Aids Care-psychological and Socio-medical Aspects of Aids/hiv, Apr 27, 2017
In March 2016, WHO reviewed evidence to develop global recommendations on the sexual and reproduc... more In March 2016, WHO reviewed evidence to develop global recommendations on the sexual and reproductive health and rights (SRHR) of women living with HIV. Systematic reviews and a global survey of women living with HIV informed the guideline development decision-making process. New recommendations covered abortion, Caesarean section, safe disclosure, and empowerment and self-efficacy interventions. Identification of key research gaps is part of the WHO guidelines development process, but consistent methods to do so are lacking. Our method aimed to ensure consistency and comprised the systematic application of a framework based on GRADE (Grading of Recommendations, Assessment, Development and Evaluation) to the process. The framework incorporates the strength and quality rating of recommendations and the priorities reported by women in the survey to inform research prioritisation. For each gap, we also articulated: (1) the most appropriate and robust study design to answer the question; (2) alternative pragmatic designs if the ideal design is not feasible; and (3) the methodological challenges facing researchers through identifying potential biases. We found 12 research gaps and identified five appropriate study designs to address the related questions: (1) Cross-sectional surveys; (2) Qualitative interview-driven studies; (3) Registries; (4) Randomised controlled trials; and (5) Medical record audit. Methodological challenges included selection, recruitment, misclassification, measurement and contextual biases, and confounding. In conclusion, a framework based on GRADE can provide a systematic approach to identifying research gaps from a WHO guideline. Incorporation of the priorities of women living with HIV into the framework systematically ensures that women living with HIV can shape future policy decisions affecting their lives. Implementation science and participatory research are appropriate over-arching approaches to enhance uptake of interventions and to ensure inclusion of women living with HIV at all stages of the research process.
AGRIS record. Record number, GB9406440. Titles, Acknowledging process: challenges for agricultura... more AGRIS record. Record number, GB9406440. Titles, Acknowledging process: challenges for agricultural research and extension methodology. Personal Authors, Cornwall, A.,Gujit, I.,Welbourn, A. Publisher, IDS. Publisher Place, Sussex Univ. (United Kingdom). Publication Date, 1993 ...
Criticisms abound among HIV activists about World Health Organization guidelines, which include a... more Criticisms abound among HIV activists about World Health Organization guidelines, which include antiretroviral treatment for all children aged under 5 with HIV. Why does WHO not consult properly with those affected by the disease, asks Alice Welbourn Alice Welbourn founding director, Salamander Trust, London 12 Sophia Forum. Reports referenced in Sophia Forum final report 2013. www.dropbox.com/ sh/mmt2xb3dir73i1f/V-g-3ROxAW. 13 WHO. Voluntary medical male circumcision for HIV prevention: Fact Sheet. Jul 2012. www.who.
Development of the Canadian Women-Centred HIV Care Model Using the Knowledge-to-Action Framework
Journal of the International Association of Providers of AIDS Care (JIAPAC), 2021
In Canada, women make up 25% of the prevalent HIV cases and represent an important population of ... more In Canada, women make up 25% of the prevalent HIV cases and represent an important population of those living with HIV, as a high proportion are racialized and systemically marginalized; furthermore, many have unmet healthcare needs. Using the knowledge-to-action framework as an implementation science methodology, we developed the “Women-Centred HIV Care” (WCHC) Model to address the needs of women living with HIV. The WCHC Model is depicted in the shape of a house with trauma- and violence-aware care as the “foundation”. Person-centred care with attention with attention to social determinants of health and family make up the “first” floor. Women’s health (including sexual and reproductive health and rights) and mental and addiction health care are integrated with HIV care, forming the “second” floor. Peer support, leadership, and capacity building make up the “roof”. To address the priorities of women living with HIV in all their diversity and across their life course, the WCHC Mode...
Key Barriers to Womens Access to HIV Treatment: A Global Review
Interpersonal neurobiology and the prevention of gender-based violence
People with HIV can now live long, healthy and productive lives as long as they have timely acces... more People with HIV can now live long, healthy and productive lives as long as they have timely access to medication when they need it, combined with care, love, respect and support. Stepping Stones and subsequently Stepping Stones Plus were manuals that grew out of a need to counter the prejudice and fear surrounding HIV, and to foster strong and mutually respectful relationships, free from violence and without sexually transmitted infections or unplanned pregnancies. Stepping Stones is recognized by WHO, UNAIDS, USAID and many others as one of the few global interventions to reduce intimate partner violence, now recognized as a key cause and consequence of HIV for women globally. Now combined into a single manual and revised and updated, Stepping Stones and Stepping Stones Plus is a training package designed to help trainers and community members organize a workshop. The training is with young and older women and men, separately and together, to explore their social, sexual and psychological needs, to overcome their communication blocks, and to practise ways of enriching their relationships. The workshop sessions help individuals, peers and their communities move step by step to change behaviours and to build healthy relationships. The manual and an optional DVD describe how to organize the workshop and run structured exercises involving role play and other participatory methods of group learning. Workshop sessions are held mostly in four separate peer groups, based on self-identified age and gender groupings, with some larger meetings. The optional DVD consists of 15 short clips designed to provide participants with a springboard for discussion during the different sessions of the workshop. Stepping Stones and Stepping Stones Plus is essential reading for social workers, community workers, health workers, NGO staff and people living with HIV working on HIV-related community programmes; also researchers and academics teaching and advising in this field.
Population health surveys are rarely comprehensive in addressing sexual health, and population-re... more Population health surveys are rarely comprehensive in addressing sexual health, and population-representative surveys often lack standardized measures for collecting comparable data across countries. We present a sexual health survey instrument and implementation considerations for population-level sexual health research. The brief, comprehensive sexual health survey and consensus statement was developed via a multi-step process (an open call, a hackathon, and a modified Delphi process). The survey items, domains, entire instruments, and implementation considerations to develop a sexual health survey were solicited via a global crowdsourcing open call. The open call received 175 contributions from 49 countries. Following review of submissions from the open call, 18 finalists and eight facilitators with expertise in sexual health research, especially in low and middle-income countries (LMICs), were invited to a 3-day hackathon to harmonize a survey instrument. Consensus was achieved ...
Population health surveys are rarely comprehensive in addressing sexual health, and population-re... more Population health surveys are rarely comprehensive in addressing sexual health, and population-representative surveys often lack standardised measures for collecting comparable data across countries. We present a sexual health survey instrument and implementation considerations for population-level sexual health research. The brief, comprehensive sexual health survey and consensus statement was developed via a multi-step process (an open call, a hackathon, and a modified Delphi process). The survey items, domains, entire instruments, and implementation considerations to develop a sexual health survey were solicited via a global crowdsourcing open call. The open call received 175 contributions from 49 countries. Following review of submissions from the open call, 18 finalists and eight facilitators with expertise in sexual health research, especially in low- and middle-income countries (LMICs), were invited to a 3-day hackathon to harmonise a survey instrument. Consensus was achieved...
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Papers by Alice Welbourn