ABSTRACTNon-communicable diseases (NCDs) are a major contributor to the global burden of disease, increasingly impacting low-income and marginalised populations in low- and middle-income countries such as Sri Lanka. Microfinance could be a potential approach to target NCDs. Using an ethnographic approach with thematic analysis, this study explored the nexus between microfinance and NCD outcomes. In-depth interviews were conducted with 29 micro-loan borrowing women across 15 field sites within Puttalam district in Sri Lanka. The findings revealed that perceived increases in income from microfinance loans contributed to enhanced household health savings ability, enabling the purchase of medicines bought out-of-pocket and from privately owned pharmacies, and spending for NCD-relevant health emergencies and health-related transportation. Additionally, perceived income increases also influenced the behavioural risks, including the spending and consumption of food, and physical activity levels, both positively and negatively. The microfinance networks also influenced women\'s perceived social support, psychological stress and coping mechanisms, and health information transmission, positively and negatively. The findings from this study provide important insights on how financial inclusion programs such as microfinance influence the health determinants and outcomes relevant to NCDs. This can help address ways to target both NCDs and inequities of socioeconomically disadvantaged and marginalised populations, particularly women.

The journey towards ending AIDS epidemic in Bangladesh by 2030 is ambitious yet achievable. Although Bangladesh has always had a low rate of HIV among its general population, it remains one of seven countries in Asia and the Pacific where new HIV cases are rising. This study evaluates the effectiveness of HIV programmatic strategies and investment scenarios using the AIDS Epidemic Model (AEM) from 2023 to 2030, focusing on optimizing resource allocation and interventions. The findings indicate that without improved program effectiveness, new HIV infections will increase to 1,382 by 2030, failing to meet the targets of the Global AIDS Strategy 2021-2026. If Bangladesh improves its HIV program effectiveness according to the Global AIDS Strategy 2021-2026, the NSP and Global AIDS Strategy targets could significantly lower new infections and AIDS-related deaths and increase treatment coverage to meet Ending AIDS targets. The NSP targets could reduce new HIV infections to under 275 annually and achieve treatment goals by 2030. The study reveals that NSP targets are the most cost-effective, offering the highest benefit-cost ratio, highlighting the urgent need to enhance HIV prevention program effectiveness, particularly among key populations, to achieve both public health and economic benefits.

Despite the potential role of health being recognised for more than a decade in fragile contexts, there are still gaps in understanding the possible paths towards peace. Particularly, current literature on health and development presents limitations, including insufficient evidence, a lack of thorough consideration for fragility and tensions between humanitarian and developmental approaches. Building upon prior discussions and limitations, this study aims to investigate the association between health indicators and the levels of economic and human development, employing panel data of 60 fragile states covering the years 1995-2021. Seven health outcome measures and three proxy measures for economic and human developments, including GDP per capita and Human Development Index with and without inequality adjustment, are employed in instrumental variable estimation. The analysis shows a positive association between the development measures and corresponding health indicators. These results suggest that promoting the health of the people, particularly among marginalised groups such as pregnant women and children, not only has the potential to protect them but also to facilitate economic and human developments of the fragile states. There is a need for approaching with people-centred and human capability perspectives to achieve the goal of \'Health and Peace for All\'.

Cabotegravir (CAB-LA), the only Food and Drug Administration-approved injectable pre-exposure prophylaxis (PrEP), is effective and may address PrEP uptake disparities among Black and Latino sexual and gender minority (SGM) men. Uptake of CAB-LA may require developing innovative non-clinic-based care delivery strategies in home-based settings. We explored SGM men\'s opinions on a future home-based CAB-LA PrEP care service to guide the adaptation of PrEP@Home, an existing home-based PrEP system for oral PrEP. Through 14 in-depth interviews with current or former SGM male participants in the PrEP@Home study, we explored the acceptability of a home-based injectable PrEP system and examined visit and communication-related preferences. All participants considered home-based CAB-LA care to be acceptable and 8/14 would utilize the system if available. Convenience and comfort with using a home-based system impacted the overall acceptance of the approach. Factors influencing acceptability included clinical teams\' affiliation with healthcare systems, a credentialed two-person team, and staff identity verification methods. Logistical preferences included communicating pre-visit patient instructions, allowing flexible scheduling hours, and the use of text, phone calls, or mobile app communication methods based on urgency. Conclusively, a home-based CAB-LA PrEP delivery system was acceptable among the interviewed SGM men, guiding its development and future implementation.Trial registration: ClinicalTrials.gov identifier: NCT03569813.

Intervention mapping (IM) is a planning approach that reflects the intricate decision-making process involved in the design of behavior interventions. The development and implementation of IM is complex in preventing HIV/AIDS transmission. Therefore, it is significant to conduct a perfect preliminary work to successfully implement HIV/AIDS prevention. The objectives of this review were to collect and evaluate the data of the first three steps using IM to prevent HIV/AIDS transmission, and summarize the key points in the preliminary steps of IM. A total of 18 studies were identified, and six studies completely described the tasks in the first three steps of IM. Three studies described the logic model of the problem (n = 3). Six studies reported the matrix of behavior changes (n = 6), including personal and environmental determinants. Among the selected determinants, most studies reported the personal level determinants (self-efficacy and skills, knowledge, attitudes, and norms). The most used practical applications in reducing HIV/AIDS risk behaviors were video roles (n = 8) and role-model stories (n = 5). The review may be helpful for healthcare professionals to carefully design and implement the key procedures of the first three steps of the IM programs for people with HIV/AIDS in preventing HIV/AIDS transmission.

Pre-exposure prophylaxis (PrEP) adherence remains a challenge among young men who have sex with men (MSM). We developed and tested a smartphone application (\"app\"), \"DOT Diary\", which combines automated directly observed therapy (DOT) with information about PrEP protection levels, pill-taking reminders, a sexual behavior diary, and a PrEP dosing calendar. To contextualize trial results, we qualitatively explored participants\' app experiences. The trial enrolled 100 young MSM in San Francisco and Atlanta. Participants were randomized 2:1 to DOT Diary versus standard-of-care and followed for 24 weeks. Interviews were conducted with 24 intervention participants. Data were analyzed using a memo-writing approach. Most expressed overall satisfaction with the app (\"it was good for its purpose\"), despite concerns about technical glitches. The most popular app features were the monthly calendar showing days PrEP was taken and information about level of protection based on pills taken. The DOT component helped participants establish PrEP routines. The reminders were \"annoying but effective\" at motivating dosing. Opinions about the sexual behavior diary varied. Overall, DOT Diary was acceptable; participants were willing to use it daily to record pill-taking. Critical components included the information about PrEP protection levels and calendar, while others may be modified to improve future success.Trial registration: ClinicalTrials.gov identifier: NCT03771638.

Natural pigments extracted from plant species are used in foods, cosmetics, and pharmaceuticals. This study evaluates the comprehensive biological activities of anthocyanins isolated from Andean blueberry (Vaccinium floribundum Kunth) and Andean blackberry (Rubus glaucus Benth), focusing on their antimicrobial, antioxidant, antitumoral, anti-inflammatory, and hemolytic properties. Chemical characterization revealed significant anthocyanin content with complex mass spectrometric profiles indicating diverse glycosylation patterns that may influence their bioactivity. The antimicrobial assays showed that the extracts were particularly effective against Gram-positive bacteria, with minimal inhibitory concentrations (MICs) as low as 1 mg/mL for Rubus glaucus, indicating strong potential for therapeutic use. The antioxidant capacity of the berries was substantial, albeit slightly lower than that of ascorbic acid. The extracts also exhibited notable antitumoral activity in various cancer cell lines, showing promise as adjunctive or preventive treatments. The anti-inflammatory effects were confirmed by inhibiting nitric oxide production in macrophage cells, highlighting their potential in managing inflammatory diseases. In terms of hemolytic activity, Rubus glaucus exhibited dose-dependent effects, potentially attributable to anthocyanins and phenolics, while Vaccinium floribundum demonstrated no significant hemolytic activity, underscoring its safety. These findings suggest that anthocyanins from Andean berries possess potent biological activities, which could be leveraged for health benefits in pharmaceutical and nutraceutical applications. Further studies are needed to isolate specific bioactive compounds and investigate their synergistic effects in clinical and real-world contexts.

We explored women\'s narratives about their experiences as victim-survivors of multiple forms of armed conflict violence and intimate partner violence (IPV) in Colombia and examined pathways that clarify the relationships between these two types of violence. Thematic analysis of 47 interviews identified connections that explain how armed conflict influences IPV at all levels of the socio-ecology. At the societal level, armed conflict events amplified patriarchal notions and intensified men\'s expressions of hypermasculinity through violence. At the community level, rules imposed by armed groups excused IPV if women did not comply with their traditional gender roles as wives and caretakers. At the relationship level, husbands/partners blamed victim-survivors of sexual violence perpetrated by armed groups, which intensified IPV situations. At the individual level, the armed conflict generated high levels of stress that contributed to increasing IPV. Results highlight the need to recognise armed conflict as an IPV risk factor that penetrates multiple socio-ecological domains. Post-conflict societies should consider the effects of the armed conflict on family dynamics and intimate partner relationships. Interventions should be developed to deconstruct hyper-militarised masculinity identities and traditional gender roles as an integral part of peace efforts.

Integration has emerged as a key strategy for promoting equitable access to health services for refugees and host populations. This study explored the perceptions and experiences of stakeholders on the integration of health services for refugees and host populations in two purposefully selected refugee-hosting districts of Adjumani and Obongi in the West Nile region, Uganda. This study used a case study design. Key informant interviews were conducted with 28 purposefully selected respondents. Data were analysed thematically. Quirkos software was used to manage and analyse data. Respondents indicated that integration is enhancing health services, providing an opportunity to strengthen them and improve coverage and access for refugees and host populations. Factors affecting integration include gaps in policy and implementation, ineffective systems and structures for service delivery, inadequate coordination and management and inadequate funding. At the service level challenges including inadequate infrastructure, shortage of health workers and stock out of medicines and essential supplies affect the integration of health services. Overall, structural and systemic issues continue to affect the integration of health services. It is important to strengthen policy implementation and build the capacity of districts to support the integration of health services.

Childhood sexual abuse (CSA) has been linked to substance use and substance use disorders in adulthood. However, there have been limited studies examining the relationship between CSA and opioid use among older adults living with HIV (OALH). Therefore, the aim of this study was to determine the association between CSA and opioid use among OALH (n = 91). Data were obtained from an HIV clinic population in South Carolina using paper-and-pen, and online questionnaires. CSA was operationalized using six questions from the Early Trauma Inventory-Self Report Form (Yes vs. No). Opioid use was self-report of the use of opioids including: heroin, fentanyl, Oxycontin, Vicodin, codeine, morphine (used vs. never used). Nested crude and multivariable logistic regression models adjusting for sociodemographic confounders were used to determine the association between CSA and opioid use. After adjusting for race, gender, age, and education, OALH who were CSA survivors were 21 times more likely to currently use opioids compared to OALH who were not exposed to CSA (adjusted OR: 21.1; 95% CI: 1.78-250.0). The association seen between CSA history and opioid use may be due to unresolved trauma among OALH. Trauma-informed interventions addressing CSA may help to reduce opioid use among OALH.