Nicola Desmond

Bio: Nicola Desmond is an academic researcher from Liverpool School of Tropical Medicine. The author has contributed to research in topics: Focus group & Population. The author has an hindex of 21, co-authored 80 publications receiving 1812 citations. Previous affiliations of Nicola Desmond include University of Glasgow & Malawi-Liverpool-Wellcome Trust Clinical Research Programme.

The uptake and accuracy of oral kits for HIV self-testing in high HIV prevalence setting: a cross-sectional feasibility study in Blantyre, Malawi.

Abstract: Background Although HIV testing and counseling (HTC) uptake has increased dramatically in Africa, facility-based services are unlikely to ever meet ongoing need to the full. A major constraint in scaling up community and home-based HTC services is the unacceptability of receiving HTC from a provider known personally to prospective clients. We investigated the potential of supervised oral HIV self-testing from this perspective. Methods and Findings Adult members of 60 households and 72 members of community peer groups in urban Blantyre, Malawi, were selected using population-weighted random cluster sampling. Participants were offered self-testing plus confirmatory HTC (parallel testing with two rapid finger-prick blood tests), standard HTC alone, or no testing. 283 (95.6%) of 298 selected adults participated, including 136 (48.0%) men. 175 (61.8%) had previously tested (19 known HIV positive), although only 64 (21.5%) within the last year. HIV prevalence was 18.5%. Among 260 (91.9%) who opted to self-test after brief demonstration and illustrated instructions, accuracy was 99.2% (two false negatives). Although 98.5% rated the test “not hard at all to do,” 10.0% made minor procedural errors, and 10.0% required extra help. Most participants indicated willingness to accept self-test kits, but not HTC, from a neighbor (acceptability 94.5% versus 46.8%, p = 0.001). Conclusions Oral supervised self-testing was highly acceptable and accurate, although minor errors and need for supervisory support were common. This novel option has potential for high uptake at local community level if it can be supervised and safely linked to counseling and care.

Uptake, accuracy, safety, and linkage into care over two years of promoting annual self-testing for HIV in Blantyre, Malawi : a community-based prospective study

Abstract: Background Home-based HIV testing and counselling (HTC) achieves high uptake, but is difficult and expensive to implement and sustain. We investigated a novel alternative based on HIV self-testing (HIVST). The aim was to evaluate the uptake of testing, accuracy, linkage into care, and health outcomes when highly convenient and flexible but supported access to HIVST kits was provided to a well-defined and closely monitored population. Methods and Findings Following enumeration of 14 neighbourhoods in urban Blantyre, Malawi, trained resident volunteer-counsellors offered oral HIVST kits (OraQuick ADVANCE Rapid HIV-1/2 Antibody Test) to adult (≥16 y old) residents (n = 16,660) and reported community events, with all deaths investigated by verbal autopsy. Written and demonstrated instructions, pre- and post-test counselling, and facilitated HIV care assessment were provided, with a request to return kits and a self-completed questionnaire. Accuracy, residency, and a study-imposed requirement to limit HIVST to one test per year were monitored by home visits in a systematic quality assurance (QA) sample. Overall, 14,004 (crude uptake 83.8%, revised to 76.5% to account for population turnover) residents self-tested during months 1–12, with adolescents (16–19 y) most likely to test. 10,614/14,004 (75.8%) participants shared results with volunteer-counsellors. Of 1,257 (11.8%) HIV-positive participants, 26.0% were already on antiretroviral therapy, and 524 (linkage 56.3%) newly accessed care with a median CD4 count of 250 cells/μl (interquartile range 159–426). HIVST uptake in months 13–24 was more rapid (70.9% uptake by 6 mo), with fewer (7.3%, 95% CI 6.8%–7.8%) positive participants. Being “forced to test”, usually by a main partner, was reported by 2.9% (95% CI 2.6%–3.2%) of 10,017 questionnaire respondents in months 1–12, but satisfaction with HIVST (94.4%) remained high. No HIVST-related partner violence or suicides were reported. HIVST and repeat HTC results agreed in 1,639/1,649 systematically selected (1 in 20) QA participants (99.4%), giving a sensitivity of 93.6% (95% CI 88.2%–97.0%) and a specificity of 99.9% (95% CI 99.6%–100%). Key limitations included use of aggregate data to report uptake of HIVST and being unable to adjust for population turnover. Conclusions Community-based HIVST achieved high coverage in two successive years and was safe, accurate, and acceptable. Proactive HIVST strategies, supported and monitored by communities, could substantially complement existing approaches to providing early HIV diagnosis and periodic repeat testing to adolescents and adults in high-HIV settings.

Effect of optional home initiation of HIV care following HIV self-testing on antiretroviral therapy initiation among adults in Malawi: a randomized clinical trial.

Abstract: RESULTS A significantly greater proportion of adults in the home group initiated ART (181/8194, 2.2%) compared with the facility group (63/8466, 0.7%; risk ratio [RR], 2.94, 95% CI, 2.10-4.12; P < .001). Uptake of HIV self-testing was high in both the home (5287/8194, 64.9%) and facility groups (4433/8466, 52.7%; RR, 1.23; 95% CI, 0.96-1.58; P = .10). Significantly more adults reported positive HIV self-test results in the home group (490/8194 [6.0%] vs the facility group, 278/8466 [3.3%]; RR, 1.86; 95% CI, 1.16-2.97; P = .006). After 6 months, 52 of 181 ART initiators (28.7%) and 15 of 63 ART initiators (23.8%) in the home and facility groups, respectively, were lost from ART (adjusted incidence rate ratio, 1.18; 95% CI, 0.62-2.25, P =. 57).

Transactional sex and HIV: understanding the gendered structural drivers of HIV in fishing communities in Southern Malawi.

Abstract: Background: In Southern Malawi, the fishing industry is highly gendered, with men carrying out the fishing and women processing, drying and selling the fish. Research has shown that individuals living in fishing communities in low-income countries are particularly vulnerable to HIV infection. One of the key drivers of HIV in fishing communities is transactional sex. In the fishing industry this takes the form of ‘‘fish-for-sex’’ networks where female fish traders exchange sex with fishermen for access to or more favourable prices of fish. By controlling the means of production, the power dynamics in these exchanges favour men and can make it more difficult for women to negotiate safe sex. Methods: Qualitative methods were used to collect data on gendered drivers of transactional sex in the fishing community and how different groups perceive HIV risk in these transactions. Observation, focus group discussions and semi-structured interviews were undertaken with members of the fishing communities, including men and women directly and indirectly involved in fishing. Results: In fishing communities transactional sex was prevalent across a spectrum ranging from gift giving within relationships, to sex for fish exchanges, to sex worker encounters. Power differences between couples in transactional sexual encounters shape individual’s abilities to negotiate condom use (with women being at a particularly disadvantaged negotiating position). The context and motivations for transactional sex varied and was mediated by economic need and social position both of men and women. Female fish traders new to the industry and boat crew members who travelled for work and experienced difficult living conditions often engaged in transactional sex. Conclusion: Transactional sex is common in Malawian fishing communities, with women particularly vulnerable in negotiations because of existing gendered power structures. Although knowledge and understanding of the HIV risk associated with transactional sex was common, this did not appear to result in the adoption of risk reduction strategies. This suggests that specially targeted strategies to increase women’s economic empowerment and tackle the structural drivers of women’s HIV risk could be important in fishing communities. Keywords: transactional sex; gender power relations; fishing communities; HIV (Published: 14 June 2012) Citation: MacPherson EE et al. Journal of the International AIDS Society 2012, 15 (Suppl 1):17364 http://www.jiasociety.org/content/15/3/17364 | http://dx.doi.org/10.7448/IAS.15.3.17364

Patient engagement in research: a systematic review

Abstract: A compelling ethical rationale supports patient engagement in healthcare research. It is also assumed that patient engagement will lead to research findings that are more pertinent to patients’ concerns and dilemmas. However; it is unclear how to best conduct this process. In this systematic review we aimed to answer 4 key questions: what are the best ways to identify patient representatives? How to engage them in designing and conducting research? What are the observed benefits of patient engagement? What are the harms and barriers of patient engagement? We searched MEDLINE, EMBASE, PsycInfo, Cochrane, EBSCO, CINAHL, SCOPUS, Web of Science, Business Search Premier, Academic Search Premier and Google Scholar. Included studies were published in English, of any size or design that described engaging patients or their surrogates in research design. We conducted an environmental scan of the grey literature and consulted with experts and patients. Data were analyzed using a non-quantitative, meta-narrative approach. We included 142 studies that described a spectrum of engagement. In general, engagement was feasible in most settings and most commonly done in the beginning of research (agenda setting and protocol development) and less commonly during the execution and translation of research. We found no comparative analytic studies to recommend a particular method. Patient engagement increased study enrollment rates and aided researchers in securing funding, designing study protocols and choosing relevant outcomes. The most commonly cited challenges were related to logistics (extra time and funding needed for engagement) and to an overarching worry of a tokenistic engagement. Patient engagement in healthcare research is likely feasible in many settings. However, this engagement comes at a cost and can become tokenistic. Research dedicated to identifying the best methods to achieve engagement is lacking and clearly needed.

세계화(globalization)와 안보 연구

Abstract: 세계화가 과연 하나의 독립변수로 사용하기에 충분할 정도로 그 의미가 명확하게 규명된 과학적 개념인가의 여부는 학계의 지속적인 의문으로 남아 있다. 특히 최근에는 현저하게 드러나고 있는 각종 반세계화 현상을 바탕으로 세계화에 대한 반론이 거세지고 있으며 일부 세계화론 주창자들조차 ‘현실’로서 세계화 현상에 대한 회의적 시각을 표출하고 있어 그 의문은 더욱 커지고 있다. 이에 따라 세계화를 설명 변수로 삼는 모든 연구 영역에서 세계화의 의미와 세계화와 관련된 연구 성과를 반추해 볼 필요성도 커지고 있다. 본 연구의 목적은 세계화의 의미 분석을 바탕으로 세계화를 안보환경 변화의 독립변수로 삼는 연구의 동향을 분석하고 연구의 방향을 제시하는데 있다. 세계화는 그 설명적 가치와 규범적 판단을 둘러싸고 논란이 계속되고 있는 개념이다. 세계화는 세계화론자를 중심으로 발전되어 온 개념이지만 이들 사이에서도 개념에 대한 합의는 존재하지 않는다. 세계화는 가장 단순하게는 하나의 현상 혹은 사건으로 간주되기도 하지만, 세계화의 본질을 규명하려는 입장에서는 세계화의 원인과 영향에 대한 인과관계는 물론 사회관계 본질이나 권력관계 변화를 적시하는 개념으로 취급하여 왔다. 그러나 세계화를 개념화하려는 노력은 수많은 하부 현상을 단일 요소로 설명해야 하며, 역으로 개념 속에 혼재되어 있는 세계화의 원인, 결과, 설명 및 규범적 판단 요소를 단순화해야 한다는 과제를 안고 있다. 특히 원인과 결과가 혼재되어 있는 세계화 개념은 현상 분석을 위한 설명체제 구성에 가장 큰 장애요인이 되고 있다. 세계화와 안보와의 관계를 다루는 연구는 대체로 세계화에 관한 중도론적 입장에서 안보에 관한 낙관론을 피하고 새로운 위협을 제시하는데 초점을 맞추는데, 이러한 경향은 안보연구에서 세계화를 가장 단순한 수준에서 정의하는 데에서 비롯된다. 그러나 지나치게 단순한 세계화 개념을 적용하는 안보연구는 질적으로 새로운 현상인 세계화를 여전히 국가중심적 시각에서 다루고 모든 안보위협을 테러리즘의 문제로 축소하려는 환원주의의 문제를 야기한다. 이러한 문제를 극복하기 위해서는 세계화 개념의 불완전성을 염두에 둔 세계화 개념에 대한 접근과 일관된 세계화 개념 적용이 요구된다. 또한 세계화 현상으로부터 직접적인 안보 사안을 도출하는 노력에서 한 차원 더 나아가 안보연구의 새로운 방향을 제시해 줄 수 있는 안보환경 변화의 전체적 특성을 분석하는 포괄적 연구가 요구된다.

Micro-credit initiatives for equitable and sustainable development : who pays?; a case study of the Grameen Bank Program in rural Bangladesh

Abstract: Abstract There is a growing acknowledgement that micro-credit programs have potential for equitable and sustainable development. However, my anthropological research on the micro-credit program of the Grameen Bank shows that bank workers are expected to increase disbursement of loans among their members and press for high recovery rates to earn profit necessary for economic viability of the institution. To ensure timely repayment in the loan centers bank workers and borrowing peers inflict an intense pressure on women clients. In the study community many borrowers maintain their regular payment schedules through a process of loan recycling that considerably increases the debt-liability on the individual households, increases tension and frustration among household members, produces new forms of dominance over women and increases violence in society.