Globally, cis and trans women face increasing rates of HIV, yet the uptake of existing HIV prevention medications often fails to meet their specific needs. This review examines HIV pre-exposure prophylaxis (PrEP) use among cis and trans women, including adolescent girls and young women; newcomers and migrants; sex workers; women who use drugs; and women who have been incarcerated, acknowledging intersectionality exists between these groups. A review of peer-reviewed published literature was conducted, and findings specifically on oral PrEP were synthesized. This review highlights several key themes shaping women's engagement with PrEP, including barriers to initiation and discontinuation; public health messaging and promotion; the role of women's networks; intimate partner violence; interpersonal trust in relationships; and "seasons of risk," where temporary reductions in perceived risk may lead to discontinuation. Additional themes include preferred access points for PrEP, regional differences, and clinical implications for practice. Peer support and peer navigators emerge as important mechanisms for creating safe spaces that enhance trust and sustained PrEP use. Improving PrEP uptake and persistence among women requires a multifaceted, women-centred approach that addresses clinical, social, and structural barriers. Context-specific implementation remains critical to addressing diverse lived realities and strengthening HIV prevention outcomes globally.
Abstract Background Psychosis is one of the most highly stigmatized mental health conditions (Thornicroft et al., 2009). Compared to those with other mental health concerns, people diagnosed with schizophrenia spectrum disorders are more likely to be perceived by others as dangerous, violent, and unpredictable. As a result, they are often socially marginalized and discriminated against (Crisp et al., 2000; Martin et al., 2007). Individuals at clinical high risk (CHR) for psychosis may be at lower risk for experiencing public stigma, given that their symptoms are often less outwardly visible at this early stage of illness. However, evidence suggests that those at CHR experience high levels of self-stigma, as they may internalize negative stereotypes related to psychosis (Yang et al., 2010; Yang et al., 2015). Internalized stigma can negatively impact help-seeking behavior and has been associated with lower self-esteem and the underreporting of mental health symptoms (Corrigan, 2004; Corrigan, 2007; Saporito, Ryan, & Teachman, 2011; Rüsch, Angermeyer, & Corrigan, 2005). Despite these findings, no studies to-date have examined how internalized stigma may impact reporting of attenuated psychosis symptoms in the CHR population. The current study aims to examine whether discrepancies between self-report and clinician-rated measures of psychosis risk are associated with internalized stigma in a sample of help-seeking adolescents and young adults. We hypothesized that higher levels of self-stigma will predict inconsistencies between self-reported symptom severity and clinician-obtained diagnoses of psychosis risk. Methods Participants will include youth classified as either non-psychosis-related help-seeking controls or at clinical high risk (CHR) for psychosis, as determined by the Structured Interview for Psychosis-Risk Syndromes (SIPS; Miller et al., 2003). The SIPS is administered by trained raters and is currently considered the gold standard tool for diagnosing clinical high-risk syndromes (Thompson et al., 2018). In addition to SIPS diagnoses, psychosis risk will also be assessed using the Prime Screen – Revised (PS-R; Miller et al., 2004), a brief, 12-item self-report questionnaire designed to measure attenuated positive symptoms. Lastly, internalized stigma will be assessed using the Internalized Stigma of Mental Illness Inventory (ISMI; Ritsher, Otilingam, & Grajales, 2003), a 29-item self-report questionnaire designed to measure subjective experiences of stigma in adolescents (e.g., endorsement of negative stereotypes, social withdrawal and feelings of alienation due to mental health problems, etc.). Results Preliminary analyses demonstrate a significant interaction between Prime scores and internalized stigma in predicting SIPS diagnoses. Specifically, higher scores on the Prime were associated with increased odds of being diagnosed as CHR on the SIPS, but only for those participants who endorsed low and mean levels of stigma. For participants who endorsed high levels of stigma, there did not appear to be any relation between Prime scores and SIPS diagnoses. Discussion At the time of submission, participant recruitment is ongoing, and results and discussion will be presented on the final sample. Findings may inform efforts to improve detection and accurate diagnosis of psychosis risk syndromes in individuals at early stages of illness.
Background Armed conflict exposes children to prolonged and multifaceted adversity, including violence, displacement, bereavement, family disruption, poverty, insecurity, and disrupted schooling. Although research on psychosocial interventions for conflict-affected children has grown, the evidence remains heterogeneous, and causal conclusions are often difficult to distinguish from feasibility, contextual, or implementation findings. Objective This systematic interpretive mapping review aimed to synthesize evidence on psychosocial interventions for children affected by armed conflict by mapping intervention types, delivery platforms, mechanism-related intervention content, family and caregiving context, and implementation conditions, while explicitly separating levels of evidentiary inference. Methods A systematic search of five major databases identified 7,729 unique records, of which 50 evidence sources met the final inclusion criteria. Evidence sources included randomized controlled trials, cluster randomized trials, crossover randomized trials, quasi-experimental studies, pilot and usability studies, observational studies, reviews, conceptual papers, guidelines, operational guidance, and implementation sources. Data were extracted and synthesized using a convergent segregated mixed-methods approach. Evidence sources were classified into 17 effectiveness studies, 2 non-comparative intervention studies, and 31 contextual or implementation evidence sources to separate cautious causal inference from feasibility, contextual, policy, and implementation interpretation. Methodological quality was assessed using Joanna Briggs Institute tools where applicable, and certainty of evidence was assessed separately from study-level methodological quality. Results Effectiveness evidence was concentrated in school-based, community-based, trauma-focused, group-based, family-focused, and emerging digital interventions, often delivered by non-specialist providers in resource-constrained or humanitarian settings. Controlled studies suggested modest and heterogeneous improvements in post-traumatic stress, depression, anxiety, behavioral difficulties, and psychosocial functioning. Family-focused and caregiver-relevant interventions appeared promising, but the number of rigorous trials was limited. Trauma-focused and skills-based interventions showed potential benefit when delivered with adequate structure, supervision, cultural adaptation, and continuity. Digital interventions remained at an early stage of evaluation. Contextual and implementation evidence highlighted the importance of caregiver functioning, ongoing daily stressors, displacement, safety, school continuity, supervision, service access, and delivery platform stability, but these factors were rarely tested as formal mechanisms or moderators. Conclusions Psychosocial interventions for conflict-affected children show promise, but outcomes vary across intervention types, populations, delivery platforms, and conflict settings. Rather than identifying a single optimal intervention, this review suggests that intervention benefit should be understood within a broader ecological and implementation system. Future research should directly test mechanisms, moderators, developmental differences, implementation conditions, equity, digital access, and long-term outcomes to strengthen causal understanding and improve intervention design in humanitarian settings.
Abstract BACKGROUND Diffuse Intrinsic Pontine Glioma (DIPG) remains an incurable pediatric brain cancer. The oncohistone H3K27M implicated in 80% of the cases, is also predicted to target Enhancer of Zeste Homolog 2 (Ezh2), the catalytic component of the Polycomb Repressor Complex 2 (PRC2). There are no reported mutations of Ezh2 and its function in DIPG is not fully determined. This work aims to address the role of Ezh2 in DIPG. METHODS Brainstem tumors were established by intracranial injections of Nestin;Tv-a; Ezh2Y641F/+ (NTv-a; Ezh2Y641F/+) neonatal pups using Replication Competent Avian Sarcoma leucosis virus long terminal repeat with splice acceptor (RCAS) viruses, expressing PDGF-B, p53 shRNA, and RCAS-CRE/Y. Immunohistochemical staining for Ki-67 and H3K27me3 were performed on the Discovery ULTRA (Ventana). RESULTS Ezh2 overexpression (Ezh2Y641F/+, RCAS CRE) conferred a survival advantage of approximately 10 days (n=20 mice/group, p<0.001). H3K27me3 levels were significantly upregulated in RCAS CRE group (50% vs 20% in RCAS Y, n=4 tumors/group, p<0.03), with a concomitant lower Ki-67 staining (30% vs. 55% in RCAS Y, n=3 tumors/group, p<0.05). Interestingly, pathological review categorized more RCAS-CRE tumors as ‘atypical’. RNA-sequencing of virus-infected neural precursor cells revealed a suppression of inflammatory/interferon gene signature in the Ezh2 overexpression group. CONCLUSIONS AND FUTURE DIRECTIONS: Enhanced Ezh2 activity appears to delay DIPG pathogenesis. Ongoing work aims to highlight the contribution of differentially expressed gene signatures that contribute to this phenotype.
Abstract Background It is well known that underweight in adolescence and early adulthood predicts later schizophrenia.1 Some studies have shown an association between future schizophrenia or psychosis and underweight in children, starting at the age of 7.2 There are very few previous studies concerning underweight in early childhood and the risk of psychosis as well as other psychiatric outcomes. Our aim was to study whether deviation from normal weight, i.e. underweight or overweight, in early childhood and adolescence predicts later development of non-affective psychosis. And if so, whether the mechanism is specific to psychosis or also predicts other psychiatric disorders. Methods The participants were derived from a general population cohort study ‘Cardiovascular Risk of Young Finns’, which was started in 1980 with 3596 children and adolescents participating from six different age groups (3–18 years), with a continued follow-up. BMI was recorded before the first hospitalization due to a psychiatric disorder (≤18 years of age) and categorized as underweight, normal weight or overweight using the BMI classification for children and adolescents provided by Cole et al.3,4 All psychiatric diagnoses of the participants were acquired from the Finnish Hospital Discharge Register. We formed DSM-IV diagnostic groups of non-affective psychosis (n=70, including a schizophrenia subgroup, n=41), personality disorders (n=44), affective disorders (mood- and anxiety disorders, n=115), and substance-related disorders (n=53). Participants in the diagnostic groups were compared with subjects with no psychiatric diagnoses (n=3313). Sex, age, low birth weight and mother’s mental disorders were used as potential confounders in the analyses. Results Underweight, but not overweight, during the age of 3 to 18 years independently predicted later development of non-affective psychosis. Underweight in childhood and/or adolescence increased the risk of psychosis over two-fold (relative risk (RR) [95% CI] 2.31 [1.2–4.4]). Results were similar for schizophrenia; underweight was associated with nearly 2.5-fold risk of schizophrenia (RR 2.44 [1.03–5.8]). Underweight or overweight in childhood and adolescence was not significantly associated with any other studied psychiatric disorder with a more severe clinical phenotype that required hospital treatment. Discussion Underweight in childhood and adolescence is an independent risk factor for later non-affective psychosis. The mechanism behind underweight in premorbid phase of psychosis is not known but e.g. low level of insulin-like growth factor-I (IGF-I) may be involved. These results support the hypothesis of schizophrenia as a neurodevelopmental disorder with somatic aspects appearing already in early childhood and psychosis as a late stage of illness. References 1.Weiser M, Knobler H, Lubin G, et al. Body mass index and future schizophrenia in Israeli male adolescents. J Clin Psychiatry. 2004;65(11):1546–1549. doi:10.4088/JCP.v65n1117. 2.Wahlbeck K, Forsén T, Osmond C, Barker DJP, Eriksson JG. Association of Schizophrenia With Low Maternal Body Mass Index, Small Size at Birth, and Thinness During Childhood. Arch Gen Psychiatry. 2001;58(1):48. doi:10.1001/archpsyc.58.1.48. 3.Cole TJ. Establishing a standard definition for child overweight and obesity worldwide: international survey. Bmj. 2000;320(7244):1240-1240. doi:10.1136/bmj.320.7244.1240. 4.Cole TJ, Flegal KM, Nicholls D, Jackson AA. Body mass index cut offs to define thinness in children and adolescents: international survey. Bmj. 2007;335(7612):194-194. doi:10.1136/bmj.39238.399444.55.
Abstract Background About 1 in 5 youth have a mental illness, with 75 percent of all mental illnesses having their onset in childhood or adolescence (Kim-Cohen et al., 2003). In Ontario, 157,900 youth rated their mental health as fair or poor, a significant increase from 2007 (Boak et al., 2014). Not only do mental health concerns cause difficulties at onset, they can also disrupt important life transitions and developmental milestones, as well as being burdensome throughout the individual’s lifespan (Ratnasingham et al., 2012). Consequently, new care approaches are needed. The TELEPROM-Y project will evaluate outpatient health care delivery using InputHealth’s electronic Collaborative Health Record (CHR) at London Health Sciences Centre, St. Joseph’s Health Care London, Woodstock General Hospital, and community agencies including Youth Opportunities Unlimited, WAYS Mental Health Support, and Leads Employment Services. Methods 120 youth (ages 14–25) will be recruited from the caseloads of 46 mental healthcare providers. Participants will use a smartphone application (app) to connect to the Collaborative Health Record. Semi-structured interviews will be conducted at baseline, 6, and 12 months. This is a participatory action research project utilizing a pre-post, mixed-methods design. A standardized evaluation framework will be instituted to facilitate systematic effectiveness, economic, ethical, and policy analyses. Some of the functions of the app, available for Apple and Android phones, include: making/changing/cancelling appointments; text messaging; emailing, and filling out questionnaires/surveys. If the youth are unable to attend a scheduled appointment in person, the care-provider and youth can have a virtual visit, similar to FaceTime or Skype. Virtual visits should reduce missed appointments. Results Descriptive information thus far of 104 participants: Psychotic Disorder (e.g. schizophrenia) (13, 12.6%), Developmental handicap (e.g. Autism) (7, 6.8%), Anxiety Disorder (e.g. PTSD) (73, 70.9%), Disorder of childhood/adolescence (e.g. ADHD) (37, 35.9%), Substance-related disorder (13, 12.6%), Personality Disorder (17, 16.5%), Mood Disorder (e.g. depression, bipolar mood disorder) (70, 68.0%), Unknown (4, 3.9%), Other (19, 18.4%). Discussion We anticipate that through the usage of the TELEPROM-Y app the participant and care-provider experience will be enhanced, leading to 1) improved healthcare outcomes and patient quality of life, and 2) reduced healthcare costs by preventing hospitalization and reducing the need for face-to-face outpatient visits.
Abstract Background Currently, most attempts at early identification and intervention for individuals at risk for schizophrenia focus on the prodromal phase of the illness during adolescence. However, cognitive and other deficits likely arise well before the prodromal phase. Many risk genes for schizophrenia play a role in early brain development, and recent studies indicate that the basic structural and functional networks of the brain are in place by the second year of life. This suggests that schizophrenia likely has origins in prenatal and early childhood brain development, and that early identification and intervention may need to be shifted to this developmental period to have a real impact on the incidence and severity of schizophrenia. Methods We studied early childhood brain development 25 children of mothers with schizophrenia and 178 control children. Children had a 3T MRI after birth and at 1 and 2 years of age, and global tissue volumes (gray matter, white matter, CSF), ventricle volumes, and cortical thickness and surface area were determined. Children were also assessed with the Mullen Scales of Early Learning at 1 and 2 years. Results Children at risk for schizophrenia had significantly lower Mullen Composite scores at both age 1 (p=0.0078) and 2 years (p=0.0001) compared to control children. Reductions were present in fine motor, expressive and receptive language scales at both ages. Overall, high-risk children did not differ from controls in global tissue volumes, though there was evidence of a gender effect. Female high-risk children tended to have reduced gray matter volumes after birth and at age 1 year (significant reduction after birth, p =0.018), while males tended have increased gray matter volumes at age 1 and 2 years (significant at 1 year, p = 0.037). Cortical thickness and surface area results tended to reflect the gray matter volume findings. Females had regions of significant cortical surface area reduction after birth, while males had several regions of significant of cortical surface area expansion at 1 year. Males had a few regions of significant changes of cortical thickness after birth. Discussion In the context of its limitations, this study confirms previous studies that find alterations of very early childhood development in children at risk for schizophrenia. It also indicates that alterations of cortical gray matter are evident in very early childhood, and that there is a gender difference in these alterations, with females having reduced gray matter volumes and males having increased gray matter volumes. Brain structure and cognitive abnormalities associated with risk for schizophrenia are present shortly after birth; future studies may be able to identify very early biomarkers of risk that will not only improve our understanding of how brain abnormalities associated with schizophrenia develop, but also define periods of childhood development that can be targeted with early intervention.
Introduction Adolescents and young people aged 10-24 years comprise 32% of the total population of Pakistan. Adolescents and young people are a heterogeneous group-in different stages of development, living in different circumstances and with differing and changing needs. Neglect of specific adolescents' sexual and reproductive health (SRH) needs can pose serious challenges and affect physical and mental health, future employment, economic well-being and adolescents' ability to reach their full potential. Evidence suggests that adolescents in Pakistan have poor access to SRH services, including access to contraception and limited knowledge of SRH and rights (SRHR), contributing to unplanned pregnancies, very early childbearing, short birth intervals, pregnancy complications, maternal death and disability. Despite recognising adolescence as an important developmental period, research on SRHR needs and access to SRH information among adolescents in Pakistan is scarce. This project will use a participatory action research (PAR) approach based on the principles of public engagement in science and innovation to develop a national SRHR and Family Planning Advocacy Toolkit for adolescents in Pakistan. Methods and analysis We will use the PAR framework to guide our study. This research project will be conducted in three stages with cyclical recurring activities involving planning, acting, observing and reflecting, as informed by the PAR framework. The three stages are: (1) establishment of youth advisory groups and identification and prioritisation of SRHR concerns, (2) planning and co-designing an appropriate intervention (ie, SRHR and Family Planning Advocacy Toolkit) and (3) implementation and usability testing of advocacy Toolkit. This project leverages strong, well-established partnerships among researchers, clinicians, lady health workers (LHWs) and adolescent communities living in rural parts of Pakistan. Ethics and dissemination This study has received ethics approval from the University of Alberta Research Ethics Board (Pro00129101_REN1) and the Ethics Review Committee at Aga Khan University (2023-8671-26021). We will actively engage adolescent advisory group members, youth partners and LHWs in the dissemination of the Toolkit to ensure that it will reach end users in the rural community. In collaboration with governmental platforms, community non-governmental organisations and educational campaigns, the Toolkit will be disseminated to ensure SRH knowledge is readily available to young adolescents. We will also publish our study findings for peer-reviewed publications, digital stories and conference presentations.
Abstract Background The implementation of a health service does not necessarily equate to a health gain. Effective Coverage (EC) aims to capture the potential benefits of a health intervention by adjusting the crude coverage for quality. The aim of this study was to assess the EC of Antenatal Care (ANC), Institutional deliveries and Postnatal Care (PNC) in Oyam district, Uganda, considering the input (drugs and equipment) and the process dimension (components of care provided). Methods The study involved 19 Health Centers (HC), 12 type II, 6 type III and 1 type IV, having a catchment area of 15.603 expected deliveries per year. The analysis covered the period between April and September 2021. Data on crude coverage were retrieved from the District Health Information Software-2. Data used to assess quality domains were extracted from checklists compiled during Supportive Supervisions and were summarized by readiness and likelihood of quality care indices. The crude coverage of the interventions was adjusted to calculate the input-adjusted and the quality-adjusted coverage. Results The readiness index was 0.81 for ANC, 0.82 for institutional delivery and 0.88 for PNC, while the likelihood of quality of care was 0.73, 0.88 and 0.89 respectively. In all three areas, the loss of coverage was mainly due to lack of materials and equipment; HCs II showed lower quality indexes than HCs III, particularly for ANC (P = 0.007). Compared to the target population, EC was 40% for ANC4 visits, 48% for institutional deliveries and 77% for PNC visits. The gap between crude and EC was higher for ANC4 (-30%) compared with the one for institutional deliveries (-18%) and PNC (-23%). Conclusions EC is a useful indicator for monitoring maternal and neonatal services in low-resource countries, bringing gaps in crude coverage to the surface. Supportive Supervision provides an opportunity to assess EC at the facility level without additional resources and to support health authorities in setting priorities. Key messages The application of EC framework can be adapted both at district and facility level, either to a single service or healthcare pathways, and guide public health intervention. Integration of Supportive Supervision data in the EC is an innovative approach and permit to include the quality of care dimension in the routine data collection.
Background Violence against women is a major public health problem that affects the physical, sexual, mental, and social wellbeing of more than one-third of all women worldwide. Hence the purpose of this study was to determine the prevalence of physical and sexual intimate partner violence (IPV) and associated factors among married adolescent girls and young women (AGYW) belonging to the pastoralist community of Dassenech district, South Omo Zone, South Ethiopia. Methods A community-based cross-sectional survey was conducted among married AGYW in the Dassenech district from March 1, 2022, to April 1, 2022. A multi-stage sampling technique was adopted to select 545 participants. The data were collected using pre-tested and standardized WHO multi-country study tools. A binary logistic regression model was fitted to identify the independent predictors of physical and sexual intimate partner violence. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to measure the effect size, and finally, a p-value<0.05 was considered statistically significant. Results The prevalence of physical IPV among AGYW belonging to the pastoralist community of Dassenech district was 44.1% (95% confidence interval (CI): 40%, 48%) and that of sexual IPV was 39.3% (95% CI: 35%, 43%). The husband only deciding for the household (AOR = 11.36; 95% CI: 6.97, 18.53), the father performing the Dimi cultural ceremony (AOR = 3.70; 95% CI: 2.22, 6.14), and frequent quarrels (AOR = 2.06; 95% CI: 1.07, 3.99) are significantly associated with physical IPV. Both partners drinking alcohol (AOR = 3.47; 95% CI: 1.94, 6.20), the husband only deciding for the household (AOR = 11.23; 95% CI: 6.91, 18.27), and frequent quarrels (AOR = 2.29; 95% CI: 1.15, 4.56) were factors significantly associated with sexual IPV. Conclusion Physical and sexual intimate partner violence is a significant public health problem in the study area. Therefore, interventional measures to change the attitude of cultural leaders, providing education to married men and women on risky sexual behavior, and empowering women need to be prioritized to prevent the occurrence of this problem.
