Jeffrey Lazarus - Academia.edu (original) (raw)

Papers by Jeffrey Lazarus

Research paper thumbnail of Benchmarking HIV health care: from individual patient care to health care evaluation. An example from the EuroSIDA study

Background: State-of-the-art care involving the utilisation of multiple health care interventions... more Background: State-of-the-art care involving the utilisation of multiple health care interventions is the basis for an optimal long-term clinical prognosis for HIV-patients. We evaluated health care for HIV patients based on four key indicators.

Research paper thumbnail of Primary healthcare providers views on improving sexual and reproductive healthcare for adolescents in Bolivia Ecuador and Nicaragua

Global Health Action, Apr 24, 2015

Objectives: To elicit the views of primary healthcare providers from Bolivia, Ecuador, and Nicara... more Objectives: To elicit the views of primary healthcare providers from Bolivia, Ecuador, and Nicaragua on how adolescent sexual and reproductive health (ASRH) care in their communities can be improved. Methods: Overall, 126 healthcare providers (46 from Bolivia, 39 from Ecuador, and 41 from Nicaragua) took part in this qualitative study. During a series of moderated discussions, they provided written opinions about the accessibility and appropriateness of ASRH services and suggestions for its improvement. The data were analyzed by employing a content analysis methodology. Results: Study participants emphasized managerial issues such as the prioritization of adolescents as a patient group and increased healthcare providers' awareness about adolescent-friendly approaches. They noted that such an approach needs to be extended beyond primary healthcare centers. Schools, parents, and the community in general should be encouraged to integrate issues related to ASRH in the everyday life of adolescents and become 'gate-openers' to ASRH services. To ensure the success of such measures, action at the policy level would be required. For example, decision-makers could call for developing clinical guidelines for this population group and coordinate multisectoral efforts. Conclusions: To improve ASRH services within primary healthcare institutions in three Latin American countries, primary healthcare providers call for focusing on improving the youth-friendliness of health settings. To facilitate this, they suggested engaging with key stakeholders, such as parents, schools, and decision-makers at the policy level.

Research paper thumbnail of Editorial: Health services strengthening in Africa - research is a key component: Editorial

Trop Med Int Health, 2010

Research paper thumbnail of Select barriers to harm-reduction services for IDUs in eastern Europe

Central European Journal of Public Health, Dec 1, 2009

Background: In eastern Europe, the high prevalence rates of HIV and the hepatitis C virus (HCV) a... more Background: In eastern Europe, the high prevalence rates of HIV and the hepatitis C virus (HCV) are concentrated among injecting drug users (IDUs). Harm reduction programmes such as needle and syringe programmes and opioid substitution therapy (OST) have been shown to be effective in preventing these infections. However, structural barriers can limit their effectiveness by hindering access.

Research paper thumbnail of Health Aid Governance in Fragile States: The Global Fund Experience

Fragile states represent key challenges for global health governance. This study analyzes Global ... more Fragile states represent key challenges for global health governance. This study analyzes Global Fund grant data from 122 recipient countries as an initial exploration into how well these grants are performing in fragile states as compared to other countries. Since 2002, the Global Fund has invested nearly US$ 5 billion in 41 fragile states, and most grants have been assessed as performing well. Nonetheless, statistically significant differences in performance exist between fragile states and other countries, which were further pronounced in states with humanitarian crises. This indicates that further investigation of this issue is warranted: variations in performance may be unavoidable given the complexities of health governance in fragile states, but may also have implications for how the Global Fund and others provide aid. For example, faster aid disbursements might allow for a better response to rapidly changing contexts, and there may need to be more of a focus on building capacity and strengthening health governance in these countries.

Research paper thumbnail of Global policy report on the prevention and control of viral hepatitis in WHO Member States

The periodic evaluation of implementation of the WHO strategy requires an initial baseline survey... more The periodic evaluation of implementation of the WHO strategy requires an initial baseline survey of all Member States. In mid-2012, WHO, in collaboration with the World Hepatitis Alliance, conducted such a survey, asking Member States to provide information relating to the four axes of the WHO strategy. In particular, Member States were asked whether key prevention and control activities are being conducted. This report presents the results. The first chapter provides an introduction to viral hepatitis and to the global response to this group of diseases. The second chapter provides a global overview of the survey findings. Chapters three through eight present findings from the six WHO regions, including summaries of data from all responding countries. Additional survey data, study methodology information and the survey instrument can be found in Annexes A–E.

Research paper thumbnail of Health service delivery models for the provision of antiretroviral therapy in sub-Saharan Africa: a systematic review

Tropical Medicine & International Health

Objectives In response to the lack of evidence-based guidance for how to continue scaling up anti... more Objectives In response to the lack of evidence-based guidance for how to continue scaling up antiretroviral therapy (ART) in ways that make optimal use of limited resources, to assess comparative studies of ART service delivery models implemented in sub-Saharan Africa.MethodsA systematic literature search and analysis of studies that compared two or more methods of ART service delivery using either CD4 count or viral load as a primary outcome.ResultsMost studies identified in this review were small and non-randomised, with low statistical power. Four of the 30 articles identified by this review conclude that nurse management of ART compares favourably to physician management. Seven provide evidence of the viability of managing ART at lower levels within the health system, and one indicates that vertical and integrated ART programmes can achieve similar outcomes. Five articles show that community/home-based ART management can be as effective as facility-based ART management. Five of ...

Research paper thumbnail of LP31 : Strengthening viral hepatitis surveillance in europe: Recommendations from two global hepatitis policy surveys (2013 and 2014)

Journal of Hepatology, 2015

Research paper thumbnail of O125 : A systematic review of hepatitis B and C testing in the countries of the who European region

Journal of Hepatology, 2015

Research paper thumbnail of Are there national strategies, plans and guidelines for the treatment of hepatitis C in people who inject drugs? A survey of 33 European countries

BMC infectious diseases, 2014

Hepatitis C virus (HCV) infection represents a major global health problem, which in high-income ... more Hepatitis C virus (HCV) infection represents a major global health problem, which in high-income countries now mostly affects people who inject drugs (PWID). Many studies show that the treatment of HCV infection is as successful among PWID as among other populations and recently PWID have been included in the international guidelines for the treatment of HCV infection. The aim of this survey was to collect data from European countries on the existence of national strategies, action plans and clinical guidelines for HCV treatment in the general population and PWID in particular. Thirty-three European countries were invited to participate. Data on available national strategies, action plans and guidelines for HCV treatment in general population and in PWID specifically were collected prospectively by means of a structured electronic questionnaire and analyzed accordingly. All of the 33 invited European countries participated in the survey. Twenty-two responses came from non-government...

Research paper thumbnail of Select barriers to harm-reduction services for IDUs in eastern Europe

Central European journal of public health, 2009

In eastern Europe, the high prevalence rates of HIV and the hepatitis C virus (HCV) are concentra... more In eastern Europe, the high prevalence rates of HIV and the hepatitis C virus (HCV) are concentrated among injecting drug users (IDUs). Harm reduction programmes such as needle and syringe programmes and opioid substitution therapy (OST) have been shown to be effective in preventing these infections. However, structural barriers can limit their effectiveness by hindering access. Through use of a semi-structured online survey sent to 65 professionals in the region, this study explores the prevalences of age restrictions, user fees or a lack of confidentiality for these programmes as well as HIV/HCV testing programmes. Twenty respondents reported that age restrictions were not widespread in the 11 reporting countries, apart from for OST. User fees were found to be very common in HCV testing and varied for other services. It was stated to be common to inform parents of young IDUs who receive HIV services, but not to inform public authorities when IDUs enter harm reduction programmes. W...

Research paper thumbnail of Re. Determinants of demand: method selection and provider preference among US women seeking abortion services

Contraception, 2008

Background: Medication abortion has the potential to increase abortion availability, primarily th... more Background: Medication abortion has the potential to increase abortion availability, primarily through new provider networks; however, without a better understanding of how and why women make decisions regarding both their abortion method and their provider, expansion efforts may be misguided and valuable resources may be wasted. Study Design: We undertook an exploratory study to investigate method and provider preferences. Semistructured one-on-one interviews were conducted with 205 abortion clients at three family planning clinics. Results: Study participants greatly preferred the clinic setting for their abortion; the majority of women in the study would not have gone to their regular physician if they had been given the option. In addition, method choice trumps provider choice for the majority of women who would have preferred their regular provider. Participants who chose the aspiration procedure were more likely to have previous knowledge about the medication method. Travel time was not a predictor of preferring one's regular physician over the clinic. Conclusions: Expanding provider networks via the private sector is unlikely to be a panacea. In addition to these efforts, more attention may need to be paid to addressing logistic barriers to access. Physicians offering abortion services need to let their patients know they offer such services prior to their patients' need for them. Questions remain regarding the information being circulated about medication abortion.

Research paper thumbnail of Addressing HCV infection in Europe: reported, estimated and undiagnosed cases

Central European journal of public health, 2008

The hepatitis C virus (HCV) is a major public health problem due to its high prevalence, high rat... more The hepatitis C virus (HCV) is a major public health problem due to its high prevalence, high rate of onward transmission and health complications. As many as 85% of people infected with HCV may go on to become chronic carriers of the disease with the risk of developing liver cancer or cirrhosis. At present, it is the most common cause of chronic liver disease and liver transplantation in a number of countries, with an estimated 250,000 people dying annually from HCV-related causes. Despite the magnitude of the problem, the virus does not receive adequate attention from either the general public or from health policy-makers. This study assesses HCV prevalence from both estimated totals and undiagnosed cases in selected European countries. Secondary sources were assessed and experts in 17 European countries were interviewed about HCV prevalence, reporting strategies and transmission. Available data suggest that only between 10% and 40% of people with HCV in Europe are aware of their ...

Research paper thumbnail of Hepatitis – a devastating epidemic in Europe

BMC Infectious Diseases, 2014

Research paper thumbnail of Global Fund investments in harm reduction from 2002 to 2009

Research paper thumbnail of Factorial validation of the Attitudes toward Women Scale for Adolescents (AWSA) in assessing sexual behaviour patterns in Bolivian and Ecuadorian adolescents

Global health action, 2014

Adolescents' health is greatly influenced by social determinants, including gender norms. Alt... more Adolescents' health is greatly influenced by social determinants, including gender norms. Although research has shown that there is an association between gender attitudes and adolescents' sexual behaviour, few studies have assessed this relationship carefully. The Attitudes toward Women Scale for Adolescents (AWSA) is widely used to assess gender attitudes among adolescents; however, to our knowledge it has not been applied in Latin America. To apply AWSA in Latin America for the first time, to perform a factorial validation of this scale and to assess the relationship of gender attitudes and sexual behaviour in Bolivian and Ecuadorian adolescents. This cross-sectional study was carried out in 2011 among 14-18 year olds in 20 high schools in Cochabamba (Bolivia) and six in Cuenca (Ecuador) as a part of a larger project. Schools were purposively selected. A Spanish version of the 12-item AWSA was employed for this study. The assessed aspects of adolescent sexual behaviour we...

Research paper thumbnail of World Hepatitis Day 2013: know it, confront it

The Lancet. Global health, 2013

The three wise monkeys call attention to how people block out the reality of viral hepatitis Worl... more The three wise monkeys call attention to how people block out the reality of viral hepatitis World Hepatitis Alliance

Research paper thumbnail of Health service delivery models for the provision of antiretroviral therapy in sub-Saharan Africa: a systematic review

Tropical medicine & international health : TM & IH, 2014

In response to the lack of evidence-based guidance for how to continue scaling up antiretroviral ... more In response to the lack of evidence-based guidance for how to continue scaling up antiretroviral therapy (ART) in ways that make optimal use of limited resources, to assess comparative studies of ART service delivery models implemented in sub-Saharan Africa. A systematic literature search and analysis of studies that compared two or more methods of ART service delivery using either CD4 count or viral load as a primary outcome. Most studies identified in this review were small and non-randomised, with low statistical power. Four of the 30 articles identified by this review conclude that nurse management of ART compares favourably to physician management. Seven provide evidence of the viability of managing ART at lower levels within the health system, and one indicates that vertical and integrated ART programmes can achieve similar outcomes. Five articles show that community/home-based ART management can be as effective as facility-based ART management. Five of seven articles investig...

Research paper thumbnail of Public expectations concerning confidentiality protection of adolescents' sexual and reproductive health care in Lithuania: findings of the surveys conducted in 2005 and 2012

The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception, 2014

An adolescent's right to confidential healthcare is protected by international law and profes... more An adolescent's right to confidential healthcare is protected by international law and professional consensus. However, parental and social support for confidential sexual and reproductive health (SRH) services, in particular, varies greatly. This study documents Lithuanian residents' expectations with regard to confidentiality protection for adolescents in this domain, and explores the factors related to the diversity of these expectations. Two national surveys of Lithuanian residents completed in 2005 and 2012 using anonymous questionnaires. Participants rated their expectations for confidentiality using a five-point Likert scale for eight types of SRH consultations. Public anticipation for confidentiality depended on whether issues related to sexual behaviour or to its consequences were addressed during adolescent consultation. Only younger respondents had higher expectations for confidentiality in both contexts. Public expectations regarding confidentiality were less dem...

Research paper thumbnail of Primary healthcare providers’ views on improving sexual and reproductive healthcare for adolescents in Bolivia, Ecuador, and Nicaragua

Global Health Action, 2013

Objectives: To elicit the views of primary healthcare providers from Bolivia, Ecuador, and Nicara... more Objectives: To elicit the views of primary healthcare providers from Bolivia, Ecuador, and Nicaragua on how adolescent sexual and reproductive health (ASRH) care in their communities can be improved. Methods: Overall, 126 healthcare providers (46 from Bolivia, 39 from Ecuador, and 41 from Nicaragua) took part in this qualitative study. During a series of moderated discussions, they provided written opinions about the accessibility and appropriateness of ASRH services and suggestions for its improvement. The data were analyzed by employing a content analysis methodology. Results: Study participants emphasized managerial issues such as the prioritization of adolescents as a patient group and increased healthcare providers' awareness about adolescent-friendly approaches. They noted that such an approach needs to be extended beyond primary healthcare centers. Schools, parents, and the community in general should be encouraged to integrate issues related to ASRH in the everyday life of adolescents and become 'gate-openers' to ASRH services. To ensure the success of such measures, action at the policy level would be required. For example, decision-makers could call for developing clinical guidelines for this population group and coordinate multisectoral efforts. Conclusions: To improve ASRH services within primary healthcare institutions in three Latin American countries, primary healthcare providers call for focusing on improving the youth-friendliness of health settings. To facilitate this, they suggested engaging with key stakeholders, such as parents, schools, and decision-makers at the policy level.

Research paper thumbnail of Benchmarking HIV health care: from individual patient care to health care evaluation. An example from the EuroSIDA study

Background: State-of-the-art care involving the utilisation of multiple health care interventions... more Background: State-of-the-art care involving the utilisation of multiple health care interventions is the basis for an optimal long-term clinical prognosis for HIV-patients. We evaluated health care for HIV patients based on four key indicators.

Research paper thumbnail of Primary healthcare providers views on improving sexual and reproductive healthcare for adolescents in Bolivia Ecuador and Nicaragua

Global Health Action, Apr 24, 2015

Objectives: To elicit the views of primary healthcare providers from Bolivia, Ecuador, and Nicara... more Objectives: To elicit the views of primary healthcare providers from Bolivia, Ecuador, and Nicaragua on how adolescent sexual and reproductive health (ASRH) care in their communities can be improved. Methods: Overall, 126 healthcare providers (46 from Bolivia, 39 from Ecuador, and 41 from Nicaragua) took part in this qualitative study. During a series of moderated discussions, they provided written opinions about the accessibility and appropriateness of ASRH services and suggestions for its improvement. The data were analyzed by employing a content analysis methodology. Results: Study participants emphasized managerial issues such as the prioritization of adolescents as a patient group and increased healthcare providers' awareness about adolescent-friendly approaches. They noted that such an approach needs to be extended beyond primary healthcare centers. Schools, parents, and the community in general should be encouraged to integrate issues related to ASRH in the everyday life of adolescents and become 'gate-openers' to ASRH services. To ensure the success of such measures, action at the policy level would be required. For example, decision-makers could call for developing clinical guidelines for this population group and coordinate multisectoral efforts. Conclusions: To improve ASRH services within primary healthcare institutions in three Latin American countries, primary healthcare providers call for focusing on improving the youth-friendliness of health settings. To facilitate this, they suggested engaging with key stakeholders, such as parents, schools, and decision-makers at the policy level.

Research paper thumbnail of Editorial: Health services strengthening in Africa - research is a key component: Editorial

Trop Med Int Health, 2010

Research paper thumbnail of Select barriers to harm-reduction services for IDUs in eastern Europe

Central European Journal of Public Health, Dec 1, 2009

Background: In eastern Europe, the high prevalence rates of HIV and the hepatitis C virus (HCV) a... more Background: In eastern Europe, the high prevalence rates of HIV and the hepatitis C virus (HCV) are concentrated among injecting drug users (IDUs). Harm reduction programmes such as needle and syringe programmes and opioid substitution therapy (OST) have been shown to be effective in preventing these infections. However, structural barriers can limit their effectiveness by hindering access.

Research paper thumbnail of Health Aid Governance in Fragile States: The Global Fund Experience

Fragile states represent key challenges for global health governance. This study analyzes Global ... more Fragile states represent key challenges for global health governance. This study analyzes Global Fund grant data from 122 recipient countries as an initial exploration into how well these grants are performing in fragile states as compared to other countries. Since 2002, the Global Fund has invested nearly US$ 5 billion in 41 fragile states, and most grants have been assessed as performing well. Nonetheless, statistically significant differences in performance exist between fragile states and other countries, which were further pronounced in states with humanitarian crises. This indicates that further investigation of this issue is warranted: variations in performance may be unavoidable given the complexities of health governance in fragile states, but may also have implications for how the Global Fund and others provide aid. For example, faster aid disbursements might allow for a better response to rapidly changing contexts, and there may need to be more of a focus on building capacity and strengthening health governance in these countries.

Research paper thumbnail of Global policy report on the prevention and control of viral hepatitis in WHO Member States

The periodic evaluation of implementation of the WHO strategy requires an initial baseline survey... more The periodic evaluation of implementation of the WHO strategy requires an initial baseline survey of all Member States. In mid-2012, WHO, in collaboration with the World Hepatitis Alliance, conducted such a survey, asking Member States to provide information relating to the four axes of the WHO strategy. In particular, Member States were asked whether key prevention and control activities are being conducted. This report presents the results. The first chapter provides an introduction to viral hepatitis and to the global response to this group of diseases. The second chapter provides a global overview of the survey findings. Chapters three through eight present findings from the six WHO regions, including summaries of data from all responding countries. Additional survey data, study methodology information and the survey instrument can be found in Annexes A–E.

Research paper thumbnail of Health service delivery models for the provision of antiretroviral therapy in sub-Saharan Africa: a systematic review

Tropical Medicine & International Health

Objectives In response to the lack of evidence-based guidance for how to continue scaling up anti... more Objectives In response to the lack of evidence-based guidance for how to continue scaling up antiretroviral therapy (ART) in ways that make optimal use of limited resources, to assess comparative studies of ART service delivery models implemented in sub-Saharan Africa.MethodsA systematic literature search and analysis of studies that compared two or more methods of ART service delivery using either CD4 count or viral load as a primary outcome.ResultsMost studies identified in this review were small and non-randomised, with low statistical power. Four of the 30 articles identified by this review conclude that nurse management of ART compares favourably to physician management. Seven provide evidence of the viability of managing ART at lower levels within the health system, and one indicates that vertical and integrated ART programmes can achieve similar outcomes. Five articles show that community/home-based ART management can be as effective as facility-based ART management. Five of ...

Research paper thumbnail of LP31 : Strengthening viral hepatitis surveillance in europe: Recommendations from two global hepatitis policy surveys (2013 and 2014)

Journal of Hepatology, 2015

Research paper thumbnail of O125 : A systematic review of hepatitis B and C testing in the countries of the who European region

Journal of Hepatology, 2015

Research paper thumbnail of Are there national strategies, plans and guidelines for the treatment of hepatitis C in people who inject drugs? A survey of 33 European countries

BMC infectious diseases, 2014

Hepatitis C virus (HCV) infection represents a major global health problem, which in high-income ... more Hepatitis C virus (HCV) infection represents a major global health problem, which in high-income countries now mostly affects people who inject drugs (PWID). Many studies show that the treatment of HCV infection is as successful among PWID as among other populations and recently PWID have been included in the international guidelines for the treatment of HCV infection. The aim of this survey was to collect data from European countries on the existence of national strategies, action plans and clinical guidelines for HCV treatment in the general population and PWID in particular. Thirty-three European countries were invited to participate. Data on available national strategies, action plans and guidelines for HCV treatment in general population and in PWID specifically were collected prospectively by means of a structured electronic questionnaire and analyzed accordingly. All of the 33 invited European countries participated in the survey. Twenty-two responses came from non-government...

Research paper thumbnail of Select barriers to harm-reduction services for IDUs in eastern Europe

Central European journal of public health, 2009

In eastern Europe, the high prevalence rates of HIV and the hepatitis C virus (HCV) are concentra... more In eastern Europe, the high prevalence rates of HIV and the hepatitis C virus (HCV) are concentrated among injecting drug users (IDUs). Harm reduction programmes such as needle and syringe programmes and opioid substitution therapy (OST) have been shown to be effective in preventing these infections. However, structural barriers can limit their effectiveness by hindering access. Through use of a semi-structured online survey sent to 65 professionals in the region, this study explores the prevalences of age restrictions, user fees or a lack of confidentiality for these programmes as well as HIV/HCV testing programmes. Twenty respondents reported that age restrictions were not widespread in the 11 reporting countries, apart from for OST. User fees were found to be very common in HCV testing and varied for other services. It was stated to be common to inform parents of young IDUs who receive HIV services, but not to inform public authorities when IDUs enter harm reduction programmes. W...

Research paper thumbnail of Re. Determinants of demand: method selection and provider preference among US women seeking abortion services

Contraception, 2008

Background: Medication abortion has the potential to increase abortion availability, primarily th... more Background: Medication abortion has the potential to increase abortion availability, primarily through new provider networks; however, without a better understanding of how and why women make decisions regarding both their abortion method and their provider, expansion efforts may be misguided and valuable resources may be wasted. Study Design: We undertook an exploratory study to investigate method and provider preferences. Semistructured one-on-one interviews were conducted with 205 abortion clients at three family planning clinics. Results: Study participants greatly preferred the clinic setting for their abortion; the majority of women in the study would not have gone to their regular physician if they had been given the option. In addition, method choice trumps provider choice for the majority of women who would have preferred their regular provider. Participants who chose the aspiration procedure were more likely to have previous knowledge about the medication method. Travel time was not a predictor of preferring one's regular physician over the clinic. Conclusions: Expanding provider networks via the private sector is unlikely to be a panacea. In addition to these efforts, more attention may need to be paid to addressing logistic barriers to access. Physicians offering abortion services need to let their patients know they offer such services prior to their patients' need for them. Questions remain regarding the information being circulated about medication abortion.

Research paper thumbnail of Addressing HCV infection in Europe: reported, estimated and undiagnosed cases

Central European journal of public health, 2008

The hepatitis C virus (HCV) is a major public health problem due to its high prevalence, high rat... more The hepatitis C virus (HCV) is a major public health problem due to its high prevalence, high rate of onward transmission and health complications. As many as 85% of people infected with HCV may go on to become chronic carriers of the disease with the risk of developing liver cancer or cirrhosis. At present, it is the most common cause of chronic liver disease and liver transplantation in a number of countries, with an estimated 250,000 people dying annually from HCV-related causes. Despite the magnitude of the problem, the virus does not receive adequate attention from either the general public or from health policy-makers. This study assesses HCV prevalence from both estimated totals and undiagnosed cases in selected European countries. Secondary sources were assessed and experts in 17 European countries were interviewed about HCV prevalence, reporting strategies and transmission. Available data suggest that only between 10% and 40% of people with HCV in Europe are aware of their ...

Research paper thumbnail of Hepatitis – a devastating epidemic in Europe

BMC Infectious Diseases, 2014

Research paper thumbnail of Global Fund investments in harm reduction from 2002 to 2009

Research paper thumbnail of Factorial validation of the Attitudes toward Women Scale for Adolescents (AWSA) in assessing sexual behaviour patterns in Bolivian and Ecuadorian adolescents

Global health action, 2014

Adolescents' health is greatly influenced by social determinants, including gender norms. Alt... more Adolescents' health is greatly influenced by social determinants, including gender norms. Although research has shown that there is an association between gender attitudes and adolescents' sexual behaviour, few studies have assessed this relationship carefully. The Attitudes toward Women Scale for Adolescents (AWSA) is widely used to assess gender attitudes among adolescents; however, to our knowledge it has not been applied in Latin America. To apply AWSA in Latin America for the first time, to perform a factorial validation of this scale and to assess the relationship of gender attitudes and sexual behaviour in Bolivian and Ecuadorian adolescents. This cross-sectional study was carried out in 2011 among 14-18 year olds in 20 high schools in Cochabamba (Bolivia) and six in Cuenca (Ecuador) as a part of a larger project. Schools were purposively selected. A Spanish version of the 12-item AWSA was employed for this study. The assessed aspects of adolescent sexual behaviour we...

Research paper thumbnail of World Hepatitis Day 2013: know it, confront it

The Lancet. Global health, 2013

The three wise monkeys call attention to how people block out the reality of viral hepatitis Worl... more The three wise monkeys call attention to how people block out the reality of viral hepatitis World Hepatitis Alliance

Research paper thumbnail of Health service delivery models for the provision of antiretroviral therapy in sub-Saharan Africa: a systematic review

Tropical medicine & international health : TM & IH, 2014

In response to the lack of evidence-based guidance for how to continue scaling up antiretroviral ... more In response to the lack of evidence-based guidance for how to continue scaling up antiretroviral therapy (ART) in ways that make optimal use of limited resources, to assess comparative studies of ART service delivery models implemented in sub-Saharan Africa. A systematic literature search and analysis of studies that compared two or more methods of ART service delivery using either CD4 count or viral load as a primary outcome. Most studies identified in this review were small and non-randomised, with low statistical power. Four of the 30 articles identified by this review conclude that nurse management of ART compares favourably to physician management. Seven provide evidence of the viability of managing ART at lower levels within the health system, and one indicates that vertical and integrated ART programmes can achieve similar outcomes. Five articles show that community/home-based ART management can be as effective as facility-based ART management. Five of seven articles investig...

Research paper thumbnail of Public expectations concerning confidentiality protection of adolescents' sexual and reproductive health care in Lithuania: findings of the surveys conducted in 2005 and 2012

The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception, 2014

An adolescent's right to confidential healthcare is protected by international law and profes... more An adolescent's right to confidential healthcare is protected by international law and professional consensus. However, parental and social support for confidential sexual and reproductive health (SRH) services, in particular, varies greatly. This study documents Lithuanian residents' expectations with regard to confidentiality protection for adolescents in this domain, and explores the factors related to the diversity of these expectations. Two national surveys of Lithuanian residents completed in 2005 and 2012 using anonymous questionnaires. Participants rated their expectations for confidentiality using a five-point Likert scale for eight types of SRH consultations. Public anticipation for confidentiality depended on whether issues related to sexual behaviour or to its consequences were addressed during adolescent consultation. Only younger respondents had higher expectations for confidentiality in both contexts. Public expectations regarding confidentiality were less dem...

Research paper thumbnail of Primary healthcare providers’ views on improving sexual and reproductive healthcare for adolescents in Bolivia, Ecuador, and Nicaragua

Global Health Action, 2013

Objectives: To elicit the views of primary healthcare providers from Bolivia, Ecuador, and Nicara... more Objectives: To elicit the views of primary healthcare providers from Bolivia, Ecuador, and Nicaragua on how adolescent sexual and reproductive health (ASRH) care in their communities can be improved. Methods: Overall, 126 healthcare providers (46 from Bolivia, 39 from Ecuador, and 41 from Nicaragua) took part in this qualitative study. During a series of moderated discussions, they provided written opinions about the accessibility and appropriateness of ASRH services and suggestions for its improvement. The data were analyzed by employing a content analysis methodology. Results: Study participants emphasized managerial issues such as the prioritization of adolescents as a patient group and increased healthcare providers' awareness about adolescent-friendly approaches. They noted that such an approach needs to be extended beyond primary healthcare centers. Schools, parents, and the community in general should be encouraged to integrate issues related to ASRH in the everyday life of adolescents and become 'gate-openers' to ASRH services. To ensure the success of such measures, action at the policy level would be required. For example, decision-makers could call for developing clinical guidelines for this population group and coordinate multisectoral efforts. Conclusions: To improve ASRH services within primary healthcare institutions in three Latin American countries, primary healthcare providers call for focusing on improving the youth-friendliness of health settings. To facilitate this, they suggested engaging with key stakeholders, such as parents, schools, and decision-makers at the policy level.