132 Projects, page 1 of 27
Over the past 20 years there have been major advances in preventing the mother-to-child-transmission (PMTCT) of HIV, and interventions based on this knowledge have resulted in transmission rates <1% in the United Kingdom and Europe, attributable largely to widespread use of combination antiretroviral therapy (ART) in pregnancy. The remarkable effectiveness of these interventions has led many to suggest that the global elimination of paediatric HIV infection may be possible. Towards this, there is particular excitement regarding universal initiation of lifelong ART for all HIV-infected pregnant women following the World Health Organisation's "Option B+" approach, and this strategy has been implemented in many parts of Africa, including the Western Cape Province of South Africa (SA) from July 2013. But despite considerable optimism, more than 300 000 new paediatric HIV infections occur each year around the globe; almost 10% of these are in SA alone. In turn there is growing recognition that the "Option B+" approach must be accompanied by effective and efficient models of care for delivering ART to unprecedented numbers of HIV-infected pregnant women. For women starting lifelong ART in pregnancy, there is particular concern about the postpartum period (for the purposes of this proposal, this is from delivery until 24 months postpartum) as a time when HIV-infected women are at a very high risk of not taking their medications (non-adherence) and/or dropping out of care altogether (non-retention). Over the last few years there has been growing evidence that the postpartum period is a difficult time for women on ART, but there are few interventions that aim to support HIV-infected women during this time. One of the few interventions for this purpose is the 'Adherence Club' model. In South Africa and most parts of Africa, HIV-infected patients (including pregnant and postpartum women) attend primary care clinics where doctors and nurses focus on the clinical care of individual patients. In contrast to this, the Adherence Club model is operated by community health workers (lay people without clinical training) working from community venues that are located closer to peoples' homes. There is preliminary evidence that the Adherence Club model could lead to better clinical outcomes than standard clinical services, but the observational studies used to generate this evidence have significant methodological flaws. To help generate robust evidence about the Adherence Club model for managing HIV-infected women on ART during the postpartum period, we plan to enroll 388 HIV-infected pregnant women on ART immediately after delivery. These women will be allocated at random to either attend routine primary health care clinics for their ART during the postpartum period, or to attend an Adherence Club. Women will be followed up by a study measurement team (that operates separately from either of the clinical services) at regular intervals through 24 months postpartum. This measurement team will check the HIV viral loads and administer questionnaires to women who are participating. The primary focus of the study is the retention of women in care, and their adherence to ART, during the 24-month period. There are secondary outcomes related to the acceptability of the Adherence Club model, and also the cost-effectiveness of the model, compared to standard primary care services as the control condition.
The Agenda 2030 of the UN sets out ambitious challenges for society to achieve 17 Sustainable Development Goals (SDGs). While all SDGs are important in Africa, those related to poverty (SDG 1, 8), inequality (SDG 5, 10) and climate change (SDG 13, 7) are especially relevant. Africa has some of the highest global poverty rates, levels of inequality, climate vulnerabilities, and shortfalls in energy access. Making substantial progress on all these SDGs will require action in any single SDG domain that maximises synergies and co-benefits and avoids as much as possible negative trade-offs. Aims and Objectives: Our project's overarching research question is: How do African societies design and implement climate action to improve sustainable livelihoods, and reduce both poverty and inequality? For example, all African countries need to adapt their food systems to be more resilient to climate change, but there are different routes to achieving this - such as investing in large-scale industrialised agriculture or supporting small-scale farmers to be more climate smart - which can result in very different livelihood benefits across society. Our second objective is to build a network of African-UK researchers who can bring deep disciplinary expertise to bear on this interdisciplinary problem. In particular, our project brings together two newly-established ARUA Centres of Excellence (CoE) on climate change and inequalities, with world-leading expertise from the UK, to form this network and to work at the nexus of climate change, inequality and poverty. Our Approach: To address the climate-poverty-inequality nexus in Africa we have created an interdisciplinary research team with expertise in development economics, livelihoods, poverty and inequality, climate policy and governance, energy and mitigation, and adaptation. We will answer our research questions through comparative research across three country settings - Ghana, Kenya and South Africa - that will allow us to synthesise commonalities and differences across these different contexts. Our approach is multi-scale and multi-dimensional, seeking to understand i) the political, economic and policy context within which transformative climate actions are enabled (or prevented); ii) how socio-economic and climate change policies have affected livelihood trajectories of different groups in society; iii) the potential outcomes from climate change actions, with a focus on how these outcomes vary across social groups, especially between men and women, but also social differences such as education, income, and land tenure; iv) how existing climate actions are working (or not) to build sustainable livelihood trajectories for communities; v) understanding the country-wide social and economic benefits of different climate actions, when applied at scale. Our project will involve close collaboration with leaders in policy and practice, and also with communities, so that their needs and priorities inform our research, and so that our research in turn shifts their thinking and actions. Project Outcomes: - A well-established, pan-African research network that has multiple collaborations within this project, and in new projects leveraged out of this project. - Evidence on the synergies and trade-offs between climate action, poverty and inequality. - Evidence on how specific national priority climate actions can be designed to deliver co-benefits for livelihoods and reducing poverty and inequality. - Ultimately, climate policies and associated actions to be transformative in improving livelihoods and well-being, reducing poverty and inequality, rather than business as usual at national and global political levels.
Twenty years after the ending of apartheid the time is ripe to evaluate South African experience of health system transformation. Much was promised and many changes have been introduced - but how much has been achieved, especially for the most vulnerable and previously disadvantaged groups? What factors have enabled or constrained change across the public health system, nationally recognised as the leading edge of efforts to improve the health and well-being of vulnerable groups? What lessons does past experience hold for continuing efforts to improve health care and health? What issues need to be tracked over time to generate the evidence needed to support future policy and managerial decision-making? This proposed grant intends to address these questions. It is jointly submitted by a team of public health system policy-makers/managers and researchers based in the Western Cape (WC) province. As South Africa is a quasi-federal state, the WC provincial government has the constitutional responsibility for ensuring an effective health system for its population. It also has a reputation for having been relatively effective in sustaining implementation of such change over the last 20 years. Examining the particular experience of one province, in comparison with wider national experience, will allow in-depth investigation of South African health system transformation. The project will consider not only what changes have been implemented, with what achievements and challenges, but also what set of political, leadership, organisational and other factors have supported or limited the implementation of change. From this analysis it will seek to identify the pathways to change underpinning health system development in the province. The project team's combination of experience and expertise will support this in-depth investigation. Better understanding of what the province has achieved and how, set against the national context, will offer insights of relevance across the country, as well as internationally. It will also, more specifically, contribute to generating the evidence base needed to support future policy and management decision-making, by supporting provincial health system monitoring and evaluation activities and identifying related, larger scale research needs.
GCRF MINE DUST AND HEALTH NETWORK SUMMARY While the mining industry contributes significantly to the economies of developing countries around the world, mining activities have notable negative environmental and health impacts. Among these, the dust emitted by mining and its associated operations is a cause of increasing concern. Apart from impacting the health of mine-workers who breathe in mineral dust particles, dust is emitted from open pit mines, ore processing and metal extraction plants, ore stockpiles, ore transport containers and mine waste deposits, impacting the wider environment and communities. Lung diseases caused or exacerbated by mine dust exposure include silicosis (caused by inhaling quartz or crystalline silica), black lung disease (caused by inhaling coal dust) and tuberculosis (silica dust exposure increases the risk of pulmonary TB, particularly in gold miners). This places a huge burden on already-strained public health and social security systems. Occupational health hazards from mining are well documented, and the link between dust and lung disease was recently recognised in a class action lawsuit against the six main mining houses in South Africa, awarded in favour of mine workers who contracted silicosis and TB working on gold mines between March 1965 and May 2018 (https://www.silicosissettlement.co.za/). However, the health effects associated with environmental dust emissions, although frequently a concern expressed by communities and community support organisations, have not been rigorously studied. Meaningful data is needed to inform what strategies and policies will work best to mitigate the effects of mine dust on communities living near mines and mine dumps, the populations of which number in their millions. Gathering such data is not simple, however. There are many complexities involved, with dust sources and their effects being influenced by inter-related factors covering the health, economic, social, geological, environmental, engineering, management, and political spheres. The issues associated with mine dust are also frequently contentious and involve diverse stakeholders and interested and affected parties with different, and often conflicting priorities. Poor engagement and communication between experts and lay persons, disciplinary silos and polarised viewpoints have made it difficult to develop a holistic understanding of the complex health issues associated with environmental emissions of mine dusts, and consequently to design meaningful and integrated approaches to address such issues. It is these challenges that our GCRF MINE DUST AND HEALTH NETWORK will seek to address by bringing together researchers, stakeholders and practitioners from a variety of disciplines and professional backgrounds to identify sources, challenges and potential mitigation opportunities associated with public health effects from dust pollution arising from mining activities. Focus will be on integrating and sharing knowledge and information across different disciplines and stakeholders on potential source and dispersion pathways; potential risks to the environment and the health, quality of life and livelihoods of mining-affected communities; monitoring methods and practices; measures to manage dispersion and impacts; stakeholder engagement and communication; and governance policies, standards and regulations. Ultimately, the GCRF Mine Dust and Health network will serve as a collaborative think-tank to inform research directions both within and across disciplines; government policy and regulations; health monitoring programmes at public clinics; industry best practice; and community healthcare and impact prevention programmes across southern Africa and, as the Network expands, the globe.