Predictors of Condom Use Among Adolescent Thai Vocational Students

Purpose: To describe the prevalence of premarital sexual behavior and condom use, and to identify predictors of condom use using the expanded health belief model (EHBM) among vocational students in Bangkok, Thailand.
Methods: A cross-sectional correlational design was used with a cluster-based sample of 425 students aged 18 to 22 years from eight randomly selected private vocational schools in Bangkok. Anonymous self-report questionnaires were used to collect the data. Stepwise multiple regression was conducted to identify predictors of condom use.
Results: Overall, 49.9% of participants were sexually active, 64.8% of men and 32% of women. Of the sexually active participants, only 6.3% reported using condoms every time when having sex in the beginning of the relationship, and 10.2% during the last few times. Twenty-four percent of sexually active participants had unplanned pregnancies, and 7% had sexually transmitted diseases (STDs). The predictive model of condom use consisted of perceived benefits from using condoms; interactions between intention to use condoms and gender: knowledge of STDs, HIV, AIDS, pregnancy and peer norms; and alcohol use and age. Adjusting for modifying factors, the predictor set explained 27% of the variance in condom use.
Conclusions: Most of this sample of sexually active Thai vocational students practiced unsafe sex, and many had unplanned pregnancies and STDs. The EHBM provided a modest predictive model of condom use.     

Evaluation of an oligonucleotide ligation assay for detection of mutations in HIV-1 subtype C individuals who have high level resistance to nucleoside reverse transcriptase inhibitors and non-nucleoside reverse transcriptase inhibitors

The oligonucleotide ligation assay (OLA) has been proposed as an affordable alternative to sequence-based HIV-1 drug resistance testing in resource poor settings. The aim was to evaluate OLA for detecting mutations K103N, Y181C, K65R, Q151M, M184V and T215Y/F in subtype C. Forty-four subtype C and 8 subtype B HIV-1 positive individuals were analysed using the ViroSeqtrade mark HIV-1 genotyping assay (Applied Biosystems, Foster City, CA). A one-step RT-PCR and nested PCR were performed using subtype B specific primers from the OLA kit (NIH AIDS Research and Reference Reagent Program). Seventy-eight subtype C sequences were used to design subtype C specific primers. Ligation and detection steps were followed according to OLA kit protocol. For codons, K103N, Y181C, K65R, Q151M, M184V and T215Y/F, four or more mismatches compared to the probe or mismatches less than four bases from the ligation site were not tolerated. Results revealed accurate identification of mutations in 2/10, 4/9 3/9, 6/7, 2/7 and 6/7 VQA samples and 5/20, 4/17 0/20, 18/24, 5/24 and 13/24 subtype C positive individuals, respectively. It was concluded that the probes and primers in the NIH reference kit would need modification to optimize detection of mutations in subtype C individuals.     

Treatments for people living with schizophrenia in Sub‐Saharan Africa: an adapted realist review

Aim

To identify the treatments and interventions available and their impact on people living with schizophrenia in Sub‐Saharan Africa.

Background

Help‐seeking behaviour and the choice of treatment are largely influenced by socio‐cultural factors and beliefs about the causes of mental illness. This review addresses the gap in knowledge regarding the treatment options available to people living with schizophrenia in Sub‐Saharan Africa.

Design

Adapted realist literature review.

Data sources

Electronic databases searched in June 2016 included PubMed, EMBASE, PsycINFO, ProQuest and CINAHL.

Review methods

The adapted realist review approach used to synthesize the published research involved identifying the review aim, searching and selecting relevant studies, extracting, iteratively analysing and synthesizing relevant data and reporting results.

Results

Forty studies from eight countries were reviewed. Most people were treated by both faith/traditional healers and modern psychiatry. Common treatments included antipsychotics, electroconvulsive therapy and psychosocial interventions. Few treatment options were available outside major centres, there was poor adherence to medication and families reported a high level of burden associated with caring for a relative.

Limitations

Major limitations of this review were the lack of studies, variable quality and low level of evidence available from most countries from Sub‐Saharan Africa and lack of generalizability.

Conclusion

People living with schizophrenia in Sub‐Saharan Africa were treated by faith, traditional healers and modern psychiatry, if at all. Further research is needed to better understand the local situation and the implications for caring for people from this region.

Implications for nursing and health policy

Mental health services in Sub‐Saharan Africa are limited by fiscal shortages, lack of mental health services and qualified mental health professionals. This review provides evidence to inform nursing and healthcare policy, including recruiting and training mental health professionals and ensuring access to evidence‐based, person‐centred and culturally relevant mental health services within the primary care context.     

Optimizing HIV retesting during pregnancy and postpartum in four countries: a cost‐effectiveness analysis

IntroductionHIV retesting during late pregnancy and breastfeeding can help detect new maternal infections and prevent mother‐to‐child HIV transmission (MTCT), but the optimal timing and cost‐effectiveness of maternal retesting remain uncertain.MethodsWe constructed deterministic models to assess the health and economic impact of maternal HIV retesting on a hypothetical population of pregnant women, following initial testing in pregnancy, on MTCT in four countries: South Africa and Kenya (high/intermediate HIV prevalence), and Colombia and Ukraine (low HIV prevalence). We evaluated six scenarios with varying retesting frequencies from late in antenatal care (ANC) through nine months postpartum. We compared strategies using incremental cost‐effectiveness ratios (ICERs) over a 20‐year time horizon using country‐specific thresholds.ResultsWe found maternal retesting once in late ANC with catch‐up testing through six weeks postpartum was cost‐effective in Kenya (ICER = $166 per DALY averted) and South Africa (ICER=$289 per DALY averted). This strategy prevented 19% (Kenya) and 12% (South Africa) of infant HIV infections. Adding one or two additional retests postpartum provided smaller benefits (1 to 2 percentage point increase in infections averted versus one retest). Adding three retests during the postpartum period averted additional infections (1 to 3 percentage point increase in infections averted versus one retest) but ICERs ($7639 and in Kenya and $11 985 in South Africa) greatly exceeded the cost‐effectiveness thresholds. In Colombia and Ukraine, all retesting strategies exceeded the cost‐effectiveness threshold and prevented few infant infections (up to 31 and 5 infections, respectively).ConclusionsIn high HIV burden settings with MTCT rates similar to those seen in Kenya and South Africa, HIV retesting once in late ANC, with subsequent intervention, is the most cost‐effective strategy for preventing infant HIV infections. In these settings, two HIV retests postpartum marginally reduced MTCT and were less costly than adding three retests. Retesting in low‐burden settings with MTCT rates similar to Colombia and Ukraine was not cost‐effective at any time point due to very low HIV prevalence and limited breastfeeding.     

Effects of the culturally-sensitive comprehensive sex education programme among Thai secondary school students

Title. Effects of the culturally‐sensitive comprehensive sex education programme among Thai secondary school students. Aim. This paper reports on a study to evaluate the effectiveness of a culturally‐sensitive comprehensive sex education programme among Thai secondary school students. Background. Increasing number of adolescents in Thailand have been engaging in premarital sex. No theory‐based, abstinence‐oriented models of sex education have been evaluated in this population. Method. A quasi‐experimental study was conducted in 2006–2007. Outcome measures included sexual behaviour, condom use, intention to refuse sex, intention to use condoms, and knowledge regarding sexually transmitted infections/human immunodeficiency virus/acquired immunodeficiency syndrome and pregnancy. Findings. Students in the experimental group had lower levels of reported sexual intercourse at 3‐ and 6‐month follow‐ups, compared with those in control group (P < 0·01). Students participating in the programme had significantly greater intention to refuse sex in the future across time than controls (P < 0·05). Sexually active adolescents participating in the programme reported significantly lower frequencies of sexual intercourse across time than controls (P < 0·01). However, the programme did not influence consistent condom use (P > 0·05), although the intervention was associated with increased intention to use condoms (P < 0·01). Knowledge about sexually transmitted infections/human immunodeficiency virus/acquired immunodeficiency syndrome and pregnancy among students in the intervention group was significantly greater than that of the controls (P < 0·05). Conclusion. School nurses can play a major role by applying this kind of sex education programme. For nurse researchers, it would be useful to extend this research by considering alternative ways to foster condom use in the non‐commercial partnerships that have become common among adolescents.