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Introduction: Individual differences in social learning impact many important decisions, from voting behavior to polarization. Prior research has found that there are consistent and stable individual differences in social information use. However, the underlying mechanisms of these individual differences are still poorly understood. Methods: We used two complementary exploratory machine learning approaches to identify brain volumes related to individual differences in social information use. Results and discussion: Using lasso regression and random forest regression we were able to capture linear and non-linear brain-behavior relationships. Consistent with previous studies, our results suggest there is a robust positive relationship between the volume of the left pars triangularis and social information use. Moreover, our results largely overlap with common social brain network regions, such as the medial prefrontal cortex, superior temporal sulcus, temporal parietal junction, and anterior cingulate cortex. Besides, our analyses also revealed several novel regions related to individual differences in social information use, such as the postcentral gyrus, the left caudal middle frontal gyrus, the left pallidum, and the entorhinal cortex. Together, these results provide novel insights into the neural mechanisms that underly individual differences in social learning and provide important new leads for future research.

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Knowledge about the environment is fundamentally important to move, find resources and forage efficiently. This information can either be acquired through individual exploration (personal information) or from other group members (social information). We experimentally assessed the use of social information and its influence on foraging efficiency in sheep, Ovis aries. Naïve individuals paired with an informed partner that knew the food patch location, found the patch significantly faster compared to naïve individuals paired with another naïve individual. Similarly, they spent a significantly lower proportion of time exploring areas away from the food patch. We further found that the outcome of using social information in one directly previous trial (success = access to feed vs failure = no access to feed) had no impact and sheep continued to use social information in the subsequent foraging trial and foraged similarly efficient. Our results suggest, naïve sheep that are unfamiliar with resource locations, forage more efficiently when informed individuals are present compared to when all individuals are naïve. If informed individuals play a similar role in larger groups, new management practices that integrate informed sheep could be developed to improve foraging efficiency when sheep are moved to new paddocks or in paddocks with heterogenous and dynamic resource distribution.

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When choosing, primates are guided not only by personal experience of objects but also by social information such as others' attitudes toward the objects. Crucially, both sources of information-personal and socially derived-vary in reliability. To choose optimally, one must sometimes override choice guidance by personal experience and follow social cues instead, and sometimes one must do the opposite. The dorsomedial frontopolar cortex (dmFPC) tracks reliability of social information and determines whether it will be attended to guide behavior. To do this, dmFPC activity enters specific patterns of interaction with a region in the mid-superior temporal sulcus (mSTS). Reversible disruption of dmFPC activity with transcranial ultrasound stimulation (TUS) led macaques to fail to be guided by social information when it was reliable but to be more likely to use it when it was unreliable. By contrast, mSTS disruption uniformly downregulated the impact of social information on behavior.

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Animals live in complex natural environments. Based on the effects of natural selection, theory on animal information use says that it is optimal for animals to make "rational" decisions, i.e., to choose alternatives which maximize fitness gains, irrespective of the number of alternatives presented to them. Yet, animals commonly make seemingly "irrational" choices in the face of complex and variable stimuli that challenge their cognitive machinery. Here, we test the choice overload hypothesis - decision-making is negatively affected when animals experience an overload of choice. Using simultaneous-choice trials that varied in choice repertoire size, we examined oviposition site selection behaviour in Aedes aegypti towards larval predators, the nymphs of Bradinopyga geminata. Based on the underlying fitness trade-offs of oviposition decision-making, we predicted that female oviposition preference would be weaker and variation in this response would be higher in complex, multiple-choice trials than in binary-choice trials. In partial support of our hypothesis, oviposition preference was weaker in the complex, multiple-choice trials, but the variation in response depended on predator density, and did not depend on choice repertoire size. We suggest that information overload can negatively affect certain aspects of animal decision-making, resulting in choices appearing as "irrational" if the complexity of the decision-making context is not incorporated. Information overload can potentially lead to alternative strategies, such as bet-hedging or decision-making with reduced discrimination.

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INTRODUCTION: Even though the information generated by routine health information systems is an essential element in the process of transforming the health sector, the information is systematically under-utilized by the health workers. Hence, this study was aimed to assess the utilization level and associated factors of routine health information system data among department heads in Eastern Ethiopia. METHODS: The cross-sectional study design was conducted among heads of departments in the health facilities of Harari region. The source populations and the study populations were all department heads. The data were collected by standardized tools through interviews, observations, and document reviews. The data were entered into Epi Data version 3.1 and then exported to SPSS version 25 for analysis. Multivariable logistic regression was performed to identify the associated factors and P-value < 0.05 was used to declare the statistically significant association. RESULT: Of the respondents, 51.8 % live in urban, 82.4 % participated in performance review meeting, 61.7 % received feedback, 80.6 % engage in HIS, and 91 % feel responsible to HIS. Routine health information system data utilization among department heads was 177 (79.7 %); 95 % CI: [73.8 %, 84.8 %] in the Harari region. Factors associated with data utilization were urban residence (AOR = 2.891; 95 %CI: 1.147-7.286), getting feedback (AOR = 3.136; 95 %CI: 1.311-7.499), active engagement in health information system activities (AOR = 2.560; 95 %CI: 1.010-6.490), participation in performance review meeting (AOR = 3.847; 95 %CI: 1.563-9.464), and feeling responsibility (AOR = 3.727; 95 %CI: 1.071-12.961). CONCLUSION: Level of data use in this study was higher than the one in other studies in Ethiopia. Residence, feedback, level of engagement in health information system activities, sense of responsibility towards health information system, and performance review meeting were the determinants of data utilization. Important attention should be given by the officials at various levels to expand the information communication technology infrastructures and strengthen the feedback system.

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Predator-prey relationships are fundamental components of ecosystem functioning, within which the spatial consequences of prey social organization can alter predation rates. Group-living (GL) species are known to exploit inadvertent social information (ISI) that facilitates population persistence under predation risk. Still, the extent to which non-grouping (NG) prey can benefit from similar processes is unknown. Here we built an individual-based model to explore and compare the population-level consequences of ISI use in GL and NG prey. We differentiated between GL and NG prey only by the presence or absence of social attraction toward conspecifics that drives individual movement patterns. We found that the extent of the benefits of socially acquired predator information in NG highly depends on the prey's ability to detect nearby predators, prey density and the occurrence of false alarms. Conversely, even moderate probabilities of ISI use and predator detection can lead to maximal population-level benefits in GL prey. This theoretical work provides additional insights into the conditions under which ISI use can facilitate population persistence irrespective of prey social organisation.

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Interceptive eavesdropping on the alarm calls of heterospecifics provides crucial information about predators. Previous research suggests predator discrimination, call relevance, reliability, and reception explain when eavesdropping will evolve. However, there has been no quantitative analysis to scrutinize these principles, or how they interact. We develop a mathematical framework that formalizes the study of the key principles thought to select for eavesdropping. Interceptive eavesdropping appears to be greatly affected by the threat faced by caller and eavesdropper, as well as presence of informational noise affecting the detection of calls and predators. Accordingly, our model uses signal detection theory to examine when selection will favor alarm calling by a sender species and fleeing by an eavesdropping receiver species. We find eavesdropping is most strongly selected when (1) the receiver faces substantial threats, (2) species are ecologically similar, (3) senders often correctly discriminate threats, (4) receivers often correctly perceive calls, and (5) the receiver's personal discrimination of threats is poor. Furthermore, we find (6) that very high predation levels can select against eavesdropping because prey cannot continuously flee and must conserve energy. Reliability of heterospecific calls for identifying threats is thought to be important in selecting for eavesdropping. Consequently, we formally define reliability, showing its connection to specificity and sensitivity, clarifying how these quantities can be measured. We find that high call relevance, due to similar vulnerability to predators between species, strongly favors eavesdropping. This is because senders trade-off false alarms and missed predator detections in a way that is also favorable for the eavesdropper, by producing less of the costlier error. Unexpectedly, highly relevant calls increase the total number of combined errors and so have lower reliability. Expectedly, when noise greatly affects personally gathered cues to threats, but not heterospecific calls or detection of predators, eavesdropping is favored.

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Fiscal tools-taxes and/or subsidies-are increasingly used to address diet-related health problems. However, some studies have found that these tools are markedly more effective if attention is drawn to the tax or subsidy, suggesting that the price change alone may go unnoticed in the complex food environments that consumers face. Interventions that prompt individuals to consider health during choice show promise for promoting healthy food choices in both simple laboratory settings and complex, real-world markets. In this pre-registered study, I examine the impact of dietary fiber health prompts and/or dietary fiber subsidies on the per-serving fiber content of foods chosen, the documented set of products considered, and (self-reported) nutrition information use by participants in an online supermarket setting. Participants were randomized to one of four conditions: 1) control, 2) subsidy, 3) fiber prompt, and 4) fiber prompt + subsidy. Results show that both the prompt and prompt + subsidy conditions significantly increase fiber content of foods chosen (with the latter having a larger effect). While all three interventions influence the probability of using nutrition information during food choice and affect the set of products that respondents consider relative to the control condition, the effects were larger for the prompt and prompt + subsidy conditions. A multiple mediation analysis illustrates that both direct and indirect (through the set of products considered and the use of fiber information during choice) pathways lead to the significant overall increase in fiber content of selected foods.

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BACKGROUND: In the European Union (EU), there are over half a million medical devices, varying from pacemakers to software. Medical devices play an important role in health care as they are used in diagnosis, prevention, monitoring, prediction, prognosis, treatment, or to alleviate disease. Medical devices are regulated in the EU by the Medical Device Regulation (MDR), which came into force on 25 April 2017 and into application on 26 May 2021. The demand for regulation arose from the need to establish a transparent, robust, predictable, and sustainable regulatory framework. This study aims to examine how the managers and regulatory professionals in health technology enterprises perceived the application of the MDR and what were their information needs regarding the MDR. METHODS: A link to an online questionnaire was sent to 405 managers and regulatory professionals representing health technology enterprises in Finland. The study included 74 respondents. Descriptive statistics were used to describe and summarise the characteristics of the dataset. RESULTS: Information related to the MDR was fragmented and the necessary information was sought from multiple information sources, while the Finnish Medicines Agency (Fimea) was regarded as the most important source of information and training provider. To some extent, the managers and regulatory professionals expressed their dissatisfaction with the performance of Fimea. The managers and regulatory professionals were not very familiar with the ICT systems provided by the EU. The size of an enterprise affected how many medical devices it manufactures and generally affected the views about the MDR. CONCLUSIONS: The managers and regulatory professionals understood the role of the MDR regarding the safety and transparency of medical devices. The available information regarding the MDR did not properly fit the needs of users and there seemed to be a gap in information quality. The managers and regulatory professionals had some difficulties understanding the available information. Based on our findings, we believe it is paramount to evaluate the challenges faced by Fimea and how it could improve its performance. To some extent, the MDR is regarded as a burden for smaller enterprises. It is important to highlight the benefits of ICT systems and to develop them to better meet the information needs of enterprises.

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People's health information-seeking behaviors differ by their health literacy levels. This study assessed the relationship between health literacy and college students' levels of trust in and use of a range of health information sources of COVID-19. We collected data from August to December 2020 among college students (n = 763) through an online survey. We used a health literacy measure containing three self-reported survey questions, developed by the CDC. We assessed the extent to which participants trusted and used any of the sixteen different sources of information about COVID-19. Respondents reported high levels of trusting and using COVID-19 information from the CDC, health care providers, the WHO, state/county/city health departments, and official government websites when compared to other sources. After controlling for demographic characteristics (i.e., gender, age, race, ethnicity, and income), those who reported having lower health literacy were significantly less likely to trust and use COVID-19 information from these health authorities when compared to participants who reported having higher health literacy. Students with lower self-reported health literacy indicated not trusting or using official health authority sources for COVID-19 information. Relying on low-quality information sources could create and reinforce people's misperceptions regarding the virus, leading to low compliance with COVID-19-related public health measures and poor health outcomes.

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Children have historically been underrepresented in randomized controlled trials and multi-center studies. This is particularly true for children who reside in rural and underserved areas. Conducting multi-center trials in rural areas presents unique informatics challenges. These challenges call for increased attention towards informatics infrastructure and the need for development and application of sound informatics approaches to the collection, processing, and management of data for clinical studies. By modifying existing local infrastructure and utilizing open source tools, we have been able to successfully deploy a multi-site data coordinating and operations center. We report our implementation decisions for data collection and management for the IDeA States Pediatric Clinical Trial Network (ISPCTN) based on the functionality needed for the ISPCTN, our synthesis of the extant literature in data collection and management methodology, and Good Clinical Data Management Practices.

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Animals use inter-specific cues as a source of information in decisions-making, but the full costs and benefits of inter-specific information use are unknown. We tested whether pied flycatchers use the body size and clutch size of great tits as cues in their reproductive decisions and what are the possible fitness consequences as a function of great tit size. The size of great tit females associated positively with flycatcher's probability to settle near a tit nest over a territory further away. Flycatcher egg mass was positively correlated with great tit female size regardless of flycatcher territory choice. However, in flycatchers that had chosen to nest near great tits, the size of nestlings decreased in relation to increasing great tit female size. Our results demonstrate the use of size of inter-specifics as a cue in reproductive decisions and the trade-off between the value of information and costs of competition information users face when using inter-specific information in decision-making.

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Social learning via the observation of or interaction with other individuals can allow animals to obtain information about the local environment. Once social information is obtained, animals may or may not act on and use this information. Animals may learn from others selectively based on particular characteristics (e.g., familiarity, age, dominance) of the information provider, which is thought to maximize the benefits of social learning. Biases to copy certain individuals over others plays an important role in how information is transmitted and used among individuals, and can influence the emergence of group-level behaviors (i.e., traditions). Two underlying factors can affect from whom animals learn: the population social dynamics - with whom you associate (e.g., familiar), and status of the demonstrator (e.g., dominant). We systematically surveyed the literature and conducted a meta-analysis to test whether demonstrator characteristics consistently influence social learning, and if social dynamics strategies differ from status strategies in their influence on social learning. We extracted effect sizes from papers that used an observer-demonstrator paradigm to test if the characteristics of the individual providing social information (i.e., the demonstrator) influence social information use by observers. We obtained 139 effect sizes on 33 species from 54 experiments. First, we found an effect of experimental design on the influence of demonstrator characteristics on social learning: between-subject designs had stronger effects compared to within-subject designs. Second, we found that demonstrator characteristics do indeed influence social learning. Characteristics based on social dynamics and characteristics based on status had a significant effect on social learning, especially when copying familiar and kin demonstrators. These results highlight the role that demonstrator characteristics play on social learning, which can have implications for the formation and establishment of behavioural traditions in animals.

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BACKGROUND: At the time of the UK COVID-19 lockdowns, online health forums (OHFs) were one of the relatively few remaining accessible sources of peer support for people living with breast cancer. Cancer services were heavily affected by the pandemic in many ways, including the closure of many of the customary support services. Previous studies indicate that loneliness, anxiety, distress, and depression caused by COVID-19 were common among people living with breast cancer, and this suggests that the role of OHFs in providing users with support, information, and empathy could have been of increased importance at that time. OBJECTIVE: This study aimed to examine how people living with breast cancer shared information, experiences, and emotions in an OHF during the COVID-19 pandemic. METHODS: This qualitative study thematically analyzed posts from the discussion forums of an OHF provided by the UK charity, Breast Cancer Now. We selected 1053 posts from the time of 2 UK lockdowns: March 16, 2020, to June 15, 2020 (lockdown 1), and January 6, 2021, to March 8, 2021 (lockdown 3), for analysis, from 2 of the forum's boards (for recently diagnosed people and for those undergoing chemotherapy). We analyzed the data using the original 6 steps for thematic analysis by Braun and Clarke but by following a codebook approach. Descriptive statistics for posts were also derived. RESULTS: We found that COVID-19 amplified the forum's value to its users. As patients with cancer, participants were in a situation that was "bad enough already," and the COVID-19 pandemic heightened this difficult situation. The forum's value, which was already high for the information and peer support it provided, increased because COVID-19 caused some special information needs that forum users were uniquely well placed to fulfill as people experiencing the combined effects of having breast cancer during the pandemic. The forum also met the emotional needs generated by the COVID-19 pandemic and was valued as a place where loneliness during the pandemic may be relieved and users' spirits lifted in a variety of ways specific to this period. We found some differences in use between the 2 periods and the 2 boards-most noticeable was the great fear and anxiety expressed at the beginning of lockdown 1. Both the beginning and end of lockdown periods were particularly difficult for participants, with the ends seen as potentially increasing isolation. CONCLUSIONS: The forums were an important source of support and information to their users, with their value increasing during the lockdowns for a variety of reasons. Our findings will be helpful to organizations offering OHFs and to health care workers advising people living with breast cancer about sources of support.

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Evidence of social learning is growing across the animal kingdom. Researchers have long hypothesized that social interactions play a key role in many animal migrations, but strong empirical support is scarce except in a few unique systems and species. In this review, we aim to catalyze advances in the study of social migrations by synthesizing research across disciplines and providing a framework for understanding when, how, and why social influences shape the decisions animals make during migration. Integrating research across the fields of social learning and migration ecology will advance our understanding of the complex behavioral phenomena of animal migration and help to inform conservation of animal migrations in a changing world.

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Environmental variability poses a range of challenges to foraging animals trying to meet their energetic needs. Where food patches are unpredictable but shareable, animals can use social information to locate patches more efficiently or reliably. However, resource unpredictability can be heterogeneous and complex. The behavioural strategies animals employ to exploit such resources also vary, particularly if, when, and where animals use available social information. We reviewed the literature on social information use by foraging animals and developed a novel framework that integrates four elements - (1) food resource persistence; (2) the relative value of social information use; (3) behavioural context (opportunistic or coordinated); and (4) location of social information use - to predict and characterize four strategies of social information use - (1) local enhancement; (2) group facilitation; (3) following; and (4) recruitment. We validated our framework by systematically reviewing the growing empirical literature on social foraging in bats, an ideal model taxon because they exhibit extreme diversity in ecological niche and experience low predation risk while foraging but function at high energy expenditures, which selects for efficient foraging behaviours. Our framework's predictions agreed with the observed natural behaviour of bats and identified key knowledge gaps for future studies. Recent advancements in technology, methods, and analysis will facilitate additional studies in bats and other taxa to further test the framework and our conception of the ecological and evolutionary forces driving social information use. Understanding the links between food distribution, social information use, and foraging behaviour will help elucidate social interactions, group structure, and the evolution of sociality for species across the animal kingdom.

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Concept learning is considered a high-level adaptive ability. Thus far, it has been studied in laboratory via asocial trial and error learning. Yet, social information use is common among animals but it remains unknown whether concept learning by observing others occurs. We tested whether pied flycatchers (Ficedula hypoleuca) form conceptual relationships from the apparent choices of nest-site characteristics (geometric symbol attached to the nest-box) of great tits (Parus major). Each wild flycatcher female (n = 124) observed one tit pair that exhibited an apparent preference for either a large or a small symbol and was then allowed to choose between two nest-boxes with a large and a small symbol, but the symbol shape was different to that on the tit nest. Older flycatcher females were more likely to copy the symbol size preference of tits than yearling flycatcher females when there was a high number of visible eggs or a few partially visible eggs in the tit nest. However, this depended on the phenotype, copying switched to rejection as a function of increasing body size. Possibly the quality of and overlap in resource use with the tits affected flycatchers' decisions. Hence, our results suggest that conceptual preferences can be horizontally transmitted across coexisting animals, which may increase the performance of individuals that use concept learning abilities in their decision-making.

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BACKGROUND: Proper utilization of health data has paramount importance for health service management. However, it is less practiced in developing countries, including Ethiopia. Therefore, this study aimed to assess routine health information utilization and identify factors associated with it among health workers in the Illubabor zone, Western Ethiopia. METHODS: A facility based cross-sectional study was conducted from March to June 2021 with a total of 423 randomly selected health workers. Data were collected using an interviewer-administered questionnaire that was developed based on the performance of routine information system management (PRISM) framework. We created composite variables for health workers' knowledge, attitude, abilities, and information utilization based on existing data. Multivariate logistic regression analysis was performed and the statistical association between the outcome and independent variables was declared using 95% CI and a P < 0.05. RESULTS: About two-thirds or 279 health workers (66.0%, 95% CI 61.3, 70.4) had good health information utilization. Two-thirds of health workers think organizational decision-making culture (67.1%, 95% CI 62.6, 71.5) and facility managers' or supervisors' promotion of information use (65.5%, 95% CI 60.9, 69.9) are positive. Over half of health workers (57.0%, 95% CI 52.2, 61.6) have a positive attitude toward data management, and the majority (85.8%, 95% CI 82.2, 88.9) believe they are competent of performing routine data analysis and interpretation activities. Only about two-thirds of health workers (65.5%, 95% CI 60.9, 69.9) were proficient in data analysis and interpretation. CONCLUSIONS: The use of routine health information was lower than the national target and data from other literatures. Unacceptably large number of health personnel did not use information. As a result, efforts should be made to increase health workers' data management knowledge and skills, as well as the organizational culture of data utilization.

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BACKGROUND: Weak health information systems (HISs) hobble countries' abilities to effectively manage and distribute their resources to match the burden of disease. The Capacity Building and Mentorship Program (CBMP) was implemented in select districts of the Amhara region of Ethiopia to improve HIS performance; however, evidence about the effectiveness of the intervention was meager. OBJECTIVE: This study aimed to determine the effectiveness of routine health information use for evidence-based decision-making among health facility and department heads in the Amhara region, Northwest Ethiopia. METHODS: The study was conducted in 10 districts of the Amhara region: five were in the intervention group and five were in the comparison group. We employed a quasi-experimental study design in the form of a pretest-posttest comparison group. Data were collected from June to July 2020 from the heads of departments and facilities in 36 intervention and 43 comparison facilities. The sample size was calculated using the double population formula, and we recruited 172 participants from each group. We applied a difference-in-differences analysis approach to determine the effectiveness of the intervention. Heterogeneity of program effect among subgroups was assessed using a triple differences method (ie, difference-in-difference-in-differences [DIDID] method). Thus, the ß coefficients, 95% CIs, and P values were calculated for each parameter, and we determined that the program was effective if the interaction term was significant at P<.05. RESULTS: Data were collected using the endpoint survey from 155 out of 172 (90.1%) participants in the intervention group and 166 out of 172 (96.5%) participants in the comparison group. The average level of information use for the comparison group was 37.3% (95% CI 31.1%-43.6%) at baseline and 43.7% (95% CI 37.9%-49.5%) at study endpoint. The average level of information use for the intervention group was 52.2% (95% CI 46.2%-58.3%) at baseline and 75.8% (95% CI 71.6%-80.0%) at study endpoint. The study indicated that the net program change over time was 17% (95% CI 5%-28%; P=.003). The subgroup analysis also indicated that location showed significant program effect heterogeneity, with a DIDID estimate equal to 0.16 (95% CI 0.026-0.29; P=.02). However, sex, age, educational level, salary, and experience did not show significant heterogeneity in program effect, with DIDID estimates of 0.046 (95% CI -0.089 to 0.182), -0.002 (95% CI -0.015 to 0.009), -0.055 (95% CI -0.190 to 0.079), -1.63 (95% CI -5.22 to 1.95), and -0.006 (95% CI -0.017 to 0.005), respectively. CONCLUSIONS: The CBMP was effective at enhancing the capacity of study participants in using the routine HIS for decision-making. We noted that urban facilities had benefited more than their counterparts. The intervention has been shown to produce positive outcomes and should be scaled up to be used in other districts. Moreover, the mentorship modalities for rural facilities should be redesigned to maximize the benefits. TRIAL REGISTRATION: Pan African Clinical Trials Registry PACTR202001559723931; https://tinyurl.com/3j7e5ka5.

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BACKGROUND: Ethiopia Population-based HIV Impact Assessment findings showed that in Addis Ababa, only 65.2% of people living with HIV (PLHIV) know their status. We present the enhanced HIV/AIDS data management and systematic monitoring experience in Addis Ababa City Administration Health Bureau (AACAHB). METHODS: AACAHB established a command-post with leadership and technical team members from the health bureau, 10 sub-city health offices, and non-governmental stakeholders. The command-post improved governance, standardized HIV program implementation, and established accountability mechanism. A web-based database was established at each health facility, sub-city, and AACAHB level. Performance was scored (green, ≥75%; yellow, 50-74%; red, < 50%). The command-post reviewed performance on weekly basis. A mentorship team provided a weekly site-level support at underperforming public and private health facilities. At facility level, quality of data on recording tools such as registers, and individual medical records were maintained through continued review, feedback mechanisms and regular consistency check of data. Percentage and 95% confidence interval were computed to compare the improvement in program performance over time. RESULTS: After 6 months of intervention period, the monthly New HIV case finding in 47 health facilities increased from 422 to 734 (1.7 times) and treatment initiation increased from 302 to 616 (2 times). After 6 months, the aggregate scoring for HIV testing at city level improved from yellow to green, HIV case finding improved from red to green, and treatment initiation improved from red to yellow. An increasing trend was noted in HIV positive case finding with statistically significant improvement from 43.4% [95% Confidence Interval: 40.23-46.59%] in May 2019 to 74.9% [95% Confidence Interval: 72.03-77.6%] in September 2019. Similarly, significant improvement was recorded for new HIV treatment from 30.9% [95% Confidence Interval: 28.01-33.94%] in May 2019 to 62.5% [95% Confidence Interval: 59.38-65.6%] in September 2019. CONCLUSIONS: Regular data driven HIV program review was institutionalized at city, sub-city and health facility levels which further improved HIV program monitoring and performance. The performance of HIV case finding and treatment initiation improved significantly via using intensified monitoring, data driven performance review, targeted site-level support based on the gap, and standardized approaches.

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