitted infections (STIs), self-reported economic and sexual behaviours/knowledge, and pregnancy at a pre-intervention and two post-intervention assessments. Eligible participants were adolescents 14 to 17 years old from a programme supporting vulnerable families in Gauteng Province, South Africa. We estimated intervention effects using repeated measures, generalised linear mixed models. Results: A total of 1773 adolescents participated (57% female). ES+HIV adolescents had the lowest STI prevalence at first endline; however, the comparison with the control was not significant (OR 0.62, 95% CI 0.27 to 1.41). ES-only or HIV-only groups were not significantly better than the control on STI prevalence (OR 1.53, 95% CI 0.73 to 3.20 and OR 1.47, 95% CI 0.69 to 3.12, respectively). STI prevalence became more similar among the groups at second endline.ES-only adolescents were more likely to participate in savings groups (p=0.004) and plan to save for education (p=0.001) versus the control. ES+HIV adolescents were more likely to plan to save for education versus the control (p=0.001) and HIV-only groups (p=0.002) but did not differ significantly from the ES-only group (p=0.803). The ES+HIV intervention's effect on HIV knowledge was significant compared with the control (p=0.03) and ES-only groups (p<0.001), but not when compared with the HIV-only group (p=0.091). Effects on pregnancy, sexual behaviours or other economic behaviours were not significant. Conclusions: We could not confirm the ES and HIV interventions, separately or combined, were effective to reduce STI prevalence. Evaluations of multicomponent interventions should use full-factorial designs to fully assess effects. Trial registration number: NCT02888678.

Engaging Patients and Caregivers in Research for Pediatric Inflammatory Bowel Disease: Top 10 Research Priorities.

INTRODUCTION: Including individuals with lived experience in pediatric inflammatory bowel disease (IBD) is essential to establishing a research agenda that is mutually impactful to both those treating and those experiencing the disease. METHODS: Using the James Lind Alliance approach to research priority setting, a 10-member steering committee composed of current and former pediatric patients with IBD, caregivers, and clinicians was formed. A national survey, disseminated across Canada, elicited uncertainties which were divided into unanswered and answered research questions. Subsequently a research prioritization survey was disseminated where respondents ranked their top 20 research uncertainties. A final prioritization meeting was held to agree upon the top 10 uncertainties. RESULTS: From 1209 research questions submitted by 363 participants, the list was reduced to 105 indicative questions that were within scope and deemed unanswered in the literature. Via the national research prioritization survey, this list was further reduced. The top 10 uncertainties identified at the final research consensus meeting, with 21 participants from all stakeholder groups, included "What are the causes of IBD?," "Can IBD be prevented?," "What role does diet have in the management of pediatric IBD?." Other questions concerned flare ups, biomarkers, optimal patient education, long-term effects of medication and early-diagnosis, role of psychological support, and optimal approach to diagnosis. CONCLUSION: This research adds a unique perspective by deriving a list of pediatric IBD research uncertainties important by patients and caregivers and clinicians.