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AbstractIntroductionIndia's national AIDS Control Organization implemented World Health Organization's option B+ HIV prevention of mother‐to‐child transmission (PMTCT) guidelines in 2013. However, scalable strategies to improve uptake of new PMTCT guidelines to reduce new infection rates are needed. This study assessed impact of Mobile Health‐Facilitated Behavioral Intervention on the uptake of PMTCT services.MethodsA cluster‐randomized trial of a mobile health (mHealth)‐supported behavioural training intervention targeting outreach workers (ORWs) was conducted in four districts of Maharashtra, India. Clusters (one Integrated Counselling and Testing Center (ICTC, n = 119), all affiliated ORWs (n = 116) and their assigned HIV‐positive pregnant/postpartum clients (n = 1191)) were randomized to standard‐of‐care (SOC) ORW training vs. the COMmunity home Based INDia (COMBIND) intervention – specialized behavioural training plus a tablet‐based mHealth application to support ORW‐patient communication and patient engagement in HIV care. Impact on uptake of maternal antiretroviral therapy at delivery, exclusive breastfeeding at six months, infant nevirapine prophylaxis, and early infant diagnosis at six months was assessed using multi‐level random‐effects logistic regression models.ResultsOf 1191 HIV‐positive pregnant/postpartum women, 884 were eligible for primary outcome assessment; 487 were randomized to COMBIND. Multivariable analyses identified no statistically significant differences in any primary outcome by study arm. COMBIND was associated with higher uptake of exclusive breastfeeding at two months (adjusted Odds Ratio (aOR), 2.10; 95% CI 1.06 to 4.15) and early infant diagnosis at six weeks (aOR, 2.19; 95% CI 1.05 to 3.98) than SOC.ConclusionsThe COMBIND intervention was easily integrated into India's existing PMTCT programme and improved early uptake of two PMTCT components that require self‐motivated health‐seeking behaviour, thus providing preliminary evidence to support COMBIND as a potentially scalable PMTCT strategy. Further study would identify modifications needed to optimize other PMTCT outcomes.

BACKGROUND: India has the highest number of HIV-infected adolescents in Asia, however, little is known about their treatment outcomes. We assessed rates and factors associated with loss to follow-up (LTFU) and mortality among Indian adolescents. METHODS: Analysis included adolescents (10–19 years) starting ART, between 2005 and 2014, at BJ Government Medical College, Pune, India. LTFU was defined as missing >3 monthly visits. Competing-risks method was used to calculate sub-distribution hazard ratios (SHR) of predictors for LTFU, with death as the competing risk. Cox proportional hazard models were used to identify predictors of mortality. RESULTS: Of 717 adolescents starting ART, 402 with complete data were included in the analysis. Of these, 61% were male, 80% were perinatally infected, median baseline CD4 was 174 cells/µl. LTFU and mortality rates were 4.4 and 4.9/100-person years, respectively. Cumulative LTFU incidence increased from 6% to 15% over six years. Age ≥15 years (adjusted SHR (aSHR) 2.44; 95% CI:1.18 – 5.02), was a risk factor for LTFU. Cumulative mortality increased from 9.5% to 17.9% over six years. WHO Stage III and IV (aHR: 2.26; 95% CI:1.14 – 4.48) and CD4 count/100 (aHR: 0.59; 95% CI: 0.43 – 0.83) were associated with mortality. CONCLUSIONS: A third of adolescents were LTFU or died by follow-up year 6. Older age, was a risk factor for LTFU and advanced clinical disease for death. Strategies to strengthen retention counselling for older adolescents and closer clinical monitoring of all adolescents, must be considered.

Summary: Clean cooking has emerged as a major concern for global health and development because of the enormous burden of disease caused by traditional cookstoves and fires. The World Health Organization has developed new indoor air quality guidelines that few homes will be able to achieve without replacing traditional methods with modern clean cooking technologies, including fuels and stoves. However, decades of experience with improved stove programs indicate that the challenge of modernizing cooking in impoverished communities includes a complex, multi-sectoral set of problems that require implementation research. The National Institutes of Health, in partnership with several government agencies and the Global Alliance for Clean Cookstoves, has launched the Clean Cooking Implementation Science Network that aims to address this issue. In this article, our focus is on building a knowledge base to accelerate scale-up and sustained use of the cleanest technologies in low- and middle-income countries. Implementation science provides a variety of analytical and planning tools to enhance effectiveness of clinical and public health interventions. These tools are being integrated with a growing body of knowledge and new research projects to yield new methods, consensus tools, and an evidence base to accelerate improvements in health promised by the renewed agenda of clean cooking.

Clean cooking has emerged as a major concern for global health and development because of the enormous burden of disease caused by traditional cookstoves and fires. The World Health Organization has developed new indoor air quality guidelines that few homes will be able to achieve without replacing traditional methods with modern clean cooking technologies, including fuels and stoves. However, decades of experience with improved stove programs indicate that the challenge of modernizing cooking in impoverished communities includes a complex, multi-sectoral set of problems that require implementation research. The National Institutes of Health, in partnership with several government agencies and the Global Alliance for Clean Cookstoves, has launched the Clean Cooking Implementation Science Network that aims to address this issue. In this article, our focus is on building a knowledge base to accelerate scale-up and sustained use of the cleanest technologies in low- and middle-income countries. Implementation science provides a variety of analytical and planning tools to enhance effectiveness of clinical and public health interventions. These tools are being integrated with a growing body of knowledge and new research projects to yield new methods, consensus tools, and an evidence base to accelerate improvements in health promised by the renewed agenda of clean cooking.

© 2017, Public Health Services, US Dept of Health and Human Services. All rights reserved. Summary: Clean cooking has emerged as a major concern for global health and development because of the enormous burden of disease caused by traditional cookstoves and fires. The World Health Organization has developed new indoor air quality guidelines that few homes will be able to achieve without replacing traditional methods with modern clean cooking technologies, including fuels and stoves. However, decades of experience with improved stove programs indicate that the challenge of modernizing cooking in impoverished communities includes a complex, multi-sectoral set of problems that require implementation research. The National Institutes of Health, in partnership with several government agencies and the Global Alliance for Clean Cookstoves, has launched the Clean Cooking Implementation Science Network that aims to address this issue. In this article, our focus is on building a knowledge base to accelerate scale-up and sustained use of the cleanest technologies in low- and middle-income countries. Implementation science provides a variety of analytical and planning tools to enhance effectiveness of clinical and public health interventions. These tools are being integrated with a growing body of knowledge and new research projects to yield new methods, consensus tools, and an evidence base to accelerate improvements in health promised by the renewed agenda of clean cooking.

Clean cooking has emerged as a major concern for global health and development because of the enormous burden of disease caused by traditional cookstoves and fires. The World Health Organization has developed new indoor air quality guidelines that few homes will be able to achieve without replacing traditional methods with modern clean cooking technologies, including fuels and stoves. However, decades of experience with improved stove programs indicate that the challenge of modernizing cooking in impoverished communities includes a complex, multi-sectoral set of problems that require implementation research. The National Institutes of Health, in partnership with several government agencies and the Global Alliance for Clean Cookstoves, has launched the Clean Cooking Implementation Science Network that aims to address this issue. In this article, our focus is on building a knowledge base to accelerate scale-up and sustained use of the cleanest technologies in low- and middle-income countries. Implementation science provides a variety of analytical and planning tools to enhance effectiveness of clinical and public health interventions. These tools are being integrated with a growing body of knowledge and new research projects to yield new methods, consensus tools, and an evidence base to accelerate improvements in health promised by the renewed agenda of clean cooking. ; Fil: Rosenthal, Joshua. National Institutes Of Health. Fogarty International Center; Estados Unidos ; Fil: Balakrishnan, Kalpana. Sri Ramachandra University; India ; Fil: Bruce, Nigel. University of Liverpool; Reino Unido ; Fil: Chambers, David. National Institutes of Health. National Cancer Institute; Estados Unidos ; Fil: Graham, Jay. The George Washington University; Estados Unidos ; Fil: Jack, Darby. Columbia University; Estados Unidos ; Fil: Kline, Lydia. National Institutes Of Health. Fogarty International Center; Estados Unidos ; Fil: Masera, Omar Raul. Universidad Nacional Autónoma de México; México ; Fil: Mehta, Sumi. Global Alliance for Clean Cookstoves; Estados Unidos ; Fil: Mercado, Ilse Ruiz. Universidad Nacional Autónoma de México; México ; Fil: Neta, Gila. National Institutes of Health. National Cancer Institute; Estados Unidos ; Fil: Pattanayak, Subhrendu. University of Duke; Estados Unidos ; Fil: Puzzolo, Elisa. Global LPG Partnership; Estados Unidos ; Fil: Petach, Helen. U.S. Agency for International Development; Estados Unidos ; Fil: Punturieri, Antonello. National Heart, Lung, and Blood Institute; Estados Unidos ; Fil: Rubinstein, Adolfo Luis. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina ; Fil: Sage, Michael. Centers for Disease Control and Prevention; Estados Unidos ; Fil: Sturke, Rachel. National Institutes Of Health. Fogarty International Center; Estados Unidos ; Fil: Shankar, Anita. University Johns Hopkins; Estados Unidos ; Fil: Sherr, Kenny. University of Washington; Estados Unidos ; Fil: Smith, Kirk. University of California at Berkeley; Estados Unidos ; Fil: Yadama, Gautam. Washington University in St. Louis; Estados Unidos