H3Africa is developing capacity for health-related genomics research in Africa

BACKGROUND Several organizations have underscored the crucial need for patient-centered decision tools to enhance shared decision-making in advanced heart failure. The purpose of this study was to investigate the decision-making process and informational and decisional needs of patients and their caregivers regarding left ventricular assist device (LVAD) placement. METHODS In-depth, structured interviews with LVAD patients, candidates and caregivers (spouse, family members) (n = 45) were conducted. We also administered a Decisional Regret Scale. RESULTS Participants reported LVAD decision-making to be quick and reflexive (n = 30), and deferred heavily to clinicians (n = 22). They did not perceive themselves as having a real choice (n = 28). The 2 most prevalent informational domains that participants identified were lifestyle issues (23 items), followed by technical (drive-line, battery) issues (14 items). Participants easily and clearly identified their values: life extension; family; and mobility. Participants reported the need to meet other patients and caregivers before device placement (n = 31), and to have an involved caregiver (n = 28) to synthesize information. Some participants demonstrated a lack of clarity regarding transplant probability: 9 of 15 patients described themselves as on a transplant trajectory, yet 7 of these were destination therapy patients. Finally, we found that decisional regret scores were low (1.307). CONCLUSIONS Informed consent and shared-decision making should: (a) help patients offered highly invasive technologies for life-threatening disease get past the initial “anything to avoid thinking about death” reaction and make a more informed decision; (b) clarify transplant status; and (c) focus on lifestyle and technical issues, as patients have the most informational needs in these domains.

Background U.S., Hispanic women have higher cervical cancer incidence rates than non-Hispanic Whites and African Americans and lower rates of cervical cancer screening. Knowledge, attitudes, and cultural beliefs may play a role in higher rates of infection of HPV and decisions about subsequent diagnosis and treatment of cervical cancer. Study aim To explore the level of HPV knowledge, attitudes, and cultural beliefs among Hispanic men and women on the Texas-Mexico border. Methodological Approach Informed by feminist ethnography, the authors used an interpretive approach to understand local respondents' concerns and interests. Focus group sessions were analyzed using thematic content analysis. Recruitment and sample Promotoras (lay health workers) recruited participants using convenience sampling methods. Group sessions were held in public service centers in Brownsville. Participants' ages ranged from 19 to 76 years. Methods analysis Focus group discussions were audio-recorded and transcribed in Spanish. Researchers read and discussed all the transcripts and generated a coding list. Transcripts were coded using ATLAS.ti 5.0. Key findings Participants had little understanding about HPV and its role in the etiology of cervical cancer. Attitudes and concerns differed by gender. Women interpreted a diagnosis of HPV as a diagnosis of cancer and expressed fatalistic beliefs about its treatment. Men initially interpreted a diagnosis of HPV as an indication of their partners' infidelity, but after reflecting upon the ambiguity of HPV transmission, attributed their initial reaction to cultural ideals of machismo. Men ultimately were interested in helping their partners seek care in the event of a positive diagnosis. Implications for practice Results suggest that understanding Hispanics' cultural norms and values concerning disease, sexuality, and gender is essential to the design and implementation of preventive interventions for HPV and cervical cancer.

In sub-Saharan Africa, the prevalence of stigma-related abuse and violence among men who have sex with men (MSM) and its potential impact on the HIV/AIDS epidemic is unknown. This study estimated the prevalence and source of violence and abuse among a sample of MSM in Tanzania and characterized the association between levels of violence and sexual and mental health variables. Data were taken from a larger study of 200 MSM in Tanzania. Frequency tabulations, bivariate analysis and logistic regression were performed to describe the prevalence and source of abuse and to determine the association between levels of violence and sexual demographics and mental health variables. The MSM sample for this study was young (median age 23), somewhat educated with the majority having attained secondary school (80%) and mostly employed (60%). Verbal (48.5%) and moral (32.5%) abuse were the most predominant types of abuse among the sample and were mostly from people in the street and neighbors. Sexual abuse (30%) was mostly from partners and physical violence (29.5%) was largely from people in the street. Participants in the high violence level group had a significantly greater number of sexual partners, depression scores and internalized homonegativity (IH) scores. IH predicted HIV infection, and verbal abuse predicted IH. There is a need for an increased awareness of violence and abuse faced by MSM in Tanzania, as well as effective programs to specifically target the issue of violence among MSM and its implication for mental health and for risky sexual behaviors and HIV transmission.

ObjectivesTo assess HIV and sexually transmitted infection (STI) prevalence and associated risk factors in men who have sex with men (MSM) in two cities in mainland Tanzania.MethodsWe conducted respondent-driven sampling of 300 MSM in Dar es Salaam and Tanga.ResultsIn Dar es Salaam, 172 (86%) men (median age 23, IQR 21–28) consented to HIV/STI testing, and 30.2% were HIV seropositive. Only five reported a previous positive HIV test: >90% were new HIV detections. 2.5% were syphilis-exposed and none hepatitis B positive, but 21.4% had a curable STI. Over 90% of the gonorrhoea and chlamydia was rectal. In Tanga, 11.1% of MSM were HIV seropositive, 8% hepatitis B positive and 0% were syphilis-exposed, with 4.4% having a curable STI. Predictors of HIV infection were number of MSM known, city, identifying as gay and having first sex with a man. Predictors for STIs were recent unprotected receptive anal intercourse, and number of MSM seen in the last month. 30% of the sample reported that they sold sex. There was no significant association between HIV and STI infection.ConclusionsHIV and STI rates were substantially lower in MSM in a provincial city than in a large metropolis and rates appear to depend on larger numbers of MSM known. Most HIV detected were new cases, and there was a high burden of asymptomatic curable rectal STIs (>1 in 5 MSM). Owing to stigma, MSM may not report homosexuality and thus not have rectal STIs treated. High need for tailored HIV testing and STI screening and treatment of MSM in Tanzania is apparent.