@Article{info:doi/10.2196/64585,
author="Baker, Jason
and Cappon, Giacomo
and Habineza, Claude Jean
and Basch, H. Corey
and Mey, Steven
and Malkin-Washeim, L. Diana
and Schuetz, Christian
and Simon Pierre, Niyonsenga
and Uwingabire, Etienne
and Mukamazimpaka, Alvera
and Mbonyi, Paul
and Narayanan, Sandhya",
title="Continuous Glucose Monitoring Among Patients With Type 1 Diabetes in Rwanda (CAPT1D) Phase I: Prospective Observational Feasibility Study",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="21",
volume="9",
pages="e64585",
keywords="CGM",
keywords="feasibility",
keywords="type 1 diabetes",
keywords="self-management",
keywords="complications",
keywords="Rwanda",
keywords="time in range",
keywords="hypoglycemia",
keywords="continuous glucose monitoring",
keywords="single-arm",
keywords="feasibility study",
keywords="diabetes",
keywords="diabetes mellitus",
keywords="euglycemic",
keywords="HbA1c",
keywords="observational study",
keywords="quantitative",
keywords="adult",
keywords="health",
keywords="public health",
keywords="health informatics",
abstract="Background: The development of minimally invasive continuous glucose monitoring systems (CGMs) has transformed diabetes management. CGMs have shown clinical significance by improving time in the euglycemic range, decreasing rates of hypoglycemia, and improving hemoglobin A1c (HbA1c). In Rwanda, CGMs are currently not routinely used, and no clinical studies of CGM use were identified in the literature. Objective: This study aims to determine the impact and feasibility of real-time CGM use among people living with type 1 diabetes (T1D) in Rwanda through assessment of sensor use, time in range, rates of hypoglycemia and hyperglycemia, HbA1c, and rates of diabetes-related hospitalizations over time. Methods: The Continuous Glucose Monitoring Among Patients with Type 1 Diabetes in Rwanda (CAPT1D) study is a single-arm, prospective observational study conducted at the Rwandan Diabetes Association clinic in Kigali, Rwanda, aiming to assess the impact and feasibility of CGM use in Rwanda. A cohort of 50 participants diagnosed with T1D were enrolled. Participants were at least 21 years old, undergoing multiple daily insulin therapy, and not currently pregnant. Phase I of the study was conducted over 12 months, using the Dexcom G6 CGM. Phase II and Phase III extended CGM use for an additional 6 months respectively, using the next-generation Dexcom G7 CGM. Here, we report the quantitative results of the Phase I study. Results: Participants used the sensor for >80\% of the time throughout the study period. A significant increase in time in range was observed within 3 months and sustained over 12 months. HbA1c decreased significantly in 3 months and stayed lower throughout the 12-month period. Mean HbA1c levels decreased by 2.8\% at 6 months (P<.001) and 3.2\% at 12 months (P<.001). A total of 12 diabetes-related hospitalizations were reported during the study period. No cases of diabetic ketoacidosis or episodes of severe hypoglycemia occurred. Conclusions: Significant and meaningful improvements in key glycemic indices indicate the potential feasibility and impact of a CGM among people living with T1D in Rwanda. Future studies could be designed to include pre- and postintervention analysis to determine the effectiveness in terms of complications and costs. ",
doi="10.2196/64585",
url="https://formative.jmir.org/2025/1/e64585"
}


@Article{info:doi/10.2196/58389,
author="Denny, Alanna
and Ndemera, Isaach
and Chirwa, Kingston
and Wu, Shu Joseph Tsung
and Chirambo, Baxter Griphin
and Yosefe, Simeon
and Chilima, Ben
and Kagoli, Matthew
and Lee, Hsin-yi
and Yu, Joseph Kwong Leung
and O'Donoghue, John",
title="Evaluation of the Development, Implementation, Maintenance, and Impact of 3 Digital Surveillance Tools Deployed in Malawi During the COVID-19 Pandemic: Protocol for a Modified Delphi Expert Consensus Study",
journal="JMIR Res Protoc",
year="2024",
month="Dec",
day="31",
volume="13",
pages="e58389",
keywords="delphi study",
keywords="COVID-19",
keywords="Malawi",
keywords="surveillance",
keywords="digital health",
keywords="delphi",
keywords="mobile health",
keywords="mHealth",
keywords="development",
keywords="implementation",
keywords="maintenance",
keywords="impact",
keywords="consensus",
keywords="protocol",
keywords="survey",
keywords="expert",
keywords="purposive sampling",
keywords="epidemiology",
keywords="descriptive statistics",
abstract="Background: The COVID-19 pandemic has highlighted the importance of strengthening national monitoring systems to safeguard a globally connected society, especially those in low- and middle-income countries. Africa's rapid adoption of digital technological interventions created a new frontier of digital advancement during crises or pandemics. The use of digital tools for disease surveillance can assist with rapid outbreak identification and response, handling duties such as diagnosis, testing, contact tracing, and risk communication. Malawi was one of the first countries in the region to launch a government-led coordinated effort to harmonize and streamline the necessary COVID-19 digital health implementation through an integrated system architecture. Objective: The aim of this study is to seek expert consensus using the Delphi methodology to examine Malawi's COVID-19 digital surveillance response strategy and to assess the digital tools using the World Health Organization mHealth (mobile health) Assessment and Planning for Scale (MAPS) toolkit. Methods: This protocol follows the Guidance on Conducting and REporting DElphi Studies. Participants must have first-hand experience on the design, implementation or maintenance with COVID-19 digital surveillance systems. There will be no restrictions on the level of expertise or years of experience. The panel will consist of approximately 40 participants. We will use a modified Delphi process whereby rounds 1 and 2 will be hosted online by Qualtrics and round 3 will encompass a face-to-face workshop held in Malawi. Consensus will be defined as ?70\% of participants strongly disagree, disagree, or somewhat disagree, or strongly agree, agree, or somewhat agree. During round 3, the face-to-face workshop, participants will be asked to complete, the MAPS toolkit assessment on the digital tool on which they are experts. The MAPS toolkit will enable the panel members to assess the digital tools from a sustainable perspective from six distinct, yet complementary axes: (1) groundwork, (2) partnerships, (3) financial health, (4) technology and architecture, (5) operations, and (6) monitoring and evaluation. Results: The ability of a country to collate, diagnose, monitor, and analyze data forms the cornerstone of an efficient surveillance system, allowing countries to plan and implement appropriate control actions. Malawi was one of the first countries in the African region to launch a government-led coordinated effort to harmonize and streamline the necessary COVID-19 digital health implementation through an integrated system architecture. Conclusions: We anticipate findings from this Delphi study will provide insights into how and why Malawi was successful in deploying digital surveillance systems. In addition, findings should produce recommendations and guidance for the rapid development, implementation, maintenance, and impact of digital surveillance tools during a health crisis. International Registered Report Identifier (IRRID): DERR1-10.2196/58389 ",
doi="10.2196/58389",
url="https://www.researchprotocols.org/2024/1/e58389"
}


@Article{info:doi/10.2196/65093,
author="Virachith, Siriphone
and Phakhounthong, Khanxayaphone
and Khounvisith, Vilaysone
and Mayxay, Mayfong
and Kounnavong, Sengchanh
and Sayasone, Somphou
and H{\"u}bschen, M. Judith
and Black, P. Antony",
title="Hepatitis B Virus Exposure, Seroprotection Status, and Susceptibility in Health Care Workers From Lao People's Democratic Republic: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Dec",
day="17",
volume="10",
pages="e65093",
keywords="hepatitis B",
keywords="hepatitis D",
keywords="health care workers",
keywords="Laos",
keywords="prevalence",
abstract="Background: Despite the high prevalence of chronic hepatitis B virus (HBV) infection in adults in Lao People's Democratic Republic (Lao PDR), Lao health care workers (HCWs) have previously been shown to have low levels of protection against infection. Furthermore, the prevalence of hepatitis D virus (HDV), which increases disease severity in individuals infected with HBV, is not known in Lao PDR. Objective: This study aimed to estimate the exposure and seroprotection against HBV, as well as exposure to HDV, in Lao HCWs from 5 provinces. Methods: In 2020, a total of 666 HCWs aged 20 to 65 years from 5 provinces of Lao PDR were recruited, and their sera were tested by enzyme-linked immunosorbent assay to determine their HBV and HDV coinfection status. Results: HBV exposure, as indicated by the presence of anti--hepatitis B core antibodies, was 40.1\% (267/666) overall and significantly higher for HCWs from Oudomxay province (21/31, 67.7\%; adjusted odds ratio 3.69, 95\% CI 1.68?8.12; P=.001). The prevalence of hepatitis B surface antigen was 5.4\% (36/666) overall and increased with age, from 3.6\% (9/248) in those aged ?30 years to 6.8\% (8/118) in those aged ?50 years. Only 28.7\% (191/666) of participants had serological indication of immunization. We could find no evidence for HDV exposure in this study. Conclusions: The study found intermediate hepatitis B surface antigen prevalence among HCWs in Lao PDR, with no evidence of HDV coinfection. Notably, a significant proportion of HCWs remains susceptible to HBV, indicating a substantial gap in seroprotection against the disease. ",
doi="10.2196/65093",
url="https://publichealth.jmir.org/2024/1/e65093"
}


@Article{info:doi/10.2196/63415,
author="Brugger, Curdin
and Dietler, Dominik
and Abu Hamad, A. Bassam
and van Gastel, Tammo
and Sittaro, Federico
and Rossi, Rodolfo
and Owen, Nia Branwen
and Probst-Hensch, Nicole
and Winkler, S. Mirko",
title="Assessment of Health and Well-Being Effects Associated With the Challenging Drinking Water Situation in the Gaza Strip: Protocol for a Cross-Sectional Household Survey Study",
journal="JMIR Res Protoc",
year="2024",
month="Nov",
day="29",
volume="13",
pages="e63415",
keywords="drinking water",
keywords="water quality",
keywords="households survey",
keywords="noncommunicable diseases",
keywords="protracted conflict",
keywords="humanitarian crisis",
keywords="Gaza Strip",
keywords="well-being",
abstract="Background: The water supply in the Gaza Strip, Palestine, has been unstable and under strain for decades, resulting in major issues with drinking water quality, reliability, and acceptability. In 2018, between 25\% and 30\% of Gazans did not have regular access to running water. The progressive deterioration of water infrastructure and concerns over the quality of piped water have resulted in a complex mix of drinking water sources used in the Gaza Strip. The challenges of safe water provision in the Gaza Strip could potentially have severe adverse effects on the population's health and well-being. Objective: The main objectives of this survey are to determine the quality of drinking water at the household level and to investigate the association of various health outcomes with water quality at the household level in the Gaza Strip. Methods: We conducted a cross-sectional household survey in the North Gaza, Gaza, and Rafah governorates between January and March 2023. We selected a subsample of households from a representative cross-sectional survey conducted in the Gaza Strip in 2020 with persons aged 40 years and older. From each household in the 2023 survey, we invited 3 individuals (2 older than 40 years and 1 between 18 and 30 years) to participate. The face-to-face interview included questions on drinking water, mental health and well-being, self-reported diagnoses for selected diseases, use of antibiotics, and knowledge about antimicrobial resistance. Additionally, we measured each participant's blood pressure. We sampled drinking water from each household and analyzed the samples for microbial contamination, nitrate, sodium, and mineral content. Results: In total, we visited 905 households and interviewed 2291 participants. In both age groups, more female participants were interviewed. A total of 56.60\% (914/1615) were aged ?40 years, and 58.9\% (398/676) were aged between 18 and 30 years. We obtained water samples from nearly all households (902/905, 99.8\%). The results are expected to be published in several papers in 2025. Conclusions: The extensive survey components, coupled with drinking water testing and building on an existing survey, allowed us to identify a broad set of potential impacts on health and well-being and to track changes over time. This study intends to identify humanitarian and development interventions that could impact the population served most. However, we completed data collection before the escalation of violence in October 2023. Given the impact of the still ongoing conflict, the initial intent of this work is no longer valid. However, the results emerging from the survey may still serve as a valuable baseline to assess the impacts of the current escalations on physical and mental health and on drinking water quality. In addition, our findings could provide important information for rebuilding the Gaza Strip in a more health-promoting way. International Registered Report Identifier (IRRID): DERR1-10.2196/63415 ",
doi="10.2196/63415",
url="https://www.researchprotocols.org/2024/1/e63415",
url="http://www.ncbi.nlm.nih.gov/pubmed/39612204"
}


@Article{info:doi/10.2196/57799,
author="Yang, Danyu
and Ma, Ling
and Cheng, Yin
and Shi, Hongjuan
and Liu, Yining
and Shi, Chao",
title="Utility of Anthropometric Indexes for Detecting Metabolic Syndrome in Resource-Limited Regions of Northwestern China: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Nov",
day="29",
volume="10",
pages="e57799",
keywords="metabolic syndrome",
keywords="MetS",
keywords="anthropometric indexes",
keywords="lipid accumulation product",
keywords="LAP",
keywords="waist-to-height ratio",
keywords="WHtR",
keywords="anthropometric",
keywords="adult",
keywords="aging",
keywords="NingXia",
keywords="China",
keywords="cross-sectional study",
keywords="population-based survey",
keywords="logistic regression",
keywords="waist-to-height",
keywords="threshold",
keywords="diagnosis",
keywords="public health",
abstract="Background: Anthropometric indexes offer a practical approach to identifying metabolic syndrome (MetS) and its components. However, there is a scarcity of research on anthropometric indexes tailored to predict MetS in populations from resource-limited regions. Objective: This study aimed to examine the association between 8 easy-to-collect anthropometric indexes and MetS, and determine the most appropriate indexes to identify the presence of MetS for adults in resource-limited areas. Methods: A total of 10,520 participants aged 18?85 years from Ningxia Hui Autonomous Region, China, were included in this cross-sectional study. Participants were recruited through a stratified sampling approach from January 1, 2020, to December 31, 2021. MetS was defined using the International Diabetes Federation (IDF) criteria. Eight anthropometric indexes were examined, including BMI, waist-to-height ratio (WHtR), weight-adjusted waist index (WWI), conicity index, a body shape index (ABSI), lipid accumulation products (LAP), visceral obesity index (VAI), and the triglyceride-glucose (TyG) index. Logistic regression analysis and restricted cubic splines (RCSs) were applied to identify the association between the anthropometric indexes. The receiver operating characteristic curve and the area under the curve (AUC) were analyzed to identify and compare the discriminative power of anthropometric indexes in identifying MetS. The Youden index was used to determine a range of optimal diagnostic thresholds. Logistic regression analysis was applied to identify the association between the anthropometric indexes. Results: A total of 3324 (31.60\%) participants were diagnosed with MetS. After adjusting for age, ethnicity, current residence, education level, habitual alcohol consumption, and tobacco use, all the 8 indexes were positively correlated with the risks of MetS (P<.05). LAP presented the highest adjusted odds ratios (adjOR 35.69, 95\% CI 34.59?36.80), followed by WHtR (adjOR 29.27, 95\% CI 28.00?30.55), conicity index (adjOR 11.58, 95\% CI 10.95?12.22), TyG index (adjOR 5.53, 95\% CI 5.07?6.04), BMI (adjOR 3.88, 95\% CI 3.71?4.05), WWI (adjOR 3.23, 95\% CI 3.02?3.46), VAI (adjOR 2.11, 95\% CI 2.02?2.20), and ABSI (adjOR 1.71, 95\% CI 1.62?1.80). Significantly nonlinear associations between the 8 indexes and the risk of MetS (all Pnonlinear<.001) were observed in the RCSs. WHtR was the strongest predictor of MetS for males (AUC 0.91, 95\% CI 0.90-0.92; optimal cutoff 0.53). LAP were the strongest predictor of MetS for females (AUC 0.89, 95\% CI 0.89-0.90; optimal cutoff 28.67). Statistical differences were present between WHtR and all other 7 anthropometric indexes among males and overall (all P<.05). In females, the AUC values between LAP and BMI, WWI, ABSI, conicity index, VAI, and TyG index were significantly different (P<.001). No statistical difference was observed between LAP and WHtR among females. Conclusions: According to 8 anthropometric and lipid-related indices, it is suggested that WHtR and LAP are the most appropriate indexes for identifying the presence of MetS in resource-limited areas. ",
doi="10.2196/57799",
url="https://publichealth.jmir.org/2024/1/e57799"
}


@Article{info:doi/10.2196/59545,
author="Wallenborn, T. Jordyn
and Sinantha-Hu, Miley
and Ouipoulikoune, Vattahanaphone
and Kounnavong, Sengchanh
and Siengsounthone, Latsamy
and Probst-Hensch, Nicole
and Odermatt, Peter
and Sayasone, Somphou
and Fink, G{\"u}nther",
title="Vientiane Multigenerational Birth Cohort Project in Lao People's Democratic Republic: Protocol for Establishing a Longitudinal Multigenerational Birth Cohort to Promote Population Health",
journal="JMIR Res Protoc",
year="2024",
month="Nov",
day="27",
volume="13",
pages="e59545",
keywords="Lao PDR",
keywords="birth cohort",
keywords="growth and development",
keywords="mental health",
keywords="dementia",
keywords="exercise",
keywords="behavior",
keywords="aging",
keywords="intergenerational",
keywords="noncommunicable disease",
keywords="hypertension",
keywords="longitudinal cohort",
keywords="low- and middle-income countries",
keywords="maternal health",
keywords="pregnancy",
keywords="antenatal care",
keywords="peripartum",
keywords="postpartum",
keywords="child health",
keywords="infant health",
abstract="Background: Rapid global population growth and urbanization have led to an increase in urban populations in low- and middle-income countries. Although these urban areas have generally better health outcomes than lower-income rural areas, many environmental, social, and health challenges remain. Vientiane, the capital of Lao People's Democratic Republic (Lao PDR), has approximately 1.5 of the 7.5 million Laotian population (2022) and provides a unique opportunity to examine health outcomes among socioeconomically diverse populations in the rapidly urbanizing context of the country. Objective: The aim of the Vientiane multigenerational birth cohort (VITERBI) project is to (1) establish a multigenerational birth cohort in Vientiane capital, Lao PDR, which is representative of the local population, (2) serve as the basis for additional observational (ie, cross-sectional) and intervention studies that promote population health in Vientiane province, and (3) investigate the social, epidemiological, and medical problems of public health importance to Lao PDR. Methods: VITERBI is a prospective multigenerational birth cohort. The study population is structured around children born between July 1, 2022, and June 30, 2023, who reside in Chanthabuly, Sikhottabong, Sangthong, or Mayparkngum districts of Vientiane. Whenever possible, children and their mothers are enrolled during pregnancy; nonreported pregnancies are enrolled after birth. The cohort plans to enroll 3000 pregnant women and their children and the infants' fathers, grandparents, and great-grandparents for a total study population of approximately 13,000 individuals. Participants will be followed throughout the life course with a range of data collected, including demographics, behavior, diet, physical activity, physiology, neurodevelopment, health history, quality of life, environmental exposures, depression, anxiety, stress, resilience, household characteristics, obstetric history, birth outcomes, and various living and dementia scales for older adults. Biomarkers collected include height, weight, blood pressure, and hemoglobin levels. Currently, no statistical analyses are planned. Results: As of April 2024, this study has enrolled 3500 pregnant women and 4579 family members. Study participation is ongoing until May 2025 at minimum, with the goal to extend follow-up until 2050. Conclusions: The study cohort will be used as a basis for further observational (cross-sectional, longitudinal) and intervention studies. It also serves as a tool to investigate social, epidemiological, and medical problems of public health importance to Lao PDR, which will contribute to broader understanding of regional and international contexts. International Registered Report Identifier (IRRID): DERR1-10.2196/59545 ",
doi="10.2196/59545",
url="https://www.researchprotocols.org/2024/1/e59545"
}


@Article{info:doi/10.2196/57265,
author="Guti{\'e}rrez-Salme{\'a}n, Gabriela
and Miranda-Alatriste, Vanessa Paola
and Ben{\'i}tez-Alday, Patricio
and Orozco-Rivera, Enrique Luis
and Islas-Vargas, Nurit
and Espinosa-Cuevas, {\'A}ngeles
and Correa-Rotter, Ricardo
and Colin-Ramirez, Eloisa",
title="Knowledge, Attitudes, and Behaviors Toward Salt Consumption and Its Association With 24-Hour Urinary Sodium and Potassium Excretion in Adults Living in Mexico City: Cross-Sectional Study",
journal="Interact J Med Res",
year="2024",
month="Nov",
day="18",
volume="13",
pages="e57265",
keywords="beliefs",
keywords="attitudes",
keywords="hypertension",
keywords="knowledge",
keywords="salt consumption",
keywords="sodium intake",
keywords="potassium intake",
keywords="Mexico",
abstract="Background: The World Health Organization recommends a daily sodium intake of less than 2000 mg for adults; however, the Mexican population, like many others globally, consumes more sodium than this recommended amount. Excessive sodium intake is often accompanied by inadequate potassium intake. The association between knowledge, attitudes, and behaviors (KAB) and actual sodium intake has yielded mixed results across various populations. In Mexico, however, salt/sodium-related KAB and its relationship with sodium and potassium intake have not been evaluated. Objective: This study primarily aims to describe salt/sodium-related KAB in a Mexican population and, secondarily, to explore the association between KAB and 24-hour urinary sodium and potassium excretion. Methods: We conducted a cross-sectional study in an adult population from Mexico City and the surrounding metropolitan area. Self-reported KAB related to salt/sodium intake was assessed using a survey developed by the Pan American Health Organization. Anthropometric measurements were taken, and 24-hour urinary sodium and potassium excretion levels were determined. Descriptive statistics were stratified by sex and presented as means (SD) or median (25th-75th percentiles) for continuous variables, and as absolute and relative frequencies for categorical variables. The associations between KAB and sodium and potassium excretion were assessed using analysis of covariance, adjusting for age, sex, BMI, and daily energy intake as covariates, with the {\vS}id{\'a}k correction applied for multiple comparisons. Results: Overall, 232 participants were recruited (women, n=184, 79.3\%). The mean urinary sodium and potassium excretion were estimated to be 2582.5 and 1493.5 mg/day, respectively. A higher proportion of men did not know the amount of sodium they consumed compared with women (12/48, 25\%, vs 15/184, 8.2\%, P=.01). More women reported knowing that there is a recommended amount for daily sodium intake than men (46/184, 25\%, vs 10/48, 20.8\%, P=.02). Additionally, more than half of men (30/48, 62.5\%) reported never or rarely reading food labels, compared with women (96/184, 52.1\%, P=.04). Better salt/sodium-related KAB was associated with higher adjusted mean sodium and potassium excretion. For example, mean sodium excretion was 3011.5 (95\% CI 2640.1-3382.9) mg/day among participants who reported knowing the difference between salt and sodium, compared with 2592.8 (95\% CI 2417.2-2768.3) mg/day in those who reported not knowing this difference (P=.049). Similarly, potassium excretion was 1864.9 (95\% CI 1669.6-2060.3) mg/day for those who knew the difference, compared with 1512.5 (95\% CI 1420.1-1604.8) mg/day for those who did not (P=.002). Additionally, higher urinary sodium excretion was observed among participants who reported consuming too much sodium (3216.0 mg/day, 95\% CI 2867.1-3565.0 mg/day) compared with those who claimed to eat just the right amount (2584.3 mg/day, 95\% CI 2384.9-2783.7 mg/day, P=.01). Conclusions: Salt/sodium-related KAB was poor in this study sample. Moreover, KAB had a greater impact on potassium excretion than on sodium excretion, highlighting the need for more strategies to improve KAB related to salt/sodium intake. Additionally, it is important to consider other strategies aimed at modifying the sodium content of foods. ",
doi="10.2196/57265",
url="https://www.i-jmr.org/2024/1/e57265",
url="http://www.ncbi.nlm.nih.gov/pubmed/39556832"
}


@Article{info:doi/10.2196/58140,
author="Hope, Mackline
and Kiggundu, Reuben
and Byonanebye, M. Dathan
and Mayito, Jonathan
and Tabajjwa, Dickson
and Lwigale, Fahad
and Tumwine, Conrad
and Mwanja, Herman
and Kambugu, Andrew
and Kakooza, Francis",
title="Progress of Implementation of World Health Organization Global Antimicrobial Resistance Surveillance System Recommendations on Priority Pathogen-Antibiotic Sensitivity Testing in Africa: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2024",
month="Nov",
day="15",
volume="13",
pages="e58140",
keywords="antimicrobial resistance",
keywords="antibiotic sensitivity testing",
keywords="global antimicrobial resistance surveillance system",
keywords="GLASS implementation",
keywords="AMR Surveillance",
keywords="Africa",
abstract="Background: Antimicrobial resistance (AMR) is a major global public health concern, particularly in low- and middle-income countries where resources and infrastructure for an adequate response are limited. The World Health Organization (WHO) Global Antimicrobial Resistance Surveillance System (GLASS) was introduced in 2016 to address these challenges, outlining recommendations for priority pathogen-antibiotic combinations. Despite this initiative, implementation in Africa remains understudied. This scoping review aims to assess the current state of implementing WHO GLASS recommendations on antimicrobial sensitivity testing (AST) in Africa. Objective: The primary objective of this study is to determine the current state of implementing the WHO GLASS recommendations on AST for priority pathogen-antimicrobial combinations. The review will further document if the reporting of AST results is according to ``susceptible,'' ``intermediate,'' and ``resistant'' recommendations according to GLASS. Methods: Following the methodological framework by Arksey and O'Malley, studies published between January 2016 and November 2023 will be included. Search strategies will target electronic databases, including MEDLINE, Scopus, CINAHL, and Embase. Eligible studies will document isolates tested for antimicrobial sensitivity, focusing on WHO-priority specimens and pathogens. Data extraction will focus on key study characteristics, study context, population, and adherence to WHO GLASS recommendations on AST. Descriptive statistics involving summarizing the quantitative data extracted through measures of central tendency and variation will be used. Covidence and Microsoft Excel software will be used. This study will systematically identify, collate, and analyze relevant studies and data sources based on clear inclusion criteria to provide a clear picture of the progress achieved in the implementation of the WHO GLASS recommendations. Areas for further improvement will be documented to inform future efforts to strengthen GLASS implementation for enhanced AMR surveillance in Africa. Results: The study results are expected in August 2024. Conclusions: To our knowledge, this scoping review will be the first to comprehensively examine the implementation of WHO GLASS recommendations in Africa, shedding light on the challenges and successes of AMR surveillance in the region. Addressing these issues aims to contribute to global efforts to combat AMR. International Registered Report Identifier (IRRID): PRR1-10.2196/58140 ",
doi="10.2196/58140",
url="https://www.researchprotocols.org/2024/1/e58140"
}


@Article{info:doi/10.2196/44492,
author="Kumar, Ashutosh
and Asghar, Adil
and Raza, Khursheed
and Narayan, K. Ravi
and Jha, K. Rakesh
and Satyam, Abhigyan
and Kumar, Gopichand
and Dwivedi, Prakhar
and Sahni, Chetan
and Kumari, Chiman
and Kulandhasamy, Maheswari
and Motwani, Rohini
and Kaur, Gurjot
and Krishna, Hare
and Kumar, Sujeet
and Sesham, Kishore
and Pandey, N. Sada
and Parashar, Rakesh
and Kant, Kamla",
title="Shift in Demographic Involvement and Clinical Characteristics of COVID-19 From Wild-Type SARS-CoV-2 to the Delta Variant in the Indian Population: In Silico Analysis",
journal="Interact J Med Res",
year="2024",
month="Oct",
day="8",
volume="13",
pages="e44492",
keywords="SARS-CoV-2",
keywords="COVID-19",
keywords="epidemiology",
keywords="demographic shift",
keywords="severity of illness",
keywords="variant",
keywords="virus",
keywords="pandemic",
keywords="population studies",
keywords="genomic analysis",
abstract="Background: The Delta variant (B.1.617.2) was considered the most dangerous SARS-CoV-2 strain; however, in-depth studies on its impact based on demographic and clinical characteristics of COVID-19 are scarce. Objective: We aimed to investigate the shift in demographic and clinical characteristics of the COVID-19 pandemic with the emergence of the SARS-CoV-2 Delta variant compared with the wild-type (WT) strain (B.1). Methods: A cross-sectional study of COVID-19 cases in the Indian population caused by the WT strain (B.1) and Delta variant of SARS-CoV-2 was performed. The viral genomic sequence metadata containing demographic, vaccination, and patient status details (N=9500, NDelta=6238, NWT=3262) were statistically analyzed. Results: With the Delta variant, in comparison with the WT strain, a higher proportion of young individuals (<20 years) were infected (0-9 years: Delta: 281/6238, 4.5\% vs B.1: 75/3262, 2.3\%; 10-19 years: Delta: 562/6238, 9\% vs B.1: 229/3262, 7\%; P<.001). The proportion of women contracting infection increased (Delta: 2557/6238, 41\% vs B.1: 1174/3262, 36\%; P<.001). However, it decreased for men (Delta: 3681/6238, 59\% vs B.1: 2088/3262, 64\%; P<.001). An increased proportion of the young population developed symptomatic illness and were hospitalized (Delta: 27/262, 10.3\% vs B.1: 5/130, 3.8\%; P=.02). Moreover, an increased proportion of the women (albeit not men) from the young (Delta: 37/262, 14.1\% vs B.1: 4/130, 3.1\%; P<.001) and adult (Delta: 197/262, 75.2\% vs B.1: 72/130, 55.4\%; P<.001) groups developed symptomatic illness and were hospitalized. The mean age of men and women who contracted infection (Delta: men=37.9, SD 17.2 years; women=36.6, SD 17.6 years; P<.001; B.1: men=39.6, SD 16.9 years; women=40.1, SD 17.4 years; P<.001) as well as developing symptoms or being hospitalized (Delta: men=39.6, SD 17.4 years; women=35.6, SD 16.9 years, P<.001; B.1: men=47, SD 18 years; women=49.5, SD 20.9 years, P<.001) were considerably lower with the Delta variant than the B.1 strain. The total mortality was about 1.8 times higher with the Delta variant than with the WT strain. With the Delta variant, compared with B.1, mortality decreased for men (Delta: 58/85, 68\% vs B.1: 15/20, 75\%; P<.001); in contrast, it increased for women (Delta: 27/85, 32\% vs B.1: 5/20, 25\%; P<.001). The odds of death increased with age, irrespective of sex (odds ratio 3.034, 95\% CI 1.7-5.2, P<.001). Frequent postvaccination infections (24/6238) occurred with the Delta variant following complete doses. Conclusions: The increased involvement of young people and women, the lower mean age for illness, higher mortality, and frequent postvaccination infections were significant epidemiological concerns with the Delta variant. ",
doi="10.2196/44492",
url="https://www.i-jmr.org/2024/1/e44492"
}


@Article{info:doi/10.2196/47416,
author="Kost, Joseph Gerald
and Eng, Muyngim
and Zadran, Amanullah",
title="Geospatial Point-of-Care Testing Strategies for COVID-19 Resilience in Resource-Poor Settings: Rural Cambodia Field Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Aug",
day="27",
volume="10",
pages="e47416",
keywords="Cambodia",
keywords="COVID-19",
keywords="diagnostic portals",
keywords="mobile-testing van and clinic",
keywords="molecular diagnostics",
keywords="point-of-care testing",
keywords="POCT",
keywords="public health resilience",
keywords="rapid antigen test",
keywords="RAgT",
keywords="SARS-CoV-2",
keywords="Solano and Yolo counties",
keywords="California",
abstract="Background: Point-of-care testing (POCT) generates intrinsically fast, inherently spatial, and immediately actionable results. Lessons learned in rural Cambodia and California create a framework for planning and mobilizing POCT with telehealth interventions. Timely diagnosis can help communities assess the spread of highly infectious diseases, mitigate outbreaks, and manage risks. Objective: The aims of this study were to identify the need for POCT in Cambodian border provinces during peak COVID-19 outbreaks and to quantify geospatial gaps in access to diagnostics during community lockdowns. Methods: Data sources comprised focus groups, interactive learners, webinar participants, online contacts, academic experts, public health experts, and officials who determined diagnostic needs and priorities in rural Cambodia during peak COVID-19 outbreaks. We analyzed geographic distances and transit times to testing in border provinces and assessed a high-risk province, Banteay Meanchey, where people crossed borders daily leading to disease spread. We strategized access to rapid antigen testing and molecular diagnostics in the aforementioned province and applied mobile-testing experience among the impacted population. Results: COVID-19 outbreaks were difficult to manage in rural and isolated areas where diagnostics were insufficient to meet needs. The median transit time from border provinces (n=17) to testing sites was 73 (range 1-494) minutes, and in the high-risk Banteay Meanchey Province (n=9 districts), this transit time was 90 (range 10-150) minutes. Within border provinces, maximum versus minimum distances and access times for testing differed significantly (P<.001). Pareto plots revealed geospatial gaps in access to testing for people who are not centrally located. At the time of epidemic peaks in Southeast Asia, mathematical analyses showed that only one available rapid antigen test met the World Health Organization requirement of sensitivity >80\%. We observed that in rural Solano and Yolo counties, California, vending machines and public libraries dispensing free COVID-19 test kits 24-7 improved public access to diagnostics. Mobile-testing vans equipped with COVID-19 antigen, reverse transcription polymerase chain reaction, and multiplex influenza A/B testing proved useful for differential diagnosis, public awareness, travel certifications, and telehealth treatment. Conclusions: Rural diagnostic portals implemented in California demonstrated a feasible public health strategy for Cambodia. Automated dispensers and mobile POCT can respond to COVID-19 case surges and enhance preparedness. Point-of-need planning can enhance resilience and assure spatial justice. Public health assets should include higher-quality, lower-cost, readily accessible, and user-friendly POCT, such as self-testing for diagnosis, home molecular tests, distributed border detection for surveillance, and mobile diagnostics vans for quick telehealth treatment. High-risk settings will benefit from the synthesis of geospatially optimized POCT, automated 24-7 test access, and timely diagnosis of asymptomatic and symptomatic patients at points of need now, during new outbreaks, and in future pandemics. ",
doi="10.2196/47416",
url="https://publichealth.jmir.org/2024/1/e47416",
url="http://www.ncbi.nlm.nih.gov/pubmed/39190459"
}


@Article{info:doi/10.2196/53331,
author="Post, A. Lori
and Soetikno, G. Alan
and Wu, A. Scott
and Hawkins, Claudia
and Mason, Maryann
and Ozer, A. Egon
and Murphy, L. Robert
and Welch, B. Sarah
and Liu, Yingxuan
and Havey, J. Robert
and Moss, B. Charles
and Achenbach, J. Chad
and Lundberg, L. Alexander",
title="South Asia's COVID-19 History and Surveillance: Updated Epidemiological Assessment",
journal="JMIR Public Health Surveill",
year="2024",
month="Aug",
day="26",
volume="10",
pages="e53331",
keywords="SARS-CoV-2",
keywords="COVID-19",
keywords="South Asia",
keywords="pandemic history",
keywords="Bangladesh",
keywords="Bhutan",
keywords="India",
keywords="Maldives",
keywords="Nepal",
keywords="Pakistan",
keywords="Sri Lanka",
keywords="surveillance",
keywords="speed",
keywords="acceleration",
keywords="jerk",
keywords="dynamic panel data",
keywords="generalized method of moments",
keywords="GMM",
keywords="Arellano-Bond",
keywords="7-day lag",
abstract="Background: This study updates our findings from the COVID-19 pandemic surveillance we first conducted in South Asia in 2020 with 2 additional years of data for the region. We assess whether COVID-19 had transitioned from pandemic to endemic at the point the World Health Organization (WHO) ended the public health emergency status for COVID-19 on May 5, 2023. Objective: First, we aim to measure whether there was an expansion or contraction in the pandemic in South Asia around the WHO declaration. Second, we use dynamic and genomic surveillance methods to describe the history of the pandemic in the region and situate the window of the WHO declaration within the broader history. Third, we aim to provide historical context for the course of the pandemic in South Asia. Methods: In addition to updating the traditional surveillance data and dynamic panel estimates from our original study, this study used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data (GISAID) to identify the appearance and duration of variants of concern. We used Nextclade nomenclature to collect clade designations from sequences and Pangolin nomenclature for lineage designations of SARS-CoV-2. Finally, we conducted a 1-sided t test to determine whether regional weekly speed or transmission rate per 100,000 population was greater than an outbreak threshold of 10. We ran the test iteratively with 6 months of data across the sample period. Results: Speed for the region had remained below the outbreak threshold for over a year by the time of the WHO declaration. Acceleration and jerk were also low and stable. While the 1-day persistence coefficients remained statistically significant and positive (1.168), the 7-day persistence coefficient was negative (--0.185), suggesting limited cluster effects in which cases on a given day predict cases 7 days forward. Furthermore, the shift parameters for either of the 2 most recent weeks around May 5, 2023, did not indicate any overall change in the persistence measure around the time of the WHO declaration. From December of 2021 onward, Omicron was the predominant variant of concern in sequenced viral samples. The rolling t test of speed equal to 10 was statistically insignificant across the entire pandemic. Conclusions: While COVID-19 continued to circulate in South Asia, the rate of transmission had remained below the outbreak threshold for well over a year ahead of the WHO declaration. COVID-19 is endemic in the region and no longer reaches the threshold of the pandemic definition. Both standard and enhanced surveillance metrics confirm that the pandemic had ended by the time of the WHO declaration. Prevention policies should be a focus ahead of future pandemics. On that point, policy should emphasize an epidemiological task force with widespread testing and a contact-tracing system. ",
doi="10.2196/53331",
url="https://publichealth.jmir.org/2024/1/e53331",
url="http://www.ncbi.nlm.nih.gov/pubmed/39013116"
}


@Article{info:doi/10.2196/56756,
author="Arueyingho, Oritsetimeyin
and Aprioku, Sydney Jonah
and Marshall, Paul
and O'Kane, Ann Aisling",
title="Insights Into Sociodemographic Influences on Type 2 Diabetes Care and Opportunities for Digital Health Promotion in Port Harcourt, Nigeria: Quantitative Study",
journal="JMIR Diabetes",
year="2024",
month="Aug",
day="21",
volume="9",
pages="e56756",
keywords="type 2 diabetes",
keywords="digital health",
keywords="t2d in nigeria",
keywords="technologies for diabetes",
keywords="pharmaceutical care for t2d",
abstract="Background: A significant percentage of the Nigerian population has type 2 diabetes (T2D), and a notable portion of these patients also live with comorbidities. Despite its increasing prevalence in Nigeria due to factors such as poor eating and exercise habits, there are insufficient reliable data on its incidence in major cities such as Port Harcourt, as well as on the influence of sociodemographic factors on current self-care and collaborative T2D care approaches using technology. This, coupled with a significant lack of context-specific digital health interventions for T2D care, is our major motivation for the study. Objective: This study aims to (1) explore the sociodemographic profile of people with T2D and understand how it directly influences their care; (2) generate an accurate understanding of collaborative care practices, with a focus on nuances in the contextual provision of T2D care; and (3) identify opportunities for improving the adoption of digital health technologies based on the current understanding of technology use and T2D care. Methods: We designed questionnaires aligned with the study's objectives to obtain quantitative data, using both WhatsApp (Meta Platforms, Inc) and in-person interactions. A social media campaign aimed at reaching a hard-to-reach audience facilitated questionnaire delivery via WhatsApp, also allowing us to explore its feasibility as a data collection tool. In parallel, we distributed surveys in person. We collected 110 responses in total: 83 (75.5\%) from in-person distributions and 27 (24.5\%) from the WhatsApp approach. Data analysis was conducted using descriptive and inferential statistical methods on SPSS Premium (version 29; IBM Corp) and JASP (version 0.16.4; University of Amsterdam) software. This dual approach ensured comprehensive data collection and analysis for our study. Results: Results were categorized into 3 groups to address our research objectives. We found that men with T2D were significantly older (mean 61 y), had higher household incomes, and generally held higher academic degrees compared to women (P=.03). No statistically significant relationship was found between gender and the frequency of hospital visits (P=.60) or pharmacy visits (P=.48), and cultural differences did not influence disease incidence. Regarding management approaches, 75.5\% (83/110) relied on prescribed medications; 60\% (66/110) on dietary modifications; and 35.5\% (39/110) and 20\% (22/110) on traditional medicines and spirituality, respectively. Most participants (82/110, 74.5\%) were unfamiliar with diabetes care technologies, and 89.2\% (98/110) of those using technology were only familiar with glucometers. Finally, participants preferred seeking health information in person (96/110, 87.3\%) over digital means. Conclusions: By identifying the influence of sociodemographic factors on diabetes care and health or information seeking behaviors, we were able to identify context-specific opportunities for enhancing the adoption of digital health technologies. ",
doi="10.2196/56756",
url="https://diabetes.jmir.org/2024/1/e56756"
}


@Article{info:doi/10.2196/53175,
author="L{\"a}nsivaara, Annika
and Lehto, Kirsi-Maarit
and Hyder, Rafiqul
and Janhonen, Sinikka Erja
and Lipponen, Anssi
and Heikinheimo, Annamari
and Pitk{\"a}nen, Tarja
and Oikarinen, Sami
and ",
title="Comparison of Different Reverse Transcriptase--Polymerase Chain Reaction--Based Methods for Wastewater Surveillance of SARS-CoV-2: Exploratory Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Aug",
day="19",
volume="10",
pages="e53175",
keywords="wastewater surveillance",
keywords="surveillance systems",
keywords="SARS-CoV-2",
keywords="COVID-19",
keywords="wastewater",
keywords="surveillance",
keywords="Finland",
keywords="monitoring",
keywords="detection",
keywords="low-resource settings",
keywords="RNA",
keywords="spatial",
keywords="temporal changes",
keywords="reverse transcription droplet digital polymerase chain reaction",
keywords="quantitative reverse transcription polymerase chain reaction",
keywords="reverse transcription strand invasion based amplification",
abstract="Background: Many countries have applied the wastewater surveillance of the COVID-19 pandemic to their national public health monitoring measures. The most used methods for detecting SARS-CoV-2 in wastewater are quantitative reverse transcriptase--polymerase chain reaction (RT-qPCR) and reverse transcriptase--droplet digital polymerase chain reaction (RT-ddPCR). Previous comparison studies have produced conflicting results, thus more research on the subject is required. Objective: This study aims to compare RT-qPCR and RT-ddPCR for detecting SARS-CoV-2 in wastewater. It also aimed to investigate the effect of changes in the analytical pipeline, including the RNA extraction kit, RT-PCR kit, and target gene assay, on the results. Another aim was to find a detection method for low-resource settings. Methods: We compared 2 RT-qPCR kits, TaqMan RT-qPCR and QuantiTect RT-qPCR, and RT-ddPCR based on sensitivity, positivity rates, variability, and correlation of SARS-CoV-2 gene copy numbers in wastewater to the incidence of COVID-19. Furthermore, we compared 2 RNA extraction methods, column- and magnetic-bead--based. In addition, we assessed 2 target gene assays for RT-qPCR, N1 and N2, and 2 target gene assays for ddPCR N1 and E. Reverse transcription strand invasion-based amplification (RT-SIBA) was used to detect SARS-CoV-2 from wastewater qualitatively. Results: Our results indicated that the most sensitive method to detect SARS-CoV-2 in wastewater was RT-ddPCR. It had the highest positivity rate (26/30), and its limit of detection was the lowest (0.06 gene copies/{\textmu}L). However, we obtained the best correlation between COVID-19 incidence and SARS-CoV-2 gene copy number in wastewater using TaqMan RT-qPCR (correlation coefficient [CC]=0.697, P<.001). We found a significant difference in sensitivity between the TaqMan RT-qPCR kit and the QuantiTect RT-qPCR kit, the first having a significantly lower limit of detection and a higher positivity rate than the latter. Furthermore, the N1 target gene assay was the most sensitive for both RT-qPCR kits, while no significant difference was found between the gene targets using RT-ddPCR. In addition, the use of different RNA extraction kits affected the result when the TaqMan RT-qPCR kit was used. RT-SIBA was able to detect SARS-CoV-2 RNA in wastewater. Conclusions: As our study, as well as most of the previous studies, has shown RT-ddPCR to be more sensitive than RT-qPCR, its use in the wastewater surveillance of SARS-CoV-2 should be considered, especially if the amount of SARS-CoV-2 circulating in the population was low. All the analysis steps must be optimized for wastewater surveillance as our study showed that all the analysis steps including the compatibility of the RNA extraction, the RT-PCR kit, and the target gene assay influence the results. In addition, our study showed that RT-SIBA could be used to detect SARS-CoV-2 in wastewater if a qualitative result is sufficient. ",
doi="10.2196/53175",
url="https://publichealth.jmir.org/2024/1/e53175",
url="http://www.ncbi.nlm.nih.gov/pubmed/39158943"
}


@Article{info:doi/10.2196/59266,
author="Chanpitakkul, Methee
and Praveen, Devarsetty
and John, Renu
and Ghosh, Arpita
and Lekagul, Salyaveth
and Kaewhiran, Malulee
and Tungsanga, Kriang
and Jha, Vivekanand",
title="Rationale, Design, and Intervention Development of a Mobile Health--Led Primary Care Program for Management of Type 2 Diabetes in Rural Thailand: Protocol for a SMARThealth Diabetes Study",
journal="JMIR Res Protoc",
year="2024",
month="Aug",
day="16",
volume="13",
pages="e59266",
keywords="health workforce",
keywords="primary health care",
keywords="diabetes",
keywords="digital technology",
keywords="Thailand",
keywords="capacity building.",
abstract="Background: Noncommunicable diseases (NCDs), particularly diabetes and chronic kidney diseases, pose a significant health burden in Thailand, especially among socioeconomically disadvantaged populations. The existing primary health care system faces challenges in providing optimal care for NCDs due to inadequate primary care workforce. The SMARThealth program offers a technology-based solution to enhance NCD management through task-sharing among nonphysician health care workers. Objective: This study aims to adapt and implement the SMARThealth Diabetes program in rural Thailand to improve diabetes management. The main objectives are to (1) adapt, validate, and integrate the SMARThealth Diabetes program for improving the management of type 2 diabetes mellitus at the primary health care level; and (2) to determine the feasibility and acceptability of the SMARThealth Diabetes program in rural communities of Thailand. Methods: A pragmatic, type 2 hybrid effectiveness or implementation, parallel-group cluster randomized controlled trial of 12 months duration and involving 51 subdistrict health offices in rural communities of Kamphaeng Phet province, Thailand, will be conducted. The intervention arm will receive the SMARThealth Diabetes program, including workforce restructuring, clinical decision support system, and continuous performance monitoring, while the control arm will continue with usual practice. Data will be collected using the SMARThealth platform and will be stored on a server in Thailand. The primary outcome measure will be the change in mean hemoglobin A1c (HbA1c) measured at randomization and 12 months from randomization between the intervention and control clusters. Secondary outcomes will include the difference in change in albuminuria status, estimated glomerular filtration rate, systolic blood pressure, and low-density lipoprotein cholesterol level. The analysis for change in HbA1c between baseline and end of study will be performed using linear mixed models. Any imbalances between the 2 arms will be addressed by sensitivity analyses. Additionally, a mixed methods process evaluation will be conducted to assess the implementation process, that will include in-depth interviews and focus group discussions, in addition to the quantitative data collected during the implementation process. The qualitative data will be thematically analyzed to explore factors that promote or inhibit the implementation and maintenance of the program. Results: The data collection commenced in November 2022, and the results will be ready for publication by the first quarter of 2025. Effectiveness of the intervention package will be assessed by change in mean HbA1c measures, and detailed feasibility, barriers, and enablers for the implementation of the intervention will be documented through a detailed process evaluation. Conclusions: The study protocol outlines a novel approach to enhancing diabetes management in rural Thailand through digital technology--based interventions that will facilitate task-sharing among health care workers. This can help inform future strategies for improving NCD care in low-resource settings globally. Trial Registration: Thai Clinical Trials Registry TCTR20200322006; https://www.thaiclinicaltrials.org/show/TCTR20200322006 International Registered Report Identifier (IRRID): DERR1-10.2196/59266 ",
doi="10.2196/59266",
url="https://www.researchprotocols.org/2024/1/e59266"
}


@Article{info:doi/10.2196/46945,
author="Anikamadu, Onyekachukwu
and Ezechi, Oliver
and Engelhart, Alexis
and Nwaozuru, Ucheoma
and Obiezu-Umeh, Chisom
and Ogunjemite, Ponmile
and Bale, Ismail Babatunde
and Nwachukwu, Daniel
and Gbaja-biamila, Titilola
and Oladele, David
and Musa, Z. Adesola
and Mason, Stacey
and Ojo, Temitope
and Tucker, Joseph
and Iwelunmor, Juliet",
title="Expanding Youth-Friendly HIV Self-Testing Services During the COVID-19 Pandemic: Qualitative Analysis of a Crowdsourcing Open Call in Nigeria",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="30",
volume="8",
pages="e46945",
keywords="crowdsourcing",
keywords="World AIDS Day",
keywords="HIV",
keywords="self-testing",
keywords="young people",
keywords="COVID-19 pandemic restrictions",
keywords="Nigeria",
keywords="HIV self-testing",
keywords="health promotion",
keywords="crowdsourcing open call",
keywords="young adult",
abstract="Background: HIV self-testing (HIVST) among young people is an effective approach to enhance the uptake of HIV testing recommended by the World Health Organization. However, the COVID-19 pandemic disrupted conventional facility-based HIV testing services, necessitating the exploration of innovative strategies for the effective delivery of HIVST. Objective: This study analyzed the outcomes of a digital World AIDS Day crowdsourcing open call, designed to elicit youth responses on innovative approaches to promote HIVST among young people (14-24 years) in Nigeria during COVID-19 restrictions. Methods: From November 2 to 22, 2020, a World AIDS Day 2020 crowdsourcing open call was held digitally due to COVID-19 restrictions. The crowdsourcing open call followed World Health Organization standardized steps, providing a structured framework for participant engagement. Young people in Nigeria, aged 10-24 years, participated by submitting ideas digitally through Google Forms or email in response to this crowdsourcing open call prompt: ``How will you promote HIV self-testing among young people during COVID-19 pandemic?'' Data and responses from each submission were analyzed, and proposed ideas were closely examined to identify common themes. Four independent reviewers (AE, SM, AZM, and TG) judged each submission based on the desirability, feasibility, and impact on a 9-point scale (3-9, with 3 being the lowest and 9 being the highest). Results: The crowdsourcing open call received 125 eligible entries, 44 from women and 65 from men. The median age of participants was 20 (IQR 24-20) years, with the majority having completed their highest level of education at the senior secondary school level. The majority of participants lived in the South-West region (n=61) and Lagos state (n=36). Of the 125 eligible entries, the top 20 submissions received an average total score of 7.5 (SD 2.73) or above. The panel of judges ultimately selected 3 finalists to receive a monetary award. Three prominent themes were identified from the 125 crowdsourcing open call submissions as specific ways that HIVST can adapt during the COVID-19 pandemic: (1) digital approaches (such as gamification, photoverification system, and digital media) to generate demand for HIVST and avoid risks associated with attending clinics, (2) awareness and sensitization through existing infrastructures (such as churches, schools, and health facilities), and (3) partnerships with influencers, role models, and leaders (such as religious and youth leaders and social influencers in businesses, churches, organizations, and schools) to build trust in HIVST services. Conclusions: The crowdsourcing open call effectively engaged a diverse number of young people who proposed a variety of ways to improve the uptake of HIVST during the COVID-19 pandemic. Findings contribute to the need for innovative HIVST strategies that close critical knowledge and practice gaps on ways to reach young people with HIVST during and beyond the pandemic. Trial Registration: ClinicalTrials.gov NCT04710784; https://clinicaltrials.gov/study/NCT04710784 ",
doi="10.2196/46945",
url="https://formative.jmir.org/2024/1/e46945",
url="http://www.ncbi.nlm.nih.gov/pubmed/38687582"
}


@Article{info:doi/10.5210/ojphi.v13i3.11550,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2021",
volume="13",
number="3",
pages="e11550",
doi="10.5210/ojphi.v13i3.11550",
url="",
url="http://www.ncbi.nlm.nih.gov/pubmed/35079321"
}


@Article{info:doi/10.5210/ojphi.v13i1.11456,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2021",
volume="13",
number="1",
pages="e11456",
doi="10.5210/ojphi.v13i1.11456",
url="",
url="http://www.ncbi.nlm.nih.gov/pubmed/33936524"
}


@Article{info:doi/10.5210/ojphi.v12i2.10574,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2020",
volume="12",
number="2",
pages="e10574",
doi="10.5210/ojphi.v12i2.10574",
url="",
url="http://www.ncbi.nlm.nih.gov/pubmed/33381279"
}


@Article{info:doi/10.5210/ojphi.v12i1.10557,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2020",
volume="12",
number="1",
pages="e10557",
doi="10.5210/ojphi.v12i1.10557",
url="",
url="http://www.ncbi.nlm.nih.gov/pubmed/32742558"
}


@Article{info:doi/10.5210/ojphi.v12i1.10416,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2020",
volume="12",
number="1",
pages="e10416",
doi="10.5210/ojphi.v12i1.10416",
url="",
url="http://www.ncbi.nlm.nih.gov/pubmed/32742555"
}


@Article{info:doi/10.5210/ojphi.v11i2.9468,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2019",
volume="11",
number="2",
pages="e9468",
doi="10.5210/ojphi.v11i2.9468",
url="",
url="http://www.ncbi.nlm.nih.gov/pubmed/31632604"
}


@Article{info:doi/10.5210/ojphi.v11i2.9956,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2019",
volume="11",
number="2",
pages="e9956",
doi="10.5210/ojphi.v11i2.9956",
url="",
url="http://www.ncbi.nlm.nih.gov/pubmed/31632603"
}


@Article{info:doi/10.5210/ojphi.v11i2.10157,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2019",
volume="11",
number="2",
pages="e10157",
doi="10.5210/ojphi.v11i2.10157",
url="",
url="http://www.ncbi.nlm.nih.gov/pubmed/31632605"
}


@Article{info:doi/10.5210/ojphi.v11i2.10244,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2019",
volume="11",
number="2",
pages="e10244",
doi="10.5210/ojphi.v11i2.10244",
url="",
url="http://www.ncbi.nlm.nih.gov/pubmed/31632609"
}


@Article{info:doi/10.5210/ojphi.v11i1.9815,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2019",
volume="11",
number="1",
pages="e9815",
doi="10.5210/ojphi.v11i1.9815",
url=""
}


@Article{info:doi/10.5210/ojphi.v11i1.9825,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2019",
volume="11",
number="1",
pages="e9825",
doi="10.5210/ojphi.v11i1.9825",
url=""
}


@Article{info:doi/10.5210/ojphi.v11i1.9782,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2019",
volume="11",
number="1",
pages="e9782",
doi="10.5210/ojphi.v11i1.9782",
url=""
}


@Article{info:doi/10.5210/ojphi.v11i1.9785,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2019",
volume="11",
number="1",
pages="e9785",
doi="10.5210/ojphi.v11i1.9785",
url=""
}


@Article{info:doi/10.5210/ojphi.v11i1.9786,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2019",
volume="11",
number="1",
pages="e9786",
doi="10.5210/ojphi.v11i1.9786",
url=""
}


@Article{info:doi/10.5210/ojphi.v10i2.9229,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2018",
volume="10",
number="2",
pages="e9229",
doi="10.5210/ojphi.v10i2.9229",
url="",
url="http://www.ncbi.nlm.nih.gov/pubmed/30349624"
}


@Article{info:doi/10.5210/ojphi.v9i1.7776,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2017",
volume="9",
number="1",
pages="e7776",
doi="10.5210/ojphi.v9i1.7776",
url=""
}


@Article{info:doi/10.5210/ojphi.v9i1.7752,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2017",
volume="9",
number="1",
pages="e7752",
doi="10.5210/ojphi.v9i1.7752",
url=""
}


@Article{info:doi/10.5210/ojphi.v9i1.7777,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2017",
volume="9",
number="1",
pages="e7777",
doi="10.5210/ojphi.v9i1.7777",
url=""
}


@Article{info:doi/10.5210/ojphi.v9i1.7770,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2017",
volume="9",
number="1",
pages="e7770",
doi="10.5210/ojphi.v9i1.7770",
url=""
}


@Article{info:doi/10.5210/ojphi.v9i1.7778,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2017",
volume="9",
number="1",
pages="e7778",
doi="10.5210/ojphi.v9i1.7778",
url=""
}


@Article{info:doi/10.5210/ojphi.v9i1.7771,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2017",
volume="9",
number="1",
pages="e7771",
doi="10.5210/ojphi.v9i1.7771",
url=""
}


@Article{info:doi/10.5210/ojphi.v9i1.7779,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2017",
volume="9",
number="1",
pages="e7779",
doi="10.5210/ojphi.v9i1.7779",
url=""
}


@Article{info:doi/10.5210/ojphi.v9i1.7772,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2017",
volume="9",
number="1",
pages="e7772",
doi="10.5210/ojphi.v9i1.7772",
url=""
}


@Article{info:doi/10.5210/ojphi.v9i1.7780,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2017",
volume="9",
number="1",
pages="e7780",
doi="10.5210/ojphi.v9i1.7780",
url=""
}


@Article{info:doi/10.5210/ojphi.v9i1.7773,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2017",
volume="9",
number="1",
pages="e7773",
doi="10.5210/ojphi.v9i1.7773",
url=""
}


@Article{info:doi/10.5210/ojphi.v9i1.7783,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2017",
volume="9",
number="1",
pages="e7783",
doi="10.5210/ojphi.v9i1.7783",
url=""
}


@Article{info:doi/10.5210/ojphi.v9i1.7774,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2017",
volume="9",
number="1",
pages="e7774",
doi="10.5210/ojphi.v9i1.7774",
url=""
}


@Article{info:doi/10.5210/ojphi.v9i1.7789,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2017",
volume="9",
number="1",
pages="e7789",
doi="10.5210/ojphi.v9i1.7789",
url=""
}


@Article{info:doi/10.5210/ojphi.v9i1.7775,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2017",
volume="9",
number="1",
pages="e7775",
doi="10.5210/ojphi.v9i1.7775",
url=""
}


@Article{info:doi/10.5210/ojphi.v9i1.7790,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2017",
volume="9",
number="1",
pages="e7790",
doi="10.5210/ojphi.v9i1.7790",
url=""
}


@Article{info:doi/10.5210/ojphi.v8i3.7089,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2016",
volume="8",
number="3",
pages="e7089",
doi="10.5210/ojphi.v8i3.7089",
url="",
url="http://www.ncbi.nlm.nih.gov/pubmed/28210427"
}


@Article{info:doi/10.5210/ojphi.v6i1.5166,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2014",
volume="6",
number="1",
pages="e5166",
doi="10.5210/ojphi.v6i1.5166",
url=""
}


@Article{info:doi/10.5210/ojphi.v6i1.5039,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2014",
volume="6",
number="1",
pages="e5039",
doi="10.5210/ojphi.v6i1.5039",
url=""
}


@Article{info:doi/10.5210/ojphi.v5i1.4402,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2013",
volume="5",
number="1",
pages="e4402",
doi="10.5210/ojphi.v5i1.4402",
url=""
}


@Article{info:doi/10.5210/ojphi.v5i1.4481,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2013",
volume="5",
number="1",
pages="e4481",
doi="10.5210/ojphi.v5i1.4481",
url=""
}


@Article{info:doi/10.5210/ojphi.v5i1.4495,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2013",
volume="5",
number="1",
pages="e4495",
doi="10.5210/ojphi.v5i1.4495",
url=""
}


@Article{info:doi/10.5210/ojphi.v5i1.4503,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2013",
volume="5",
number="1",
pages="e4503",
doi="10.5210/ojphi.v5i1.4503",
url=""
}


@Article{info:doi/10.5210/ojphi.v5i1.4504,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2013",
volume="5",
number="1",
pages="e4504",
doi="10.5210/ojphi.v5i1.4504",
url=""
}


@Article{info:doi/10.5210/ojphi.v5i1.4509,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2013",
volume="5",
number="1",
pages="e4509",
doi="10.5210/ojphi.v5i1.4509",
url=""
}


@Article{info:doi/10.5210/ojphi.v5i1.4393,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2013",
volume="5",
number="1",
pages="e4393",
doi="10.5210/ojphi.v5i1.4393",
url=""
}


@Article{info:doi/10.5210/ojphi.v5i1.4398,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2013",
volume="5",
number="1",
pages="e4398",
doi="10.5210/ojphi.v5i1.4398",
url=""
}


@Article{info:doi/10.5210/ojphi.v3i2.3602,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2011",
volume="3",
number="2",
pages="e3602",
doi="10.5210/ojphi.v3i2.3602",
url="",
url="http://www.ncbi.nlm.nih.gov/pubmed/23569612"
}


@Article{info:doi/10.5210/ojphi.v3i2.3800,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2011",
volume="3",
number="2",
pages="e3800",
doi="10.5210/ojphi.v3i2.3800",
url="",
url="http://www.ncbi.nlm.nih.gov/pubmed/23569611"
}