Experiences and challenges of pre-exposure prophylaxis initiation and retention among high-risk populations: qualitative insights among service providers in Thailand.

Objectives: Pre-exposure prophylaxis (PrEP) has been an essential element of the national combination prevention package and included in the Universal Health Coverage (UHC) of Thailand since 2019. As a part of the national monitoring and evaluation framework, this qualitative study aims to describe experiences and barriers concerning PrEP initiation and retention among service providers from both hospital and Key Population Led Health Service (KPLHS) settings under the country's UHC roll-out. Methods: Between September and October 2020, ten focus group discussions with PrEP service providers from both hospitals and KPLHS across Thailand were conducted of which there were six hospitals, one health service center, three KPLHS. All interviews were recorded and transcribed verbatim to identify providers' experiences, attitudes, and perceived barriers regarding PrEP service delivery in Thailand. Results: Among the 35 PrEP service providers, most of them reported positive attitudes toward PrEP and believed that it is an effective tool for HIV prevention. Men who have sex with men were perceived to be the easiest group to reach while PrEP uptake remains a challenge in other key populations. Integration of a PrEP clinic with other HIV services at hospitals made most healthcare providers unable to adopt an active approach in recruiting new clients like at KPLHS settings. Challenges in delivering PrEP services included lack of public awareness, high workload, limited benefit package coverage, structural and human resources. Conclusion: Additional services to address different health needs should be considered to increase PrEP uptake among harder-to-reach populations. Novel approaches to PrEP service integration and close collaboration between hospitals and KPLHS would be essential in optimizing PrEP uptake and retention. Support regarding raising awareness, expanding service coverage and access, improving facilities and workforce, and providers' capacities are crucial for the success of the national PrEP programme.

A comparison of attitudes and knowledge of pre-exposure prophylaxis (PrEP) between hospital and Key Population Led Health Service providers: Lessons for Thailand's Universal Health Coverage implementation.

BACKGROUND: HIV Pre-exposure prophylaxis (PrEP) has demonstrated efficacy and effectiveness among high-risk populations. In Thailand, PrEP has been included in the National Guidelines on HIV/AIDS Treatment and Prevention since 2014. As a part of the national monitoring and evaluation framework for Thailand's universal coverage inclusion, this cross-sectional survey was conducted to assess knowledge of, attitudes to and practice (KAP) of PrEP service providers in Thailand. METHODS: We conducted a cross-sectional survey to explore knowledge of, and attitudes towards PrEP among providers from hospital and Key Population Led Health Services (KPLHS) settings. The questionnaire was distributed online in July 2020. Descriptive and univariate analysis using an independent-sample t-test were applied in the analyses. Attitudes were ranked from the most negative (score of 1) to the most positive (score of 5). RESULTS: Overall, there were 196 respondents (158 from hospitals and 38 from KPLHS) in which most hospital providers are female nurse practitioners while half of those from KPLHS report current gender as gay. Most respondents report a high level of PrEP knowledge and support provision in all high-risk groups with residual concern regarding anti-retroviral drugs resistance. Over two-fifths of providers from both settings perceive that PrEP would result in risk compensation and half of KPLHS providers are concerned regarding risk of sexual transmitted infections. Limited PrEP counselling time is a challenge for hospital providers. CONCLUSIONS: Service integration between both settings, more involvement and distribution of KPLHS in reaching key populations would be essential in optimizing PrEP uptake and retention. Continuing support particularly in raising awareness about PrEP among healthcare providers and key populations, facilities and manpower, unlimited quota of patient recruitment and PrEP training to strengthen providers' confidence and knowledge would be essential for successful PrEP implementation.

Application technology to fight the COVID-19 pandemic: Lessons learned in Thailand.

Demands to address the COVID-19 pandemic rapidly surpassed global resources. Successful implementation of application technology resulting in people taking greater control of their own health and medical and public health personnel improving efficiency was requested by authorities in Thailand to reduce the demand on health resources to meet the health needs of the people. This paper examines the creation and implementation of three real-time application technologies using a bottom-up approach in an attempt to examine COVID-19 challenges and highlight control measures. These lessons learned represent participatory action research methods involving the people who were responsible for taking actions to improve their own and their communities' health. The objective was to build participation of users, academics and service organizations in a novel technology enhanced system leading to quality management of the COVID-19 pandemic. A new technology enhanced system for medical field personnel encouraged network participation resulting in co-creation of a health data center. Application technology assisted COVID-19 infected patients and high-risk people to identify their own symptoms and to provide a rapid tracking method that could be employed until public health surveillance was achieved. A patient and hospital management system employing new application technology was effective in monitoring COVID-19 patients utilizing an interconnected hospital network. Application technology was beneficial in promoting health, enhancing patient satisfaction, reducing readmission rates and extending health resources.

Application technology to fight the COVID-19 pandemic: Lessons learned in Thailand.

Demands to address the COVID-19 pandemic rapidly surpassed global resources. Successful implementation of application technology resulting in people taking greater control of their own health and medical and public health personnel improving efficiency was requested by authorities in Thailand to reduce the demand on health resources to meet the health needs of the people. This paper examines the creation and implementation of three real-time application technologies using a bottom-up approach in an attempt to examine COVID-19 challenges and highlight control measures. These lessons learned represent participatory action research methods involving the people who were responsible for taking actions to improve their own and their communities' health. The objective was to build participation of users, academics and service organizations in a novel technology enhanced system leading to quality management of the COVID-19 pandemic. A new technology enhanced system for medical field personnel encouraged network participation resulting in co-creation of a health data center. Application technology assisted COVID-19 infected patients and high-risk people to identify their own symptoms and to provide a rapid tracking method that could be employed until public health surveillance was achieved. A patient and hospital management system employing new application technology was effective in monitoring COVID-19 patients utilizing an interconnected hospital network. Application technology was beneficial in promoting health, enhancing patient satisfaction, reducing readmission rates and extending health resources.

Improving Team Performance for Public Health Preparedness.

OBJECTIVE: Between May 2010 and September 2011, the University of Minnesota School of Public Health partnered with the Minnesota Department of Health (MDH) to assess the effect of exercises on team performance during public health emergency response. METHODS: Participants were divided into 3 research teams exposed to various levels of intervention. Groups consisted of a control group that was given standard MDH training exercises, a didactic group exposed to team dynamics and communication training, and a treatment group that received the didactic training in addition to a post-exercise facilitated debriefing. To assess differences in team performance, teams engaged in 15 functional exercises. RESULTS: Differences in team performance across the 3 groups were identified, although there was no trend in team performance over time for any of the groups. Groups demonstrated fluctuation in team performance during the study period. Attitudinal surveys demonstrated an increase in workplace satisfaction and confidence in training among all groups throughout the study period. CONCLUSIONS: Findings from this research support that a critical link exists between training type and team performance during public health emergency response. This research supports that intentional teamwork training for emergency response workers is essential for effective public health emergency response. (Disaster Med Public Health Preparedness. 2017;11:7-10).

One Health Core Competency Domains.

The emergence of complex global challenges at the convergence of human, animal, and environmental health has catalyzed a movement supporting "One Health" approaches. Despite recognition of the importance of One Health approaches to address these complex challenges, little effort has been directed at identifying the seminal knowledge, skills, and attitudes necessary for individuals to successfully contribute to One Health efforts. Between 2008 and 2011, three groups independently embarked on separate initiatives to identify core competencies for professionals involved with One Health approaches. Core competencies were considered critically important for guiding curriculum development and continuing professional education, as they describe the knowledge, skills, and attitudes required to be effective. A workshop was convened in 2012 to synthesize the various strands of work on One Health competencies. Despite having different mandates, participants, and approaches, all of these initiatives identified similar core competency domains: management; communication and informatics; values and ethics; leadership; teams and collaboration; roles and responsibilities; and systems thinking. These core competency domains have been used to develop new continuing professional education programs for One Health professionals and help university curricula prepare new graduates to be able to contribute more effectively to One Health approaches.

Disaster behavioral health capacity: Findings from a multistate preparedness assessment.

PURPOSE: To identify gaps in disaster behavioral health, the Preparedness and Emergency Response Learning Center (PERL) at the University of Minnesota's School of Public Health supported the development and implementation of a multistate disaster behavioral health preparedness assessment. Information was gathered regarding worker knowledge of current disaster behavioral health capacity at the state and local level, and perceived disaster behavioral health training needs and preferences. METHODS: Between May and July 2015, 143 participants completed a 31-item uniform questionnaire over the telephone by a trained interviewer. Trained interviewers were given uniform instructions on administering the questionnaire. Participants included county and city-level public health leaders and directors from Minnesota, Wisconsin, and North Dakota. FINDINGS: Findings demonstrate that across the three states there is a need for improved disaster behavioral health training and response plans for before, during, and after public health emergencies. This study identified perceived gaps in plans and procedures for meeting the disaster behavioral health needs of different atrisk populations, including children, youth, and those with mental illness. There was consistent agreement among participants about the lack of behavioral health coordination between agencies during emergency events. VALUE: Findings can be used to inform policy and the development of trainings for those involved in disaster behavioral health. Effectively attending to interagency coordination and mutual aid agreements, planning for effective response and care for vulnerable populations, and targeted training will contribute to a more successful public health response to emergency events.

Effectiveness of a motivational interviewing intervention on medication compliance.

This study investigated the effectiveness of training geriatric home-based primary care (HBPC) nursing staff in motivational interviewing (MI) techniques, with the goal of increasing patient medication adherence. Nursing staff received 4 hours of training in MI techniques from a licensed psychologist. Results indicated that the MI training increased medication adherence in the HBPC veteran sample by a small, but statistically significant, margin both 1 month and 6 months after the intervention. Although the effect size may be considered small, the clinical and cost ramifications of even a small gain in adherence are extremely important for the patient, clinician, and the medical facility. MI techniques may provide a cost-effective and impactful means of enhancing patient adherence to medications.

Mobile phone use among Medical Reserve Corps coordinators and volunteers: an exploratory study.

OBJECTIVE: To better understand how mobile phones can be used during emergency response, this study identifies a) current mobile phone use among Medical Reserve Corps (MRC) volunteers and coordinators in their daily lives and during response; b) challenges for mobile phone use during response; and c) areas for capacity building. DESIGN: In 2012, 459 MRC volunteers and coordinators responded to a 35-question survey conducted online through SurveyMonkey. Respondents were asked how they use their mobile phones in their daily lives and during response, and how they would like to use them during response. Frequencies were calculated using SurveyMonkey and Excel. MAIN OUTCOME MEASURES: Respondents reported frequent and varied mobile phone use in their daily lives, with 99 percent of respondents owning a phone, 82 percent texting, and 87 percent of smartphone owners using apps. Although 80 percent of respondents who had been deployed used mobile phones during response, use of sophisticated mobile phone features was low; only 10 percent accessed emergency preparedness apps and 23 percent browsed the Internet for emergency response information. Respondents indicated a desire to use more features during response, such as emergency preparedness apps (72 percent) and e-mail to send or receive response instructions (80 percent). CONCLUSION: Results indicate that given access to mobile technology and training, emergency responders would like to increase their mobile phone use during response. Implications of these findings show a need for organizations to improve their support of mobile phone use.

Using gaming simulation to evaluate bioterrorism and emergency readiness training.

INTRODUCTION: The University of Minnesota: Simulations, Exercises and Effective Education: Preparedness and Emergency Response Learning Center uses simulations, which allow trainees to participate in realistic scenarios, to develop and evaluate competency. BACKGROUND/RATIONALE: In a previous study, participants in Disaster in Franklin County: A Public Health Simulation demonstrated that prior bioterrorism and emergency readiness training (BT/ER) is significantly associated with better performance in a simulated emergency. We conducted a second analysis with a larger data set, remapping simulation questions to the Public Health Preparedness and Response Core Competency Model, Version 1.0. METHODS/ACTIVITY: We performed an outcome evaluation of the impact of public health preparedness training. In particular, we compared individuals with significant BT/ER training to individuals without training on the basis of performance in a simulated emergency. We grouped participants as group 1 (≥45 hours of BT/ER training) and group 2 (<45 hours). Dependent variables included effectiveness of chosen responses within the gaming simulation, which was measured as the proportion of questions answered correctly for each participant. The relationship of effectiveness with significant BT/ER training was estimated using either multiple linear or logistic regression. RESULTS/OUTCOMES: For overall effectiveness, group 1 had 2% more correct decisions, on average, than group 2 (P < .001). Group 1 performed significantly better, on average, than group 2 for competency 1.1 (P = .001) and competency 2.3 (P < .001). However, group 1 was significantly worse on competency 1.2 than group 2. DISCUSSION: Results indicate that prior training is significantly associated with better performance in a simulated emergency using gaming technology. Effectiveness differed by competency, indicating that more training may be needed in certain competency areas. NEXT STEPS: Next steps to enhancing the usefulness of simulations in training should go beyond questioning if the learner learned and included questions related to the organizational factors that contributed to simulation effectiveness, and attributes of the simulation that encouraged competency and capacity building.

One Health: Lessons Learned from East Africa.

Africa is faced with many of the most daunting challenges of our time. It comprises roughly 15% of the world's human population, and most of its countries are perpetually ranked "Low" on the United Nations' Human Development Index. On the other hand, Africa has arguably the largest proportion of intact natural ecosystems, biodiversity, and sociocultural capital and the lowest impact on global warming of any continent. Thus, African leaders are faced with competing demands and values among a multitude of complex issues, such as high human population growth, extreme poverty, food insecurity, land use policy, climate change, and biodiversity conservation. In this context, building sustainable national systems for human and/or animal health is one of the grand challenges of this generation. Today's complex global health and development challenges require long-term commitment and a range of approaches that are too broad for any one discipline, institution, or country to implement on its own. The One Health concept recognizes the interconnectedness of global health issues and, as such, promotes the importance of and need for international, interdisciplinary, and cross-sectoral communication and collaboration at local, national, and international levels. By taking advantage of natural cultural tendencies for shared leadership, resource allocation, and community values, African leaders are currently proactively demonstrating the principles of One Health, and thus becoming a model for this global vision. And by focusing on partnerships rather than donor-recipient relationships, they are fostering the development of shared priorities and are increasingly driving their own health agenda to fulfill their own needs.

Games, simulations, and learning in emergency preparedness: a review of the literature.

Between 2007 and 2011, a comprehensive review of the literature was conducted to identify the usefulness of educational games and simulations in developing and evaluating the competency of public health professionals to prepare for, respond to, and recover from emergencies. This article presents an overview of the literature related to the use of games and simulations in education and training, summarizes key findings, identifies key features of gaming simulation design for educational effectiveness, and suggests that use of these emerging teaching and learning strategies be considered in the development of a comprehensive approach for creating and evaluating competency.

The evidence base for effectiveness of preparedness training: a retrospective analysis.

OBJECTIVES: In 2007, the Centers for Disease Control and Prevention (CDC) commissioned an Evidence-Based Gaps Collaboration Group to consider whether past experience could help guide future efforts to educate and train public health workers in responding to emergencies and disasters. METHODS: The Group searched the peer-reviewed literature for preparedness training articles meeting three criteria: publication during the period when CDC's Centers for Public Health Preparedness were fully operational, content relevant to emergency response operations, and content particular to the emergency response roles of public health professionals. Articles underwent both quantitative and qualitative analyses. RESULTS: The search identified 163 articles covering the topics of leadership and command structure (18.4%), information and communications (14.1%), organizational systems (78.5%), and others (23.9%). The number of reports was substantial, but their usefulness for trainers and educators was rated only "fair" to "good." Thematic analysis of 137 articles found that organizational topics far outnumbered leadership, command structure, and communications topics. Disconnects among critical participants--including trainers, policy makers, and public health agencies--were noted. Generalizable evaluations were rare. CONCLUSIONS: Reviews of progress in preparedness training for the public health workforce should be repeated in the future. Governmental investment in training for preparedness should continue. Future training programs should be grounded in policy and practice needs, and evaluations should be based on performance improvement.

A longitudinal study of the impact of an emergency preparedness curriculum.

OBJECTIVE: We conducted a longitudinal study to evaluate the impact of a curriculum designed to develop competency in emergency preparedness among public health professionals. METHODS: At six and 12 months following completion of one or more courses in the areas of emergency preparedness, response, and recovery, or in food protection, course participants were contacted and asked to identify if their participation allowed them to develop targeted competencies, identify important knowledge or skills they had acquired, provide examples of application of learning, and describe the impact of changes. Over five years, 36 sets of data were collected. RESULTS: The response rate of those who responded at either six or 12 months, or for both time periods, was 63%. At both six and 12 months,those who responded agreed that the learning activity helped them develop the competency associated with it in the curriculum plan. Respondents described multiple applications of learning and reported the development of reflective and systems-thinking abilities. CONCLUSIONS: The results provide compelling evidence that learners do develop competencies that impact their work activities as a result of competency-based educational programming and are able to apply these competencies in their work and organizational activities.

Using gaming simulation to evaluate bioterrorism and emergency readiness education.

OBJECTIVE: We performed an outcome evaluation of the impact of public health preparedness training as a group comparison posttest design to determine the differences in the way individuals who had participated in training performed in a simulated emergency. METHODS: The Experimental Group 1 included students who had graduated from or were currently enrolled in the bioterrorism and emergency readiness (BT/ER) curriculum at the University of Minnesota School of Public Health. The comparison groups included individuals who had access to the Internet and were aware of the 2006 online simulation Disaster in Franklin County: A Public Health Simulation. The evaluation process employed surveys and the gaming simulation as sources for primary data. RESULTS: Participants in the BT/ER curriculum (p=0.0001) and other participants completing at least 45 hours of training in the past year (p=0.0001) demonstrated higher effectiveness scores (accuracy of chosen responses within the simulation) than participants who did not report significant amounts of training. CONCLUSIONS: This evaluation research demonstrated that training is significantly associated with better performance in a simulated emergency using gaming technology.

Demonstrating excellence in the scholarship of practice-based service for public health.

Practice-based scholarship in public health addresses community health issues. The accredited schools of public health (SPHs) have played a significant role in defining and implementing the multidisciplinary, interprofessional, ecological approach to improving the health and safety of communities through academic public health practice. These schools have addressed the challenges raised by the Institute of Medicine for enhancing academic-practice linkages. The Association of Schools of Public Health (ASPH) established the Council of Public Health Practice Coordinators (Practice Council), whose members are delegates from each of the SPHs accredited by the Council on Education for Public Health (CEPH); there were 40 as of 2008. The Practice Council's priorities are to (1) promote greater commitment to scholarship in public health practice-based research, teaching, and service within SPHs, and (2) facilitate recognition and reward for practice-based scholarship in academic institutions. Extensive alignment of efforts by the Practice Council, SPHs, federal agencies, private institutions, and the practice sector have invigorated scholarship in academic public health practice.

Lifelong learning for public health practice education: a model curriculum for bioterrorism and emergency readiness.

In 2002, the University of Minnesota School of Public Health (UMNSPH) adopted an approach that supports basic, advanced, and continuing education curricula to train current and future public health workers. This model for lifelong learning for public health practice education allows for the integration of competency domains from the Council on Linkages Between Academia and Public Health Practice's core public health workforce competency levels and the Centers for Disease Control and Prevention's Bioterrorism and Emergency Readiness Competencies. This article describes how UMNSPH has implemented the model through coordination with state planning efforts and needs assessments in the tristate region of Minnesota, North Dakota, and Wisconsin. In addition, we discuss methods used for credentialing practitioners who have achieved competency at various levels of performance to enhance the capacity of the public health preparedness systems.