CSDE Affiliate Dr. Mia Bennett (Geography) co-authored research led by her former PhD student, Dr. Xiaofeng Liu, in Eurasian Geography and Economics, titled “Going out and going green: NGOs in the environmental governance of Global China“. While the roles of actors such as the state and state-owned enterprises within “Global China” elicit significant scholarly attention, non-governmental organizations (NGOs) are relatively less critiqued. These members of Chinese civil society are playing an increasingly important role in the environmental governance of the country’s overseas activities. By analyzing firsthand observations and interviews and secondhand materials produced by NGOs and the Chinese government, this article traces how and why Chinese NGOs seek to “green” China’s engagement beyond its borders.

First, the authors identify four types of Chinese NGOs with a variety of state- and non-state founders. Then, they examine how NGOs’ objectives and state policies jointly shape the way they “go out.” As both knowledge and political actors, Chinese NGOs accumulate, produce, and disseminate knowledge related to Global China’s environmental issues, across domestic and international spaces. Though the specific strategies pursued by NGOs depend on their type, overall, their alignment with Chinese state policies and interests constitutes a crucial condition for their success. This research offers new insights into Chinese non-state actors’ expanding participation in international activities. As the country’s civil organizations endeavor to exert influence both within and beyond China’s borders, the effects of their interventions on global governance may grow.

CSDE Affiliate Dr. Alison Roxby (Global Health and Medicine) recently published two articles with colleagues on bacterial vaginosis amongst adolescent girls and women in Kenya. Bacterial vaginosis is a risk factor for sexually transmitted infections, including HIV. The first article is published in BMJ Open, titled “Longitudinal assessment of bacterial vaginosis prior to and during incident pregnancy: an observational study in Kenyan adolescent girls and young women“, where authors sought to determine bacterial vaginosis (BV) status at multiple time points among adolescent girls and young women (AGYW) and assess the impact of pregnancy on their BV status. The second article is published in the American Journal of Obstetrics and Gynecology, titled “Low prevalence of bacterial vaginosis in Kenyan adolescent girls and rapid incidence after first sex“. This study aimed to describe bacterial vaginosis in younger African women, before and after first sex, and to determine the incidence of bacterial vaginosis and significant correlates of bacterial vaginosis incidence and recurrence.

CSDE Affiliate Dr. Alison Fohner (Epidemiology) and co-authors released research in the Journal of Alzheimer’s Disease, titled “Proteome Network Analysis Identifies Potential Biomarkers for Brain Aging“. Alzheimer’s disease and related dementias (ADRD) involve biological processes that begin years to decades before onset of clinical symptoms. The plasma proteome can offer insight into brain aging and risk of incident dementia among cognitively healthy adults. This study sought to identify biomarkers and biological pathways associated with neuroimaging measures and incident dementia in two large community-based cohorts by applying a correlation-based network analysis to the plasma proteome. Although associations from the discovery cohort did not replicate, proteome networks can help identify biological pathways in preclinical brain atrophy.

CSDE Affiliate Dr. Claire Rothschild (Population Services International) and colleagues released their research in Sexual and Reproductive Health Matters, “Assessing acceptability and effectiveness of a pleasure-oriented sexual and reproductive health chatbot in Kenya: an exploratory mixed-methods study“. Integrating pleasure may be a successful strategy for reaching young people with sexual and reproductive health and rights (SRHR) interventions. However, sexual pleasure-related programming and research remains sparse. Authors aimed to assess chatbot acceptability and describe changes in SRHR attitudes and behaviours among Kenyan young adults engaging with a pleasure-oriented SRHR chatbot.

They used an exploratory mixed-methods study design. Between November 2021 and January 2022, participants completed a self-administered online questionnaire before and after chatbot engagement. In-depth phone interviews were conducted among a select group of participants after their initial chatbot engagement. Quantitative data were analysed using paired analyses and interviews were analysed using thematic content analysis. Of 301 baseline participants, 38% (115/301) completed the endline survey, with no measured baseline differences between participants who did and did not complete the endline survey. In-depth interviews were conducted among 41 participants. They observed higher satisfaction at endline vs. baseline on reported ability to exercise sexual rights (P ≤ 0.01), confidence discussing contraception (P ≤ 0.02) and sexual feelings/needs (P ≤ 0.001) with their sexual partner(s). Qualitative interviews indicated that most participants valued the chatbot as a confidential and free-of-judgment source of trustworthy “on-demand” SRHR information. Participants reported improvements in sex-positive communication with partners and safer sex practices due to new learnings from the chatbot. We observed increases in SRHR empowerment among young Kenyans after engagement with the chatbot. Integrating sexual pleasure into traditional SRHR content delivered through digital tools is a promising strategy to advance positive SRHR attitudes and practices among youth.

CSDE Affiliate Dr. Grace John-Stewart (Global Health, Epidemiology, Medicine, and Pediatrics) co-authored research in the Pediatric Infectious Disease Journal, titled “Maternal HIV Status and Risk of Infant Mycobacterium Tuberculosis Infection as Measured by Tuberculin Skin Test“. Dr. Jerphason Mecha (Kenya Medical Research Institute) and Dr. Sylvia LaCourse also played key roles as authors on this article. The effect of maternal HIV on infant Mycobacterium tuberculosis (Mtb) infection risk is not well-characterized. Pregnant women with/without HIV and their infants were enrolled in a longitudinal cohort in Kenya. Mothers had interferon gamma-release assays (QFT-Plus) and tuberculin skin tests (TST) at enrollment in pregnancy; children underwent TST at 12 and 24 months of age. Authors estimated the incidence and correlates of infant TST-positivity using Cox proportional hazards regression.

Among 322 infants, 170 (53%) were HIV-exposed and 152 (47%) were HIV-unexposed. Median enrollment age was 6.6 weeks [interquartile range (IQR): 6.1–10.0]; most received Bacillus Calmette-Guerin (320, 99%). Thirty-nine (12%) mothers were TST-positive; 102 (32%) were QFT-Plus-positive. Among HIV-exposed infants, 154 (95%) received antiretrovirals for HIV prevention and 141 (83%) of their mothers ever received isoniazid preventive therapy (IPT). Cumulative 24-month infant Mtb infection incidence was 3.6/100 person-years (PY) [95% confidence interval (CI): 2.4–5.5/100 PY]; 5.4/100 PY in HIV-exposed infants (10%, 17/170) versus 1.7/100 PY in HIV-unexposed infants (3.3%, 5/152) [hazard ratio (HR): 3.1 (95% CI: 1.2–8.5)]. More TST conversions occurred in the first versus second year of life [5.8 vs. 2.0/100 PY; HR: 2.9 (95% CI: 1.0–10.1)]. Infant TST-positivity was associated with maternal TST-positivity [HR: 2.9 (95% CI: 1.1–7.4)], but not QFT-Plus-positivity. Among HIV-exposed children, Mtb infection incidence was similar regardless of maternal IPT.

Mtb infection incidence (by TST) by 24 months of age was ~3-fold higher among HIV-exposed children, despite high maternal IPT uptake. Overall, more TST conversions occurred in the first 12 months compared to 12–24 months of age, similar in both HIV-exposed and HIV-unexposed children.