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The article describes an equity-focused scientific framework and set of principles to guide public health efforts to fulfill the health equity mission of the U.S. Centers for Disease Control and Prevention (CDC). Topics include principles of health equity science, examples of implementation actions, and factors that may help ensure that the health-related questions of highest priority to socially marginalized or excluded populations are not overlooked.

Objective To evaluate changes in Ebola-related knowledge, attitudes and prevention practices during the Sierra Leone outbreak between 2014 and 2015. Methods Four cluster surveys were conducted: two before the outbreak peak (3499 participants) and two after (7104 participants). We assessed the effect of temporal and geographical factors on 16 knowledge, attitude and practice outcomes. Findings Fourteen of 16 knowledge, attitude and prevention practice outcomes improved across all regions from before to after the outbreak peak. The proportion of respondents willing to: (i) welcome Ebola survivors back into the community increased from 60.0% to 89.4% (adjusted odds ratio, aOR: 6.0; 95% confidence interval, CI: 3.9-9.1); and (ii) wait for a burial team following a relative's death increased from 86.0% to 95.9% (aOR: 4.4; 95% CI: 3.2-6.0). The proportion avoiding unsafe traditional burials increased from 27.3% to 48.2% (aOR: 3.1; 95% CI: 2.4-4.2) and the proportion believing spiritual healers can treat Ebola decreased from 15.9% to 5.0% (aOR: 0.2; 95% CI: 0.1-0.3). The likelihood respondents would wait for burial teams increased more in high-transmission (aOR: 6.2; 95% CI: 4.2-9.1) than low- transmission (aOR: 2.3; 95% CI: 1.4-3.8) regions. Self-reported avoidance of physical contact with corpses increased in high but not low-transmission regions, aOR: 1.9 (95% CI: 1.4-2.5) and aOR: 0.8 (95% CI: 0.6-1.2), respectively. Conclusion Ebola knowledge, attitudes and prevention practices improved during the Sierra Leone outbreak, especially in high-transmission regions. Behaviourally-targeted community engagement should be prioritized early during outbreaks. [phrase omitted] [phrase omitted] Objectif Evaluer l'evolution des connaissances, attitudes et techniques de prevention en matiere d'Ebola durant l'epidemie qui a touche la Sierra Leone entre 2014 et 2015. Methodes Quatre enquetes en grappes ont ete menees: deux avant le pic de l'epidemie (3499 participants) et deux apres (7104 participants). Nous avons mesure l'impact des facteurs geographiques et temporels sur 16 resultats lies aux connaissances, aux attitudes et aux techniques de prevention. Resultats Quatorze des seize resultats lies aux connaissances, aux attitudes et aux techniques de prevention ont progresse dans toutes les regions entre la periode avant le pic et celle apres le pic. La proportion de repondants disposes a: (i) accueillir les survivants a Ebola de retour dans leur communaute est passee de 60,0% a 89,4% (odds ratio ajuste, ORA: 6,0; intervalle de confiance de 95%, IC: 3,9-9,1); et (ii) attendre l'equipe d'inhumation apres la mort d'un proche a egalement augmente, passant de 86,0% a 95,9% (ORA: 4,4; IC de 95%: 3,2-6,0). La proportion de repondants ayant abandonne la pratique risquee des funerailles traditionnelles est passee de 27,3% a 48,2% (ORA: 3,1; IC de 95%: 2,4-4,2), tandis que celle convaincue de l'efficacite des guerisseurs spirituels pour traiter Ebola a diminue, passant de 15,9% a 5,0% (ORA: 0,2; IC de 95%: 0,1-03). La probabilite que les repondants attendent les equipes d'inhumation a augmente dans les regions a haut risque de transmission (ORA: 6,2; IC de 95%: 4,2-9,1), plus que dans les regions a faible risque de transmission (ORA: 2,3; IC de 95%: 1,4-3,8). Les repondants declarent avoir davantage evite tout contact physique avec les corps dans les regions a haut risque de transmission, mais pas dans les regions a faible risque de transmission (ORA: 1,9; IC de 95%: 1,4--2,5 et ORA: 0,8; IC de 95%: 0,6-1,2). Conclusion Les connaissances, attitudes et techniques de prevention en matiere d'Ebola ont evolue durant l'epidemie qui a touche la Sierra Leone, surtout dans les regions a haut risque de transmission. Il faut privilegier l'engagement communautaire axe sur le comportement des les premiers stades de l'epidemie. [phrase omitted] Objetivo Evaluar los cambios en los conocimientos, las actitudes y las practicas de prevencion relacionadas con el ebola durante el brote ocurrido en Sierra Leona entre 2014 y 2015. Metodos Se realizaron cuatro encuestas por conglomerados: dos antes del pico del brote (3499 participantes) y dos despues (7104 participantes). Se evaluo el efecto de los factores temporales y geograficos en 16 resultados de conocimientos, actitudes y practicas de prevencion. Resultados 14 de 16 resultados de conocimientos, actitudes y practicas de prevencion mejoraron en todas las regiones desde antes hasta despues del pico del brote. El porcentaje de los encuestados dispuestos a: (i) acoger a los supervivientes del ebola en la comunidad aumento del 60,0 % al 89,4 % (proporcion de probabilidad ajustada, aOR: 6,0; intervalo de confianza del 95 %, IC: 3,9-9,1); y (ii) esperar al servicio funerario tras la muerte de un familiar aumento del 86,0 % al 95,9 % (aOR: 4,4; IC del 95 %: 3,2-6,0). El porcentaje de personas que evitaron los entierros tradicionales inseguros aumento del 27,3 % al 48,2 % (aOR: 3,1; IC del 95 %: 2,4-4,2) y el porcentaje de personas que creen que los sanadores espirituales pueden tratar el ebola disminuyo del 15,9 % al 5,0 % (aOR: 0,2; IC del 95 %: 0,1-03). La probabilidad de que los encuestados esperan a los servicios funerarios aumento mas en las regiones de alta transmision (aOR: 6,2; IC del 95 %: 4,2-9,1) que en las de baja transmision (aOR: 2,3; IC del 95 %: 1,4-3,8). Segun los reportes de los mismos encuestados, se evito mas el contacto fisico con los cadaveres en las regiones de alta pero no de baja transmision, aOR: 1,9 (IC del 95 %: 1,4-2,5) y aOR: 0,8 (IC del 95 %: 0,6-1,2), respectivamente. Conclusion Los conocimientos, las actitudes y las practicas de prevencion del ebola mejoraron durante el brote en Sierra Leona, en especial en las regiones de alta transmision. Se debe dar prioridad a la participacion de la comunidad orientada al comportamiento en las primeras etapas de los brotes., Introduction The 2013-2016 Ebola virus disease outbreak in West Africa mostly affected Guinea, Liberia and Sierra Leone. In Sierra Leone, over 14 000 cases of Ebola and about 4000 deaths [...]

The article discusses the importance of Programme Science in the President's Emergency Plan For AIDS Relief (PEPFAR) and its role in achieving the UNAIDS targets and ending the HIV pandemic by 2030. Programme Science emphasizes the need for context-specific evidence and ongoing knowledge to inform programmatic decisions. The article highlights the challenges faced by PEPFAR, such as reaching populations not effectively covered by existing services and supporting continuity of care for people living with HIV. It also emphasizes the need to address system-level challenges and integrate HIV services into primary care systems. The article calls for the integration of science into program planning and execution and the empowerment of HIV programs to use Programme Science to improve programs. PEPFAR is planning future initiatives to contribute to Programme Science and encourages others to do the same. The article concludes by emphasizing the importance of evidence-based policies and strategies tailored to different communities and regions. [Extracted from the article]

Abstract Background HIV-negative members of sero-discordant couples are at high risk for HIV acquisition but few behavioral prevention interventions have been implemented in sub-Saharan Africa and discordance is not well understood by couples themselves. Methods In this nested sub-study, we interviewed 40 HIV sero-discordant couples before and after a 6-month behavioral intervention that was comprised of four group discussions on specific HIV prevention and care topics. The content of the sessions included: 1) understanding HIV serodiscordance and reducing risk, 2) couple communication, 3) reproductive health and HIV serodiscordance, 4) coping with HIV serodiscordance and ongoing support. Couple members were interviewed individually. Data were analyzed thematically using ‘Framework Analysis’ which incorporated dyadic factors to address couple issues. Results Analysis revealed pre-identified concepts and emergent themes that were relevant to the final conceptual model. Four major categories of factors affecting couple relations, beliefs and current risk behaviors emerged: intervention factors, structural/contextual factors, physical health factors, and past risk behavior. The topics within the intervention most relevant were communication and reproductive health. The contextual factors highlighted by couples were gender norms around sexual decision-making and multiple partnerships. Individual beliefs regarding HIV serodiscordance persisted over all time points for some couples. Interestingly, some couple members had divergent views about their HIV status; some believing the HIV-negative member was negative while others described multiple beliefs around the negative member’s blood surely being positive for HIV. Couple communication emerged as an important theme mediating beliefs and behavior. Conclusions In addition to biomedical and behavioral interventions, HIV-serodiscordant couple interventions must embrace the contextual complexity and cultural understanding of HIV infection and discordance as well as the dynamic nature of couple communication to influence risk behavior.

BackgroundAntiretroviral therapy (ART) may influence the biological, social and behavioral determinants of pregnancy in HIV-infected women. However, there are limited longitudinal data on the reproductive intentions and outcomes among women on ART in Africa. METHODOLOGY /PRINCIPAL FINDINGS: Using a prospective cohort design, we analyzed trends in desire for children and predictors of pregnancy among a cohort of 733 HIV-infected women in rural Uganda who initiated ART between May 2003 and May 2004 and were followed up in their homes until June 2006. Women answered in-depth social and behavioral questionnaires administered every quarter in year 1 after initiating ART, and every 6 to 12 months thereafter. Use of family planning methods was assessed at 18 and 24 months after starting ART. We tested for non-constant pregnancy incidence by using a shape parameter test from the Weibull distribution. We modeled repeated measurements of all variables related to the women's desire for children over time using a generalized estimating equation (GEE) extension to the logistic regression model. Risk factors for pregnancy were examined using Cox proportional hazards model. 711 women eligible for the study were followed-up for a median time of 2.4 years after starting ART. During this time, less than 7% of women reported wanting more children at any time point yet 120 (16.9%) women experienced 140 pregnancies and pregnancy incidence increased from 3.46 per 100 women-years (WY) in the first quarter to 9.5 per 100 WY at 24 months (p18.5 (HR = 1.09, CI: 1.01-1.18) and not having used condoms consistently in the last 3 months (HR = 1.79, CI: 1.02-3.13) were independently associated with pregnancy.Conclusion/significanceWomen on ART and their partners should be consistently counseled on the effects of ART in restoring fertility, and offered regularly free and comprehensive family planning services as part of their standard package of care.

West Africa detected its first case of Ebola virus disease (EVD) in March 2014 within the forest region of Guinea; shortly thereafter, Liberia and Sierra Leone detected cases of the [...]

Author(s): Muin J. Khoury 1,*, Gregory L. Armstrong 2, Rebecca E. Bunnell 3, Juliana Cyril 4, Michael F. Iademarco 5 Summary points The field of precision public health (PPH) has [...]

Objective To provide guidance for male circumcision programmes in Kenya by estimating the population of uncircumcised men and investigating the association between circumcision and infection with the human immunodeficiency virus (HIV), with particular reference to uncircumcised, HIV-uninfected men. Methods Data on men aged 15 to 64 years were derived from the 2007 Kenya AIDS Indicator Survey, which involved interviews and blood collection to test for HIV and herpes simplex virus 2 (HSV-2). The prevalence of HIV infection and circumcision in Kenyan provinces was calculated and the demographic characteristics and sexual behaviour of circumcised and uncircumcised, HIV-infected and HIV-uninfected men were recorded. Findings The national prevalence of HIV infection in uncircumcised men was 13.2% (95% confidence interval, Cl: 10.8-15.7) compared with 3.9% (95% CI: 3.3-4.5) among circumcised men. Nyanza province had the largest estimated number of uncircumcised, HIV-uninfected men (i.e. 601 709), followed by Rift Valley, Nairobi and Western Province, respectively, and most belonged to the Luo ethnic tribe. Of these men, 77.8% did not know their HIV status and 33.2% were HSV-2-positive. In addition, 65.3% had had unprotected sex with a partner of discordant or unknown HIV status in the past 12 months and only 14.7% consistently used condoms with their most recent partner. However, only 21.8% of the uncircumcised, HIV-uninfected men aged 15 to 19 years were sexually active. Conclusion The Kenyan male circumcision strategy should focus on the provinces with the highest number of uncircumcised, HIV-uninfected men and target young men before or shortly after sexual debut. [TEXT NOT REPRODUCIBLE IN ASCII.] Programmes de circoncision masculine au Kenya: lecons tirees de l'enquete de 2007 sur les indicateurs du SIDA au Kenya Objectif Conseiller des programmes de circoncision masculine au Kenya en estimant le nombre d'hommes non circoncis et en recherchant l'association entre la circoncision et l'infection par le virus de l'immunodeficience humaine (VIH), avec une reference particuliere aux hommes non circoncis et non infectes par le VIH. Methodes Des donnees sur des hommes ages de 15 a 64 ans ont ete obtenues de l'enquete de 2007 sur les indicateurs du SIDA au Kenya, impliquant des entretiens et des prises de sang afin de rechercher la presence du VIH et du virus de l'herpes simplex 2 (VHS-2). La prevalence de l'infection par le VlH et la circoncision dans les provinces kenyanes a ete calculee, et les caracteristiques demographiques ainsi que le comportement sexuel des hommes circoncis et non circoncis, des hommes infectes et non infectes par le VIH ont ete enregistres. Resultats La prevalence nationale de l'infection par le VIH chez les hommes non circoncis s'elevait a 13,2% (intervalle de confiance de 95%, IC: 10,8-15,7) par rapport a un pourcentage de 3,9% (IC de 95%: 3,3-4,5) chez les hommes circoncis. La province de Nyanza presentait l'estimation du plus grand nombre d'homme non circoncis et d'hommes non infectes par le VIH (601 709), suivie de la vallee du Rift, de Nairobi et de la province occidentale, respectivement, dont la plus grande partie appartenait a la tribu ethnique des Luo. Chez ces hommes, 77,8% ne connaissaient pas leur seropositivite et 33,2% etaient positifs au VHS-2. De plus, 65.3% d'entre eux avaient eu des rapports sexuels non proteges avec une partenaire de statut HIV inconnu ou discordant au cours des 12 derniers mois, et seuls 14,7% d'entre eux utilisaient constamment des preservatifs avec leur derniere partenaire. Cependant, seuls 21,8% des hommes non circoncis et non infectes par le VIH ages de 15 a 19 ans etaient sexuellement actifs. Conclusion La strategie de circoncision des hommes kenyans doit s'orienter sur les provinces presentant le plus grand nombre d'hommes non circoncis et non infectes par le VIH, mais aussi cibler les jeunes hommes avant ou peut de temps apres leur premiere experience sexuelle. [TEXT NOT REPRODUCIBLE IN ASCII.] Los programas de circuncision masculina en Kenia: lecciones de la Encuesta de indicadores del SIDA en Kenia 2007 Objetivo Proporcionar orientacion para las programas de circuncision masculina en Kenia calculando la poblacion de hombres circuncidados e investigando la relacion entre la circuncision y la infeccion con el virus de la inmunodeficiencia humana (VIH), haciendo alusion especial a las hombres no circuncidados ni infectados par el VIH. Metodos Las datos acerca de las hombres con edades comprendidas entre 15 y 64 anos se obtuvieron de la Encuesta de indicadores del SIDA en Kenya del ano 2007, que incluyo entrevistas y la recogida de muestras de sangre para realizar las pruebas del VIH y del virus del herpes simple de tipo 2 (VHS-2). Se calculo la prevalencia de la infeccion par el VIH y la circuncision en las provincias de Kenia y se registraron las caracteristicas demograficas y el comportamiento sexual de las hombres circuncidados y no circuncidados, infectados y no infectados con el VIH. Resultados La prevalencia nacional de la infeccion par VIH en las hombres circuncidados fue del 13,2% (intervalo de confianza del 95%, IC: 10,8 -15,7) comparada con el 3,9% (IC 95%: 3,3 - 4,5) entre los hombres circuncidados. La provincia de Nyanza tuvo el mayor numero estimado de hombres no circuncidados y no infectados par el VIH (esto es, 601 709), seguida par la provincia Rift Valley, Nairobi y la provincia Occidental, respectivamente, y la mayoria de ellos pertenecia a la tribu etnica Luo. De esos hombres, el 77,8% no canada su estado serologico y el 33,2% estaba infectado con el VHS-2. Ademas, el 65,3% habia mantenido relaciones sexuales sin proteccion con una pareja serodiscordante o que no canada su estado serologico en las ultimos 12 meses y solo el 14,7% habia empleado preservativos de manera sistematica con su pareja mas reciente. No obstante, solo el 21,8% de las hombres circuncidados e infectados par el VIH con edades entre los 15 y las 19 anos era sexualmente activo. Conclusion La estrategia de circuncision masculina en Kenya deberia centrarse en las provincias con el mayor numero de hombres no circuncidados y no infectados por el VIH y dirigirse a las hombres jovenes antes o poco despues de la primera relacion sexual., Introduction Of an estimated 33.4 million people living with human immunodeficiency virus (HIV) infections worldwide, approximately 22.4 million live in sub-Saharan Africa and, of these, 1.5 million live in Kenya. [...]