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Introduction: Annual seasonal influenza vaccination in healthcare workers prevents nosocomial transmission to patients, coworkers, and visitors, and reduces absenteeism. This study aimed to describe knowledge, attitudes, and practices (KAP) of seasonal influenza vaccine among public healthcare workers attending patients in Costa Rica. Methodology: We conducted a cross-sectional survey of healthcare personnel attending patients in public hospitals in 2017–2018. Frequency distributions of demographics, vaccination KAP, sources of information, clinical manifestations and reasons for non-vaccination were reported. Logistic regression was used to analyze associations between exposures of interest (demographics, sources of information, knowledge, attitudes towards vaccination) and self-reported influenza vaccination. Results: We surveyed 747 healthcare workers in 2017–2018. Of 706 participants who knew their vaccination status, 55.7% were vaccinated for seasonal influenza. Only 20.7% of participants knew the influenza vaccine was an inactivated virus, and 94.6% believed the vaccine causes flu-like symptoms. Factors associated with current influenza vaccination were vaccination in previous year (aOR: 8.13; 95% CI: 5.65–11.71) and believed influenza vaccination may be harmful (aOR: 0.62; 95% CI: 0.44–0.89). Reasons for non-vaccination included fear of adverse effects and access limitations. Conclusions: Suboptimal influenza vaccination among healthcare workers may be attributed to misconceptions about the vaccine and limited engagement strategies focusing on healthcare workers. Appropriate interventions are needed to increase healthcare worker vaccination rates and improve their knowledge and beneficence, which would improve patient safety in hospitals.

Introduction: Men who have sex with men and transgender women across the globe experience barriers to timely linkage-to-HIV care. Health navigation is a strengths-based approach, originally developed for cancer patients, to address these barriers and provide support. We piloted a health navigation strategy to improve timely linkage-to-care among men who have sex with men and transgender women recently diagnosed with HIV in three sexual health clinics in Guatemala City. Methods: Participants included individuals who were at least 18 years old, identified as a cisgender man or transgender woman, reported having had sex with a man in the past 12 months, and had received a positive HIV diagnosis at one of the participating clinics. Three health navigators were trained in health navigation including: assets-based counselling and support; health system information; and advocacy. We used a combination of quantitative data collected during clinic visits and qualitative data collected through in-depth interviews with participants who accepted navigation to characterize the acceptability, effectiveness, and our primary outcome of time to linkage, defined as having the first clinical care visit. Results: Out of 61 men who have sex with men and transgender women diagnosed at the participating clinics during the study period, 54 were offered participation and enrolled in our pilot (n=52 men who have sex with men; n=2 transgender women). Fifty participants (92.6%) accepted navigation, all who accepted were successfully linked-to-care. The median time to linkage was 3 days (Interquartile Range 2–5 days). In qualitative interviews, participants expressed feeling extremely scared and alone following their diagnosis and appreciated the support of a navigator especially when they did not feel they could access their existing support networks. Conclusions: Navigation was a highly acceptable and effective strategy for facilitating timely linkage-to-care among newly diagnosed men who have sex with men at participating clinics in Guatemala City. Differentiated approaches should be used to improve engagement with transgender women. Based on these findings, navigation strategies are currently being integrated into HIV prevention and care models in the Central American region. Rigorous implementation science research and evaluation should continue to explore the use of health navigation with key populations recently diagnosed with HIV.

Background and objectives: Although acute respiratory illness (ARI) is a leading cause of hospitalization among young children, few data are available about cost of hospitalization in middle-income countries. We estimated direct and indirect costs associated with severe ARI resulting in hospitalization among children aged < 10 years in El Salvador and Panama through the societal perspective. Methods: During 2012 and 2013, we surveyed caregivers of children hospitalized with ARI about their direct medical (i.e., outpatient consultation, medications, hospital fees), non-medical (transportation, childcare), and indirect costs (lost wages) at discharge and 7 days after discharge. We multiplied subsidized hospital bed costs derived from administrative data by hospitalization days to estimate provider costs. Results: Overall, 638 children were enrolled with a median age of 12 months (IQR 6-23). Their median length of hospitalization was 4 days (IQR 3-6). In El Salvador, caregivers incurred a median of US$38 (IQR 22-72) in direct and indirect costs per illness episode, while the median government-paid hospitalization cost was US$118 (IQR 59-384) generating an overall societal cost of US$219 (IQR 101-416) per severe ARI episode. In Panama, caregivers incurred a median of US$75 (IQR 39-135) in direct and indirect costs, and the health-care system paid US$280 (IQR 150-420) per hospitalization producing an overall societal cost of US$393 (IQR 258-552). Conclusions: The cost of severe ARI to caregivers and the health care system was substantive. Our estimates will inform models to estimate national costs of severe ARI and cost-benefit of prevention and treatment strategies.

Background Seasonal influenza is a highly contagious vaccine-preventable disease that may cause high morbidity and mortality in susceptible populations. Healthcare workers are a priority group for seasonal influenza vaccination to protect them from contracting influenza and prevent nosocomial transmission to patients. This study aimed to evaluate knowledge, attitudes, and practices (KAP) of seasonal influenza vaccination among healthcare workers in Honduras. Method From August 24 to October 21, 2018, we conducted a cross-sectional KAP survey regarding seasonal influenza vaccination to a random sample of healthcare workers who attended patients in hospitals of the Ministry of Health of Honduras (SESAL) and Honduran Social Security Institute (IHSS). We reported frequency distributions of demographics, vaccination KAP, sources of information, and reasons for non-vaccination. We used principal components factor analysis to create knowledge and attitude scores. We used linear regression to analyze associations between demographics and sources of information about the influenza vaccine, and knowledge and attitude scores. We used logistic regression to analyze associations between demographics, sources of information, knowledge scores, and attitude scores, and influenza vaccination. Result We surveyed 947 healthcare workers who attended patients in 13 SESAL hospitals and two IHSS hospitals. Only 4.6% of participants knew the seasonal influenza vaccine was composed of inactivated viruses, 94.7% believed vaccination causes flu-like symptoms, and 52.0% were vaccinated for influenza in 2018. Knowledge scores were lower for nursing assistants and other healthcare professionals compared to doctors, and higher for healthcare workers who attended a healthcare facility training (P-values≤0.030). Attitude scores were higher for healthcare workers who attended ≥11 patients per day having ≤10 patients per day as reference, self-reported influenza vaccination in previous year, and cited trainings and informal information at the healthcare facility as sources of information for influenza vaccination (P-values≤0.030). Factors associated with self-reported vaccination were self-reported influenza vaccination in previous year (aOR: 7.61; 95% CI: 5.24–11.04), attitude score (aOR: 1.14; 95% CI: 1.07–1.21), and worked in a SESAL hospital (aOR: 1.73; 95% CI: 1.12–2.68) having IHSS as reference. Conclusion Although influenza vaccination is required by law in Honduras and available for free in public health centers, coverage of healthcare workers in 2018 was half that reported in 2017. Lower coverage may be attributed to misconceptions of vaccination side effects.