Manuel napua - Academia.edu (original) (raw)

Papers by Manuel napua

Research paper thumbnail of Additional file 1 of HIV-exposed infant follow-up in Mozambique: formative research findings for the design of a cluster randomized controlled trial to improve testing and ART initiation

Additional file 1. Agregated_data_tables.

Research paper thumbnail of Additional file 2: of Research capacity building integrated into PHIT projects: leveraging research and research funding to build national capacity

Metrics table outlining each countryâ s indicator measurement. (DOCX 32Â kb)

Research paper thumbnail of Additional file 1: of Research capacity building integrated into PHIT projects: leveraging research and research funding to build national capacity

PHIT Cross-site paper on Research Capacity Building Data Collection Form Round 1 of Data Collecti... more PHIT Cross-site paper on Research Capacity Building Data Collection Form Round 1 of Data Collection. (DOCX 36Â kb)

Research paper thumbnail of The prevalence of hypertension and its distribution by sociodemographic factors in Central Mozambique: a cross sectional study

BMC Public Health, 2020

Background Hypertension (HTN) is a major risk factor for cardiovascular diseases, and its prevale... more Background Hypertension (HTN) is a major risk factor for cardiovascular diseases, and its prevalence has been rising in low- and middle-income countries. The current study describes HTN prevalence in central Mozambique, association between wealth and blood pressure (BP), and HTN monitoring and diagnosis practice among individuals with elevated BP. Methods The study used data from a cross-sectional, representative household survey conducted in Manica and Sofala provinces, Mozambique. There were 4101 respondents, aged ≥20 years. We measured average systolic and diastolic BP (SBP and DBP) from three measurements taken in the household setting. Elevated BP was defined as having either SBP ≥140 or DBP ≥90 mmHg. Results The mean age of the participants was 36.7 years old, 59.9% were women, and 72.5% were from rural areas. Adjusting for complex survey weights, 15.7% (95%CI: 14.0 to 17.4) of women and 16.1% (13.9 to 18.5) of men had elevated BP, and 7.5% (95% CI: 6.4 to 8.7) of the overall ...

Research paper thumbnail of Geographic distribution and determinants of mental health stigma in central Mozambique

Social Psychiatry and Psychiatric Epidemiology, 2019

Research paper thumbnail of Developing a representative community health survey sampling frame using open-source remote satellite imagery in Mozambique

International Journal of Health Geographics, 2018

Background: Lack of accurate data on the distribution of sub-national populations in low-and midd... more Background: Lack of accurate data on the distribution of sub-national populations in low-and middle-income countries impairs planning, monitoring, and evaluation of interventions. Novel, low-cost methods to develop unbiased survey sampling frames at sub-national, sub-provincial, and even sub-district levels are urgently needed. This article details our experience using remote satellite imagery to develop a provincial-level representative community survey sampling frame to evaluate the effects of a 7-year health system intervention in Sofala Province, Mozambique. Methods: Mozambique's most recent census was conducted in 2007, and no data are readily available to generate enumeration areas for representative health survey sampling frames. To remedy this, we partnered with the Humanitarian OpenStreetMap Team to digitize every building in Sofala and Manica provinces (685,189 Sofala; 925,713 Manica) using up-to-date remote satellite imagery, with final results deposited in the open-source OpenStreetMap database. We then created a probability proportional to size sampling frame by overlaying a grid of 2.106 km resolution (0.02 decimal degrees) across each province, and calculating the number of buildings within each grid square. Squares containing buildings were used as our primary sampling unit with replacement. Study teams navigated to the geographic center of each selected square using geographic positioning system coordinates, and then conducted a standard "random walk" procedure to select 20 households for each time a given square was selected. Based on sample size calculations, we targeted a minimum of 1500 households in each province. We selected 88 grids within each province to reach 1760 households, anticipating ongoing conflict and transport issues could preclude the inclusion of some clusters. Results: Civil conflict issues forced the exclusion of 8 of 31 subdistricts in Sofala and 15 of 39 subdistricts in Manica. Using Android tablets, Open Data Kit software, and a remote RedCap data capture system, our final sample included 1549 households in Sofala (4669 adults; 4766 children; 33 missing age) and 1538 households in Manica (4422 adults; 4898 children; 33 missing age). Conclusions: Other implementation or evaluation teams may consider employing similar methods to track population distributions for health systems planning or the development of representative sampling frames using remote satellite imagery.

Research paper thumbnail of Measuring health systems strength and its impact: experiences from the African Health Initiative

BMC health services research, Dec 21, 2017

Health systems are essential platforms for accessible, quality health services, and population he... more Health systems are essential platforms for accessible, quality health services, and population health improvements. Global health initiatives have dramatically increased health resources; however, funding to strengthen health systems has not increased commensurately, partially due to concerns about health system complexity and evidence gaps demonstrating health outcome improvements. In 2009, the African Health Initiative of the Doris Duke Charitable Foundation began supporting Population Health Implementation and Training Partnership projects in five sub-Saharan African countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia) to catalyze significant advances in strengthening health systems. This manuscript reflects on the experience of establishing an evaluation framework to measure health systems strength, and associate measures with health outcomes, as part of this Initiative. Using the World Health Organization's health systems building block framework, the Partnerships pr...

Research paper thumbnail of Mentorship and coaching to support strengthening healthcare systems: lessons learned across the five Population Health Implementation and Training partnership projects in sub-Saharan Africa

BMC health services research, Dec 21, 2017

Despite global efforts to increase health workforce capacity through training and guidelines, cha... more Despite global efforts to increase health workforce capacity through training and guidelines, challenges remain in bridging the gap between knowledge and quality clinical practice and addressing health system deficiencies preventing health workers from providing high quality care. In many developing countries, supervision activities focus on data collection, auditing and report completion rather than catalyzing learning and supporting system quality improvement. To address this gap, mentorship and coaching interventions were implemented in projects in five African countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia) as components of health systems strengthening (HSS) strategies funded through the Doris Duke Charitable Foundation's African Health Initiative. We report on lessons learned from a cross-country evaluation. The evaluation was designed based on a conceptual model derived from the project-specific interventions. Semi-structured interviews were administered to key...

Research paper thumbnail of Health system strengthening: a qualitative evaluation of implementation experience and lessons learned across five African countries

BMC health services research, Dec 21, 2017

Achieving the United Nations Sustainable Development Goals in sub-Saharan Africa will require sub... more Achieving the United Nations Sustainable Development Goals in sub-Saharan Africa will require substantial improvements in the coverage and performance of primary health care delivery systems. Projects supported by the Doris Duke Charitable Foundation's (DDCF) African Health Initiative (AHI) created public-private-academic and community partnerships in five African countries to implement and evaluate district-level health system strengthening interventions. In this study, we captured common implementation experiences and lessons learned to understand core elements of successful health systems interventions. We used qualitative data from key informant interviews and annual progress reports from the five Population Health Implementation and Training (PHIT) partnership projects funded through AHI in Ghana, Mozambique, Rwanda, Tanzania, and Zambia. Four major overarching lessons were highlighted. First, variety and inclusiveness of concerned key players (public, academic and private)...

Research paper thumbnail of Data-driven quality improvement in low-and middle-income country health systems: lessons from seven years of implementation experience across Mozambique, Rwanda, and Zambia

BMC health services research, Dec 21, 2017

Well-functioning health systems need to utilize data at all levels, from the provider, to local a... more Well-functioning health systems need to utilize data at all levels, from the provider, to local and national-level decision makers, in order to make evidence-based and needed adjustments to improve the quality of care provided. Over the last 7 years, the Doris Duke Charitable Foundation's African Health Initiative funded health systems strengthening projects at the facility, district, and/or provincial level to improve population health. Increasing data-driven decision making was a common strategy in Mozambique, Rwanda and Zambia. This paper describes the similar and divergent approaches to increase data-driven quality of care improvements (QI) and implementation challenge and opportunities encountered in these three countries. Eight semi-structured in-depth interviews (IDIs) were administered to program staff working in each country. IDIs for this paper included principal investigators of each project, key program implementers (medically-trained support staff, data managers and...

Research paper thumbnail of Tackling the hard problems: implementation experience and lessons learned in newborn health from the African Health Initiative

BMC health services research, Dec 21, 2017

The Doris Duke Charitable Foundation's African Health Initiative supported the implementation... more The Doris Duke Charitable Foundation's African Health Initiative supported the implementation of Population Health Implementation and Training (PHIT) Partnership health system strengthening interventions in designated areas of five countries: Ghana, Mozambique, Rwanda, Tanzania, and Zambia. All PHIT programs included health system strengthening interventions with child health outcomes from the outset, but all increasingly recognized the need to increase focus to improve health and outcomes in the first month of life. This paper uses a case study approach to describe interventions implemented in newborn health, compare approaches, and identify lessons learned across the programs' collective implementation experience. Case studies were built using quantitative and qualitative methods, applying the World Health Organization Health Systems Strengthening Framework, and maternal, newborn and child health continuum of care framework. We identified the following five primary themes ...

Research paper thumbnail of Research capacity building integrated into PHIT projects: leveraging research and research funding to build national capacity

BMC health services research, Dec 21, 2017

Inadequate research capacity impedes the development of evidence-based health programming in sub-... more Inadequate research capacity impedes the development of evidence-based health programming in sub-Saharan Africa. However, funding for research capacity building (RCB) is often insufficient and restricted, limiting institutions' ability to address current RCB needs. The Doris Duke Charitable Foundation's African Health Initiative (AHI) funded Population Health Implementation and Training (PHIT) partnership projects in five African countries (Ghana, Mozambique, Rwanda, Tanzania and Zambia) to implement health systems strengthening initiatives inclusive of RCB. Using Cooke's framework for RCB, RCB activity leaders from each country reported on RCB priorities, activities, program metrics, ongoing challenges and solutions. These were synthesized by the authorship team, identifying common challenges and lessons learned. For most countries, each of the RCB domains from Cooke's framework was a high priority. In about half of the countries, domain specific activities happened...

Research paper thumbnail of Evaluation of a Systems Analysis and Improvement Approach to Optimize Prevention of Mother-To-Child Transmission of HIV Using the Consolidated Framework for Implementation Research

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2016

Research paper thumbnail of Option B+ in Mozambique: Formative Research Findings for the Design of a Facility-Level Clustered Randomized Controlled Trial to Improve ART Retention in Antenatal Care

Journal of acquired immune deficiency syndromes (1999), Aug 1, 2016

With the rollout of "Option B+" in Mozambique in 2013, initial data indicated major cha... more With the rollout of "Option B+" in Mozambique in 2013, initial data indicated major challenges to early retention in antiretroviral therapy (ART) among HIV-positive pregnant women. We sought to develop and test a pilot intervention in 6 large public clinics in central Mozambique to improve retention of mothers starting ART in antenatal care. The results from the formative research from this study described here were used to design the intervention. The research was initiated in early 2013 and completed in early 2014 in each of the 6 study clinics and consisted of (1) patient flow mapping and measurement of retention through collection of health systems data from antenatal care registries, pharmacy registries, ART clinic databases, (2) workforce assessment and measurement of patient waiting times, and (3) patient and worker individual interviews and focus groups. Coverage of HIV testing and ART initiation were over 90% at all sites, but retention at 30-, 60-, and 90-day pha...

Research paper thumbnail of Suicide Attempts and Deaths in Sofala, Mozambique, From 2011 to 2014

Research paper thumbnail of Early ART initiation among HIV-positive pregnant women in central Mozambique: a stepped wedge randomized controlled trial of an optimized Option B+ approach

Implementation science : IS, Jan 30, 2015

Despite effective prevention strategies and increasing investments in global health, maternal to ... more Despite effective prevention strategies and increasing investments in global health, maternal to child transmission (MTCT) of HIV remains a significant problem globally, especially in sub-Saharan Africa. In 2012, there were 94,000 HIV-positive pregnant women in Mozambique. Approximately 15% of these women transmitted HIV to their newborn infants, resulting in nearly 14,000 new pediatric HIV infections that year. To address this issue, in 2013, the Mozambican Ministry of Health implemented the World Health Organization-recommended "Option B+" strategy in which all newly diagnosed HIV-positive pregnant women are counseled to initiate combination anti-retroviral therapy (ART) immediately upon diagnosis regardless of CD4 count and to continue treatment for life. Given the limited experience with Option B+ in sub-Saharan Africa, few rigorous pragmatic trials have studied this new treatment strategy. This study utilizes an initial formative research process involving patient and...

Research paper thumbnail of The availability of essential medicines for mental healthcare in Sofala, Mozambique

Global Health Action, 2015

Research paper thumbnail of HIV-exposed infant follow-up in Mozambique: Formative research findings for the design of a cluster randomized controlled trial to improve testing and ART initiation

Background HIV-exposed infant diagnosis (EID) and initiation of HIV-positive infants on anti-retr... more Background HIV-exposed infant diagnosis (EID) and initiation of HIV-positive infants on anti-retroviral therapy (ART) requires a well-coordinated cascade of care. Loss-to-follow-up (LTFU) can occur at multiple steps and effective EID is impeded by human resource constraints, difficulty with patient tracking, and long waiting periods. The objective of this research was to conduct formative research to guide the development of an intervention to improve the pediatric HIV care cascade in central Mozambique. The study was conducted in Manica and Sofala Provinces where the adult HIV burden is higher than the national average. The research focused on 3 large clinics in each province, along the highly populated Beira corridor.Methods The research was initiated in 2014 over 3 months at six facilities and consisted of 1) patient flow mapping and collection of health systems data from postpartum, child-at-risk, and ART service registries, 2) measurement of patient waiting times, and 3) patien...

Research paper thumbnail of Additional file 1 of HIV-exposed infant follow-up in Mozambique: formative research findings for the design of a cluster randomized controlled trial to improve testing and ART initiation

Additional file 1. Agregated_data_tables.

Research paper thumbnail of Additional file 2: of Research capacity building integrated into PHIT projects: leveraging research and research funding to build national capacity

Metrics table outlining each countryâ s indicator measurement. (DOCX 32Â kb)

Research paper thumbnail of Additional file 1: of Research capacity building integrated into PHIT projects: leveraging research and research funding to build national capacity

PHIT Cross-site paper on Research Capacity Building Data Collection Form Round 1 of Data Collecti... more PHIT Cross-site paper on Research Capacity Building Data Collection Form Round 1 of Data Collection. (DOCX 36Â kb)

Research paper thumbnail of The prevalence of hypertension and its distribution by sociodemographic factors in Central Mozambique: a cross sectional study

BMC Public Health, 2020

Background Hypertension (HTN) is a major risk factor for cardiovascular diseases, and its prevale... more Background Hypertension (HTN) is a major risk factor for cardiovascular diseases, and its prevalence has been rising in low- and middle-income countries. The current study describes HTN prevalence in central Mozambique, association between wealth and blood pressure (BP), and HTN monitoring and diagnosis practice among individuals with elevated BP. Methods The study used data from a cross-sectional, representative household survey conducted in Manica and Sofala provinces, Mozambique. There were 4101 respondents, aged ≥20 years. We measured average systolic and diastolic BP (SBP and DBP) from three measurements taken in the household setting. Elevated BP was defined as having either SBP ≥140 or DBP ≥90 mmHg. Results The mean age of the participants was 36.7 years old, 59.9% were women, and 72.5% were from rural areas. Adjusting for complex survey weights, 15.7% (95%CI: 14.0 to 17.4) of women and 16.1% (13.9 to 18.5) of men had elevated BP, and 7.5% (95% CI: 6.4 to 8.7) of the overall ...

Research paper thumbnail of Geographic distribution and determinants of mental health stigma in central Mozambique

Social Psychiatry and Psychiatric Epidemiology, 2019

Research paper thumbnail of Developing a representative community health survey sampling frame using open-source remote satellite imagery in Mozambique

International Journal of Health Geographics, 2018

Background: Lack of accurate data on the distribution of sub-national populations in low-and midd... more Background: Lack of accurate data on the distribution of sub-national populations in low-and middle-income countries impairs planning, monitoring, and evaluation of interventions. Novel, low-cost methods to develop unbiased survey sampling frames at sub-national, sub-provincial, and even sub-district levels are urgently needed. This article details our experience using remote satellite imagery to develop a provincial-level representative community survey sampling frame to evaluate the effects of a 7-year health system intervention in Sofala Province, Mozambique. Methods: Mozambique's most recent census was conducted in 2007, and no data are readily available to generate enumeration areas for representative health survey sampling frames. To remedy this, we partnered with the Humanitarian OpenStreetMap Team to digitize every building in Sofala and Manica provinces (685,189 Sofala; 925,713 Manica) using up-to-date remote satellite imagery, with final results deposited in the open-source OpenStreetMap database. We then created a probability proportional to size sampling frame by overlaying a grid of 2.106 km resolution (0.02 decimal degrees) across each province, and calculating the number of buildings within each grid square. Squares containing buildings were used as our primary sampling unit with replacement. Study teams navigated to the geographic center of each selected square using geographic positioning system coordinates, and then conducted a standard "random walk" procedure to select 20 households for each time a given square was selected. Based on sample size calculations, we targeted a minimum of 1500 households in each province. We selected 88 grids within each province to reach 1760 households, anticipating ongoing conflict and transport issues could preclude the inclusion of some clusters. Results: Civil conflict issues forced the exclusion of 8 of 31 subdistricts in Sofala and 15 of 39 subdistricts in Manica. Using Android tablets, Open Data Kit software, and a remote RedCap data capture system, our final sample included 1549 households in Sofala (4669 adults; 4766 children; 33 missing age) and 1538 households in Manica (4422 adults; 4898 children; 33 missing age). Conclusions: Other implementation or evaluation teams may consider employing similar methods to track population distributions for health systems planning or the development of representative sampling frames using remote satellite imagery.

Research paper thumbnail of Measuring health systems strength and its impact: experiences from the African Health Initiative

BMC health services research, Dec 21, 2017

Health systems are essential platforms for accessible, quality health services, and population he... more Health systems are essential platforms for accessible, quality health services, and population health improvements. Global health initiatives have dramatically increased health resources; however, funding to strengthen health systems has not increased commensurately, partially due to concerns about health system complexity and evidence gaps demonstrating health outcome improvements. In 2009, the African Health Initiative of the Doris Duke Charitable Foundation began supporting Population Health Implementation and Training Partnership projects in five sub-Saharan African countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia) to catalyze significant advances in strengthening health systems. This manuscript reflects on the experience of establishing an evaluation framework to measure health systems strength, and associate measures with health outcomes, as part of this Initiative. Using the World Health Organization's health systems building block framework, the Partnerships pr...

Research paper thumbnail of Mentorship and coaching to support strengthening healthcare systems: lessons learned across the five Population Health Implementation and Training partnership projects in sub-Saharan Africa

BMC health services research, Dec 21, 2017

Despite global efforts to increase health workforce capacity through training and guidelines, cha... more Despite global efforts to increase health workforce capacity through training and guidelines, challenges remain in bridging the gap between knowledge and quality clinical practice and addressing health system deficiencies preventing health workers from providing high quality care. In many developing countries, supervision activities focus on data collection, auditing and report completion rather than catalyzing learning and supporting system quality improvement. To address this gap, mentorship and coaching interventions were implemented in projects in five African countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia) as components of health systems strengthening (HSS) strategies funded through the Doris Duke Charitable Foundation's African Health Initiative. We report on lessons learned from a cross-country evaluation. The evaluation was designed based on a conceptual model derived from the project-specific interventions. Semi-structured interviews were administered to key...

Research paper thumbnail of Health system strengthening: a qualitative evaluation of implementation experience and lessons learned across five African countries

BMC health services research, Dec 21, 2017

Achieving the United Nations Sustainable Development Goals in sub-Saharan Africa will require sub... more Achieving the United Nations Sustainable Development Goals in sub-Saharan Africa will require substantial improvements in the coverage and performance of primary health care delivery systems. Projects supported by the Doris Duke Charitable Foundation's (DDCF) African Health Initiative (AHI) created public-private-academic and community partnerships in five African countries to implement and evaluate district-level health system strengthening interventions. In this study, we captured common implementation experiences and lessons learned to understand core elements of successful health systems interventions. We used qualitative data from key informant interviews and annual progress reports from the five Population Health Implementation and Training (PHIT) partnership projects funded through AHI in Ghana, Mozambique, Rwanda, Tanzania, and Zambia. Four major overarching lessons were highlighted. First, variety and inclusiveness of concerned key players (public, academic and private)...

Research paper thumbnail of Data-driven quality improvement in low-and middle-income country health systems: lessons from seven years of implementation experience across Mozambique, Rwanda, and Zambia

BMC health services research, Dec 21, 2017

Well-functioning health systems need to utilize data at all levels, from the provider, to local a... more Well-functioning health systems need to utilize data at all levels, from the provider, to local and national-level decision makers, in order to make evidence-based and needed adjustments to improve the quality of care provided. Over the last 7 years, the Doris Duke Charitable Foundation's African Health Initiative funded health systems strengthening projects at the facility, district, and/or provincial level to improve population health. Increasing data-driven decision making was a common strategy in Mozambique, Rwanda and Zambia. This paper describes the similar and divergent approaches to increase data-driven quality of care improvements (QI) and implementation challenge and opportunities encountered in these three countries. Eight semi-structured in-depth interviews (IDIs) were administered to program staff working in each country. IDIs for this paper included principal investigators of each project, key program implementers (medically-trained support staff, data managers and...

Research paper thumbnail of Tackling the hard problems: implementation experience and lessons learned in newborn health from the African Health Initiative

BMC health services research, Dec 21, 2017

The Doris Duke Charitable Foundation's African Health Initiative supported the implementation... more The Doris Duke Charitable Foundation's African Health Initiative supported the implementation of Population Health Implementation and Training (PHIT) Partnership health system strengthening interventions in designated areas of five countries: Ghana, Mozambique, Rwanda, Tanzania, and Zambia. All PHIT programs included health system strengthening interventions with child health outcomes from the outset, but all increasingly recognized the need to increase focus to improve health and outcomes in the first month of life. This paper uses a case study approach to describe interventions implemented in newborn health, compare approaches, and identify lessons learned across the programs' collective implementation experience. Case studies were built using quantitative and qualitative methods, applying the World Health Organization Health Systems Strengthening Framework, and maternal, newborn and child health continuum of care framework. We identified the following five primary themes ...

Research paper thumbnail of Research capacity building integrated into PHIT projects: leveraging research and research funding to build national capacity

BMC health services research, Dec 21, 2017

Inadequate research capacity impedes the development of evidence-based health programming in sub-... more Inadequate research capacity impedes the development of evidence-based health programming in sub-Saharan Africa. However, funding for research capacity building (RCB) is often insufficient and restricted, limiting institutions' ability to address current RCB needs. The Doris Duke Charitable Foundation's African Health Initiative (AHI) funded Population Health Implementation and Training (PHIT) partnership projects in five African countries (Ghana, Mozambique, Rwanda, Tanzania and Zambia) to implement health systems strengthening initiatives inclusive of RCB. Using Cooke's framework for RCB, RCB activity leaders from each country reported on RCB priorities, activities, program metrics, ongoing challenges and solutions. These were synthesized by the authorship team, identifying common challenges and lessons learned. For most countries, each of the RCB domains from Cooke's framework was a high priority. In about half of the countries, domain specific activities happened...

Research paper thumbnail of Evaluation of a Systems Analysis and Improvement Approach to Optimize Prevention of Mother-To-Child Transmission of HIV Using the Consolidated Framework for Implementation Research

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2016

Research paper thumbnail of Option B+ in Mozambique: Formative Research Findings for the Design of a Facility-Level Clustered Randomized Controlled Trial to Improve ART Retention in Antenatal Care

Journal of acquired immune deficiency syndromes (1999), Aug 1, 2016

With the rollout of "Option B+" in Mozambique in 2013, initial data indicated major cha... more With the rollout of "Option B+" in Mozambique in 2013, initial data indicated major challenges to early retention in antiretroviral therapy (ART) among HIV-positive pregnant women. We sought to develop and test a pilot intervention in 6 large public clinics in central Mozambique to improve retention of mothers starting ART in antenatal care. The results from the formative research from this study described here were used to design the intervention. The research was initiated in early 2013 and completed in early 2014 in each of the 6 study clinics and consisted of (1) patient flow mapping and measurement of retention through collection of health systems data from antenatal care registries, pharmacy registries, ART clinic databases, (2) workforce assessment and measurement of patient waiting times, and (3) patient and worker individual interviews and focus groups. Coverage of HIV testing and ART initiation were over 90% at all sites, but retention at 30-, 60-, and 90-day pha...

Research paper thumbnail of Suicide Attempts and Deaths in Sofala, Mozambique, From 2011 to 2014

Research paper thumbnail of Early ART initiation among HIV-positive pregnant women in central Mozambique: a stepped wedge randomized controlled trial of an optimized Option B+ approach

Implementation science : IS, Jan 30, 2015

Despite effective prevention strategies and increasing investments in global health, maternal to ... more Despite effective prevention strategies and increasing investments in global health, maternal to child transmission (MTCT) of HIV remains a significant problem globally, especially in sub-Saharan Africa. In 2012, there were 94,000 HIV-positive pregnant women in Mozambique. Approximately 15% of these women transmitted HIV to their newborn infants, resulting in nearly 14,000 new pediatric HIV infections that year. To address this issue, in 2013, the Mozambican Ministry of Health implemented the World Health Organization-recommended "Option B+" strategy in which all newly diagnosed HIV-positive pregnant women are counseled to initiate combination anti-retroviral therapy (ART) immediately upon diagnosis regardless of CD4 count and to continue treatment for life. Given the limited experience with Option B+ in sub-Saharan Africa, few rigorous pragmatic trials have studied this new treatment strategy. This study utilizes an initial formative research process involving patient and...

Research paper thumbnail of The availability of essential medicines for mental healthcare in Sofala, Mozambique

Global Health Action, 2015

Research paper thumbnail of HIV-exposed infant follow-up in Mozambique: Formative research findings for the design of a cluster randomized controlled trial to improve testing and ART initiation

Background HIV-exposed infant diagnosis (EID) and initiation of HIV-positive infants on anti-retr... more Background HIV-exposed infant diagnosis (EID) and initiation of HIV-positive infants on anti-retroviral therapy (ART) requires a well-coordinated cascade of care. Loss-to-follow-up (LTFU) can occur at multiple steps and effective EID is impeded by human resource constraints, difficulty with patient tracking, and long waiting periods. The objective of this research was to conduct formative research to guide the development of an intervention to improve the pediatric HIV care cascade in central Mozambique. The study was conducted in Manica and Sofala Provinces where the adult HIV burden is higher than the national average. The research focused on 3 large clinics in each province, along the highly populated Beira corridor.Methods The research was initiated in 2014 over 3 months at six facilities and consisted of 1) patient flow mapping and collection of health systems data from postpartum, child-at-risk, and ART service registries, 2) measurement of patient waiting times, and 3) patien...