Fabienne Shumbusho and colleagues evaluate a task-shifting model of nurse-centered antiretroviral treatment prescribing in rural primary health centers in Rwanda and find that nurses can effectively and safely prescribe ART when given adequate training, mentoring, and support.

Our results partially counter fears that HIV programs are producing adverse effects in non-HIV service delivery. Rather than leading to declines in other primary health care delivery, our findings suggest that the integration of HIV clinical services may contribute to increases.

Death audits and reviews for reducing maternal, perinatal and child mortality.

Football, gambling and gambling-harms v3; 1 st July 2016 2 Media reports suggest high rates of gambling amongst professional footballers but little is known about how footballers develop and then seek help for gambling problems. Here, we report the findings of in-depth, qualitative interviews with 11 British professional footballers who had, or who were, being treated for gambling problems at a residential clinic. These individuals experienced gambling as a highly salient feature of life as a professional football player in UK professional leagues. Often gambling began as part of social networks of young players, but then progressed to gambling problematically in isolation. Factors that facilitated this transition included structural aspects of professional football as an occupation (e.g. high salaries, spare time, gambling as a shared leisure pursuit) as well as the competitive and emotional challenges of the game (e.g. loss of form, injury or contract release and their effects upon mood). Seeking help was delayed by a reluctance to disclose problems to peers and club managers, but facilitated by recommendations from other players with similar experiences. Football, gambling and gambling-harms v3; 1 st

BackgroundA high burden of HIV in many sub-Saharan African countries has triggered renewed interest in volunteer-based community health programmes as a way to support treatment roll-out and to deliver services to children orphaned due to HIV. This study was undertaken as an evaluation of a USAID project implemented by a consortium of 7 NGOs operating in 52 Zambian districts. We aimed to examine motivations for becoming volunteer caregivers, experiences in service and commitment to continue volunteering in the future.MethodsA mixed-method survey approach was adopted incorporating close- and open-ended questions. District selection (3 of 52) was purposive, based on representation of urban, peri-urban and rural volunteers from a mix of the consortium’s NGO affiliates. Individual volunteer recruitment was achieved via group information sessions and opportunistic sampling was used to reach a quota (~300) per study district. All participants provided written informed consent.ResultsA total of 758 eligible caregivers were surveyed. Through parallel analyses of different data types and cross-over mixed analyses, we found shifting patterns in motivations across question type, question topic and question timing. In relation to motivations for entering service, responses to both open- and close-ended questions highlighted the importance of value-oriented functions and higher order social aspirations such as “helping society” or “humanity”. However, 70% of participants also agreed to at least one close-ended economic motivation statement and nearly a quarter (23%) agreed to all four. Illustrating economic need, as well as economic motivation, over half (53%) the study respondents agreed that they had become a volunteer because they needed help from the project. Volunteers with lower and mid-level standard-of-living scores were significantly more likely to agree with economic motivation statements.ConclusionsReliance by national and international health programmes on volunteer workforces is rooted in the assumption that volunteers are less costly and thus more sustainable than maintaining a professional cadre of community health workers. Understanding individuals’ motivations for entering and remaining in volunteer service is therefore critical for programme planners and policy makers. This study demonstrated that volunteers had complex motivations for entering and continuing service, including “helping” and other pro-social values, but also manifest expectations of and need for material support. These findings contribute to evidence in support of various reforms needed to strengthen the viability and sustainability of volunteer-dependent services including the need to acknowledge and plan for the economic vulnerability of so-called volunteer recruits.